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Isnin, 19 Mei 2014

Penjagaan selepas bersalin Caesarian

How will I feel emotionally after my caesarean?

How you will feel depends on your individual case. A lot will depend on the circumstances of your baby's birth, and what kind of experience you were expecting.

You may just be glad the birth is over and grateful that you and your baby are well. You may feel elated and delighted, if everything went to plan. Or you may be upset and perhaps disappointed that you didn't give birth to your baby vaginally, if that is what you were hoping for.

If things changed swiftly during your labour and you had an emergency caesarean, you may feel deeply upset by what you've been through. It may help your emotional recovery to go over again the reasons why your caesarean became necessary.

After your baby is born, you should have the chance to talk through what happened. Before you leave hospital your doctor can have a chat with you about your baby's birth. This will also give you the chance talk about how your caesarean may affect your future pregnancies.

How will I feel physically after my caesarean?

A caesarean is major surgery. Even so, it may still come as a surprise how much it hurts afterwards. You may feel you can't do anything on your own.

Just to make small movements, such as shifting up the bed, you'll probably need something or someone to hold onto. It will hurt to cough or laugh.

Supporting your wound with your hands or by holding a pillow over your stomach will help.

To help your recovery and ease your discomfort:

  • Eat and drink as soon as you feel hungry or thirsty. Drink plenty and eat fibre-rich foods to help prevent constipation. Peppermint water can soothe the pain of trapped wind, which often follows surgery.
  • Wear loose clothes and cotton underwear. Try wearing knickers that are a size bigger or borrow a pair of your husband's boxer shorts. Your hospital can also provide special knickers made from stretchy gauze to fit over your scar.
  • Your wound dressing will be taken off the day after your caesarean. Keep an eye on your wound for signs of infection, such as extra soreness, redness or discharge. Tell a nurse if you spot these signs, or if it looks like the wound is coming apart.
  • Wash and dry your wound every day. It's fine to have a shower or bath and to use soap on the wound, as long as you rinse it off. Don't rub the wound while you are washing. Gently pat it dry with a clean towel.

You'll need to use sanitary pads after your caesarean because the bleeding from your uterus, or lochia, is the same as after a vaginal birth. If your caesarean was an emergency, your medical team may first have tried to help your baby be born with ventouse or forceps. If so, you're likely to have a sore perineum, especially if you've had stitches. Change your pad often and follow our tips for healing quickly.

What kind of pain relief will be available?

You probably had a regional anaesthetic - a spinal or an epidural - to numb you for your caesarean. You'll be given more pain relief to get you through the hours after surgery. An epidural can be topped up while you're in the recovery room.

If you had a general anaesthetic, you should be given pain relief while you're still asleep to last you for the hours after surgery.

Doses of painkiller you can control yourself, or patient-controlled anaesthetic (PCA), are often used soon after a caesarean. This gives you pain-relieving drugs through a fine tube into a vein in your arm. You can control the dose by pressing a button.

As you recover, you'll be offered more relief, depending on how much pain you're in. Having good pain relief will help you move around, and to feed and cuddle your baby. Be gentle with yourself, though. You could be getting backache or sore nipples without realising it.

Pain relief works best if you have it before the pain kicks in, rather than waiting for it to get bad before you use it. If you haven't got PCA, call for a nurse if you're uncomfortable or know that you're due your next dose of pain relief.

How long will it be before I can get out of bed?

At first you'll probably feel as though you'll never walk again. So it may come as a surprise when your doctor and nurses encourage you to get out of bed and move around. Even if it's the last thing you feel like doing, it's worth making the effort. Try to get up as soon as you can after your baby's been born, and definitely within 24 hours.

The sooner you get going, the better it is for your circulation and general recovery. Being mobile also means you can have your bladder catheter removed, although it's usually left it in for at least 12 hours after your last epidural top-up. Once you've got up for the first time, the next time will be easier.

You'll be encouraged to do ankle exercises while you're in bed to improve circulation to your legs. After childbirth and surgery - and remember you've been through both - there's a chance you could develop a blood clot. This could be serious if it lodges in a vein in your leg or your lung. Doing exercises will reduce the chance of this happening.

Will I be able to breastfeed?

Yes, and once you've got started you're just as likely to breastfeed your baby successfully as if you've had a vaginal birth.

Breastfeeding can be more challenging in the early days after a caesarean because of the pain from your wound. Make sure you get plenty of support and and keep trying different positions until you are comfortable.

Try to have someone else around when you're feeding your baby. They can help you to get comfortable before you start, and then hand your baby to you. Some hospital beds have cots that clip onto the bed that make it easier for you to reach your baby for feeds. Lying on your side may be easier than sitting up.

The caesarean won't affect your milk supply and most painkillers are safe to take while breastfeeding. If you're taking other medication you'll need to check with your nurses and doctor that they're safe to take. You will be given alternatives if they are not.

What will the scar look like?

In most caesareans, the cut is made along your bikini line. At first your scar will look very red, but as the weeks and months go by it will gradually fade and be covered by your pubic hair. While your scar heals it may be sensitive and itchy, particularly when the hair re-grows.

You may notice some numbness on or around your scar. This usually gets better a few months after the operation but it can carry on for longer. If your scar becomes very sore, red or inflamed, you may have developed an infection. It's important you tell your doctor if this happens.

A year or two after your operation, the scar will probably have faded to a faint line. It will always be a slightly different colour to your normal skin tone but may eventually be almost invisible. Some women regain a flat tummy after a caesarean birth, but it's common to have a bit of tummy overhang.

If you want to see what your scar may look like, visit www.caesarean.org.uk where you can see pictures of scars taken days, weeks, months or years after caesarean operations.

When can I go home and how will I feel once I'm home?

You'll probably stay in hospital for three or four days. If you want, you can go home after about 24 hours, provided you are recovering well. You'll be given follow-up care at home. Or you may prefer to stay in hospital, with the knowledge that medical staff are nearby if you need them.

When you're home, you shouldn't lift anything heavy. Unfortunately, this includes your toddler, if you have one. Movements that involve stretching upwards will be difficult for you for some time. Vacuuming and other strenuous jobs around the house will also be off limits. If you have people who can help you, let them! You may find some movements painful for up to six months after the surgery.

You might not feel well enough to drive for up to six weeks after your caesarean, as turning and twisting may be awkward and having to do an emergency stop could be very painful.

You will be encouraged to start gentle postnatal exercises the day after your operation. This will help speed your physical recovery. You should not start a more strenuous exercise programme until eight to 10 weeks after your caesarean.

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