What do you need to know about recovering from a vaginal or caesarean birth? MH asks the experts.
WORDS CHRISTEL GERALYN GOMES
While a vaginal delivery is generally encouraged in the absence of complications, some women may end up needing or opting for a caesarean section for various reasons. Either way, recovering from a natural delivery is quite different from that of a caesarean. Here’s everything you need to know about what to expect.
The Ease of Delivery
A caesarean is most likely to be much easier in terms of delivery – it will be far quicker and it will happen with much less effort on your part. You can expect to be given an epidural and/or either regional anaesthesia which will numb the lower half of your body, or general anaesthesia which will knock you out. Regional anaesthesia is more common and you will be awake during the operation. You will then be wheeled into the operating room and a screen will be raised so you can’t see the operation. Your doctor will make an incision, reach in and pull your baby out – as simple and fuss-free as that!
What you gain in terms of ease of delivery, you make up for later. “Recovery is much longer for a caesarean, and there is usually more post-delivery pain. The risk of a caesarean section is also higher and includes injury to other organs, bleeding, and wound infection,” says Dr Watt Wing Fong, specialist in obstetrics and gynaecology, Raffles Women’s Centre.
A normal vaginal delivery, on the other hand, can last a long time and you can expect a significant amount of pain. “Women attempting a vaginal birth need to go through the labour process, which can take many hours. During labour, there will be regular painful contractions but pain relief can be offered during labour,” says Dr Watt. Recovery, however, is much less complicated with a vaginal birth and you can expect to be in less pain after delivery than if you have had a caesarean.
Recovery: Vaginal Delivery
Here are a few things you can expect during your recovery from a vaginal birth.
If you’ve had a vaginal delivery, no matter how short your labour was, expect swelling and what feels like small, occasional contractions. Fret not, this is a good thing because it means your uterus is shrinking back to its original size. Dr Michele Lee, consultant obstetrician and gynaecologist at Michele Lee Women and Fertility Clinic Pte Ltd at Mount Alvernia Medical Centre says to expect that your vaginal soreness may linger for several weeks. “In the acute phase, usually the first two days after delivery, you may use a sitz bath (warm water and sea salt) and ice packs to the perineum to help with the pain. You can also use a soft pillow or padded ring, adequate pain relief and stool softeners.”
If you’ve had some stitches done due to vaginal tearing, you may experience some itchiness but this should go away in about three weeks. Also, any vaginal soreness you have should be gone in about two weeks.
You should also expect bleeding and discharge for a few weeks and this is called “lochia”. “Lochia refers to vaginal discharge after your delivery that contains blood, mucus, and tissue from the uterus,” says Dr Ng Ying Woo, consultant at NUH Women’s Centre. He adds that typically, the duration of lochia is an estimated four to six weeks and this also happens in mothers who have had a caesarean section. Postpartum bleeding can be compared to a period – stock up on those maxipads, they’ll become your close companion for a while.
Also, although there is no definite period, Dr Lee advises that sexual intercourse be put off until lochia has stopped. Dr Ng agrees, adding, “Most importantly, you must feel ready both physically and mentally.”
If moving your bowels has become a painful process, it could be due to haemorrhoids that are a common after-effect of all that pushing during delivery. However, even if you’ve had a caesarean section, Dr Ng says that you might still have constipation due to the medicines used during surgery.
If you’ve delivered vaginally, Dr Ng suggests that you take a stool softener to help.
If you experience slight pain when you pee, this is also normal. Your urethra may be bruised and sore from the delivery process. Most women experience some leaking during a cough, laugh or sneeze. Rest assured, this should ease up after the first week or so.
The main thing you need to do is Kegel exercises to get the strength and tone back in your muscles.
Recovery: Caesarean Section
Unfortunately, the pain from a surgical incision is greater and lasts a lot longer than the soreness of a vaginal birth. According to Dr Ng, you will likely have to stay in the hospital for one to two nights for recovery. Depending on the hospital and doctor, you may also be asked to stay three to four nights.
The surgical wound
According to Dr Lee, your incision wound will take about 10 days to heal. Dr Ng adds that the pain should subside within a couple of weeks. “Try to keep the wound dry,” he says.
The scar from the incision will not fully disappear. “The scar will look red or pink for a few months and eventually fade into a pale white thin line after a year. Though the scar will not go away, fortunately, most C-section scars are usually below the pubic hairline, and will not be noticeable,” says Dr Ng.
“Breastfeeding after a caesarean section delivery is more challenging due to the pain from pressure on the wound site. However, this can be managed by using a more comfortable side lying position or clutch hold the baby instead of the traditional cradle hold after vaginal delivery,” says Dr Ng.
If you’ve had a caesarean section, Dr Lee advises not to do any strenuous exercise or heavy lifting in the first couple of months. “Once you feel comfortable with pelvic floor exercises, you can begin to work on your lower tummy muscles, which will help to strengthen your back. It’s fine to do gentle toning exercises in the first six weeks. It won’t rip your stitches, or damage your scar so there’s no need to wait unless it feels painful. You may feel your stitches twinge, but you won’t be doing any harm. If these exercises hurt your scar a lot, ask your health visitor to check them. The tissues around your scar will benefit from being gently flexed. So standing up straight and doing gentle tummy exercises will help your scar to knit together more strongly,” she says.
You can gradually increase activity at a pace that suits you after the first six weeks. Start with a five-minute walk, and gradually extend this. Keep in mind that “the effects of pregnancy hormones can affect your joints for up to six months after birth, so don’t do any high-impact activities too soon”, says Dr Lee.
You can expect to be less mobile than other mothers because after all, you’ve had a major operation (albeit the best kind). No need to jump to get chores done, even simple ones. Let everything be your partner’s responsibility for a few weeks or hire help. It’s okay to lie down a lot, especially in the beginning.
Let yourself be taken care of, because on top of recovering from surgery, you will also be dealing with the same set of recovery symptoms as those who have had a vaginal birth – these include: postpartum fatigue, the after pains of uterus contraction, lochia, breast engorgement and possibly also vaginal soreness if you tried to deliver vaginally before going into surgery.
In the case that other complications do arise after a caesarean section, Dr Tony Tan, consultant obstetrician and gynaecologist, Raffles Hospital tells us that the following are possible: immediate ones include bleeding, infection, deep vein thrombosis and pulmonary embolism, longer hospital stay and recovery time, decreased bowel function, reaction to anaesthesia, and rarely, injury to bowel, bladder, or foetus, or even death (although this may also happen in a vaginal delivery it is less common). Future complications include the possibility of needing a repeat Caesarean section for the next pregnancy, a higher risk of organ injury during future surgeries, placenta praevia, placenta accreta, placental abruption, and uterine rupture.