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Making decisions about birth after caesarean

Recovery & complications after previous caesarean

Even though caesarean is now considered to be a routine medical procedure, it remains a major operation. Women may take more time to recover than after a vaginal birth and there will be some pain and soreness as the wound heals. Of course, everyone's pain threshold is different and recovery varies from person to person. Several women we talked to felt they had recovered quite quickly and did not experience any problems with their scar healing. Still, many women mentioned the after-effects of having a caesarean and the length of recovery as important reasons why they might want to avoid caesarean birth in future pregnancies (see 'Reasons for wanting vaginal birth after caesarean').

 

Her family expected her to need extra support, but she felt so well that she went shopping the...

Her family expected her to need extra support, but she felt so well that she went shopping the...

Age at interview: 41
Sex: Female
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I had quite a good experience, although it' although it was an emergency Caesarean, I recovered very well, because I know when'When they decided we were going for emergency Caesarean, my husband had actually phoned his mother to say, 'Oh, [wife's] going in for Caesarean,' and she must have then phoned her other daughter who'd had a Caesarean before and said, 'Oh Mum, you're going to have to get down there, [husband's] not going to know what to do.' Because she' it took her quite a long time to recover, she couldn't get out of bed, but I was completely different, I was' I had the Caesarean on the Monday, and they advise you to sort of stay in bed really on the Monday, but on the Tuesday they like you to start walking about a little bit, and that was absolutely fine, fine for me, yeah.

In fact, I probably was on my feet probably a little too quickly, I was walking out to the shops and found' I was getting a bit tired and when the midwife came to see me she said, 'That's far too far for you to be walking,' because I hadn't actually been advised about' that was probably something about after a Caesarean, so I'm probably one of these people if I can manage it I'll go and do it, but probably wasn't aware that I probably shouldn't have been walking that far.

 

She was surprised by the speed of her recovery and was astonished that she could have a shower...

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She was surprised by the speed of her recovery and was astonished that she could have a shower...

Age at interview: 38
Sex: Female
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Well, it was even better, because as I said, I thought I'd have to like spend two or three days in bed, but I was up on my feet the next day. 

And was that you initiated that getting up?

No, no, no, it was the people at [Hospital]. I remember my caesarean was at about five o'clock in the afternoon, and the next morning a really lovely lady came along and helped me to the shower, got me up and I was just flabbergasted and she was just, you know, 'Get in, get in the shower, on your feet, have a wash, you'll feel better', and I did.

And that's what you wanted?

Yeah, and I stayed' I was on my feet instantly. I didn't go back to bed.
 

Women are usually advised to get up and start moving around within six to twelve hours of the operation to aid circulation and help avoid the formation of blood clots in the legs. However, many women find moving around in the first few days quite painful and need plenty of pain relief. Even with pain relief, women may find that their movement is limited and they need the support of those around them.

Amongst the women we spoke to, experiences of recovery varied greatly. A couple of women felt well enough to get up and move about within a day of the operation and were surprised to feel much better than they had expected. Others had the opposite experience and were surprised at the amount of pain they experienced. Several women said they found it difficult to get in and out of bed and to lift their baby. A few commented that the information they had received from professionals before the operation had not prepared them for the length of recovery time. Experiences of support from hospital staff were mixed. A few women found it difficult to ask for help from busy staff. They felt relieved when they could return home. Several women had been advised not to drive for the first six weeks after the operation. For some, not being able to use a car made them feel even more dependent on others. 

 

She was mistaken to expect a quick recovery. Not being able to drive and having no family nearby...

She was mistaken to expect a quick recovery. Not being able to drive and having no family nearby...

Age at interview: 37
Sex: Female
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Unfortunately because I'm a nurse I had this preconception that it was only a section so therefore it wasn't major surgery and I'd recover quickly, and I didn't' Because I overdid it probably, ran around too quickly'The first few weeks are just so restricted in comparison to other people that have given birth naturally. One of my friends had given birth naturally and she was running around, driving. Whereas for myself having no family around, I was very restricted not being able to' drive, and also not being able to walk places and get anywhere. And the difficulty of getting out of bed just to pick up my child was really horrible. Just everything was really, really hard after having a section' looking back.

 

She felt very ill after the operation and took a good month to fully recover. She hadn't realised...

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She felt very ill after the operation and took a good month to fully recover. She hadn't realised...

Age at interview: 19
Sex: Female
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I felt really weak, I felt ill actually, I got' and I felt really ill. I felt very dizzy and' get a bit worried about what's, what's wrong with you because you don't normally feel like that, it's something you don't experience, especially sort of after you've got a new baby you expect to feel like a bit more with it [laughs].

And how long were you like that?

I was like that for a long time, even when I came out of hospital. I came out of hospital on the' I had him on the Tuesday and I came out on the Friday and on the Friday night I didn't get discharged until about eight o'clock at night. And I got home and I felt really, really terrible. I felt' you get worried, like you're thinking 'oh my God, well, what's wrong with me?' But' no, it went on for quite a while. It went on' I didn't feel normal again for a good month, over a month.

And did that surprise you?

Yeah, because you expect to sort of bounce back quite quick, but you don't realise it is a major operation. I don't think, because it's so routine now, I think people get into the habit of thinking, 'Oh well, it's'' or, 'I'll go'' all these people having caesareans, they think 'oh, I'll, I'll have a caesarean', but it's not all that easy really.

Okay. And did you have any long-term worries about either you or the baby being affected? 

Long-term? Not really, because my scar' I was lucky, I never had any problems with my, like the healing and that. I healed like brilliantly really.

And did you worry that you were unable to do as much as you'd like to have done?

Well, I was supposed to be drive' learning to drive and, because I, I was driving right up until I had my test in like a couple of months before he was due. And I failed, and I had it re-booked, and I had to cancel it because I had the section and you can't drive for six weeks. And obviously then, I had to have a couple more lessons before, so that took a lot longer than I would have liked. I think that's the main thing, you don't realise you can't drive, you can't do- the normal things, just like getting out of bed and things is a lot more difficult.
 

Several women had worried that they might not be able to breastfeed their baby after a caesarean. Women may struggle to lift the baby by themselves or to find a comfortable position during feeding due to pain from the scar. Some research also suggests that a caesarean can affect the milk coming in, though it is not clear why this might happen. Many women we talked to didn't experience any problems breastfeeding after caesarean. A couple of women who had planned on breastfeeding their babies felt too unwell to do so immediately after the operation. They were upset that being so poorly themselves meant they missed out on the close contact and bonding with their child immediately after the birth. 

 

She needed antibiotics after developing an infection. The pain from her scar made it hard for her...

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She needed antibiotics after developing an infection. The pain from her scar made it hard for her...

Age at interview: 31
Sex: Female
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Did you have any complications that you think were associated with having had a section?

Yeah, well, I had a, well my uterus didn't go back so quickly as it should have done and they discovered I had an infection, so I was on antibiotics for a week or so with that. And then, I just had a lot of pain afterwards, so' and I think it was just, it' that was the main thing, obviously that, that the infection, but also, I think the' I found it very hard to breastfeed because obviously I was in a lot of pain, and there wasn't really any sort of support given to me for, for the breastfeeding afterwards, so I, I knocked it on the head.

And how long did you manage to do it for?

Well, I tried unsuccessfully for a number of days and then I actually hired an electric pump for a month and expressed, so it was about a month all in all, really. But'

And did you have any worries, long-term worries that either you or your daughter were affected by how you delivered?

No, no.

And did you have any difficulties going to the loo or resuming your sex life after?

Going to the toilet was very painful for about three or four days afterwards. Whilst they give you things like peppermint tea and stuff like that in hospital, it's still, you know, obviously because everything's been pushed and shoved around, it's still very, very painful. Sex life, no, no complications as such through the C-section, just obviously, obviously, very sort of' the whole area was a bit painful really for a while.

None of the women we talked to felt that they had suffered serious long-term complications as a result of caesarean birth. Such complications are rare, but they do happen. 

A few women we talked to felt quite badly affected in the first few days and weeks after the operation. Depending on the circumstances of the operation, women may remain connected to a drip or catheter for several hours afterwards. More rarely, women who have lost a large amount of blood may be given a blood transfusion to help them regain their strength. They may also receive a course of antibiotics to prevent or treat infections of the uterus or caesarean scar. Bleeding from the uterus (known as the 'lochia') is the same as those experienced after vaginally delivery and can last for up to six weeks. A couple of women we spoke to, who felt very ill and tired immediately after the birth, said receiving a blood transfusion had helped them regain their energy. 

Very rarely, women's experience of birth can be so stressful that they might experience symptoms of post-traumatic stress disorder (PDST)

 

After the caesarean, she developed heart palpitations that lasted for several months and which...

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After the caesarean, she developed heart palpitations that lasted for several months and which...

Age at interview: 33
Sex: Female
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When my daughter was delivered I had quite a lot of pain in my right shoulder and no-one could really tell me at the time why that happened, and it lasted a few days and I was given painkillers for it. And also I had quite a few problems with my heart after as well; whether it was due to the stress of the delivery I don't know or if it was just' I really don't understand why it happened, but I ended up having to see a heart specialist because of it because it went on for about four or five months.

And what kind of problem was that?

It was, it just felt like my heart was thumping really hard in my chest all the time, almost like palpitations I suppose.

And how did that resolve, did that do it by itself or '?

It resolved itself in the end. They said that if it didn't I would have to take medication, but luckily it did, it did go eventually.
 

Several women had concerns about their caesarean scar. These included concerns about the visible appearance of the scar and concerns that the wound might get infected. Some were also concerned about whether the scar would affect future pregnancies. Many women said that it had taken them a fair while to get 'back to normal' in all aspects of their lives. Several women felt nervous at first about going to the toilet or resuming their sex life. A couple of women were amused to receive advice on contraception when having sex was the last thing on their mind. A couple of women also said they were put off by the thought of becoming pregnant again.

 

She experienced bleeding for six weeks after the birth. Sex was the last thing on her mind.

She experienced bleeding for six weeks after the birth. Sex was the last thing on her mind.

Age at interview: 26
Sex: Female
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And did you have any problems either going to the loo or resuming your sex life afterwards at all?

No, no. I mean, I did kind of panic a little bit obviously because of it healing and everything, I sort of thought, 'Be gentle with me'. But I mean obviously the last thing on your mind is sex [laughs] once you've had a baby, but obviously you've got all the heavy bleeding and everything afterwards and mine sort of lasted about sort of six' it was about six weeks-ish. So obviously that was another no-no really. But, I mean, that's the funniest thing when you go to the doctors and they ask you what sort of contraception you're on, and you're thinking, "Well I don't want him anyway near me', keep him away!" [laughs].

 

She experienced deep pain from her scar for almost a year but was reassured by the doctor that...

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She experienced deep pain from her scar for almost a year but was reassured by the doctor that...

Age at interview: 38
Sex: Female
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The only worry was that the pain, sort of deep pain from the scar went on for I'd say almost a year. Sort of twinges and that's' I went to see the doctor about that and she just said well you've had a' it's the nerve endings knitting and just expect it. So after I'd been told that and I knew it wasn't anything going wrong. And obviously you worry about the stitches coming open.
 
 

She felt scared when she first looked at her scar but it healed very well and eventually faded.

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She felt scared when she first looked at her scar but it healed very well and eventually faded.

Age at interview: 33
Sex: Female
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I think the, the scary part was when I looked down and I've sort of been half, half-shaved, and it looked, it did look quite, obviously bruised and tender and there was sort of still the anti-bacterial dye but then, as time went on and the shape went back to normal, and the hair started to grow back, it was like, looking in the mirror, sort of, you know, 'This is me again', and it didn't bother me, because the scar did heal up ever so well. It went quite faded and wasn't quite noticeable.
 
 

She feels a bit more tentative than she used to since her caesarean, but her scar healed well and...

She feels a bit more tentative than she used to since her caesarean, but her scar healed well and...

Age at interview: 40
Sex: Female
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Okay and did you have any trouble going to the loo or resuming your sex life after? 

No I mean it was' obviously I'm assuming it was longer than what it would have been normally. Loo wise, no I think' they talk about the incontinence thing but I think that's been for a natural labour as well as a caesarean and that's not really affected me that much but it's when you sneeze and that sort of thing it's- a little bit different.

A bit more tentative?

Yes.

Okay that makes sense. And you still feel like that now?

Yes, yeah.

And did it affect how you felt about yourself at all ' having a section?

No' I mean you obviously think about the scar because that's a personal thing isn't it? But I was soon into my bikini the next summer, so' [laughs].

And do you think that's because you're such an active person?

Most probably yeah because you know I do' I do go to the gym, I keep fit and it helps and you know' and it was a- it was a good section, I've been told it was a good scar in terms of the stitching and things, so...

At the time of the operation, many women said that their main concern had been for their baby and not for themselves. Most women felt confident that a caesarean was necessary for their baby's health and safety. However, a few women worried about how a caesarean might affect their baby. For example, one woman was concerned that her baby might get cut during the operation (Interview 29). A few women had also read that coming through the birth canal is good for the baby as it helps to clear mucus and stimulate breathing. They wondered whether being born by caesarean might have been more stressful for their child.

 

Her son experienced breathing difficulties and had a low Apgar score at birth. Feeling very sick...

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Her son experienced breathing difficulties and had a low Apgar score at birth. Feeling very sick...

Age at interview: 32
Sex: Female
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I recovered quickly, I didn't have any complications with my scar or anything. 'And luckily [Son] was a good feeder because I think that would be a concern. Now I know about sections, you know that possibly' because I was sick from one of the drugs so I was' my blood pressure went really low and I was sick. It was three o'clock the operation and I was being sick for the rest of that day. So I didn't actually get to hold [Son] or feed him for several hours.

And you carried on breast feeding after that?

Yep, but I think the first feed was probably two or three hours after he was born.

Okay. And did you have any worries immediately after that you or the baby were in some way harmed or affected by the way he was born?

I did when he was delivered because he didn't cry for ages. And they had to suck the meconium out, it hadn't gone down too far, and they had to help him to breathe and he had a low score* initially. But there was a paediatrician and everything there and' it was all very stressful, the actual operation.

*APGAR score (a measure of the baby's condition at birth).
 

Two mothers who'd had their babies delivered prematurely needed to have them looked after in the Special Care Baby Unit (SCBU) for several weeks. They felt helpless about the situation and were very upset to return home without their baby. A couple of other women had to have their babies readmitted to hospital due to weight loss and other concerns.

 

Her daughter weighed 1 pound 15 ounces at birth and was kept at the Special Care Baby Unit for...

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Her daughter weighed 1 pound 15 ounces at birth and was kept at the Special Care Baby Unit for...

Age at interview: 33
Sex: Female
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So, your baby was taken, was she taken to SCBU or ITU?

The SCBU straight away.

So how long did she stay there for?

Seven weeks, which wasn't that bad really, sort of compared to other babies that were in there for like five months. Because she was breathing on her own, and didn't need ventilation, that she, you know, she had antibiotics to overcome infections and possibly, there was the chance of a blood transfusion for septicaemia, but then, you know, once she got over these little infections, it was just a general case of sucking reflexes to take feeds properly and then just to gain the weight.

So she didn't have any other problems, just apart from the fact that she was one pound fifteen?

One pound fifteen, yeah. It went down to one pound eight. I, my mum, she sort of knows obviously more'

That's alright, there's no right or wrong answers, don't worry. And what about you, were you well afterwards? You didn't have any complications?

No, no. I think I had a reaction to the morphine, burning hands and itchy face and, sort of tiredness and people wanting to come and see you all the time and you didn't get a minute to sort of sit down for yourself, because everyone sort of expects you to, because you're walking about and you're wearing make-up or something, everyone expects that this is how you actually are, but not on the inside.

So when did you go home?

I had her, got referred on the Thursday, everything went kicking off on the Sunday, she was born on the Monday and I went home on the Sunday, so I was in there for nine days in total.

So, what was it like going home without your baby? 

Horrible. Really horrible. I mean, my daughter's dad had said, you know, he'd pick me up, we'd have a Sunday lunch and just sort of stay in at his house and just relax and he came to pick me up and I just said, 'I can't, I've got to go back in and see her', and we went back in and sat, just sat with her and had a quick cuddle, but I just ' I, I got used to it as the days went on but the initial, actually going out into the air and back out in, because I'd been in that hospital all that time, not even gone outside the building. It was horrible, leaving her there.
 

(See also 'Bonding, feeding and support after caesarean' and 'Women's feelings about their previous caesarean'.)

* APGAR score (a measure of the baby's condition at birth).

Last reviewed August 2018.
Last updated November 2012.
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