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Recuperation After A Cesarean Delivery

The Cesarean mother experiences the same physiological changes and many of the procedures and discomforts which the vaginally delivered mother does. My attempt in this article is to point out those experiences that particularly affect the Cesarean mother.

Know that the rate of recuperation after a Cesarean - the the time it takes, the extent of discomfort experienced - varies from individual to individual and even from one birth experience to another in the same woman. Some women - the minority - feel very little discomfort during their postoperative period. They leave the hospital earlier than usual - perhaps a few days after delivery - and some of these women can resume many of their normal activities within a few weeks.

However, many more Cesarean mothers find the immediate postoperative days difficult to handle. They are physically limited and they “hurt.” The slightest movement causes discomfort, if not pain. Their physical condition takes away from the joy of the occasion: the birth of the baby.

After the baby, placenta, and membranes are removed from the uterus, the doctor examines the uterus to be sure that no pieces of placental tissue have been left inside. Then, the surgical repair begins: the uterine incision, which is almost always horizontal (also referred to as a transverse or low-segment incision) and only sometimes vertical (classical), is sutured with absorbable material. Then, the abdominal wall incision is sewn - layer by layer of muscle and fascial tissue beneath the surface of the skin. These internal sutures are also absorbable.

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The external incision may have been vertical (from just below the navel to the pubic hairline) or transverse (“bikini” or Pfannenstiel incision, just above the pubic bone, about six or seven inches long).

To close the external incision, doctors frequently use individually tied off (interrupted) stitches which are made of non-absorbable material and, therefore, must later be removed.

If the external incision was transverse, either interrupted stitches or one continuous suture may be used to suture the layer of tissue directly beneath the outer skin layer (subcuticular stitch). The suture material can be either absorbable or not. With this method, there are no exteriorly visible stitches.

Another technique involves the use of surgical clamps or clips to close the external incision instead of - or sometimes in addition to - sutures. Some women find the clamps uncomfortable when they move. Before leaving the hospital, the edges of the skin will have fused together and the clamps or clips are removed. Stitch, clip, or clamp removal is usually painless. Sometimes, during the removal of sutures, there is a slight burning sensation.

The type of suturing and incision depends on the doctor, and may vary from mother to mother and even from one delivery to another in the same woman.

After suturing is complete - which takes approximately forty-five minutes - you will be moved to the recovery room or special recovery area. If the hospital does not have an obstetrical recovery room, you may be placed in an unoccupied labor room or directly outside one of the labor rooms, within the labor and delivery area where you will remain for about two to six hours, depending on the hospital's routine and your condition.

If you have had general anesthesia and were asleep for the delivery, you will be very drowsy during the early recovery period. You may awaken now and then, fall back asleep, and may also experience nausea and vomiting as a result of the anesthesia. If, prior to receiving general anesthesia, you had a long, difficult labor, or, if you had been given scopolamine (an amnesiac) during labor, when you awake in the recovery room you may find it difficult to believe that your baby has already been born.

You may also have a sore throat. This results from a tube which is usually placed into your mouth and throat while you are under anesthesia to ensure a clear breathing passageway and to prevent fluids from getting into your lungs in case you vomit. Usually, before you leave the operating (or delivery) room, the tube is removed.

Your mouth may be dry-probably due to medication (usually atropine) given prior to the administration of general anesthesia (and sometimes prior to regional anesthesia) intended to dry up secretions in the mouth and throat. You may request a lemon-flavored swab which is usually available to wet your mouth until you are allowed to drink fluids.

If you have had a regional anesthetic, it may have been a spinal or an epidural. If it was a spinal, you will probably be required to lie flat in bed, without lifting your head, for about eight to twelve hours. (Breastfeeding can still be accomplished.) It is commonly believed that if you do not follow these instructions you risk getting “spinal headaches,” which can be painful and can last for days. There is some thought to the contrary, however, which indicates that spinal headaches may have nothing to do with the mother's position after delivery, but may result from the loss of some spinal fluid at the time of administration of the medication.

If you have had an epidural - which does not involve the spinal fluid - you should not be troubled with headaches.

You may have little or no feeling in your legs because of the regional anesthetic. As it begins to wear off - sometimes beginning about two hours after administration - you may begin to feel sensation in the form of tingling or “pins and needles” in your toes arid legs and may be able to move them a bit. Do not be frightened, however if sensation returns slowly and then only to parts of your legs at a time, or if numbness remains for several hours. You will probably stay in the recovery room until you can move both your legs. Do not be frightened if the nurse asks you to move your legs and you think you can but somehow cannot. It takes a while, sometimes hours, to regain control of your movements.

As you begin to have feelings in your legs, you will also become aware of discomfort at the site of the incision in your abdomen. Do not wait for it to become extremely painful before asking for medication. Painkillers will have been ordered for you and will be administered by injection; a pill is not used because you are not permitted to take anything by mouth during the early recovery period.

During the hours following delivery, you may be either wide awake or sleepy even if you have had spinal anesthesia. Drowsiness may be a result of a long and difficult labor, the administration of a tranquilizer before the spinal, or a tranquilizer or narcotic after delivery of the baby, while suturing is taking place.

In some cases, after a spinal anesthetic was administered and the baby has been born, to ensure continued relaxation and more complete relief of pain, an additional general anesthetic may be given before the suturing is done.

If the baby's father has been with you during the delivery - a growing trend in more and more hospitals - he may follow you into recovery, where the two of you and the baby - if hospital procedure and the condition of mother and baby allow - can spend some time together. Then, the father is usually invited to follow the baby to the nursery, where he can observe through the nursery window. If the father was not present for the delivery, he; usually waits in a waiting room or the lobby to hear the news of the birth from the doctor when surgery is completed - which sometimes takes as long as an hour or so. The new father is then admitted to the recovery room to join you - and hopefully, the baby before he or she is taken to the nursery.

Your blood pressure, pulse, temperature, and respiration will be checked often, as will your incision and the amount, consistency, and color of your vaginal bleeding. Yes, there is vaginal bleeding after a Cesarean, because the no-longer-necessary blood and uterine lining will be coming out of the cervical opening and through the vaginal canal.

Your uterus will be checked (by palpating your abdomen) to be sure that it is contracting as it should. This may be very painful to you because of the abdominal surgery you had, no matter how gentle the nurse is.

The most you can do to minimize this pain - for the several seconds of its duration - is, first of all, to know that it will take only several seconds, and, secondly, to release your entire body as much as possible with the help of a breathing technique such as the Lamaze slow chest or light panting.

The I.V. which had been set up during labor or prior to surgery will remain with you during the recovery period and for the first twenty-four to forty-eight hours, giving you sugar and water (and sometimes salts). It will be discontinued when you begin to take fluids by mouth. The intravenous solution is also necessary to help minimize postoperative fever by avoiding dehydration.

Through the LV. you will also be given - during the early recovery period - an oxytocic drug which stimulates contractions of the uterus, thus helping it to become firm and to prevent excessive blood loss.

These contractions may feel rather strong and might even be painful. It will help if you release all your body muscle groups and do a Lamaze breathing technique here again. If the contractions become too painful to handle with breathing and relaxation techniques plus medication, or if they seem to be one continuous pain or contraction, tell the nurse!

If you are awake and wish to breastfeed your baby, be prepared for the resulting uterine contractions to be strong and perhaps painful. Slow chest breathing might be helpful, or your doctor can prescribe a pain reliever that will have the least possible effect on your nursing baby.

Since the breastfeeding experience requires that you be as relaxed as possible, it might be a good idea to attempt breastfeeding in the recovery room while the regional anesthetic is still effective. If you are asked to wait until hours later, when you are in your own room, the regional anesthetic will have worn off and the incision area may be very sore; this may make it difficult for you to enjoy this every special moment. Medication for pain may help, although it might make you and your baby drowsy. This, of course, depends on the kind and dosage of the medication.

If at all possible, whether you plan to breastfeed or not, ask to have your baby (if this is your desire) while lying in the recovery room, where you are able to hold him or her in your arms. (In the delivery room you may not have been able to hold your child if your arms were strapped down.) This allows you and the baby to establish early bonding.

Even if the hospital policy does not require twenty-four- hour observation of the baby in a special care unit you may not be given the baby immediately because the medical staff may need some time - perhaps an hour or several hours - to observe the baby in the nursery to be sure the vital signs and body temperature are stable, even if surgery was not due to fetal distress. You may not even be interested in holding the baby - especially if you are exhausted and feeling much discomfort from the surgery. When you do get your baby, you will probably need help in order to find a comfortable way to hold him or her.

If the baby is not permitted to stay with you in the recovery room or for the next few hours when you're in your postpartum room - either because of routine hospital policy, because the child is in actual need of intensive care, or because his or her body temperature needs regulating - try to arrange for the father to be permitted to make trips between you and the nursery so he can fill you in on the baby's activities, condition, and whatever procedures are involved. Later on in your own room, if you do not feel comfortable enough to hold and feed the baby, it might be a good idea to have the baby's father care for the baby at your bedside so you can see and get acquainted with your baby.

The urinary catheter (thin plastic tube) which has been inserted into your urethra prior to surgery usually remains there until approximately twenty-four hours afterward. This was necessary to empty your bladder during the surgical procedure and continues to be necessary afterward because the bladder may not regain its normal functioning for a while after surgery and anesthesia.

In order to know that your kidneys are functioning properly, the catheter is connected to a special plastic container which measures your urine output. It will be removed painlessly when you are able to walk to the bathroom yourself or sooner. Even then, your urine output will most probably continue to be measured, this time by catching your urine in a special pan attached to the inside of the toilet bowl. If will be helpful for you to drink fluids and do your vaginal floor exercises in order to encourage urine output and to control urination. Drinking enough fluids may also have some bearing on when the I.V. can be removed from your arm.

You may begin to feel discomfort, aches, or pain in one or both shoulders. This is believed by some health care professionals to be the postoperative result of air accumulations under the diaphragm.

One of the first and most important things you should do in the recovery room - or as soon as you can after delivery - is the following abdominal tightening exercise, which will help prevent painful gas buildup and begin to restore your abdominal muscle tone.

Hold both your palms, fingers interlaced, firmly over your incision, or hold a pillow firmly against your abdomen with your hands joined together on top of the pillow at the location of the incision. Inhale slowly and deeply through your nose and exhale slowly through your mouth while you apply pressure on your incision with your hands or pillow. Do this again and increase the amount of pressure slightly. Do this once more, but this time after you inhale, hold your breath for a count of five and exhale slowly as before, while putting pressure on the incision. Do a set of these, every hour, increasing pressure a little each time, but lessen the pressure if you feel pain.

Supporting your abdomen with your hands (with or without a pillow) is called “splinting”. It is important that you “splint” whenever you cough, laugh, move your bowels, stand up, sit down, walk, or do anything which strains the abdomen during the early postpartum days.

After The Recovery Room

When you're in your own ro.om in the hospital, a nurse will, from time to time, examine your breasts, incision, and your sanitary napkin (to check the amount, color, and. consistency of the bloody discharge from your vagina). Your fluid intake and output will be measured. Your blood pressure and temperature will be taken. A low fever is common after surgery and usually does not indicate infection. If it rises above 100 degrees, however, you and your baby will probably be separated.

You will be encouraged to move your legs and to breathe deeply to prevent possible postoperative complications such as phlebitis or pneumonia.

Belly Binders And Elastic Stockings

Your doctor may prescribe a belly binder - especially if you've had a vertical incision - either in the form of a large bandage wrapped around your abdomen or a wide elastic belt to be worn when you get out of bed and are mobile. When you are resting or asleep, it should be removed. Because the binder gives support to your abdomen when you begin to walk, it eases the discomfort. Since your muscles were stretched during pregnancy and have just been cut during surgery, binder enthusiasts insist that something must support your abdomen. If, when you stand and walk, nothing is there to support the abdominal wall in its flabby after-delivery state, its own weight, as it hangs loosely and uncontrolled, pulls at the incision. This increases pain at the incision site and may cause you to feel that it will split open.

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If you do use the binder while in the hospital, expect, when you go home, to feel very strange and perhaps even uncomfortable when walking and standing without it. You may even experience the sensation that “everything is falling out.” To prevent this feeling, before leaving the hospital have someone purchase a loose stretchable panty girdle to take the place of the binder. This will give you some degree of support, which may still be needed during your first few days at home - until your own abdominal muscles can begin to take over. For women who have had the “bikini cut,” the binder is not considered as necessary, but some support, such as from a panty girdle, is usually recommended for walking and standing during the early postpartum days.

Some doctors claim that the incision bandage gives firm enough support during the first few days. When the bandage is removed you might feel you need other means of support simply because it feels better. Some physicians and other health care professionals believe that it is not wise to have you rely on artificial support. They believe it is better for you, from the beginning, to learn to use your own abdominal muscles - albeit with the help of your hands (with or without a pillow), applying pressure and support (splinting) when you stand, turn over, cough, etc.

Some health care professionals believe a judicious mixture of both methods would be a good compromise for the best possible outcome. For example, the use of the binder for those with vertical incisions or the loosely elastic panty girdle for those with bikini incisions during the first few days of recuperation in the hospital, and only when getting on and off the bed, standing, and walking. During rest and sleep periods, the artificial abdominal support may be removed. All the while, abdominal tightening exercises should be done to re-build muscular ability for self-support. By the time you leave the hospital, you can “graduate” from the binder to part-time wearing of the lightweight panty girdle, or from the girdle to less and less use of it, meanwhile continuing abdominal tightening exercises. Eventually, you should be able to use your own muscle power to pull in the abdominal wall.

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If your doctor advises you to wear elastic stockings after surgery to help prevent phlebitis, wear them, take them home with you, and continue to wear them for as long as your doctor recommends.

Walking

Within the first twenty-four hours after surgery, you will be encouraged to get off the bed and walk, with the assistance of a nurse. Sitting up for some mothers will be hard enough; walking can be quite difficult and painful, but it must be done. The longer you put it off, the harder it will be to take that first step. Walking improves circulation (which is vital to your recuperation) and helps to prevent other postoperative complications. Moving around is nature’s way of getting all your body's functions back to normal. After your first bout with a bed-pan you may even welcome the struggle of getting off the bed and walking to the bathroom!

To minimize your discomfort, perhaps you can arrange for your first few walks to take place about forty-five minutes after receiving medication for pain. You might become somewhat dizzy from the medication so be sure to have help the first few times.

One of the most common fears of Cesarean mothers is that the incision will open. Be assured that this is highly unlikely. The fear is usually intensified by the frightening feeling - as you are trying to sit up, get off the bed, and stand - of pulling in the area of the incision. It may reassure you - as it has others - to take a good look at your incision before attempting to get off the bed. Actually seeing it, instead of leaving it to your imagination, may give you more confidence in trusting its durability. Also, remembering that there are layers of tissue beneath the skin which are also sutured can reassure you of the strength of the repair. Then force yourself to get up and out of bed, keeping in mind that this feeling is normal and that incisions rarely open.

How To Get Out Of Bed

To get up from a lying-down position, there are several recommended maneuvers. Let us assume you wish to get off the bed from the right hand side:

A:1. Lie flat on the bed and inch your body over to the right edge of the bed. Then position your body and be ready so that when the upper part of the bed is raised , your buttocks will be where the bed creases or “breaks” and there will be no pressure on your abdomen while the bed pushes you into an upright position.

2. When you are ready, ask the nurse to slowly raise the back of the bed all the way up, inch by inch, while you concentrate on keeping your back flat against the bed. Remember to ask for the stepstool to be positioned and ready for you.

3. Ask for the upper half of the right rail to be raised so you can use it for arm support when you are ready to stand.

4. The back of the bed is now supporting your weight and you are already almost sitting straight up. Place your right hand palm down on the bed alongside and close to your right buttock and your left hand on the bed close to your left buttock. Press down with all your might with both hands as though they were crutches, just to learn how to raise your body a bit off the bed. Rest. Do it again using your arms, not your abdominal muscles, and this time lift your body, inching your hands and body over to the edge of the bed. Rest. Support yourself again with your arms as crutches and then, inch by inch or one leg at a time, or both, get your legs over the side of the bed.

5. Rest. Dangle your feet a while (have your slippers put on) and when you feel ready, brace your arms for support. Your right hand can use the side rail; your left hand can press into the bed or be supported by the nurse. Use your arms as crutches again to lift or slide your bottom off the bed, aiming your feet for the stepstool. (Wearing a binder if you have a vertical incision and wearing a loose elastic panty girdle if you have the bikini cut can make it much easier for you to support your abdomen for this maneuver; there will be less pulling on your incision.)

6. Once standing, you must straighten up and stand tall! It will help if you splint your incision with your hands or pillow as you straighten up.

B: 1. While on your back, inch over to the right edge of the bed. Turn onto your right side, splinting your abdomen, and have the nurse raise the bed back slowly to a thirty-five- or forty-five-degree angle. Have someone tie a bed sheet securely to the foot of the bed and hold your end of the bed sheet with your left hand.

2. Using your left hand, pull on the bed sheet (or someone's hand) to help pull yourself up to a sitting position while you exert pressure with your right arm against the bed to push yourself up. As you rise upward, swing both your legs together, one movement, over the side of the bed.

3. Continue as in No. 5 of the previous maneuver.

To get back into bed, use reverse procedures.

Important: You may be extremely reluctant to stand straight up because it may hurt a lot. But it is imperative that you fight the common desire to hunch over and adopt the stance referred to as the “Cesarean shuffle.” This may impede the healing process and can hurt even more.

Remember to walk like a high fashion model the first and every time that you walk. Keep that image in mind. Also, keep in mind the image of a thin straight scar which logically results from standing upright. Remember that the more mobile you become and the straighter you stand, the better you will actually feel.

Cesarean mothers and others who have had abdominal surgery advise that it is better for you to straighten up by yourself, setting your own pace of movement according to the discomfort that you are feeling at the time. The nurse who may be encouraging, leading, cheering you on to straighten up straighter or move a bit faster cannot possibly know the extent of the “pulling” or discomfort you may be feeling. Moving faster than you feel you can manage may cause intense pain and you may have to go back to the position where you started and re-do the process from the beginning. Therefore, brace yourself on a sturdy object or person, but be sure the person does not pull you or lead you. The lead should be taken by you.

Be prepared too for the normal sudden gush of blood from the vagina when you stand up after having been prone for hours. Before standing, wrap the disposable pad from your bed, diaper-style, onto you: It will help catch extra blood which your sanitary napkin may not. (It can be less embarrassing for you if no visitors are present during the first few times you attempt to get out of bed.)

Another possibility is that you may feel faint, weak, or dizzy. This is normal for Cesarean or vaginally delivered mothers and is yet another reason to be sure you have assistance before attempting to get up the first few times.

You may find it easier to walk or stand the first few days out of bed if your slippers have a small, wedge-type heel. Whenever you can, and if you can, try pulling in your abdominal muscles whether walking, standing, sitting, or lying down.

Showers - not tub baths - are usually permitted within a few days after delivery.

If you received general anesthesia, you will periodically be asked to cough and breathe deeply in order to expel secretions and expand your lungs. Before you cough (or even laugh), try to tighten your abdominal muscles as you hold your hands or pillow firmly against your abdomen for support.

Pain Relief

If you feel pain coming on, ask for medication before it becomes too painful to handle. Do not wait for the nurse to offer it to you simply because four hours have passed since the last dose. You must request it if needed. Be sure to remind your doctor if you are breastfeeding so he or she can prescribe medication that will have the least effect on the baby.

Before leaving the hospital, ask your doctor to give you a prescription for some type of pain medication. Although your need for pain relief has probably decreased considerably, you may still need some mild pain-killers now and then, after you are home and more active.

Sanitary Belt

The sanitary belt, or the clasp on the belt, may bother your incision. You can try placing an extra pad beneath the belt, directly under the clasp. If this does not help, try using safety pins to attach the napkin directly to your underpants. Or, you can have someone purchase self-adhesive napkins (if the hospital does not have these) which attach directly to your underpants. You can also ask if your hospital has specially designed “Cesarean sanitary belts”; some do.

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Underwear

It is not wise to wear bikini-style underpants in the early postpartum period, no matter which incision you've had. In either case, irritation of the incision is likely where the elastic band makes contact. Have someone purchase full-cut, waist-high panty briefs for you - preferably cotton.

Elimination

After surgery, moving your bowels becomes a major concern. Be sure to eat foods and drink liquids which can best encourage easier movements with minimal straining. When you do have a bowel movement, remember to splint the incision while straining.

Healing

Your incision may not bother you at all, or it may feel numb, “pull,” or ooze a little. The pulling sensation may be coming from inside the abdomen at the site of the deeper internal incision which may be higher than your skin incision.

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If your incision becomes itchy as it heals, your doctor may advise applying warm compresses. After it heals, baby oil may help relieve itching. Avoid wearing nylon or rayon underpants during this itchy period and while pubic hair is growing back. Cotton panties will be more comfortable. When you get the urge to scratch your incision, try scratching a different part of your body; you may be surprised at how that can help.

Removing The Sutures

Before you leave the hospital, the outer sutures - if they are the non-absorbable type - will be removed. If one continuous suture was used directly beneath the skin (subcuticular), the doctor will clip one end and pull it out. You might shiver at the thought, but this is not considered painful. If anything, there might be a slight burning sensation, depending on the material used. If individual sutures were used, they will be clipped and removed one by one.

If clamps were used, these will be removed about five to eight days after surgery and this procedure should not be painful. If your recuperation is good and you want to leave the hospital early, you can have the sutures or clamps removed in your doctor's office after you come home.

First Foods

Many doctors recommend that your first oral nourishment be clear fluids (water, juices, broth, tea, jello), either warm or at room temperature, followed by a soft diet (yogurt, mashed potatoes, creamed soups, farina, broiled fish), before beginning more solid foods.

The rationale is that your gastrointestinal tract needs time to recuperate after surgery before getting back to work on the digestion of solids. Other physicians believe solids should not be delayed but given as soon as tolerated to prevent or minimize what others consider inevitable: gas pains. Also, they believe you need the nutrients of a well-balanced diet as soon as you are ready to eat it – after childbirth and surgery.

If your diet is restricted to liquids and you do not believe you are receiving the nutritives you'd like, ask your doctor if you can have supplemental vitamin and mineral tablets to replenish your system after the ordeal of surgery. (After childbirth - without having had surgery - you would need a well-balanced diet for health and energy; after surgery, your need is even greater.) Whatever you eat, stay away from spicy and other gas-producing foods.

Gas Pains

Gas pains after surgery are common, although their intensity varies from mild to extreme. They are believed to be caused by one or all of the following: the unavoidable handling of your intestines and exposure to air during the Cesarean (which occurs in any abdominal surgery situation); the temporary stoppage of intestinal activity due to anesthesia and the lack of stimulation of normal intestinal action by your inactivity and lack of food.

To relieve yourself of gas.

Be mobile. Get off the bed and walk.

If you are confined to bed and cannot be mobile, move about in your bed; turn over as often as you can (holding your incision with your hands or pillow).

Ask for the flexible rectal tube to be inserted into your rectum while you are lying down resting or going to sleep for the night. This is not painful and can be very helpful in allowing gas to escape. (In some cases, a suppository or enema may be advised by the doctor.)

Lying on your belly, with a pillow beneath your hips, can also help you expel gas.

Lying on your left side, knees bent, while gently kneading your abdominal wall, encourages the release of gas.

If the back of your bed is raised, be aware of your tendency to curl up in a ball toward the lower end of the bed after a while. This position may block the escape of intestinal gas. Pull yourself up to a sitting position or flatten the bed and straighten yourself out so you are lying flat on your back or abdomen for a while.

Drink fluids - warm rather than cold - to get your intestinal system working.

Use the water in the pitcher at your bedside - without the ice.

Avoid cold drinks.

Avoid carbonated drinks, which tend to produce more gas. Some doctors, however, recommend that you drink some warm ginger ale to encourage burping - another way to rid yourself of gas. If so, sip it slowly through a straw after some of the bubbles have subsided.

Try using slow, deep breathing to relax your entire system and help relieve you of gas.

After a Cesarean delivery you may expect to remain in the hospital approximately five to ten days - depending on your rate of recuperation and the routine of your hospital and physician. Remember to ask for a prescription for pain medication to have handy at home if and when you need it.

Just as vaginally delivered mothers have physical restrictions during the first weeks at home, so do Cesarean mothers - although extra precautions are usually advised. Avoid lifting, climbing stairs, housework, and all strenuous activity until approved by your doctor. Rest, with your feet up, and sleep as much as necessary. Driving a car is sometimes not recommended because you may feel dizzy and have hot flashes for weeks.

If the lochia (postpartum vaginal bleeding) again becomes profuse after it has tapered off, or if it has a foul odor or seems unusual in any way, discuss it with your doctor.

Be sure to return to your doctor for your postpartum examination, at which time your breasts incision and abdominal wall will be checked. You will also be given an internal examination (to check your cervix and size and position of the uterus). If all is well, you will probably be allowed to resume normal activities including sexual relations.

Breastfeeding After A Cesarean

There is no reason why you cannot breastfeed your baby just because you've had a Cesarean. Every statement made to the effect that it cannot be done, it should not be done, or “you'll be so exhausted from the ordeal of surgery that you will not have enough milk ” can be countered with a statement to the contrary from a satisfied nursing Cesarean mother. As a matter of fact, a feeling commonly expressed by Cesarean mothers who breastfeed is that after being inactive, non-participating, and out of control of the situation during the delivery process, it meant so much to them to be able to actively participate and feel in control, through the act of breastfeeding.

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If you are taking medication for pain, some of it may reach the baby through your colostrum or milk and might make the infant a bit sleepy. Your doctor can prescribe medication with the least possible effect on your baby.

Whether you breastfeed or bottle feed your baby, it may be difficult for you to sit comfortably while feeding. Because of the I.V. in your arm and the incision in your abdomen, your movements and positions will be very limited.

Suggested Positions For Breast Or Bottle feeding

1. Sit up with good back support and place the baby in your arm, resting your arm and baby on two thick pillows in your lap. This avoids pressure on your abdomen and strain in your arm, shoulder and back. To burp the baby, lean him or her forward to a sitting position, supporting the baby by cupping the chin in your hand while rubbing the back with your other hand.

2. Lie in bed on your side with a pillow supporting your back and your abdomen. Place the baby on its side, on the bed, so he or she can reach your nipple. To burp the baby, roll the baby onto his or her stomach, or place the baby belly down on your chest, roll onto your back with the baby, and gently rub the baby's back. To turn over to your other side, keep the baby on your chest, holding him or her there as you roll over.

Position For Breastfeeding

You can sit up and hold your baby in the “football hold.” For example, using your left arm, hold the back of the baby's head in your open palm, with the body resting along the length of your arm, at your side, and the legs pointing in the direction behind your body. You can have a pillow or two along your left side for added support for your arm and baby. This position avoids any pressure on your abdomen from the weight of the baby. If you are having trouble, ask the nurse to help you get the baby into the football hold position. To burp the baby, turn the infant onto its stomach across the pillow at your side.

Helpful Hints

Always keep a small pillow handy for ready aid in splinting.

To lie on your side, place pillows behind your knees and back, as well as in front of your stomach for support.

To turn over, splint your incision while you turn. Do not hold your breath. In fact, try inhaling before you turn, then, as you turn, apply pressure to the incision and exhale slowly.

Before sneezing, coughing, laughing, defecating - splint your incision. (Do not suppress a cough for fear of opening your incision. Splint the incision, take a few in and out breaths, and cough.)

Wear cotton nightgowns instead of nylon or rayon. Cotton does not cling, is absorbent, is cooler, and therefore causes less perspiration - a real help because increased perspiration and “hot flashes” are common during the postpartum period. If you cannot locate suitable cotton nightgowns, use other loose-fitting cotton garments.

Remember, you have had a baby, but you have also had major surgery. Any new mother, after childbirth, needs rest to recuperate, and any person who has had abdominal surgery is expected to go home to bed and rest! You have had both.

If, in addition, you had a long, difficult labor prior to the Cesarean, you need even more rest.

Arrange things at home so that you will not need to climb stairs for the first two weeks. Set up your sleeping area on the same floor where there is a bathroom.

Help at home after a Cesarean delivery is vital to your recuperation. Someone - not you - is needed to prepare meals and clean up afterward, do laundry and food shopping, cleaning, and other household chores. Taking care of the baby and your own rest and health care needs is more than enough for you at this time. The more rested you are during the first two weeks, the better you will be able to resume responsibilities afterward.

If you do not expect to have someone helping you at home, be sure to inquire in the hospital if a public health nurse or a visiting nurse can come to your home once or twice a week without charge to help you out for a while with baby care.

If you have nobody living in with you to help, you might want to keep your baby in a bassinet near your bed, along with a supply of diapers, lotions, and clothing changes so you will have less walking to do. If you are breastfeeding, all you have to do is lift the baby from the bassinet and bring him or her into bed with you. If you are bottle feeding you can ask your mate to warm up and bring the bottle to you so you can remain in bed to feed the baby.

The more help you ask for and take, the sooner you will recuperate and be able to resume your normal activities.

Try always to have someone with you or readily available during the first two weeks. If you are not up to dealing with a crying baby when you're trying to deal with your own abdominal discomfort and exhaustion, it can be a blessing to have your mate, neighbor, friend, mother, or relative cuddle the baby for a while.

Eating a well-balanced diet is essential to all new mothers, and even more important to the Cesarean mother to aid the healing process.

Plan to wear loose-fitting clothes for a while. You may be feeling too tender to wear regular slacks or jeans the first few weeks even if you can fit into them. Zipper-front pants are especially difficult to negotiate.

Showers are more practical than baths because they are easier to manage than getting in and out of a low tub.

You might be able to obtain (through rental or purchase) an elevated toilet seat that easily attaches to your regular one. You can use this in the hospital as well as at home. This minimizes the discomfort involved in lowering and raising yourself to and from the level of the ordinary seat, which, after abdominal surgery, becomes a major project.

When riding in the car, use the seatbelt - placing a small pillow between the belt and your belly if your incision is tender.

Remember that each day you will feel better than the day before.

If you have older children, you will temporarily be unable to lift or play with them the way you may have before - due to your recent surgery. You will also be spending a lot of time resting in bed. Use this time to give your older children the love and attention they need. Ask them to keep you company and read, draw pictures, talk, sing, cuddle, or watch TV together.

After you have your postpartum examination and receive permission to resume sexual relations, you may be faced with some of the same problems experienced by vaginally delivered mothers, including lack of or decreased desire, exhaustion, decreased vaginal secretions, embarrassment concerning leaking breasts, stretch marks, and flabby abdomen, and general physical discomfort. (No pain in the perineum, however, because there was no episiotomy!).

In addition, the Cesarean mother (and father) may fear that sexual relations might cause pain at the site of the incision, cause rupture of the scar, or in some way interfere with the healing process. If your doctor has given you the go-ahead after your postpartum checkup, you can be sure that this will not occur.

Position is sometimes a problem. For some, the man-above position is very uncomfortable, but the woman-above position gives more freedom of movement and is more comfortable. For others, the woman-above position is more difficult due to the pull of gravity on the incision, but the man-above position is less stressful (providing his body is not pressed against hers). Much depends on the extent of healing and the physical builds of the partners, etc.

Body image after childbirth is usually a problem – whether the baby was born vaginally or abdominally. This is often a greater source of difficulty for the Cesarean mother, who has to deal not only with flabbiness and stretch marks on her belly, but also itchy pubic hair re-growth and the appearance of the Cesarean scar on her abdomen.

The vividness of the stretch marks and scar will fade in time, but somehow, knowing this does not help at the moment. What can help is dimming or changing the color of your bedroom lights (try a pink bulb), wearing an attractive shortie nightgown, and directing your thoughts far away from your incision and stretch marks.

Repeat Cesarean Deliveries

“Once a Cesarean, always a Cesarean” has been the general rule to which most obstetricians adhere - although there has been some shifting of medical opinion on this recently. If the reason for the first Cesarean continues to be present for the second delivery, however, there is no choice; another Cesarean is indicated. Such a situation exists, for example, when the size of the mother's pelvis was too small for the first baby to be born vaginally and it is likely that the second baby will be at least the same size or larger.

Even if the reason for the initial Cesarean is unlikely to exist the second time around, such as in the case of fetal distress, most physicians are reluctant to allow the mother to go into labor for fear that the uterus may rupture at the site of the original incision during the stress of labor. Although this is extremely rare, they prefer not to risk it because a ruptured uterus means almost certain death for the fetus and places the mother in immediate danger. Therefore, a date for surgery is scheduled in order to deliver the second baby before labor begins. In such cases, tests of the amniotic fluid may be made (amniocentesis), or a sonogram (sound wave photo image) may be taken in advance of the scheduled date to be sure the baby is mature enough for delivery.

Some doctors (definitely in the minority) will allow labor to begin naturally – trial labor - and, if progress is good, they may permit the labor to continue to a vaginal delivery. In some cases, some doctors will agree to such a trial of labor only If you take the full responsibility for the decision.

A common concern is the number of children a woman can safely have by Cesarean and how close they may be spaced. Medical opinions vary on this, but a common recommendation is that Cesarean deliveries be limited to three and that they be about two years apart.

Postpartum Exercises After Cesarean Birth

There are several exercises that should be done after a Cesarean delivery to prevent possible postoperative complications. These exercises involve respiration circulation, and muscle tone.

SLOW CHEST BREATHING (LAMAZE). To expand your lungs after inactivity during surgery, inhale a long, deep breath slowly through your nose; exhale slowly through your mouth. Let the exhalation take a long time in getting out; try imagining making a candle flame flicker with your slowly exhaled breath for as long as possible. Do three of these ms and outs every fifteen minutes as soon as possible after delivery. (Each group of three should not be done less than one time an hour.)

SLOW BREATHING WITH ABDOMINAL SPLINTING. To prevent and relieve gas pains and to shorten the recuperation period, the following technique should be started as early as one hour after delivery and should be continued four or five times every hour that you are awake for at least five days. You will find this very uncomfortable the first time you try it but it becomes easier each time.

Splint your incision with your hands or pillow. Take a deep breath into your chest. Let it all out slowly while applying a little more pressure on the incision. Take another deep chest breath in and hold it for a count of five; let it all out while slightly increasing the pressure. Take a final deep chest breath in and let it out, applying slightly more pressure. The pressure should not result in pain. (Note: if you are able to tighten or pull in your abdominal muscles, while you breathe out and splint, do so.)

Not all hospitals are familiar with this exercise technique, so you may be questioned by the nurses as to what you are doing and why. This exercise is becoming a standard recommendation by Cesarean childbirth support and education groups.

HUFFING (INSTEAD OF COUGHING). Postoperative patients are told to cough during the early recuperative period in order to dislodge mucus from the lungs. Coughing as we know it is not usually effective, partially because the postoperative patient is so afraid that her abdomen will hurt that she attempts to please the nurse and gives a few cough-like sounds from the throat while tensing up, thereby increasing internal pressure on the abdomen and pelvic floor muscles. This action is counterproductive because it usually does not bring up mucus and causes unnecessary muscular strain.

To better accomplish this dislodging of mucus with less discomfort and more benefit to the internal organs, a technique referred to as “huffing” is being recommended by Cesarean support groups and its use is spreading among post-Cesarean mothers.

Before huffing, splint your incision with your hands or a pillow. To huff, pull in your abdominal wall and use your diaphragm to force air from your lungs (all the while helping yourself by holding your incision). Your mouth should be opened wide with your jaw dropped. A huff should be quick (in order to be most effective) and the sound you would be making is that of a loud whispered “ha.” You should huff one or two times every hour.

If mucus comes up into your mouth, be sure to spit it out into a tissue or cup. Swallowing it only defeats the purpose of huffing and you will have wasted your effort.

ANKLE ROTATING. For blood circulation and toning of leg muscles, rotate each foot at the ankle in a circle. Rotate from one side to the other and then point the toes downward, bringing them around, and finishing a circular motion. Rotate each foot separately or both together in the same or opposite directions.

FOOT FLEXING AND STRETCHING. This exercise too is for blood circulation and leg muscle toning. Flex your foot slowly at the ankle with toes pointed toward your body; you will feel stretching in your calf muscles. Then point your toes slowly away from you. Do this several times with each foot. You can do one foot at a time or both together in the same or opposite directions.

SINGLE LEG-SLIDING. To strengthen the abdominal muscles, from a flat-on-your-back position, slide one leg up toward you, bending your knee, until your heel is near your buttocks. Then slowly slide the leg back down to its starting position and press the leg into the bed, holding it for a count of three. (Do not hold your breath.) Do the same with the other leg. Do a minimum of five each leg, every hour, for the first two days at least.

BUTTOCKS. Contract your buttock muscles, holding tightly for a count of four. (Do not hold your breath.) Do five of these contractions every hour for the first two days at least.

PELVIC FLOOR. Contract your pelvic floor muscles (those you would use to stop the flow of urine) and hold them for a count of three. (Do not hold your breath.) Do five of these contractions every hour for the first two days at least. Eventually build up to a total of fifty vaginal contractions a day for the rest of your life.

PELVIC ROCK. To strengthen abdominal muscles improve posture, relieve backache, and to stimulate intestinal activity, lie flat on your back with no pillow beneath your head, knees bent and feet flat on the floor. Take a slow, deep breath in through your nose, allowing the small of your back to curve away from the floor. Exhale slowly through your mouth as you slowly pull your abdominal muscles in tightly, with the aid of splinting, and let out all your air as you go. Also, be aware of pressing the small of your back as flat as you can against the floor. Then start again, eventually reaching a total of five ins and outs.

ROCKING. The use of a rocking chair helps blood circulation.

After your doctor has given you the okay, you can increase your exercises and other physical activities as you feel ready and as your strength and abilities grow.

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