Dr. Sara Kostant returns to Healthful Woman to discuss the early stages of recovery for new mothers after vaginal and cesarean delivery. In this episode, she and Dr. Fox explain what patients and their loved ones can expect immediately after delivery until the first postpartum visit. This includes care if the patient tears, symptoms like swelling, breastfeeding a newborn, and more.
“Recovery from Vaginal and Cesarean Delivery” – with Dr. Sara Kostant
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In this episode, Dr. Sara Kostant and Dr. Fox discuss recovery after a vaginal or cesarean delivery. Dr. Kostant explains that “people forget delivery is a big deal,” as its only relatively recently in history that it’s assumed a patient will walk away fine, though delivery is a very serious medical or surgical event. Most patients do very well while recovering, but there are some things they should look out for and be aware of. Dr. Kostant reassures patients that most of their experiences are normal and shared by most women.
The First Days after Delivery
A lot happens during delivery that contributes to the recovery process, including blood loss or tears, and labor is taxing on the body. Dr. Fox says that he starts talking about the recovery process early, even as he’s repairing tears and before the epidural wears off. Generally, Dr. Kostant recommends Motrin or Tylenol around the clock for the first day or two after a vaginal delivery, but may suggest prescription pain medication for a severe tear. She also recommends that patients wash with a spray bottle every time they use the bathroom, and encourage patients to walk around with help as soon as possible after their delivery. Swelling in the legs is normal because patients are usually more hydrated than usual because of IVs. Dr. Kostant explains that this swelling should be even in both legs and shouldn’t be tender or painful. Finally, she advises patients that it usually takes 2-3 days for milk to come in, and reassures them that a newborn’s stomach is very small – smaller than a golf ball!
Recovery from Vaginal Delivery
Dr. Kostant explains that when assessing whether a patient is ready to go home after a vaginal delivery, she checks how their general pain is being controlled (including tears, incisions, and cramping), whether bleeding is under control, whether they are experiencing postpartum depression and have adequate support at home, and checks with the patient to see if they’re comfortable leaving the hospital.
After a vaginal delivery, Dr. Kostant says that a patient’s expectation “really depends on the type of vaginal delivery they’ve had.” For example, if a patient had a long labor and pushed for a long time, recovery could be longer than a patient who had a C-section.
However, patients who had an average vaginal delivery with only a small tear “overall feel much better” about a week after the birth. Dr. Kostant explains “being run-down and exhausted is very normal.” Because of sleep deprivation, she says “even if someone’s having an otherwise physically okay recovery, I’ll sometimes see patients come in for concerns” because the lack of sleep makes symptoms seem worse than they are. Regardless, she notes that at most six-week postpartum visits, “from a physical standpoint, by then most women are pleasantly surprised.”
Recovery from C-Section
Dr. Kostant says that after a C-section, “often, the first day, women are pretty comfortable” due to residual pain medication. She advises them to take Motrin “pretty much around the clock” to stay on top of cramping and incisional pain, and to remain on narcotics while still in the hospital. While some mothers have concerns about breastfeeding and prescription pain medication, Dr. Kostant says that only trace amounts end up in breast milk, and this is not harmful to the baby.
Dr. Kostant also says that “I try to de-mystify the incision” for C-section patients. She explains that “for many women, this is the first surgery they’ve ever had.” Dr. Kostant encourages patients to look at the incision if they can, and explains to them that there are dissolvable stitches, steri-strips, and bandages in place and what to expect as the incision heals.
Dr. Kostant explains that it’s normal to take prescription pain medication for about a week after a C-section, but needing narcotics after a week and a half can indicate that something’s wrong. However, some patients will take medication longer than others for a variety of reasons. For example, those who need to be more active sooner may require more medication.