The actual surgical recovery was a cinch, but there were some super uncomfortable side effects I definitely hadn’t prepared for.
I had a scheduled cesarean section (aka C-section) at 38 weeks due to a pesky placenta situation. I was, of course, nervous for my first time in the operating room — and for major abdominal surgery, at that.
I was also anxious to meet my baby and see for myself — in real life and not on an ultrasound monitor — that he was just right.
And, as for my little boy, well, his 10 little fingers and toes are just delicious.
Yes, the actual surgical recovery was quick: I was walking around as soon as those horrid compression devices were stripped from my legs, and I was bounding up and down my stairs practically the moment I arrived home with my son — with only some Tylenol and Motrin to keep the occasional pain at bay. (Talk about stubborn new mom adrenaline!)
But there was C-section aftermath — super intense, although certainly not life-threatening, side effects — that I never fully expected. And they are, in fact, much more common than I thought.
I was warned about some post-op swelling, but I came home from the hospital larger — much larger — than I was during my entire pregnancy.
I felt like I looked roughly 20 months pregnant while already holding my newborn in my arms. I envisioned being able to easily button the cute pajamas I brought to the hospital, but instead I could barely tell where my legs ended and feet began.
Oh, and finding shoes to mash my feet into for my son’s bris 8 days after delivery caused a proper meltdown. (Hello, hormones!)
Anita Saha, MD, FACOG, notes that what I experienced is called postpartum edema — otherwise known as “the unspoken aftermath.” And, yes, to me it was just as jarring as it sounds, although apparently not uncommon.
“The cause of postpartum edema is directly related to what your body is programmed to do normally during a pregnancy,” explains Saha, a New Jersey-based obstetrician/gynecologist. “By the beginning of the third trimester, your blood has increased its plasma volume, without increasing red blood cells.”
That, she says, coupled with the dilution of albumin (a protein that keeps water in our veins) and the dilation of our veins themselves to increase blood flow to the placenta, causes swelling — especially in the feet, ankles, and legs, which due to gravity, have trouble getting blood back to the heart. These veins, she says, become “leaky.”
I wasn’t too swollen when I arrived at the hospital, but once I delivered, it really was like the weight in my abdomen dispersed throughout my body. That’s because, says Saha, all that extra blood in my uterus (that was once pressing down on the inferior vena cava and the veins in the pelvis) did actually spread into circulation and into those “leaky” veins… hence even more swelling.
Saha notes that while the aftermath can affect all types of deliveries, people who have C-sections sometimes experience more immediate swelling because they receive more IV fluids during the process. Lucky us!
While it seemed like an eternity, Saha says edema usually resolves in 7 to 10 days. When it finally did, it was like a literal weight was lifted.
As soon as I was given the go-ahead, I asked to have the Foley catheter that was inserted into my bladder before my C-section removed so I could move around and get my blood flowing.
I did, but my bladder apparently didn’t realize that it was supposed to work on its own.
Many hours and numerous trips to the bathroom later, I still couldn’t pee. Only after two attempts to reinsert the catheter (holy smokes was this painful), did my body kick into gear.
While I originally thought my extreme swelling was the culprit, Saha says this is usually due to the epidural or spinal anesthesia — which causes a relaxation in the bladder muscle and therefore an increase in bladder capacity.
Post-epidural urinary retention is the official term for this common post-delivery side effect.
This can occur despite having a Foley catheter inserted to help with constant drainage during a C-section and post-op. As Saha explains it, hospitals have protocols about when the catheter can be removed, usually after 12 to 24 hours.
But as she points out, “Despite protocols, individuals metabolize and clear the anesthesia in their body at a different pace. That means that some patients will have urinary retention because they are still experiencing the effects of the opioid medications in the epidural and/or spinal.”
It’s important to note, Saha says, that proper emptying of the bladder doesn’t mean dribbling or small amounts of frequent urination. Reaching this milestone means having a normal flow — and more communication with patients is needed to address this so they don’t have a problem later.
(Pooping is a whole other story that many new moms can tell. Are you worried your stitches will pop? Yes, yes you are.)
Perhaps I wasn’t sure if my abdomen even hurt after the surgery because the day I got home — so a little more than 72 hours post-op — I began developing a horribly painful and itchy rash across my midsection.
Which suddenly appeared on my lower back. And my upper thighs. Seemingly anywhere the surgical antiseptic (in my case, chlorhexidine) was applied.
And it lasted for more than a week.
I was literally walking around with ice packs secured by my underwear band to relieve the itchiness and additional swelling.
While I thought my case was an anomaly, Saha notes that chlorhexidine allergy isn’t rare.
“I also see allergies in the exact distribution of the adhesive tape that is on the surgical drape, so it looks like a band at the level of the belly button going around the sides. Some people also have allergies where the adhesive is on the inner thigh for the Foley catheter,” she explains.
“Unfortunately, it is impossible to predict who will develop an allergy when using a substance for the first time,” she adds.
I was reluctant to take anything for the discomfort because, well, I was a nervous new breastfeeding mom.
Saha advises topical hydrocortisone or Benadryl lotion for the reaction, but to avoid oral antihistamines and cold medications because they may drop your milk supply — which may not just naturally appear when your baby does.
Yep, I will write that again: Your milk supply might not just naturally appear when your baby does.
I was able to physically breastfeed my baby as soon as I was given the post-surgical green light. And he was a natural. He had a good latch. We got into a proper position. And he was getting all the good stuff colostrum provides.
But that was all he was getting, and I had to pump, pump, pump (starting on day 3 of my hospital stay) to make my actual milk come in.
It was exhausting and upsetting — and I felt guilty, like I was failing at the first task that I wanted to accomplish as a mom.
Finally, after several days of nonstop pumping and feeding (and a few bottles of supplemental formula later, thanks to our pediatrician’s guidance), our exclusive breastfeeding relationship began — and pretty much lasted that way for roughly 10 months.
Clearly, I was not alone.
“This is, unfortunately, the most common problem for all patients after delivery,” notes Saha. “It can take up to 5 days for the transitional milk — the white appearing milk — to come in after any delivery.”
And it’s the hardest for moms who’ve had a planned C-section. Why? “With vaginal delivery, natural oxytocin is released during the labor process that triggers the breasts to start the milk production process — in conjunction with the hormone prolactin,” explains Saha.
“It is true that the separation of the placenta from the uterus does cause hormonal shifts that transition your body into milk production mode, but it is also well known that this transition happens slower after a first time C-section,” she says.
“With a planned C-section, there is no preceding labor. These patients have the hardest time getting their breast milk to come in typically,” Saha explains.
Of course, there may be other post-op factors at work, and lactation consultants should be on hand to help patients — and not just with the technical aspects of breastfeeding. They should also make sure that new moms know that they’re not alone, that fed is ultimately best, and that supplementing with formula until one’s milk comes in (even if the goal is to exclusively breastfeed when it does) is just fine.
And new moms shouldn’t feel guilty like I did.
But, then again, bouts of mom guilt — as well as learning to roll with the punches starting at that miraculous moment you’re given your new baby to hold — is kind of like an initiation into motherhood.
Barbara Kimberly Seigel is a New York City-based editor and writer who has explored everything — from wellness and health to parenting, politics, and pop culture — through her words. She’s currently living the freelance life as she tackles her most rewarding role yet — mom. Visit her website.