The percentage of babies delivered by cesarean section in the United States shows no signs of slowing: In 2016, nearly 32 percent of all babies in this country were delivered by C-section. Still, in many childbirth classes, a cesarean delivery – and the recovery that follows – is not covered in much depth, if at all. Here's what you need to know.
Immediately after surgery, you'll move to a post-operative area where you'll remain under observation, with hospital staff monitoring things like bleeding (from your vagina and incision), blood pressure, and temperature. An IV will deliver fluids and a catheter will collect your urine in a bag, which eliminates your need to get up for the bathroom.
At this point, you'll still be without sensation in your lower body because of the anesthesia, and you may feel a bit shaky and woozy from morphine in your IV.
The good news: Barring complications, you'll be able to hold and breastfeed your baby right away.
After several hours (considering there aren’t any complications), you'll be wheeled from the post-op area to the postpartum recovery unit. You may be offered ice chips and then switched to a liquid diet (think broth and juice) until your doctor clears you to eat solid food.
Following your surgery, nurses will massage your uterus to encourage it to contract and shrink to its normal size. (Sadly, this isn't as soothing and spa-like as it sounds.) You'll be encouraged to get out of your bed, if possible, on the same day. Yes, you just had major abdominal surgery – but the activity will help speed your C-section recovery.
C-section pain typically spikes 18 hours after delivery. "That's when the pain medication you were given with your spinal anesthesia wears off," says San Diego perinatologist Sean Daneshmand, M.D. At that point, you will be given an oral narcotic; or you may have "patient controlled analgesia," in which pain medication is delivered through your IV. By the time you go home, you will probably only need a nonprescription anti-inflammatory such as ibuprofen.
Your catheter is likely to be removed on the morning of the day following your surgery. This means you'll be walking – at least to the bathroom and back, and possibly farther. "After the first day, we recommend increasing activity as rapidly as possible, but do recognize that this may be painful. Increase your activity as rapidly as you can do comfortably," says Aaron B. Caughey, M.D., a former member of the American College of Obstetricians and Gynecologists committee on obstetrics practice. "Increased physical activity helps with circulation, improves bowel function, and will get you back to baseline sooner."
You also can shower within a day of your surgery; doing so helps reduce the risk of infection. "Don't scrub your incision, but let the soapy water run over it," Edelman says. (Your bandages will likely be removed about 24 hours after surgery and replaced with small sticky bandages called Steri-Strips; it's fine if these get wet.) Dry the area by gently patting it or using a blow-dryer set on cool. It's safe to take a bath when the incision has healed, generally seven to 10 days after surgery.
You'll be wearing a pad for bleeding, which may last several weeks following delivery. (Yes, even after a C-section!) This totally normal discharge is called lochia, and it's a combination of leftover blood, mucus, and uterine tissue.
After your IV is removed, you'll be asked about your pain (repeatedly!) and given pain medicine as necessary. By this point, if not earlier, you're likely eating solid food.
Gas pains can be excruciating during C-section recovery. They should pass within a week, once your bowels are moving normally again (abdominal surgery causes them to "shut down" temporarily). In the meantime, taking anti-gas medication and a stool softener will help – so will walking around. "My nurses practically forced me to get out of bed and move in order to relieve the gas pains I had following my first C-section," says Maureen Connolly, a mother of three in Montclair, N.J. Your physician might also recommend taking simethicone tablets (Gas-X), which help alleviate gas and bloating.
Although moms who give birth vaginally generally stay in the hospital for about two days, the C-section recovery timeline has you staying in the hospital for approximately four days. (Of course, this is dependent on your insurance coverage and barring any complications). Most likely, you'll be getting ready to go home now. Before you leave, your doctor will remove your staples, if you have them (sutures will dissolve on their own) and cover your incision with Steri-Strips, which are similar to paper Band-Aids and should fall off on their own.
You'll be advised on caring for your incision – and keeping the wound clean and undisturbed is your best course. "There have not been any good scientific studies demonstrating that any of the over-the-counter preparations are better than just proper wound care," says Rajiv B. Gala, M.D., the American College of Obstetricians and Gynecologists' young physician at large.
You'll also be instructed not to lift anything heavier than your baby, and be told to avoid sex, tampons, and douching until after your six-week checkup; the American College of Obstetricians and Gynecologists recommends not placing anything in the vagina for several weeks to prevent infection.
Other no-nos include driving and walking stairs, so you may want to help your C-section recovery by moving your essentials downstairs if you have a multistory home – or, at the very least, batching your trips so that you climb stairs only when it's essential.
You'll see your doctor again around this time for a postpartum checkup to examine your incision, which should not show excessive swelling, redness, or signs of infection. (If you see these signs, or are running a fever higher than 100.4°, call your doctor.) Discuss any concerns you have, and ask for an update on recommendations regarding activity as you continue to heal.
Although you're only two weeks out from a major abdominal surgery, you should expect to feel tremendously better, and on the road to recovery by this stage. But keep in mind that you’ll feel cramping for several weeks. "Whether you delivered vaginally or by C-section, it takes six weeks for the uterus to contract to its normal size," Daneshmand says. Resting a heating pad or hot-water bottle on your belly (but not on the incision) can help; so can ibuprofen.
You can still expect to look pregnant at this stage (and much longer, for many people) before your uterus shrinks down to its original size
By this point, you'll be moving more swiftly and comfortably, taking longer walks, and noticing your bleeding taper off. But keep your expectations in check.
"Don't compare your recovery to someone else's because our recoveries vary as much as our genetics, and comparisons will only frustrate those who take a bit longer to recover," says Shawn Tassone, M.D., an Austin, Texas-based Ob-Gyn and author of the books Hands Off My Belly! and Spiritual Pregnancy. "Listen to your body, and if things hurt, slow down; if you feel tired, rest as much as you can. And it's okay to take the pain medications prescribed to you by your provider."
Good news: You're likely fully healed now! "Full recovery from an uncomplicated cesarean section can range between four and six weeks," says Dr. Gala, who notes, "The healthier you are before surgery, the quicker the recovery."
At this point, Dr. Tassone says, most of your sutures, if you had them, will have been about 50 percent absorbed, your uterus will be back down to its normal size, and you'll be free to have sex.
"Some women may still have pain if they're bumped along the incision, but for the most part the wound is perfectly healed at this point, and you can resume all normal activities," he says.