21.5: Cesarean Birth Discomforts

Learning Objectives

By the end of this section, you will be able to:

• Describe the postpartum recovery after a cesarean birth
• Plan the nursing education provided to a postpartum person who experienced a cesarean birth before being discharged home

Postpartum recovery after a cesarean birth includes many of the same assessments as a vaginal birth and postoperative surgeries. Vital signs, breasts, location and tone of the fundus, lochia, extremities, and level of pain are all assessed. Additional assessments of the postpartum person after a cesarean birth include the dressing over the incision for the first 24 hours and the incision itself after that, nausea and vomiting and abdomen, deep vein thrombosis (DVT), mobility, and the lungs for signs of infiltrates if general anesthesia was used. Pain and discomfort will be increased in persons after a cesarean birth.

Discomforts Related to Cesarean Births

The nurse recognizes certain discomforts related to cesarean birth, such as abdominal pain, incision pain, increased constipation and gas, and difficulty with ambulation. Education provided to the postpartum person includes education on and remedies for these discomforts. The nurse encourages ambulation, pain management prior to the pain becoming extreme, eating a healthy diet, and asking for help with activities of daily living.

Cultural Context

Culture, Breast-Feeding, and Cesarean Birth

The breast-feeding rates in China show a 6-month exclusive rate of only 27.8 percent. Chinese people with a history of cesarean birth have even lower rates of breast-feeding at 6 months. Hu et al. (2020) found that people in China having a cesarean birth had a decreased willingness to breast-feed and more difficulty in breast-feeding than those having a vaginal birth. Because the cesarean rate in China increased to 35.9 percent, educating people about the importance of breast-feeding is essential. In this study, patients scheduled for cesarean section were provided additional breast-feeding education during their postpartum stay. Results showed the intervention group had higher breast-feeding rates up to 4 months postpartum, fewer cracked nipples, and fewer reports of insufficient milk supply. Education made a significant difference to the persons and infants in this study.

(Hu et al., 2020)

Gas Pain

Gas pain is common after a cesarean birth. Anesthetics used during surgery slow the bowels and decrease peristalsis. This leads to constipation and difficulty in passing gas. Also, opening of the peritoneum during surgery allows air to become trapped in the abdomen. That air must be absorbed and released as flatulence. The nurse encourages early and frequent ambulation and avoidance of extremely cold liquids to help release gas. Simethicone is often prescribed to relieve gas pain by aiding in gas release (Elsevier, 2024).

Incisional Pain

Pain related to cesarean birth is mostly incisional pain. As in any surgery, postpartum persons will feel increased incisional pain with movement, coughing, and ambulation. When coughing, the person is encouraged to splint the incision by placing a pillow over the lower abdomen to decrease pain (Figure 21.8). The nurse also encourages the person to ambulate slowly and to splint the incision when getting in and out of bed. Some health-care providers will order an abdominal binder to act as a splint.

Figure 21.8 Managing Incision Pain after Cesarean Birth (a) Splinting the incision with a pillow helps to reduce the incisional discomfort when coughing and deep breathing or moving after a cesarean birth. (b) Instructing the postpartum patient in how to get in and out of bed helps to decrease incisional discomfort after a cesarean birth. (CC BY 4.0; Rice University & OpenStax)

Pain medication will be ordered by the health-care provider. The nurse will assess pain frequently and administer medications as needed. A morphine injection (Duramorph) may be used if spinal anesthesia was administered for a cesarean birth. A patient-controlled analgesia pump may be used, which slowly administers pain medication and allows the patient to give themselves a bolus when pain is intense. Some health-care providers will insert a catheter into the incision. The catheter is connected to a pain ball pump that administers a steady flow of pain medication directly to the incision to control pain. Figure 21.9 shows a pain pump used after cesarean birth.

Figure 21.9 Pain Pump The pain pump catheter is threaded along the incision to slowly release pain medication to reduce incision pain. (credit: “ON-Q® PainBuster®” by unknown/Braun, Public Domain)

Sleep Difficulties

Sleep can be difficult after a cesarean birth because of incisional and gas pain. The postpartum person experiences pain at the incision while turning or moving. This can disrupt sleep. Breast-feeding or holding the newborn can also cause incisional pain and difficulty in sleeping. The nurse encourages relaxation techniques, deep breathing, and relaxation imagery to help the person release stress prior to sleeping. The nurse assesses pain and provides pain medications prior to pain becoming severe and interfering with sleep (Elsevier, 2024). The nurse can cluster assessments and interventions to decrease the number of sleep interruptions. They can also encourage the patient to take naps and ask the family to limit interruptions.

Incisional Healing

Incisions from cesarean births heal differently, depending on the type of incision. The majority of cesarean births involve low, transverse incisions. These incisions heal faster with less pain than vertical incisions. For incisions closed with staples, the staples will be removed several days after the surgery. Other incisions are closed with suture that is dissolvable and will not need removal of stitches. Still other incisions are closed using surgical glue. Almost all cesarean birth incisions are covered with a dressing immediately after surgery. The dressing most often is removed the next day to allow for airflow to the incision. The nurse assesses the incision and instructs the postpartum patient to keep the incision clean and dry.

Restrictions Related to Surgery

After surgery, ambulation is encouraged. Exercise, however, is restricted until the patient is seen by the health-care provider at the 6-week postpartum checkup. The nurse discourages lots of stair climbing and housework. Sexual intercourse is restricted with a cesarean birth until the patient is seen for follow-up. While persons are taking pain medications, driving a car is restricted (Elsevier, 2024).

When to Follow Up

Postpartum follow-up will be determined by the health-care provider, if complications occur, and if staples need removing. For staple removal, the person is usually seen within the first few days after discharge. Otherwise, persons are usually seen in the office between 2 and 6 weeks to evaluate the incision, screen for postpartum depression, discuss contraception, and perform a postpartum assessment. In addition, some health-care providers see the person for follow-up again between 10 and 12 weeks for an annual gynecologic exam.

Nursing Education for the Birthing Person Experiencing a Cesarean Birth

For persons experiencing a cesarean birth, the nurse provides routine postpartum education, education on pain medications, along with education on restrictions and recommendations related to the procedure.

Opioid Medication

Opioid medication causes drowsiness and sleepiness. The nurse encourages the postpartum patient to rest and focus on caring for themselves and the newborn. The nurse explains that while taking opioid pain medications, the postpartum person should not drive a car. Driving is safe once the person has transitioned to only acetaminophen or ibuprofen.

Lifting Restrictions

Lifting is restricted to the weight of the newborn for the first 6 weeks postpartum. Persons are discouraged from lifting older children. The nurse encourages the family to assist the older child to sit next to the postpartum person in a chair or on the couch.

Importance of Fluids

Increased water intake helps to increase breast milk and prevent dehydration. Persons experiencing a cesarean birth are at higher risk for blood clots. Dehydration can increase that risk even more.

Pillow on the Lap

The person can use a pillow or an abdominal binder to splint the incision while moving or getting out of bed. The pillow can also be used to assist in holding the newborn. When the person coughs or sneezes, the pillow is also used for splinting to prevent pain (see Figure 21.8).

Football Hold for Breast-Feeding

Breast-feeding can be painful if the newborn is held against the incision. The nurse will demonstrate different ways to hold the newborn while nursing. Football hold allows the newborn to avoid contact with the incision but still nurse with a good latch. The newborn is held to the person’s side supported by pillows. The hand supports the baby’s head and turns the baby to face the breast (Figure 21.10).

Figure 21.10 Breast-Feeding Position to Minimize Cesarean Incision Pain This illustration shows a postpartum person using the football, or clutch hold, when nursing. Note how a pillow under the newborn assists in bringing the newborn to the breast for a better latch and also provides a cushion to keep the newborn away from direct contact with the abdominal incision after a cesarean birth. (CC BY 4.0; Rice University & OpenStax)

Importance of Ambulating

Ambulation after cesarean section is important for several reasons. Ambulation keeps the blood moving in the extremities helping to prevent venous stasis and DVTs. Ambulation aids in relieving gas pain and preventing constipation in the postpartum person. Ambulation also aids in recovery by increasing circulation and helping to decrease edema.