Caring for Moms after a C-Section

One of the most rewarding parts of my job is caring for a woman who has had a c-section. I usually see these women in their home, immediately after their discharge from the hospital. They often feel just awful. In addition to the pain they are dealing with, they are exhausted. Their legs, hands and feet are terribly swollen, which is concerning and very uncomfortable for them. They have been told to pump, are just barely getting drops, and are convinced that they have no milk. Their baby has lost a considerable amount of weight, and they have been instructed to feed their baby formula. Nothing is going according to their plan and often they are despondent. All they want to do is nurse their baby.

Imagine their surprise when I tell them to forget about nursing for a couple of days and focus on taking care of themselves. This is a judgement call I make based on my patient’s physical and emotional health when I see them. If they are nursing successfully, I help them keep going. If it is not going well, we take a break. If a Mom is too wiped out, we don’t even try. They look at me amazed when I suggest that everything is happening exactly as I would expect it to. The relief when I reassure them that it is all going to be fine is palpable. I tell them they will be able to nurse their baby, they just might not be able to do it today. I start explaining what is going on and how we will turn things around, and I can see tension leave their face. Reassurance and anticipatory guidance might be my superpower!

The most obvious side effect of having a C-section is pain. Women are often hesitant to take their pain meds, and worry that it is not safe for the baby to have Mom’s milk when she is on this medication. But it is safe, and I start my explanation by instructing them to take their prescribed pain medication as indicated according to the schedule on the bottle. This allows them to stay ahead of their pain and manage it, rather than taking it after they are uncomfortable in the hopes of making it go away. If they do this, they will find that they don’t need it in a couple of days, or need less each day. I encourage Moms to assign someone in the family to be responsible for making sure she takes her medication, and have them give it to her at the appropriate times.

I then address the swelling they are experiencing as it is often very concerning for new mothers. They often have swelling in their legs and feet, and sometimes also in their hands and forearms. They might have difficulty holding their baby when attempting to nurse and feel very clumsy-almost as if their brain is telling them what to do, but they can’t make their arms and hands do it. This is due to the IV fluids received during a C-Section, and the inactivity that occurs afterwards, because they have just had major surgery and aren’t up to much. There are four ways to combat this.

1. Eat plenty of protein. I tell moms to make sure they have it at each meal and snack. Protein in your bloodstream pulls fluid out of your tissues so that you can pee it out.

2. Drink more water than you think you should. When your body is holding on to fluid, if you give it the fluid it needs, it will start to release the excess water. I suggest they either have a water bottle handy and take big sips all day long, or chug a glass of water before and after each feeding session with their baby.

3. Walk around as much as you can tolerate. Movement gets the water moving out of your body.

4. Lastly, when laying down, do so with your feet up higher than your heart. I suggest to moms that they lay on the couch with their baby on their chest and their feet propped up on pillows.

Moms are amazed at how their body changes in 48 hours if they do these things.

Another thing worth noting is that the IV fluids that made them swell have the same effect on their baby. So the weight loss their baby has experienced is often water weight, and usually nothing to be concerned about. The baby’s pediatrician may have recommended supplementing. This is a temporary solution, and not a long-term proposition. I suggest moms do as they are instructed, but keep in mind that soon their baby will be getting pumped milk rather than formula, and before long, will be nursing.

It is also important to remember that swelling impacts when a mom’s milk comes in. Moms are often very frustrated, as their breasts feel swollen and heavy, but no milk comes out when they pump. Their breasts are swollen with water in their tissues but not yet milk in their breasts. Remember that breast milk is a body fluid, and if your body is holding onto water, it is holding on to milk. Women who have had a C-section can expect that their milk might not come in until after day 5, sometimes not until day 7. This is why babies who are born via a C-section sometimes require supplementation. I find that the amount of milk a mom gets increases as the swelling goes down - so they should focus on the above steps to get rid of that extra fluid. Then they should make sure they are either nursing or pumping at least every 3 hours, even if they feel they are getting nothing out. They are doing this for stimulation, so I remind them to please not fret if nothing comes out. It is also important that if they are pumping that they are doing it correctly. In the beginning, it is easiest to pump one breast at a time for 5 minutes, going from side to side 2 or 3 times, while massaging your breasts with your free hand. This Pointers for Pumping article will help. The important thing is that your breasts are being stimulated, preferably by the baby, and if not by the pump, at least 8-10 times daily.

My last recommendation for a woman who has had a C-section is to get sleep. I encourage them to get a solid uninterrupted six hours each night, alone in their own bed, while being completely off baby duty. They should nurse or pump at the beginning and the end of the stretch, and set the alarm to wake six hours later. They will essentially be missing just one feeding, and I am confident it can be made up during the day with an additional nursing or pumping session. Hopefully, they are getting an additional 3 hours on either side of the 6 hours. This will do a world of good to help with the pain and swelling, and the mental and physical fatigue that sets in a day or two after a mom gets home. After a few nights of this, and when nursing is going well, they will find that they don’t need it and will happily (most of the time) get up to nurse.

It probably goes without saying that no man would be handed a newborn to care for after having abdominal surgery. Don’t have that expectation for yourself either! Please try to remember that you have had a significant surgery and can’t do everything, even most things that you want to. Let others help you. Get the food, rest, water and medication your body needs. Remember the things that are typical after a section: pain, swelling, fatigue, a delay in your milk coming in, feeling uncoordinated and clumsy, infant weight loss and need for supplementation. Often, when you know what to expect, and that it is typical, it makes it easier to deal with. And know that these things are temporary and look for progress each day. I promise you that a week later, it will all be a blurry memory.