One of the chief things pregnant people hear about a C-section is that the recovery is much worse than the recovery from a vaginal birth. The specter of healing from “major abdominal surgery” can be an intimidating one when you’re contemplating this outcome, whether planned or unplanned, but many women report that C-section recovery is not nearly as brutal as they were led to believe.
So perhaps instead of “better” or “worse,” it would make more sense to simply describe C-section recovery as different. Your ability to move will be a little more restricted, at least at first. Your incision will be painful and need treatment while you are getting to know and caring for a newborn. But millions of women who’ve had C-sections have bonded with their infants right away, began breastfeeding successfully, and accompanied their newborn babies to doctors appointments within days of birth, proof that healing from a C-section is manageable, especially if you know what to expect.
We talked to OB-GYNs, midwives, delivery and postpartum nurses, doulas, pelvic floor therapists, psychologists, and parents who have had C-section births to gather everything you’ll need to know, whether your C-section is planned or unexpected. This guide covers:
- What to expect right after surgery
- What to expect in the first few days
- What to expect once you’re home
- What to expect in the long term
- Breast- or chest-feeding
- Intimacy and sexual health
- Emotional and mental health
- How to know when you’re healed
1. What to expect immediately after surgery
Right after the doctor is finished suturing you in the operating room and the nurses clean you up, you will be wheeled into a recovery room near the OR where nurses will monitor you for a few hours. Sometimes you’ll be the only one there, and sometimes there will be other post-op patients recovering near you. While you are in the recovery room, the nurses will be monitoring your blood pressure, oxygen, heart rate, temperature, and pain level. You will still have your IV line and a catheter (lots of wires!), and you’ll probably be wearing some compression socks to prevent blood clots in your legs. As the anesthesia wears off, you will slowly start to feel your legs and be able to move them around. You might feel a little groggy and may start to feel some pain in your incision site; you might also get the shakes, a common side effect of the anesthesia.
Unless your newborn requires NICU care, the baby can be with you in the recovery room, and your partner or support person should be able to be there with you as well. This is a great time to start doing skin to skin and breast- or chest-feeding.
The nurses will be monitoring your pain levels and can give you pain medication through your IV. There is no reason not to take it — the dosage that they’ll give you is safe for breastfeeding mothers and their newborns. “Ask for pain medicine when you notice pain begin, rather than toughing it out until you have to ask,” says Genevieve Smith, a labor and delivery nurse and certified doula in Summit, New Jersey. “Pain medication takes time to begin working, and the pain is likely to grow from when you first notice it.”
Erika Alpern, who lives in Brooklyn and had a C-section two years ago, describes that moment in the recovery room as “surreal and special.” Her doula and her partner were there and helped her do skin to skin and initiate breast or chest-feeding. “I was in labor for so long and then had an unplanned C-section, so I was pretty exhausted and a bit anxious. When my son was finally out, I felt this rush of love and joy that was so palpable, but I was also in disbelief that he was actually there and that I could hold him and nurse him,” she says. “The monitors were blaring, so I was wavering between hyper awareness of the surgical setting and then getting completely lost in the smell of my cute nursing newborn.”
Not everyone feels ready to start feeding right away. Missy Baldwin, a mother of three who lives in western Wisconsin, says she was too tired to nurse in the recovery room, but she still got in lots of bonding with her newborns in those first minutes after their births. “I was exhausted after all three of my C-sections, but my husband knew I wanted to do skin to skin so he held the babies on me while I recovered,” she says.
2. What to expect in the first few days
Moving And Eating
When the nurses are sure you’re stable post-op, you will be moved to the postpartum unit of the hospital. After a C-section, you usually stay there for two to three nights. You probably won’t get out of bed for the first 12 hours or so, which means you likely won’t shower until 24 hours after delivery.
The nurses will start you with a liquid diet, and you’ll gradually advance to solids. After the first 12 hours, the nurses will encourage you to start moving around a little more and to take short walks around the hospital bed. This is important for preventing blood clots and easing gas discomfort. (In the hours and days after surgery, you will care more than you ever have before about gas. This is just a fact.)
You will get pain medication through your IV at first, then switch to oral medication the day after surgery. At first, the oral meds are a combination of a few different drugs, says Beth J. Simon, M.D., an OB-GYN in Scarsdale, New York. “People usually get a very strong [anti-inflammatory] called Toradol and narcotics like Oxycontin and Percocet,” she explains.
The most important thing to know about pain management is to speak up as soon as your pain increases. “Stay ahead of the pain,” says Lynn McIntosh, a maternity nurse in Colorado. “Pain is easier to treat when you’re at a lower pain level than it is once you get to a higher pain level, because at that point, other areas of your body have also kicked it up and joined the party.” Severe pain increases inflammation, causing the muscles around the incision to clench up, which in turn causes more pain.
“After (my) C-section, I felt like a magician’s assistant that was really cut in half, and I needed the drugs,” says Amina Sarraf, 47, in Virginia, who had a planned C-section at 34 weeks due to preeclampsia. Sarraf had learned from past surgeries that her pain tolerance was low. “I knew from those experiences that it was important to stay ahead of it.”
As the pain becomes more manageable, C-section patients typically step down to just Toradol, then only ibuprofen and Tylenol.
Caring For Your Baby
Most hospitals now encourage parents to room-in with their babies to facilitate bonding and breast or chest-feeding. Depending on the hospital, you might still have the option to send your baby to the nursery for periods of time during your stay; make sure to ask about this during your prenatal visit so you know what to expect! When you do have the baby in your room, your limited mobility might make it hard to get out of bed and pick them up when they are crying or need a diaper change. You should be getting lots of support from the nursing staff during this time, but it’s also helpful if your partner or another support person can stay with you to help with initial baby care. You can also ask the hospital staff for abdominal binders or belts, which may make basic movement easier. If those aren’t available, “one of the best things to ask for is additional pillows,” McIntosh says. You can brace the pillow against your incision whenever movement might be painful.
Throughout your stay, nurses will come in periodically to check your vitals, monitor everything from your emotional well-being to your bowel function, and make sure that your incision is healing well. If your doctor closed you up with staples, which are less common now but still in use, your OB usually takes them out before you go home from the hospital. (This process is less scary than it sounds.) Whether you had sutures or staples, the incision will be covered with strips of tape that stay on for up to two weeks.
You will be cleared for discharge when you’re stable, meaning you have normal vital signs, no signs of infection, and your pain is manageable, typically two to four days after the surgery. Unless your baby is in the NICU and needs additional care, they will go home with you.
3. What to expect once you’re home
After you are discharged and recovering at home, you should still try to stay ahead of your pain, although now you will most likely be managing it with over-the-counter pain medicine. “Very few patients now go home with narcotics because they are constipating, and a lot of the post-op pain is more from gas than it really is incisional pain,” Simon says. “Once your intestines go to sleep, you get very gassy, so sometimes people require around the clock GasEx.” Instead of narcotics, Simon prescribes two extra strong Tylenol every four to six hours and 800 milligrams of Motrin every four to six hours as needed. Depending on your pain tolerance, you might take these for the first two weeks or so. You might also be prescribed a stool softener to avoid constipation.
If you have sutures, they typically dissolve on their own, and the incision tape will either fall off or will be removed by your OB-GYN at your first post-op visit, which happens two weeks after your C-section.
In the meantime, don’t be afraid to shower. “I tell patients they can definitely shower and should just pad dry the incision versus rubbing it dry,” Simon says. “They shouldn’t use any soap or creams on that area.” Before you get dressed, check or have someone else check for signs of infection at the incision site; these include redness, swelling, discharge, and heat.
Even though your baby did not exit through your vagina, you will, in fact, bleed from your vagina for two to six weeks or so as your body pushes out all the extra blood, mucus, and tissue it had built up in your uterus to support the fetus. The bleeding starts like a heavy period and should gradually decrease in volume over the first six weeks postpartum, on average. “If you are bleeding through an entire sanitary pad in one hour or less or have a clot the size of an egg or larger, call your OB-GYN,” says Zoë, a postpartum and labor and delivery nurse at a hospital in New Jersey who prefers not to use her last name. When you start moving around more, your bleeding may temporarily increase, Simon notes. As long as it’s not soaking a whole pad in an hour or coming out in clots, you’re still fine.
Though you’re encouraged to walk around a little every day, most experts recommend limiting physical activity during the first week. Just caring for your baby is plenty of exertion right after surgery. “Keep movement slow and minimal in the first two weeks,” advises Casey Selzer, certified nurse midwife and director of education at Oula Health, a combined obstetrics and midwifery center in Brooklyn, who acknowledges that this can be a tall order for parents who are “doers.” “You should not lift anything heavier than your baby,” she adds. “That includes the car seat.”
Learning to move the right way is key. “Get up slowly from chairs and bed; when getting out of bed, roll to your side, hang your legs and feet off the side of the bed, and then use your arms to push yourself up to a sitting position and then stand,” says Emily Bruno, a certified birth doula in Richmond, Virginia. “If you have a tall bed, put a stool next to it” to step on on your way up and down. “Don’t try to use your abs too much. And keep your bladder empty!” (This will help you avoid urinary retention, a problem postpartum that can have long-term consequences.) Parents who have had C-sections also recommend avoiding stairs at first and having a pillow to hold against your belly when you cough, sneeze, or laugh to reduce the pain.
And just because you can move more, doesn’t mean you should. “If you feel good, it means that you’re healing well and should keep resting, not that you can get up and do more,” Bruno says.
Red Flags To Look Out For
Once you’re home, it is pretty much up to you and your support people to monitor your healing process and let your doctor know if anything doesn’t feel right. This can be hard to do when you’re taking care of a newborn, but remember, you are recovering from a significant surgery.
Some of the most common concerns and reasons to call your doctor include:
- Redness, swelling or discharge at your incision site.
- Excessive vaginal bleeding: Soaking through a pad in an hour or less, or seeing blood clots bigger than a golf ball.
- Fever: According to Simon, “Fever with breast pain is a sign of mastitis. But fever with incision pain (and if any puss is coming out) can be a sign that the incision is infected.”
- Red or swollen legs: “It’s normal to have some swelling after delivery that gets better in a few weeks, even if you didn’t have swelling in pregnancy,” Zoë, the New Jersey-based labor and delivery nurse, says, “but a red, swollen leg that is painful or warm to the touch, especially on one side only, can be a sign of a deep vein thrombosis (a blood clot that is in the legs).”
- Headaches, blurry vision, or seeing spots: “You must let your OB-GYN know right away. This can be a sign of elevated blood pressure, related to preeclampsia, which can happen in pregnancy and/or postpartum,” Zoë says.
Call 911 Right Away If You Experience:
- Pain in the chest, obstructed breathing, or shortness of breath: “These can be signs of either cardiac disease or a blood clot in the lungs, called a pulmonary embolism. These can be life-threatening,” Zoë says.
- Seizures, which can be a sign of preeclampsia (a condition that can be developed prenatally or postpartum) and need emergency treatment.
“As a doula, I tell my clients, if you have a gut feeling, a worry, a concern, it is OK to call the doctor and check in and make sure what you are feeling is normal,” says Cheyenne Varner, founder of the Educated Birth in Virginia. “It is always better to be cautious.”
4. What to expect in the long term
Once your incision has closed, you will have a scar; how visible it is depends on a variety of factors, from how big the incision was to your age, ethnicity, and genetics. Some experts recommend applying products to help it heal more completely. Selzer advises applying vitamin E oil to the wound twice a day for two weeks after your two-week post-op visit with your OB. Vitamin E is thought to reduce inflammation, although the evidence on its effectiveness is mixed. If you decide to use it, avoid doing so longer than two weeks because prolonged exposure can discolor the skin. “After that you can start using the scar gel and silicone scar sheets. The gel should be applied at night for two months and the silicone scar sheets should be used during the day for three months,” she says.
Pelvic Floor Therapy & Physical Therapy
Pelvic floor therapy has been trendy of late, but it’s not a gimmick. The term “pelvic floor” refers to the network of muscles, nerves, ligaments, peritoneum (the tissue that lines your abdominal wall and covers most of the organs in your abdomen), and fasciae (connective tissue made of collagen that surrounds and connects them) in your pelvis that contract and relax in intricate concert to support a lot of major bodily functions. You can thank your pelvic floor for four main things: First, it supports your organs, holding your uterus, bladder, vagina, rectum, and abdominal muscles in place. Second, it’s crucial to continence, helping you hold in pee and poop. Third, it helps you orgasm, and fourth, it’s crucial to stabilizing your whole body. Because your pelvic floor is connected to your core, it helps you move your abs and back.
During pregnancy, your pelvic floor supports a lot more weight than it’s used to (remember, the uterus grows to about the size of a watermelon), so it is under a lot of stress. Many people know that pushing during a vaginal birth can injure the pelvic floor, but most people don’t realize that C-sections can, too. When you have a cesarean, the doctor has to cut through several components of the pelvic floor (nerves, fasciae, peritoneum, and your abdominal muscles) before they get to the uterus. Core rehab can ensure proper healing and “bowel and bladder health, pain-free intimacy, joyous orgasm, and complete elimination, all things we want to be able to do seamlessly,” says Lindsey Vestal, an occupational therapist whose practice, the Functional Pelvis, has locations in New York and Paris.
If you’re still having pelvic pain six weeks after surgery, Selzer says, pelvic floor therapy is the way to go. She refers all post-op patients to a licensed pelvic health physical therapist after the six-week postpartum visit. In addition to addressing muscular issues, “a qualified PT can help identify how the wound is healing both externally and internally,” Selzer says.
People are typically told not to exercise during the first six weeks postpartum, though some new parents feel ready to start light movement before then. To wade back in, start with 20 minutes of light exercise, then take the next day off to see how your body recovers, Simon says. If you’re in pain or start bleeding more, you’re not ready. Otherwise, you can gradually increase the time and intensity of your workouts. The best gauge of whether you’re overdoing it is a blessedly simple one, especially if you work out with a friend: “You definitely want to be able to talk while you’re exercising.”
5. Breast- or chest-feeding
If you’re planning to nurse your baby, you should get lots of support from the staff while in the hospital. They will teach you how to help the baby latch and make sure your baby is getting enough milk to gain weight and establish your milk supply. Because milk production is a demand and supply process (generally speaking, the more milk is pulled out of you, the more milk your body will produce), Carrie Dean, international board certified lactation consultant (IBCLC), recommends getting a head start by introducing hand expression and/or pumping in the hospital.
Because it is not uncommon for your milk to be slightly delayed after having a C-section (your body will produce colostrum for the first few days after your baby is born before your milk comes down, typically around Day 2 to Day 5), it’s also a good idea to get the name of a good lactation consultant and their fee before you give birth. (The cost for a consultation can range from $150 to $500, depending on your location; these are sometimes covered by insurance.) That way if you have concerns after you get home, you know who to call, Dean says. “Reach out for professional help as soon as there is a sign of a problem.” Common issues include breast or nipple pain, engorgement, latch issues, or your baby not gaining enough weight.
Dean also recommends having a nursing caddy where you keep your essentials for feeding and pumping, including water, snacks, breast pumps, nipple creams, and hand sanitizer. You can carry it with you to different feeding spots in your home, or you can set up a few different stations around your house or apartment. The point is to have everything within reach while getting up repeatedly is still painful or just difficult. “Rule No. 1 is for you to be comfortable, so having lots of pillows, bolsters, and rolled up blankets can help, too,” Dean says.
In terms of breastfeeding positions, you’ll want to find ones that don’t put pressure on your incision. Dean recommends the football or rugby hold (look them up!). “You can also do cross-cradle or even lay back but place the baby on a diagonal angle to avoid the incision,” she says. “Placing a small pillow on top of your belly to guard the incision is a good idea, too.”
6. Intimacy and sexual health
Most OB-GYNs and midwives don’t recommend intercourse until after until they’ve examined you at your six-week visit. That does not mean you have to or should be ready for intercourse, or any other type of sex, for that matter, after six weeks. How people feel about sex postpartum varies widely — truly.
Experts we spoke to are pretty unanimous that best way to get reacquainted with sex when you want to is to approach it with 1) honesty and 2) acceptance: First, be honest with your partner(s) about your current boundaries, and then, instead of measuring your feelings against an imagined universal timeline, think about sex in terms of exploring your evolving body and needs.
Masturbation can be a great way to safely start to figure out what you like and dislike before you resume having sex with a partner. Experiment with both vibrators and manual stimulation. If any of this hurts, don’t panic. You simply may not have completely healed. If the pain persists after a month or two of trying to masturbate, you may need to see a PT or pelvic floor therapist.
If you are feeling ready for intercourse, know that the hormonal changes your body is going through (especially if you’re breast- or chest-feeding) can make your vaginal canal dryer than usual, even if you didn’t deliver your baby through it. This is normal, which is why most experts recommend using lots of lube at first. If you have pain or discomfort at this point, you may need more time to heal before intercourse, or this may be when you reach out to your doctor or a pelvic floor therapist. In the meantime, there are other ways to be intimate and have fun together.
If you historically have heterosexual sex, your doctor or midwife will likely mention birth control at the six-week visit. As with the clearance to have sex, try not to hear this question as a statement that you should be ready for sex. Holly Adams, a Connecticut mother of three and full-time nursing student, was caught off guard when her doctor brought it up. “I had just had a baby, was still healing and hardly thinking about sex at all, let alone pregnancy prevention,” she says. “She asked, ‘What are you using for birth control?’ And I felt embarrassed to say, ‘Nothing, currently.’”
If your birth control plan includes a prescription, you can ask your doctor for one at the six-week visit or even get an IUD inserted during the appointment. “My midwife discussed my options with me about halfway through my third trimester, including what options would work best if I was done having babies, breastfeeding, etc.,” says Amanda, a Michigan-based mom of four. “This gave me the time to research what would work best for me. I chose the Paraguard IUD between babies, [then] after our last baby, decided that a tubal ligation was the way to go because our family was complete.”
On all matters related to post-baby sex, “be patient with your body,” advises Alex Fine, a New York City-based sexologist who recently had a C-section. “There are so many intimacy challenges postpartum. Wherever you are, just know it is totally normal! If you don’t want to have sex yet, that is OK.” If you’re conflicted about the transition back to sex, Fine recommends first identifying exactly what you’re feeling, without any sense that you need to “fix” yourself. “Maybe the issue is just that your body is different and you’re not used to it. Identifying if it is a physical issue, or a body confidence issue, or a new identity/transformation issue is a good place to start.”
The hormonal changes that enable nursing — increased prolactin and decreased estrogen — may have temporarily sapped your libido, or you may be exhausted or in the throes of postpartum depression or anxiety.
No matter what you’re hearing from your partner, friends, or society at large, there is no deadline you have to meet, and you are in charge. “Try to understand what is causing your issues, and understand if you want to change them,” Fine says.
7. Emotional and mental health
While some C-sections are planned and scheduled ahead of time, many others happen as a response to an emergency during labor. A childbirth experience that deviates in a major way from the expected can result in trauma, Dr. Sharon Dekel, an assistant professor at Harvard Medical School and founder of the Traumatic Childbirth Laboratory at Massachusetts General Hospital, tells Romper.
“There is definitely evidence associating an unplanned, unscheduled C-section as a mode of delivery with negative mental health outcomes,” Dekel says. Instances of postpartum depression and anxiety and childbirth related post-traumatic stress disorder (PTSD) may be higher in moms who’ve had an emergency C-section, especially if they aren’t provided interventional treatment in the hours and days following delivery.
Whether you have a C-section or a vaginal birth, at your six-week post-OP visit, your OB-GYN will screen you for any perinatal mood or anxiety disorders (PMADs). However, what most people don’t realize is that symptoms can appear up to two years after giving birth. That means it is important to monitor how you’re feeling emotionally, even if you’ve already healed physically.
“It’s normal to experience ‘negative’ emotions about your birth experience, such as grief, sadness, or disappointment, especially if you expected this moment to feel joyful,” says Emma Levine, Ph.D., a psychologist licensed in New York and Connecticut. “As a psychologist, I become more concerned when a person’s reflex is to compound these already painful feelings with a sense of guilt or shame that blocks her ability to care for themselves, or to respond to the needs of the baby.”
If you find yourself experiencing any of the above, the first thing to know, Levine says, is that “these feelings are not a reflection of who you are as a parent, or the love you have for your new baby.” Levine recommends reaching out to a therapist who specializes in postpartum mood disorders who will help you identify the thoughts driving your lows and give you tools for coping. The most basic tool is sleep — “High-quality sleep postpartum is a protective resilience blanket, and insufficient sleep can lead to the development of PMADs,” Levine says — and to figure out exactly how you feel about your birth and let those emotions exist, whatever they are. “It is particularly important to process your experience so that you find a way to integrate it into your narrative of becoming a mother,” she adds. For more on how to tell your C-section birth story in a way that feels right to you, click here.
8. How to know when you’re healed
Nobody wants to hear this, but pregnancy and birth change your body, and some of those changes are permanent. Even after you’re medically cleared and your uterus has shrunk back and your scar has healed, your body will feel different. In many ways, you will be a different person, with a new perspective on your life and different needs and wants. Whether that terrifies you or provides relief from the fiction of “bouncing back,” be patient with yourself as you heal and acclimate to so much newness. You have time. Postpartum is the rest of your life!
“In midwifery, we think of healing as happening on a continuum. We shed one version of ourselves when we give birth and grow into a new form of ourselves, in a body that carries wounds as a reminder of the amazing power of growing life and giving birth,” says Selzer, the Brooklyn-based nurse midwife. Everyone heals slightly differently. Even if you’re anxious to get on with it because you want to have another baby soon, your body needs what it needs. The American College of Obstetrics and Gynecology (ACOG) recommends waiting no fewer than six months and ideally at least 18 months to conceive after a cesarean birth. We’ll say it again: Take your time.
If you or someone you know is seeking help for mental health concerns, visit the National Alliance on Mental Illness (NAMI) website, or call 1-800-950-NAMI (6264). For confidential treatment referrals, visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website, or call the National Helpline at 1-800-662-HELP (4357). In an emergency, contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or call 911.
Photo Credit: Jelena Markovic, Jennifer Bogle, Erin Brant, Tatiana Timofeeva, Sweenshots & Shaymone, Chaoshu Li/Stocksy
Genevieve Smith, a labor and delivery nurse and certified doula in Summit, New Jersey
Beth J. Simon, M.D., an OB-GYN in Scarsdale, New York
Lynn McIntosh, a maternity nurse in Colorado
Casey Selzer, certified nurse midwife and director of education at Oula Health, a combined obstetrics and midwifery center in Brooklyn
Emily Bruno, a certified birth doula in Richmond, Virginia
Cheyenne Varner, founder of The Educated Birth in Virginia
Lindsey Vestal, an occupational therapist whose practice, The Functional Pelvis, has locations in New York and Paris
Carrie Dean, international board certified lactation consultant (IBCLC)
Alex Fine, a New York City-based sexologist
Dr. Sharon Dekel, an assistant professor at Harvard Medical School and founder of the Traumatic Childbirth Laboratory at Massachusetts General Hospital
Emma Levine, Ph.D., a psychologist licensed in New York and Connecticut