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Caesarean birth—enhanced recovery program

There are situations where the safest option for you and/or your baby is to have a caesarean birth. Your obstetrician will explain why a caesarean birth is recommended for you and inform you of any possible risks and side effects. Do not hesitate to ask questions. It is important to make an informed decision. Your doctor will ask you to sign a consent form prior to your surgery. A caesarean birth planned in advance is called an elective caesarean birth.

Potential risks associated with a caesarean birth for women include:

  • increased blood loss
  • wound infection and breakdown
  • blood clots in your legs (DVT)
  • pulmonary embolus (a blood clot that moves from your leg to your lungs and is very dangerous) 
  • potential damage to organs near the operation site, including your bladder 
  • increased likelihood of needing a caesarean with your next baby
  • slower recovery due to having an operation.
  • Potential risks associated with a caesarean birth for babies include:
  • breathing difficulties—this is significantly reduced if your baby is born after 39 weeks
  • being cut with the scalpel during the operation (very rare)
  • bruising to the face or head due to the use of forceps, if required.

What is the caesarean birth enhanced recovery program?

Enhanced recovery care has been established for women undergoing routine elective caesarean birth to aid in reducing the risks to you and to create an after-birth environment that maximises the opportunity for you to return to your usual lifestyle as quickly as possible.

Across Australia and worldwide, maternity hospitals have successfully introduced enhanced recovery caesarean birth as a new model of care. Enhanced recovery means you will be able to safely transfer back to the comfort of your own home 24 hours after your caesarean birth.

The benefits of going home early include:

  • resting and sleeping more comfortably in your own bed
  • increased privacy with greater opportunity for your partner, family and friends to be near and available to you and your new baby
  • fewer interruptions, allowing you to rest quietly. In hospital, there are a large number of activities that occur on a regular basis throughout the day and night. These activities can disturb new mothers who are trying to rest or sleep, especially when two mothers are sharing a room
  • reduced risk of infection e.g. wound infection or other types of infection
  • reduced risk of blood clots as you are likely to move around more when discharged home
  • increased patient satisfaction as you will have greater independence than when you are in a hospital

Preparing for surgery

You will receive a phone call from the hospital approximately 48 hours prior to your scheduled caesarean birth to confirm your admission time. You will be asked to present to main reception, level 5, Mater Mothers’ Hospital, two hours prior to your procedure.

After your admission process has been completed your midwife will prepare you for surgery.

  • Your midwife will clip the front of your pubic hair as far as the groin. This allows the wound dressing to stick to your skin. Do not shave or wax your pubic hair in the week prior to your operation as this can increase the risk of developing a wound infection.
  • All make-up, nail polish, hair pins or jewellery, including any piercings, need to be removed. Your wedding band, or jewellery that cannot be removed, will need to be covered with tape during the procedure.
  • You will be fitted with special stockings which assist in preventing blood clots in your legs during periods of immobility. These are to be worn prior to your caesarean birth; you should continue to wear these in hospital and at home for the next few weeks after your caesarean, or until you are fully mobile. You may remove them for showering.

Support person

If you are having a spinal anaesthetic, you may have one support person with you in theatre. Your support person will be required to dress in theatre clothes and will sit next to you during your caesarean birth. However, if there are any complications during your surgery it may be appropriate for theatre staff to ask your support person to leave.

Your support person may bring a camera and take photos. If you wish to have a video recorded, all staff involved in your birth will need to give permission first. Please advise the perioperative midwife who will be with you in the operating theatre of your request prior to your caesarean birth.

In the operating theatre

After you arrive in the operating theatre, the anaesthetist will insert an intravenous line (IV) into your arm or hand, and may give you a small drink of sodium citrate to neutralise the acid in your stomach. The anaesthetist will ask you to either sit up or lie on your left side, and then proceed to insert your spinal anaesthetic. This involves placing a needle into your lower back under local anaesthetic. A small dose of local anaesthetic and usually some opioid medication, such as morphine, is injected into your spinal fluid. Only small amounts of medication are used, so they do not affect your baby.

The anaesthetist may also insert an epidural catheter, which is a fine plastic tube. Extra local anaesthetic can be injected down this tube if needed. This is called a combined spinal-epidural, or CSE. Both these anaesthetics are effective. The medications injected into your spinal fluid act directly on the nerves as they leave the spinal cord. These nerves will be affected fairly quickly and your lower abdomen will go numb so while you will have non-painful sensations only such as tugging, pulling and possibly some wetness when your waters break, you will not be able to feel anything sharp or painful during the caesarean birth. Your legs will also become quite heavy; this is normal. Before the caesarean begins, the anaesthetist will check that the anaesthetic is working properly.

Sometimes the anaesthetic lowers your blood pressure, and you might feel a bit dizzy or sick. The anaesthetist will measure your blood pressure frequently and give you some medication in your drip to stop this happening. If you have a spinal or combined spinal-epidural anaesthetic you will be awake throughout the birth but you will not feel pain.

After your anaesthetic is established, a small tube will be inserted into your urethra/ bladder (urinary catheter) to drain your urine. To reduce the chance of an infection, a small swab will be used to clean inside your vagina. Your abdominal skin will be cleaned with an antiseptic solution, and you will be given an antibiotic through your drip prior to your baby’s birth. A screen will be put across your chest so you cannot see what is happening; however, your doctors will speak to you and let you know what they are doing. You may feel tugging, pulling and possibly some wetness when your waters break.

The caesarean birth usually takes about 30 to 40 minutes. One advantage of a spinal anaesthetic is that you are awake during your birth and can see your baby immediately.

Common side effects of spinal/epidural anaesthetics:

  • low blood pressure – this can make you feel faint or sick, and can be controlled with fluids and medication given via the drip
  • itching – medication can relieve this
  • headaches – as the spinal/epidural wears off and you begin to move around.

Supporting breastfeeding when having a caesarean birth

Skin-to-skin contact with your baby after a caesarean birth is vitally important. Where possible, the midwife caring for you throughout your caesarean birth can help facilitate this process for you. Your baby should be naked against your skin and will have warmed blankets placed over their back and a hat placed on their head.

Skin-to-skin contact will help your baby stabilise their temperature and start to initiate an instinctive feeding response that will enhance bonding and breastfeeding establishment. Your baby’s instinctual response to breastfeed is heightened in the first two hours after birth; skin-to-skin contact during this time increases these responses and the likelihood that your baby will attach and feed well at the breast. It will also help to stop some of the shaking you may experience after your caesarean birth and spinal anaesthetic.

After your caesarean birth there are a number of feeding positions you can try to help decrease any pressure on your wound. You may be more comfortable lying on your side. When you are more mobile; you can sit in bed or in a supportive chair with a footstool for comfort. You will need to maintain good posture throughout the feed and should always bring your baby to your breast and not your breast to your baby.

If you require further information about breastfeeding please refer to Mater’s brochure Breastfeeding and your new baby, (also accessible via brochures.mater.org.au).

Skin-to-skin contact is still beneficial for you and your baby if you have chosen to formula feed.

Mater supports bed sharing—feeding and holding your baby in bed while you are awake; however, Mater does not support co-sleeping (mother and baby asleep together in bed). If you are holding your baby in bed and are drowsy from pain medication or feel you may fall asleep, please ring for assistance to place your baby into their cot.

Recovering from your caesarean birth

Pain management

During your spinal anaesthesia your anaesthetist may have given you an opioid (strong medication) with your anaesthetic which lasts for up to 24 hours after the birth and reduces the need for other pain relief during that time. Most women will then require only oral tablets to control any pain. By using a combination of medications you will need less to have good pain relief with fewer side effects.

Assessing your pain

After your caesarean birth you will be asked to regularly score your pain with a number where zero equals no pain and 10 equals the worst pain you can imagine. Our aim is to manage your pain so you are comfortable enough to care for both you and your baby with minimal assistance, i.e. pain score of four or less.



Pain medication

Simple analgesics such as paracetamol (Panadol) and non-steroidal anti-inflammatory drugs (Ibuprofen) will be used to treat your pain while you are in hospital and at home. These will often be prescribed together and taken on a regular basis, as regular doses of this combination works well for mild to moderate pain. If your method of pain relief is not effective, speak to your midwife/nurse or doctor before your pain becomes severe; pain is harder to treat if it gets out of control. It may not always be possible to completely stop pain or discomfort, but it can be improved.

Wound care

  • Your wound dressing will remain on for about five days. Your doctor or midwife will tell you when and how to remove it.
  • If your wound oozes fluid or blood, report this to your midwife or doctor immediately as the dressing may need to be replaced.
  • Maintaining good hygiene is important to prevent infection.
  • Do not use a hair dryer on the wound, as drying the wound delays the normal healing process; instead gently pat your wound area with a clean towel to remove excess water after showering.

Mobility and exercises

Getting in and out of bed carefully, and using movements and activities while caring for yourself and your baby that do not cause strain or increased pain, will help you to recover faster.

Initially, for the first few hours after your caesarean birth, you will be resting in bed. However, once your sensation and movement has returned (usually within 4–6 hours), you will be supported out of bed and into a chair and, if you feel strong enough, you may have a shower with assistance. During this time it is important to do deep breathing and leg exercises regularly. Bed exercises and walking around in the early stages after your operation is very important to help reduce the likelihood of chest infections and the formation of blood clots in your legs, and also helps to speed up your recovery.

If you require further information about mobility and exercise please refer to Mater’s video Post-caesarean birth.

While still in bed, you can:

  • take 5 or 6 deep, slow breaths each hour—relax your shoulders as you exhale
  • bend your ankles up and down; tighten thigh and buttocks muscles
  • gently draw in the pelvic floor muscles, pause, and then let go
  • draw in the pelvic floor muscles before, and as you move your legs, but always keep breathing—this protects your tummy from strain
  • with both knees bent up, try slow, gentle pelvic rocking and knee rolling (aim to do these exercises two or three times each hour)


  • change your resting position regularly
  • if sitting in bed to feed, make sure the back of the bed is upright and place a small pillow/rolled up towel behind your lower back; try not to slide down the bed
  • if lying on your side in bed to feed, make sure your head and neck are supported on a pillow, and ensure that your body is not twisted; a pillow between your knees might feel more comfortable.

Getting in and out of bed

  • lie on your back in the centre of the bed with both knees bent
  • roll over to your side without twisting too much (keep your knees bent)
  • with your top arm well in front of you, push your upper body forward and up, and allow your legs to go down at the same time
  • remember to keep breathing, keep your knees well bent and come forward and up to a sitting position in one smooth action.


IIf you have not passed wind, or have some wind pain, try these tips

  • pelvic rocking and knee rolling
  • gentle wind massage: start at the lower right side of your tummy, using a gentle slow circular motion as you slowly move up to waist level, move across the belly button and down the left side
  • standing, lean forward onto the end of the bed and do some gentle hip circles
  • warm showers
  • frequent walks
  • relax on the toilet in the ‘hips flexed’ position

How to protect your incision when you cough

  • With your knees bent, place both hands over your wound, anchoring your fingers onto the pubic bone, and your forearms resting firmly across the abdomen.
  • Draw in the pelvic floor and hold your arms in firmly as you cough.



Bladder care

  • Your urinary catheter will be removed in the first 4 to 6 hours after your caesarean birth once movement and sensation has returned to your legs.
  • Your midwife will encourage you to pass urine within 4 hours of your catheter removal.
  • You must inform your midwife as soon as you pass urine to enable a bladder assessment to check that you have emptied your bladder completely.
  • It is important to let your midwife and physiotherapist know if you are having difficulty passing urine, only passing small amounts of urine, or having accidental loss of urine.


Eating and drinking

Upon returning to the ward after your caesarean birth, you are encouraged to eat and drink as desired. As soon as you are able to drink and/or eat, your IV fluids will be removed which will enable you to move around and care for your baby more freely and comfortably. For your convenience, Mater has Australia’s first room service menu where you are able to order your meals via the telephone anytime between 6.30 am to 7 pm every day.

There is also some evidence to suggest that chewing gum after your caesarean birth may assist with your bowels opening sooner so we would also encourage you to bring in some chewing gum to aid in this aspect of your recovery.

Discharge – planning for going home

Mater’s Maternity Homecare Program is available to mothers who are on the enhanced recovery program. You will be visited the day following your discharge and, depending on your individual needs, you may continue to receive visits as required. The midwives who visit you at home will discuss how you and your baby are progressing. If you have any concerns, your midwife will be happy to help where possible.

Going home

The discharge time for women on the Enhanced Recovery after caesarean birth pathway is 24 hours after your caesarean birth.

Before you leave you will be reviewed by a number of different health professional staff to ensure you are medically safe and that you have all the correct advice and information to be safe at home. These staff will include: obstetric and paediatric doctors, physiotherapist, pharmacist and your midwifery team.

On the day you go home (with the assistance of your adult support person):

  • you will be able to care for yourself and your baby with minimal support
  • your pain will be controlled with prescribed tablets
  • your wound should be free from signs of infection (i.e. no redness or discharge)
  • your baby will be checked by a paediatric doctor or your midwife/nurse and you will also have had a doctor check and both of you will have been deemed fit for transfer to home.

Please discuss any concerns, regarding you or your baby, with your midwife/nurse or doctor prior to discharge. Your midwife/nurse will complete your baby’s health record book and give it to you before you go. You should take this health record with you whenever you see a child health nurse, paediatrician or general practitioner (GP).

While you should be able to perform all the normal activities to care for yourself and your baby with minimal support in the initial days, you should avoid doing anything which will cause you significant discomfort. Gradually, you will be able to return to your full range of activities. This can take a variable amount of time—usually between 2–6 weeks. Listen to your own body.

Driving can be resumed when you feel comfortable to do so. However, if you don’t think you can drive with full control of the vehicle, i.e. brake suddenly, push the pedals or turn the steering wheel (all without pain), you should avoid driving for approximately four weeks or until your doctor advises it is safe for you to drive. As some insurance companies consider caesarean birth to be major surgery, you need to check with your company to confirm if there is an exclusion period.

When and what to do if you have any concerns at home

If the situation is an emergency, call an ambulance immediately and ask to be taken to your nearest hospital, or return to our Pregnancy Assessment Centre.

This includes the following symptoms:

  • Excessive bleeding either from your wound or vagina.
  • Headache and/or severe epigastric pain and/or blurred vision.
  • Other immediate life-threatening concerns resulting from your birth.

Call 13 HEALTH or visit your GP/nearest hospital or our Pregnancy Assessment centre in regard to: feeling unwell with a temperature or cough

  • uncontrolled pain
  • urinary or faecal incontinence
  • bowels not opened for a number of days
  • other non-life-threatening concerns resulting from your birth

Remember to take a copy of the Matrix Discharge Summary provided to you when you left Mater as this will help communicate to other healthcare professionals what occurred before, during and in the immediate postnatal period after your caesarean birth.

If your concerns relate to your baby please refer to Mater’s brochure After Birth – care of your baby.

Mater acknowledges consumer consultation in the development of this patient information.
Mater Doc Num: PI-CLN-430199
Last modified 11/7/2018.
Consumers were consulted in the development of this patient information.
Last consumer engagement date: 12/2/2018
For further translated health information, you can visit healthtranslations.vic.gov.au/ supported by the Victorian Department of Health and Human Services that offers a range of patient information in multiple languages.
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