Every day, there is a woman giving birth somewhere in the world, and this could either be a vaginal birth or through a caesarean section (C-section). However, medics advise women who have undergone a C-section to follow some steps until the wound is fully healed.

Dr Rachna Pande, a specialist in internal medicine, says a C-section involves cutting of the lower abdomen, opening the uterus, extracting the baby and then suturing the different cut layers of the abdomen. The natural healing occurs between two to three months; hence, women should be very careful about the recovery process after a C-section.

WHAT TO AVOID

"A shower should be avoided until the medical caregiver says it is okay, that is mostly after 24 hours or even longer, depending on the state of the post C-section wound. However, during the bath, water should be just lukewarm, not very hot or allowed to run over the wound,” she explains.

Dr Iba Mayele, an obstetrician gynaecologist at Gynaecology Clinic Galien Kimironko, says, "We usually give one dose of antibiotics before the operation, however, after the operation we do not advise a woman to take antibiotics, especially when she is recovering well. On the second day, we open the wound to see if there is any problem so that we give possible treatment before one is discharged.”

Pande warns that soap should not be used for some days but if at all it is necessary, a soft soap should be used and, avoid rubbing soap over the site of C-section.

In the early days for at least about a week, an occlusive dressing should be put over the post C-section wound, while taking a shower.  Regular dressings should be done as per the schedule given by the doctor or nurse, Pande explains.

She adds that it is important to avoid any activity that would strain the recently cut abdominal muscles, as it would interfere with the healing of the wound; it can also be a risk factor of incisional hernia later on — such activities include bending forward and lifting heavy weights.

Pande warns that while cleaning the wound; avoid vigorous cleaning or scrubbing, rather, clean gently.

Pande says that women should avoid sex for some days to avoid acquiring any infection.

PROPER CARE AFTER THE OPERATION

Dr Hebatallah Ibrahem Salama, a specialist obstetrician and gynaecologist at Legacy Clinics in Kicukiro and Nyarugunga, says that after cleaning the wound properly, make sure it is fully dried to avoid any infection.

She cautions one to check again after a week to see if the wound has no infection. For up to 14 days, doctors still check for infection to see if the wound is healing.

For people with a low immunity status like those with HIV/AIDs, diabetes and obesity, Salama says that they should be given antibiotics, like prophylactic, after the operation. In case of any discharge from the wound, opening, or when the pain in the wound is increasing day after day instead of reducing, Salama advises to see a doctor.

"Good hygiene of the wound is necessary to prevent it from getting infected, an infected wound becomes red, inflamed, and there may be pus discharge, and or fever. If not treated, the infection can spread to deeper layers of the abdomen,” Pande explains.

Dr George Ruzigana, an obstetrician gynaecologist at University Teaching Hospital, Butare, says that usually, they advise women to keep the dressing on for two days and then have it removed by the doctor on the day of discharge; they assess the wound to check if it is clean, dry and that the edges are intact.

Dr John Muganda, an obstetrician gynaecologist at Harmony Clinic Kigali, says if you do not clean the wound properly after the operation, you can develop a post-operation infection which can cause poor wound healing, and may need further treatment, including antibiotics.

Ruzigana explains that poor hygiene around the operated area can lead to a local surgical site infection or even peritoneal infection peritonitis if the fascia is open or infected.

He adds that if it’s a localised infection, cleaning and packing the wound with gauze is done but if it is peritonitis, doctors usually operate and do a washout with warm normal saline solution, this can be followed with antibiotics. However, only until the infection is cleared do they close the skin layers.

Pande recommends new mothers to feed on a full balanced diet as they have to keep strong and also feed the baby.

She notes that the requirement of iron and calcium is increased during pregnancy, as well as breastfeeding but failure to meet this demand results in chronic anaemia and softening of the bones. So the diet of a woman post C-section should include fresh vegetables, fruits, whole grains, nuts, milk and milk products, eggs and fish.

"Apart from these measures, after a C-section, a mother needs sufficient rest to facilitate the healing of the wound and also remain strong to take good care of the new-born. She should keep all things necessary close at hand, sleep when the baby sleeps and if possible, help can be sought from a friend or relative to do the multiple chores associated with a household and or baby care,” Pande says.

Iba says that before leaving the hospital, a woman will be encouraged to get up and try to go to the bathroom within the first 24 hours after surgery. This will help start the healing process and get her used to moving around with the incision, however, remember to move slowly because one might experience dizziness or shortness of breath, or even heavy bleeding.

He adds that for up to six weeks, one will need extra-absorbent menstruations pad; do not use tampons during this time.

Iba advises women to watch out for fever or pain as both could be signs of infection.

WHY THE C-SECTION?  

"Doctors could recommend a C-section due to maternal (mother) or foetal (baby) causes; maternal causes may be a narrow pelvis that cannot permit passage of the baby or conditions like heart disease or others that cannot permit the mother to deliver normally. For foetal causes, it may be the position of the baby (malposition) or foetal distress,” says Dr Stephen Rulisa, an obstetrician gynaecologist at University Teaching Hospital of Kigali.

He adds that doctors can do a C-section if the labour is not progressing as it should; it may occur if the contractions are too weak, or if the baby is too big.

"If a woman’s labour doesn’t progress normally, in many cases, the woman may be given medication (pitocin or oxytocin) to be sure that contractions are adequate for several hours, when labour still doesn’t progress after several hours, a caesarean delivery may be recommended,” says

Dr Ruzindana Kenneth, a gynaecologist at Kibagabaga Hospital.

He further says that when the baby’s heart rate suggests that it is not taking labour well, if the baby is in a transverse (sideways) or breech position (buttocks first) when labour begins, a C-section is done.

Ruzindana also says that a C-section can be done in case of heavy vaginal bleeding; this can occur if the placenta separates from the uterus before the baby is delivered (a placental abruption) and if there is a medical emergency that threatens the life of the mother or infant. 

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