Recovery after cesarean is difficult, both emotionally and physically. Sometimes we focus so much on the emotional repercussions that we ignore or neglect our physical healing.
What Does the Research Say?
It is clear from the research that women who have another cesarean after a “trial of labor” (TOL) have higher rates of complications than women who have an Elective Repeat Cesarean Section (ERCS) or VBAC.
Since more than two-thirds of women who try for a VBAC will have one, most providers still feel that the balance of benefits and risks still tends to fall in favor of a TOL for most women. However, for those who do end up with a CBAC, it’s important to be aware of the potential for physical complications, as this can delay healing and impose further emotional burdens onto the mother. Infectious morbidity and hemorrhage are particular risks to watch for.
El-Sayed (2007) found that women who have CBACs (compared to VBACs) have higher rates of chorioamnionitis (25.8% vs. 5.5%), postpartum hemorrhage (35.8% vs. 15.8%), hysterectomy (1% vs. 0%), neonatal jaundice (17.4% vs. 10.2%), and composite major neonatal morbidities (6.3% vs. 2.8%).
Hibbard (2001) found a higher rate of chorioamnionitis, as well as a higher rate of endometritis and blood transfusions. Durnwald and Mercer (2004) also found a higher rate of infectious morbidity and lower Apgar scores among the infants involved. Scifres (2011) found that 2.1% of women with a TOL experience major maternal morbidity, but that this morbidity cannot be predicted accurately.
And of course, there are also those mothers who have major physical complications, such as surgical damage to adjacent organs, uterine rupture, or even hysterectomy. Although rare, these complications do sometimes occur and add major physical burdens to recovery.
The lesson here is that about 2% of moms who went through a “trial of labor” may be dealing not only with the disappointment of CBAC, but also with significant physical fallout afterwards. This can complicate or delay emotional processing.
Therefore, it’s important for care providers and birth workers to always ask a mother about her physical recovery as well as her emotional recovery.
And it’s vital for mothers to focus first on their physical recovery. It’s hard to finish processing things emotionally if your body is still dealing with an infection, significant blood loss, or the aftermath of major injury.
It is very important that women take the time and resources they need to recover fully after a cesarean. Emphasize good nutrition, drink plenty of fluids, eat plenty of iron-rich foods, and get as much rest as you can.
Don’t try to get back to a full schedule too soon; allow yourself a “babymoon” so that your body can recover. Put a high priority on taking one-on-one time to bond with baby too.
Don’t be afraid to enlist post-partum help, whether that be from friends, family, or a post-partum doula. Have someone else run errands for you, let your partner or a family member do the cooking and cleaning, and have friends take your older children for play dates so you can get a much-needed nap. If you have limited family and resources, check with local doulas; there may be some programs to help provide discounted post-partum help.
Your body needs time to recover. If you had just had any other major surgery, your friends and family would pitch in to help and would allow you plenty of recovery time. Yet somehow we expect women to bounce back almost immediately after a cesarean and pick all the household chores and family activities right back up.
Cesareans are real surgery. Some have easy recoveries, while others are much harder. You never know which kind you are going to get ahead of time. CBACs can be doubly hard because they represent recovery from both prior surgery and this surgery, because they have a higher chance of infectious morbidity, blood loss and injury, and because they usually represent recovery from both a hard labor and a surgery.
Give yourself grace and time for adequate healing. Place your physical recovery first and the emotional recovery will follow in time.
El-Sayed YY, Watkins MM, Fix M, Druzin ML, Pullen KKM, Caughey AB. Perinatal outcomes after successful and failed trials of labor after cesarean delivery. American Journal of Obstetrics and Gynecology 2007 Jun;196(6):583.e1-5; discussion 583.e5. PMID: 17547905
Hibbard JU, Ismail MA, Wang Y, Te C, Karrison T, Ismail MA. Failed vaginal birth after a cesarean section: how risky is it? I. Maternal morbidity. American Journal of Obstetrics and Gynecology. 2001 Jun;184(7):1365-71; discussion 1371-3. PMID: 11408854.
Durnwald C and Mercer B. Vaginal birth after Cesarean delivery: predicting success, risks of failure. J Matern Fetal Neonatal Med 2004 Jun;15(6):388-93. PMID: 15280110
Scifres CM, Rohn A, Odibo A, Stamilio D, Macones GA. Predicting significant maternal morbidity in women attempting vaginal birth after cesarean section. Am J Perinatol 2011 Mar;28(3):181-6. PMID: 20842616
Stamilio D, Macones GA. Predicting significant maternal morbidity in women attempting vaginal birth after cesarean section. Am J Perinatol 2011 Mar;28(3):181-6. PMID: 20842616