We don’t usually learn about recovering from a Caesarean section until we are IN recovery. That’s not what we recommend. This can leave you blindsided, confused and disheartened.
If you listened to our last ep, you’d know that caesarean section is not rare SO good birth prep means we need to include recovery from Caesarean section right?
In this ep we talk about:
The hours just after a caesarean section
What happens in the hospital in the first few days
Pain and pain relief
Moving after a Caesarean section
What to do when you need to cough, sneeze and go to the toilet
What to expect in the first 6 weeks.
And a big thank you for listening to ‘The Kick’ and please if you haven’t already please subscribe (iTunes) or follow (Spotify) and share with a friend.
Photo credit: @biancamaycheah
Brigid [00:00:36] Well, welcome, everyone, to Episode 19, and this is part two of our Caesarean section podcast. And it's a good thing that we split it up, isn't it, Pat, because it was quite long. The first one. Yes, sorry about that everybody 40 minutes, I hope it was riveting.
Brigid [00:00:51] Yes. We like to keep our podcasts to like 20, 30 minutes. And that one just snuck over. It is a big topic. And it's an important topic, you know, to get out there, I think.
Patrick [00:01:03] So here we are recording Part 2, which is recovery from a caesarean section. And we're actually recording them back to back because we're going away.
Brigid [00:01:12] We're batching.
Patrick [00:01:13] We have to make sure there was plenty of material to come out while we're away.
Brigid [00:01:17] We are ridiculously excited about going away.
Patrick [00:01:20] So it's not even a straight holiday. It's conference and holiday.
Brigid [00:01:24] Yeah. Yeah. We carefully planned these holidays, don't we? Absolutely. Yeah. Six nights away.
Patrick [00:01:29] But just perfect to find a little window where nobody was due. Yeah. No babies. And there was a little chance to get away and learn something and have a bit of a break. So we're pretty excited about that.
Brigid [00:01:41] Yeah. So we're going to sunny Gold Coast and then on to Byron Bay. Very, very excited. All right. We'll try and keep our excitement under wraps a little bit. So, Paddy, you were telling me a little bit about this couple that had been listening to our podcast.
Patrick [00:01:59] How great is this? You know, I just really like to send a shout out to these people. Let's call them. Bill and Sharon, who came in the other day. And they needed some ovulation induction.
Patrick [00:02:12] And they were just finishing my sentences for me because they had listed to our ep about ovulation induction. This is sweet. So that it was just a pleasure to chat about about that process with some people who were super well informed already.
Brigid [00:02:30] Yeah. So let me think. That's. Oh well that's early. That's episode 2 how to become an ovulation ninja. And I suppose if everybody's listening to the caesarean section, they're already pregnant, so they don't need that episode. Maybe send your friends along if that's what they're up to anyway. So, again, you know, this is part two, how to recover from a caesarean section. Yes. last week we talked about on why you might need a caesarean section. And if you are here again this week listening to this one, well, good on you, because this is another step to being sort of really well prepared for your baby's birth. And we would like to congratulate you on that.
Patrick [00:03:10] Yes. By sort of considering in the overall total of everything you learn during a pregnancy to learn a little something about caesarean section because that might happen.
Brigid [00:03:20] Yeah. So last week we left you with your baby snuggling on your chest skin to skin contact. Of course, if the baby signs are all good and you can do that. And the obstetrician is busy still putting you back together again, the finishing touches on, the nice, neat stitching. Yes. So we thought about well, we thought we would talk about what happens next.
Patrick [00:03:43] So when that sort of early phase what we like to do at my hospitals, is keep that family unit together. So mum and partner and baby back to the recovery room together, start up breastfeeding. It helps to promote breastfeeding if we let the baby find the find its way to the nipple straight away.
Brigid [00:04:03] Yeah. Your midwife is helping you the whole way. Don't don't feel like you’ve been left on your own. Your midwife is with you the whole way to the recovery room. And then in the recovery room.
Patrick [00:04:16] And that stimulation of the nipple doesn't only help to promote the early stages of breastfeeding, but it helps to prevent post-partum haemorrhage as well. If the nipples being stimulated, then the uterus contracts harder. And the contracting uterus won't bleed.
Brigid [00:04:34] Oh, I just I just remember that. You know, that's when the oh, this is liquid gold as they're starting to get the colostrum.
Patrick [00:04:50] It is liquid gold. You might be in recovery for an hour or so and then go back if everything's normal and then back up to the post-natal ward where women have already had their babies are. And at that point, sometimes for the first night or so in some hospitals, you'll be in a room that's closer to the nurses station.
Brigid [00:05:08] I remember that. And it's a bit noisy people.
Patrick [00:05:10] It can be noisy.
Brigid [00:05:12] They do like a chat
Patrick [00:05:13] And sometimes just I don't know what hospital architects are up to, but that was that will often be a crappy room. Yeah. Compared to the other nice rooms that are more like a suite. Yeah. I think when our little two were born you might have been there cause you were on your third and fourth sections and that someone would probably be keeping a closer than average eye on.
Brigid [00:05:30] I think I was there for the other two as well because one there was an emergency caesarean. And I remember being in this room right next to the nurses station when I was exhausted and all the machines going beep. Oh, good. And you’re still numb from the epidural, aren't you?
Patrick [00:05:50] Yes. So what they put down the epidural is a combination of some local anaesthetic that makes a numb for the operation and also some morphine. Yes. It goes down there as well. And that morphine provides very effective pain relief for about the first day or so.
Brigid [00:06:07] You need that cocktail of drugs too don't you.
Patrick [00:06:08] Yeah, yeah, yeah. So people will report feeling a little bit numb for quite awhile. And then eventually the motor block wears off and your legs come back.
Brigid [00:06:18] Yeah, you can start moving your legs around and. Yeah.
Patrick [00:06:21] But often on that first day because of the spinal morphine, the pain levels are low. Yeah. They'll often be worse on the second day.
Brigid [00:06:28] Yes. Oh yeah. It's a false sense of security a little bit. It's “this is not too bad”. It's a bit like, it's a bit like when our oldest had their tonsils out and we went to, you know, recovery and they're in their room and they're basically swinging from the rails, totally fine. Like this is fantastic. Couple of days later. No, no, no. We thought, oh, yes, this is gonna hurt badly. All right. So you're starting to feel a little bit like you can move your legs. What hour does that sort of happened and I can't remember?
Patrick [00:06:59] So if you have a planned Caesar in the morning by late by late that afternoon, or you start to get some motor control back again. Yeah, but usually not enough to get up and take yourself to the toilet. So usually the catheter is still in and we'd spend that whole day in bed get up next morning.
Brigid [00:07:16] And I remember I hated the catheter the first couple of times. Second time our third and fourth time I thought this is this is fabulous. I don't have to get up.
Patrick [00:07:27] Yeah. I mean, you need a catheter for the operation itself because that keeps the bladder small and out of the way. So we can we can open the uterus and get the baby, and we don't find a full bladder there blocking our path. And then the spinal block also means that you can't get up to get the toilet. So. So you've got to keep the bladder empty all of that day. And yeah, that that is your friend. And then the next morning as soon as soon as you've got your sea legs back again then take catheter out and take yourself to the toilet.
Brigid [00:07:55] Yeah. And the midwives really do encourage you to get up quite early don't they. You know, as soon as you have that movement back in your legs, you can get up and have a little stumble walk.
Patrick [00:08:08] So, early mobilization is really in practice right across the surgical world these days. Amongst all the good things it does is that it helps prevent deep venous thrombosis. So back in the day, we used to do an operation and then leave people in bed for a week. And oddly enough, they found that that blood would pool a bit in people's legs, clot. And that was a serious complication. Turns out if you get up in about much earlier, then that's much, much safer for you.
Brigid [00:08:38] Yeah. And we're not talking about you getting up and running laps around the hospital ward. And we're just you know, this is you wandering to the toilet and back again. That's about it. Yeah. And so you hear a lot about women getting ready to leave the hospital at two, three days after caesarean section. I think we were there for four to five days. And that was probably about right for me. About on the fourth day, I was getting a little bit tired of being in the hospital, but I certainly needed to be there. But what's your gold standard of care?
Patrick [00:09:10] Well, there's a different there's some difference between private and public in this discussion, to be honest. There's usually a lot more bed pressure in public wards. I think I think give or take, we do send women having their first baby by vaginal birth or caesarean section home a bit soon in the public sector. But that's a resource allocation problem. And then in the private sector, we've got to be a little bit more leeway and can be, I think, perhaps more confident that the woman has really got it and knows exactly how to look after that baby and how to safely take that baby home before we discharge.
Brigid [00:09:51] What day are you thinking here?
Patrick [00:09:52] Oh, I think I think, you know, in an ideal world would send people after section home after four days.
Brigid [00:09:59] Yes. And if you go home earlier, you've got to know what you're going home to. So if you're going home earlier than that and you're going home to a houseful of kids. Yes. It's really tough.
Patrick [00:10:09] Yes. So that's a problem. Yeah. The people that sometimes hate being in the hospital are the ones who want to go home straight away. Well, I guess the ideal person for that would be somebody who has had at least one section before and knew what they were getting themselves into. Yeah, but if they've had one section before, there's a toddler at home. Yes. I always say the hospitals for working at not being a patient in. You know, if I was if I had an operation, I'd want to go home soon. I want to go home early as well. But I think that if we are going to look at really early discharge from caesarean section, we need a lot of support.
Brigid [00:10:39] Yeah, that's right. And be ready for that at home. Like you've got family at home. Your partners there at home and knows what his or her duty is. And yeah, it's really important to think of not just the birth, but actually what your plans are for when you bring the baby home the first couple of days. Absolutely. Speaking about your partner, I just I always felt that it was really great to have you there with me. The first night, maybe the second night. Then you could go after that.
Patrick [00:11:09] Yeah, look, I think that's right. On the first night. You know, even if you got a really great set up in the hospital with a double bed or a foldout chair that the partner can sleep on, for that first night, you're going to need help just getting stuff and getting the baby from a hospital crib to your arms. And that's dad's job to get up and do that on those first night. Yeah. When mum's literally got a block still working. Yeah. And second night mum's more able to do a few things and then after that.
Brigid [00:11:44] You're just a nuisance. Never a nuisance it's alright. And one thing that I didn't realize is that I definitely I can't remember my first pregnancy, what it was that they gave me. But I really hated being on one of the pain killers that they gave me afterwards that made me feel very sort of giddy and dizzy in the head. And I think being in the hospital, getting to know what pain relief you need to is ideal as well.
Patrick [00:12:11] Yeah, look, I think I wouldn't want people to be to be scummy with the pain relief. It's there for a reason. Yeah. It's not only the operations these days aren't it's not something you're supposed to try and endure and put up with pain as if someone's going to come around and give you a badge and say, well done for having your gallbladder out and having no pain relief. Part of the safety of operations is that we treat pain properly so that people aren't lying there in dreadful pain, not moving because they're in pain and developing blood clots because they're not moving. So using pain relief is part of good management. Even if you feel tough and want to wait it out. And some will suit you and some won't. But it's nice to take note of the things that you've found good for pain relief and take note of the things you hated so that if you ever need another operation in the future, you can tell the anaesthetists.
Brigid [00:13:01] Yeah, well, I better go back and look at my op notes or something. I think that it's an interesting time about and, you know, talking about pain because people's pain is so vastly different. And actually pain for me in the four caesarean sections was very different as well. So I don't know what do you see? Do you think that most people have horrendous pain? Okay pain?
Patrick [00:13:27] No. I think people's pain is very in general very well managed. Very well managed. I think the major breakthrough was spinal morphine so that you could have a lot of pain relief in the first day or so without needing to take that morphine systemically with its obvious side effects. So that that made a big difference. And then the other pain relievers, some people need a lot, some people need a little.
Brigid [00:13:52] I think in my first caesarean section, after day two or three, I didn't need anything, weird. However, for the fourth section, I really did need pain relief. Didn't I like calling it during the day? I think need some more of that.
Patrick [00:14:09] So I think that that just goes to show it's different every time. Yeah. Plus there's more tissue trauma in a fourth section than there is in the first year. So from surgeons, from the obstetricians point of view, the first section is easy, tissue planes just all give way and it's very easy to get down to the uterus and open the uterus to get the baby out. By the time you up to your fourth section. There's a lot more scarring that you have to go through. Things that need to be carefully cut through, moved to other ways, scarring that needs to be burned through the diathermy and so forth. And there's it's there's more trauma. Right.
Brigid [00:14:40] Like, if we didn't go for that fifth, then lucky. Lucky. And I know that this is a question that gets asked all the time. And because it's there's so many answers to it. But when can I start driving after my caesarean section?
Patrick [00:14:52] Yeah. My rule is three weeks. I know. Some people recommend up to six. But I think that that after three weeks, most people would be fine to drive.
Brigid [00:15:01] People talk about their insurance.
Patrick [00:15:01] And to be careful you should probably check with your insurer. Yeah. But I don't think many of them would have a problem if three, four weeks had gone by. Yeah. Remember, those rules are more about everybody else then they are about you?
Brigid [00:15:12] What do you mean?
Patrick [00:15:12] Well, if you've had a general anaesthetic, you don't have to for a caesarean section. And that's part of my point. If you've had a general anaesthetic for your big operation, your judgments impaired for a fair while afterwards, in fact, longer than we used to think. And then if you add to that that you're still on some pain relievers and add to that, that you're still in some pain, then you're just not a safe driver out there. Yeah, for everybody else's sake as well as yours.
Patrick [00:15:37] So if you feel fine, maybe you're not fine. You should be. Out of respect for the other drivers on the road. We should be waiting until we are fine.
Brigid [00:15:45] Right. Oh, I didn't realize that. I thought it I thought it was a little bit with the caesarean section. Is it about where the seatbelt goes?
Patrick [00:15:52] Less important? I think you're right. Yeah. So after three weeks of an operation that wasn't a general anaesthetic in the first place, I think most people would be safe to drive. But you should you should check with your insurer that they don't have a rule about that.
Brigid [00:16:06] I actually wanted to just talk about something about our last podcast and we talked about historically caesarean sections were done under a general anaesthetic. Occasionally they're still done under GA. I know that this is sort of a segway, but they're still done under general anaesthetic. Very rarely. Yeah, yeah, a few. So I just wanted to say that, you know, that is an unusual caesarean section, but it still does happen.
Patrick [00:16:32] There are all sorts of special circumstances where that might be required and probably the most common is a really, really lights and sirens emergency. Where the anaethetist feels that they can pop you off to sleep faster than they could get in a spinal cord.
Brigid [00:16:43] Yeah. Okay. All right. So back to recovering from a caesarean section. So in your recovery, I'm sure. What are the red flags? What am I looking for?
Patrick [00:16:52] Well, I think that what sort of advice to people is when you go home, you should be basically on an upward trajectory of mobility and downward trajectory of pain relief requirements. So if you're needing more and more pain relief instead of less and less with each passing day, then that's worth reporting to your team. The amount of bleeding is relevant.
Brigid [00:17:13] That was such a surprise to me that I still bled after my first caesarean section because I just thought you guys sucked it all out like that or the lining was gone. Like why was I still bleeding?
Patrick [00:17:23] I doesn't really work that way. So. Yep. So the uterus after a baby will bleed no matter what. And even if someone has a caesarean section where they haven't laboured at all, the blood in the uterus after the operation will still make its way down through the cervix and down the vagina. Right. And sometimes in a caesarean section we will put a finger through the cervix from above. To make sure that there's a good pathway to drain that blood. So that so that you should have the same. You know, you should have blood loss like any other woman for about six weeks. And a useful measure can be if it's more or less than a normal period. Yeah. So it shouldn't be consistently more than a normal period.
Brigid [00:18:04] Right. And. And you do pass some clots don't you.
Patrick [00:18:07] You can do, certainly in the first day or two.
Brigid [00:18:09] Yes, absolutely. And when when is. Sorry. This is too much information. But if it were what. When is it too late? The clot is too big or too that you need to alert somebody that.
Patrick [00:18:20] Well, that's sort of in hospital stuff. Yeah. We would be watching for those sort of things in those first few days.
Brigid [00:18:26] I remember that midwives sort of always asking the size of the blood clot. All right. And what about the actual incision spot, the scar, the wound?
Patrick [00:18:36] Yeah. So it should be getting progressively less painful. Yeah. And once you have that initial dressing off, perhaps after about five days and then take a little steri strips off perhaps a day of a few days after that, then it should just look like a straight line on your skin and the things that we're looking for - if it gets puffy and sore, that's infection and if part of it seems to come apart a little bit, then obviously we'd contact the team straight away if either of those things were happening.
Brigid [00:19:01] Right. And just in protection of the wound, that's you know, I could highly recommend getting very big undies to go up over.
Patrick [00:19:10] Yeah, big undies are ideal. And the other thing I really love is those is those caesarean section recovery shorts. Yeah. Yeah. Really dear. Yeah. For a pair of shorts. But they really work. They provide that sort of moderate level of compression that need to go well and a feeling like it's not your insides aren't about to fall out.
Brigid [00:19:29] And I found I could only put them on probably on about day a week after the birth. Yeah.
Patrick [00:19:35] Some people can put them on at the start but yeah they can be sore to put on.
Brigid [00:19:39] Yeah. And the physio pops in don't they. And they give you that little bit of tubigrip. What some of some hospitals would have this that the physio comes to visit and will help you out with some compression. So yeah.
Patrick [00:19:52] So I think in a perfect world people get seen by the physio in the hospital. Yeah. I think in a perfect world everyone would get seen by physio outside the hospital as well. Yeah, absolutely. Even if they were going well. Yeah. That doesn't happen quite enough.
Brigid [00:20:05] No. And at what week do you think somebody should come and see a physio?
Patrick [00:20:10] Look, I think if someone's had a problem before then maybe earlier, but otherwise around about six weeks back when you check back in with your care team.
Brigid [00:20:18] Yeah. When you are thinking about maybe sort of starting exercise again.
Patrick [00:20:21] Yeah. Before you go back to the gym. Yeah. And before you go back to lifting and things. Talk to the physio about how to do that in a safe way. Yeah.
Brigid [00:20:30] Are there any other red flags in recovery?
Patrick [00:20:32] We should be looking out for any of those other post-natal risk factors that could have been anybody, no matter how their baby was born. You know, things like a terrible headache, blood pressure problems that go on, for postnatal depression and so forth. But with specific reference to caesarean section, there's a higher risk of deep venous thrombosis. And that's the DVT that starts in your legs and people sort of worry about their legs if they're a bit swollen. It can be perfectly normal to have one or both legs swollen after the baby's born. And that's just some of that fluid that collects during the pregnancy that hasn't circulated yet. So the thing about deep venous thrombosis is it's painful. So if you got a clot in your leg, it will almost certainly be painful.
Brigid [00:21:12] Well, that's a good distinction. You know, it's funny. My feet would puff up during the pregnancy and they just return to normal as soon as the baby was born. But my face would puff up, wouldn't it, afterwards.
Patrick [00:21:22] So. So that's I think that's that for the other fluids you had in the first 24 hours in intravenously.
Patrick [00:21:29] But yeah, I mean, you know, deep venous thrombosis is usually very painful. So people would know the difference between that and just the puffiness they had from being pregnant.
Brigid [00:21:37] You know, what I want to go on to talk about now is all the things that aren't your friends just after having a cesarean section. And this is when you need to sneeze or cough. Laughing is also troublesome. Getting out of bed, your first poo. Yeah.
Patrick [00:21:53] So I think the hospital physios are really great at that. So they talk to you about how to brace. Yes. And put your hand over the wound and then cough or sneeze. Yes. Or push a poo out. Yes. Because in those early days, when you feel like if you do those things, you might come apart. Yeah.
Brigid [00:22:09] Yeah. I definitely had a pillow close by. Like, you know, if you know that you sneeze or cough or even laugh. I used to put the pillow just over the wound. Yeah.
Patrick [00:22:19] Absolutely. And when it comes to that first poo thing, I think that one of the things we should be doing in the hospital is managing that preventively. Yes. So if somebody is really worried about that so ok, you know, in addition to your hospital, food might be might not be quite what you normally have at home. So let's have some food as well. Yeah, or like lactulose. You know that drink that can help keep your poo soft so that when you do go, you don't have to push too hard.
Brigid [00:22:41] If this is your first baby and you're listening to this podcast, wow. If you’ve had more than one baby you would know that you talk about poo quite a lot. But the first time it is, it's a bit sort of well I was really fearful because you think how is that all going to work? Yeah. And I think a lot of people do talk about it as if it's a major issue. But yes, I think what I did to begin with was in my first meal after cesarean section, I just ate too much! We should be eating small, nutritious meals that are, you know, full of fresh fruit, fresh veggies, drinking plenty of water, which kind of like some of the hospital food doesn't lend itself to that does it.
Patrick [00:23:21] Now, we could probably do a better job with that. I think that. Yeah, that's right. Don't eat too much in the first 24 hours.
Brigid [00:23:27] Yes. I saw a post of what a postnatal woman gets in a Japanese hospital and I thought, well, they've got that right. Like it just was highly nutritious, highly delicious. Yeah. And I thought that's what we need is someone to bring in good food for women when they've just had their baby. Getting out a bed is a big issue, too, when you've had a caesarean.
Patrick [00:23:50] Yes. So that's what that thingo over the bed, that swings out over the bed is for. So that you can hold onto that. The hoist. The hoist. Yeah. And use your biceps to pull yourself up to a seated position. Yes. Rather than trying to use your abs in that in those early days.
Brigid [00:24:04] Yeah. In our Grow My Program we've actually got our wonderful physiotherapist Belinda Matthews who's done a video series on just posture and simple everyday movements that we do that if we do them correctly can really help in terms of pain and just keeping a mobile. So that's worthwhile. One of the things that she says is, you know, getting out of bed, you sort of have to swing both your legs over to the edge and then using your elbow to push yourself up at some point be closer to the edge before you stand out, especially if you're on a low couch. No, really, wiggle your bottom forward to that right on the edge of the couch before you even attempt to get up.
Patrick [00:24:42] Yeah. Because a lot of this is a little bit counterintuitive. You don't know this for a fact before you do it in the that sort of hands on advice from a physio can be so valuable.
Brigid [00:24:50] Yeah. Another thing that I found really. Oh, look, it was hard is that when you've got the caesar wound and you're trying to breastfeed, you just become the queen of pillow positioning. You know, this is where your partner is going to be really helpful, position those pillows, just so you don’t strain to hold your baby as your breastfeeding if that's what you're choosing to do.
Patrick [00:25:11] Yes. So in that first at least in that first few weeks even no matter how your babies being born, you need help with feeding so you can sit in the feeding chair and not have to give up every time you think of what you don't have on you. So that someone's there to help.
Brigid [00:25:26] Yeah. Oh, gosh, that's a good point. And for those women that are bringing home their baby to a houseful of kids and toddlers still need lots of cuddles. You can't lift the toddlers?
Patrick [00:25:37] No, that's absolutely not in that first six weeks, so, you know, one or two year olds are too heavy. Yeah. So we need to learn how to get down to them or have them come up to us like we lift it up to us. Yeah. So there's a you know, there's a way to do all of this in a safer way. Yeah. But our first instinct is just to, you know, especially for toddlers crying.
Brigid [00:26:01] Oh, gosh, if they've hurt themselves and we want to do is comfort them by lifting them up, by giving them a cuddle. Yeah. So we have the cuddle couch. So we've got this green couch at home. And whenever the boys, even now I do it because they're getting so heavy. So now I sit on the couch and I say, come to me and they climb onto my lap and then we have our little cuddle. And that's really important when you're recovering from a caesarean section, when you come home with your toddler. Yep. Or from a vaginal birth. Oh, yes, of course. Yes. So, you know, this is probably the most important thing about recovery from any birth. And we talk about caesarean section here, but it's rest. You need tonnes of rest. Even in with our fourth child. So I was feeling really good. Remember this? We're about two, three weeks in and we thought we'd go for a walk,.
Patrick [00:26:53] Down the street.
Brigid [00:26:55] So we ended up doing about a 30 minute walk and ended up at Myer. And where they're just shopping, actually, we're shopping for you.
Patrick [00:27:06] This is a shameful story.
Brigid [00:27:09] And I was trying to find a shirt and I'm pushing the double pram. And all of a sudden I thought, what am I doing? I feel faint. And so I think we had to get a taxi home. But we were completely kind of in a brain fade about what I should be doing.
Patrick [00:27:23] Yeah. I think sometimes you just you. You do too much and you think that your experience from your previous baby is going to. I know. Yeah. You need you need rest. And I think we've got to we've still got a bit to go as a community working out exactly how to really properly support women when they bring babies home. Yeah. It's still a really big deal.
Brigid [00:27:44] It really is. I think we've done a disservice to ourselves in a way you about this. We can have it all and we can jump back to work. And actually, it's not right. And I think for a lot of women, it's that nurturing that you need after you've just nurtured a whole new human being. Yeah. It's really important.
Patrick [00:28:00] Yeah. So, I mean, regardless of when people choose to get on with this and that, I'll go back to work the first that first six weeks. Yeah. The underrated bit is just rest.
Brigid [00:28:10] Yeah. Yeah. Cause lots of things are still happening. Like your uterus is still shrinking down to size. You're still trying to establish breastfeeding if that's what you're choosing to do, you're still getting to know your baby. You and your partner are trying to work out what this new relationship looks like.
Patrick [00:28:22] So this is a 24 hour well, it's a full time job just being a mum in those early days and those 24 hours a day.
Brigid [00:28:30] Yeah. And on top of that, that you're recovering from an operation.
Patrick [00:28:33] Yes. That's right. So in addition to all of that, which is common, everybody there's the recovery from surgery for women who've had a section.
Brigid [00:28:41] Yeah. And so we're sort of tiptoeing around this emotional recovery that kind of needs to happen. What do you think is an ideal situation?
Patrick [00:28:49] Yeah. This is a tricky one. And I think when it comes to sections, it really depends on the circumstances. So for the emotional recovery, I think that I think broadly speaking, people might go a little bit better if it's not a big shock. So if I've got someone who was diagnosed with a placenta previa on a or a low lying placenta on a 20 week scan, and when we re scanned at 32 weeks, it was still totally, you know, major previa covering the opening. And that was essentially known all along that she's going to need a section. So she has had plenty of time to adapt to that. And I think that she may emotionally recover a little bit better than that than the person for whom it was a massive shock on the day. You know, pregnancy, perfect, normal body weight. I'm totally healthy and fine. And yet still, for whatever reason that the labour ended in caesarean section. And I think sometimes those people have got the added burden of a more difficult emotional recovery as well. Yeah, that all comes at the same time as you've got all of the tasks related to being a brand new mum.
Brigid [00:29:53] For my first and I have talked about it quite a few times if everyone's sick of hearing about, just tell us. But for my first birth. I did feel of that and I found one of the best things for me was to have a birth debrief. Yes, it was in a public system so I couldn't actually talk to any of their caregivers that I had on the day, but I had a debrief with a midwife and it was good. I don't think it completely resolved how I felt about it, but it definitely put things into perspective where I felt like it was, I started to shift my thinking about, well, that was the outcome. The outcome was a positive outcome that you were both well and that we were both well. Yeah. Yeah. Rather than the process.
Patrick [00:30:35] So I think debriefs are really good. I think there's definitely some good ways to handle them in some bad ways to handle them.
Brigid [00:30:41] Yes. My midwife was very good. I'll give her a shout out, it was Rhea Dempsey. And she was very good at because I think what she didn't do was blame the caregiver from the day.
Patrick [00:30:56] As a caregiver, I appreciate that.
Patrick [00:30:57] I think that it's rarely somebodies fault. It’s mostly how things unfold for various reasons. But, you know, in Australia in 2019, there's rarely happens as a result of a mistake or an error of some time.
Brigid [00:31:12] So if somebody feels that, perhaps it's the communication that was lacking.
Patrick [00:31:16] Absolutely. So that's the value of a debrief. One of the things I think it is said at debriefs a little too often which is not actually that good, is to say at least you and the baby are fine. Yeah. Because people come into having a baby in Australia in 2019 fully expecting to be alive at the end of the process. Yes. And it's cold comfort if you are grieving that you didn't have a vaginal birth to be told at least you're alive, you know. So there are there are ways of doing this that are better than others. And there's a bit of a science behind a good debrief. When my patients come back to see me, my private patients come back to see me for the six week review. I kind of know already. I already know the exact circumstances of everyone's birth and I know already who's likely to be potentially upset about that and who is likely to have taken it in their stride or which ones that caesarean section was always something that was fairly likely or certain. So from that very first six week review, I'm trying to drop in a plan for next time. Yes. And I've actually found that to be useful.
Brigid [00:32:19] So you're talking about things such as, you know what, they're possibility for their second or third or whatever child might be. Is that what you mean?
Patrick [00:32:28] Well put in. So. Exactly. So people tend to say “I haven't even remotely turned my mind to next time”. And also the woman has obviously got tonnes on her plate. However, are you aware that there's a thing called VBAC, vaginal birth after season? Are you aware that the circumstances of the labour that you just had six weeks ago that ended in caesarean section for you are unlikely to happen again and you'd be a good candidate for VBAC? Yeah, just drop it in.
Brigid [00:32:54] That's right. And I think it's the potential, you're giving somebody hope if that's if they were really keen on a vaginal birth. Yeah. Yeah, it's good to have that hope for the next time.
Patrick [00:33:06] And so some people aren't. Some say no, I will just have another section.
Brigid [00:33:11]. So people in a public system, who do you think the best person to do that debrief might be?
Patrick [00:33:21] Well, I think in the public system. It depends what the outcome was. I think that if there's any sort of really poor outcome that needs to be discussed, like an injury to mother or baby or a stillbirth situation or anything like that, it's senior.
Brigid [00:33:36] So you're asking for a consultant obstetrician?
Patrick [00:33:41] Yep. And a senior midwife. And seniority is critical in that situation because there's a way of doing it that's a lot better than other ways. Yeah. And the person needs to be able to respond with compassion and accurate assessment of what happened and medically accurate advice about how we might do it differently next time or how it might go differently next time. Yeah.
Brigid [00:34:05] All right. Well, are we going to put some things in the show notes? We might just put down those ideas that we had about, you know, how to recover from this caesarean section, such as, you know, what to do when you need to sneeze and so forth. So we'll put that into the show notes.
[00:34:20] So you've got something to refer back to. Other than that, everything on both Part 1 and Part 2 will be on our website, which is growmybaby.com.au. So jump on it. All the other podcasts are up there as well. So other than bye from us for now. We'll see you next time.