What is included in post-operative care following a cesarean delivery (C-section)?

Updated: Dec 14, 2018
  • Author: Hedwige Saint Louis, MD, MPH, FACOG; Chief Editor: Christine Isaacs, MD  more...
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Answer

Answer

In the recovery room, vital signs are taken every 15 minutes for the first 1-2 hours, and urine output is monitored on an hourly basis. In addition to routine assessment, palpate the fundus to ensure that it feels firm. Pay attention to the amount of vaginal bleeding.

If the patient had regional anesthesia, they usually receive a long-acting analgesic with the regional anesthetic. Therefore, pain control is usually not an issue in the first 24 hours. If a patient did not receive a long-acting analgesic or had general anesthesia, administer narcotics either intramuscularly (IM) or intravenously (IV), on schedule or with a basal rate supplemented with patient-controlled boluses. When the patient is tolerating liquids, administer narcotics orally as needed.

When patients recover sensation after a regional anesthetic and vital signs have been stable with minimal vaginal bleeding, they can be taken to their room. Vital signs should be taken every hour for at least the first 4 hours—again, with particular attention paid to urine output.

Overall, a patient should receive approximately 3-4 L of IV fluid from the initiation of IV fluid replacement through the first 24 hours. The patient can be started on clear liquids 12-24 hours after an uncomplicated procedure, and diet can be advanced accordingly. When the patient is able to tolerate good oral intake, the IV fluids may be stopped.

The bladder catheter can be removed 12-24 hours postoperatively once the patient is ambulatory. If the patient is unable to void in 6 hours, consider replacing the Foley for an additional 12-24 hours.

On the first postoperative day, encourage the patient to ambulate. Increase ambulation every day as tolerated by the patient. The dressing can be removed 12-24 hours after surgery and can be left open after that time. Typically, the blood count is checked 12-24 hours after surgery, or sooner if a greater than average blood loss has occurred.

If a patient plans to breastfeed, this can be initiated within a few hours after delivery. If a patient plans to bottle feed, a tight bra or breast binder should be used in the postoperative period.

If the patient has recovered well postoperatively, she can be discharged safely 2-4 days after surgery. If staples were used to approximate the skin, remove them prior to discharge. If the patient has had a vertical skin incision or is at risk for poor healing (eg, from diabetes or long-term steroid use), the physician may elect to keep the staples in for 2-3 extra days and have the patient return to the office at that time.

Before discharge, a discussion about contraception should take place unless the patient had immediate postpartum LARC placement. Stress that even if a mother is breastfeeding, she still can conceive. Ask patients to refrain from intercourse for 4-6 weeks postpartum.


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