May 27, 2019

Reviewed by Kimberly Langdon M.D.

One of the problems we’re trying to fix at MamaMend is that so much of the advice and info about the postpartum period is generic and aimed at the “average” mom. This is particularly true when talking about the first month or two and recovering from delivery.

Even though roughly a third of births in the US are cesarean births (aka c-sections), a lot of the information out there doesn’t account for it. So today, we’re going to talk about what to expect when recovering from a c-section, and how that might be different from a vaginal birth.

First, it’s important to keep in mind that even though they’re very common, c-sections are major abdominal surgery. You might see another new mom out and about at 2 weeks postpartum, and think “I should be doing that” but c-sections require more rest, and everyone recovers differently.

Here’s what to expect, and what to watch out for, during the first 4-6 weeks after a c-section:

Incision pain - Your incision (where you were cut) is going to be sore. Your doc can prescribe pain meds (some are safe for breastfeeding), but it’s still going to hurt. You also might feel some itchiness and numbness for the first few weeks, which is normal. There is a risk of infection, so if you have a fever, redness around the incision, or a sudden onset of pain in that area, call your doctor. To reduce the risk, keep the incision area clean and dry and wash your hands frequently.

Cramping - This is actually not different from a vaginal birth, but no one ever talks about it. Basically, as your uterus starts to shrink, it might feel like menstrual cramps or even like labor contractions (just when you thought you were done with those), and they often get more intense when you breastfeed. But, every day they should get more and more mild, and shouldn’t last more than a week.

Bleeding or discharge (aka lochia) - While some vaginal births may have additional bleeding thanks to tears, everyone is going to have a massive “period” called lochia. It usually lasts 4-6 weeks, so load up on the pads (no tampons allowed). There might be some clots that come out and if they’re bigger than a golf ball, tell your doctor. The flow is also dependent on activity and position changes, so if you notice a heavier day, take it a bit easier. And if you’re soaking a pad or more an hour for 3 or 4 hours, call your doctor.

Blood clots - One of the scariest risks of childbirth is a blood clot in the leg (which can lead to a pulmonary embolism, and having a c-section increases your chances. It’s pretty rare, but be aware of the symptoms, like a swollen, red, painful spot in your leg or shortness of breath, and be sure to speak up if you notice something.

Breastfeeding - Long-term (3-6 months), there are no differences in breastfeeding rates between those who had c-sections and those who had vaginal births. But, initially, there might be more breastfeeding challenges, for example, finding a position that you can comfortably hold after a c-section (the football hold is a favorite). Lactation consultants (LCs) can help with everything from positioning, to latch, to supply, and LC visits are often covered by insurance, so ask for help if that’s something that’s important to you.

Pelvic floor dysfunction - Even though it was spared the trauma of a vaginal birth, your pelvic floor still went through a lot. For some pelvic floor issues, there is no difference in the prevalence among vaginal and cesarean birth. For some, the incidence is higher among vaginal births, and for some it’s actually higher for c-sections. So, if you’re having symptoms, talk to your doctor or consider seeing a pelvic floor PT.

Related: What is a pelvic floor?

Exercise and activity level - Until your incision heals, you should not be lifting anything heavier than your baby, pulling, or pushing, but it’s really beneficial to get a walk in most days, as soon as you feel up for it. There is not a lot of guidance on when to resume more vigorous exercise after a c-section, but it’s generally recommended to wait at least 6 weeks and get sign off from your doctor before you go back to working out. It can be helpful to find fitness professionals and programs that specialize in prenatal and postpartum fitness and can take into account any limitations you might have.

PMADs - Studies don’t show a strong indication that having a c-section increases your risk of developing postpartum depression or other perinatal mood and anxiety disorders. However, there is an increased risk of PTSD for those who had a traumatic birth (which includes an “emergency c-section” or an assisted vaginal birth). Check out the symptoms of PTSD and get help if you need it.

Related: PMADs vs. postpartum depression

Sources:

https://www.acog.org/Patients/FAQs/Cesarean-Birth

https://www.medicalnewstoday.com/articles/323229.php

https://www.ncbi.nlm.nih.gov/books/NBK115312/

https://americanpregnancy.org/labor-and-birth/cesarean-aftercare/

Kimberly Langdon M.D. is a retired University-trained obstetrician/gynecologist with 19-years of clinical experience. She graduated from The Ohio State University College of Medicine and then completed her OB/GYN residency program at The Ohio State University Medical Center. Recently, she founded a medical device start-up company that focuses on non-drug treatment for common maladies.