Caesarean section rates have risen globally, with about one in five births now by caesarean according to WHO. Caesarean is major abdominal surgery and recovery takes time, but the woman is also a new mother who wants to hold, feed and bond with her baby. Good post-operative care balances surgical safety with a positive postnatal experience.
Immediately after surgery
- Observations: pulse, BP, respiratory rate, SpO₂, temperature, sedation and pain scores frequently in the first hours, per protocol (often using a modified obstetric early warning score).
- Uterine tone and vaginal bleeding: check the fundus and pads regularly. Postpartum haemorrhage can occur after caesarean too. See PPH management.
- Wound: check the dressing for bleeding.
- Urine output: a catheter is often in place for several hours after spinal anaesthesia.
- Spinal/epidural effects: return of sensation and movement; watch for headache, itching or respiratory depression from opioids.
Skin-to-skin and early feeding
Where mother and baby are well, support skin-to-skin contact and breastfeeding as early as possible, even in theatre or recovery. Help with positioning to avoid pressure on the wound (e.g. side-lying or the “rugby ball” hold).
Pain relief
Good analgesia helps mobility, breastfeeding and bonding. Regular paracetamol and NSAIDs (if not contraindicated), with opioids as needed. Assess pain regularly and don’t let women “suffer quietly”. See opioid safety.
Enhanced recovery
- Early eating and drinking once she feels ready, usually within hours.
- Early mobilisation: sitting up, then walking within the first day.
- Early catheter removal per protocol, then monitor voiding.
VTE prevention
Caesarean significantly raises the risk of blood clots. Assess risk, give prescribed LMWH and/or stockings, encourage mobility and hydration. Teach her to recognise leg swelling and breathlessness. See VTE prevention.
Wound care and infection
Caesarean wound infections are a significant problem in many settings. Keep the dressing on as advised, then keep the wound clean and dry, especially under an abdominal skin fold. Teach signs of infection. See surgical site infection and suture removal.
Discharge advice
- Avoid heavy lifting (anything heavier than the baby) for several weeks.
- Driving: when she can comfortably do an emergency stop and turn to look, and her insurer allows it.
- Gradual return to activity; gentle walking is encouraged.
- Contraception and spacing: discuss future pregnancies. Many women can have a vaginal birth after caesarean (VBAC); advise discussion with her care team in future pregnancies.
- Danger signs: see postnatal danger signs.
- Emotional support: some women feel disappointed or traumatised by an emergency caesarean; offer a debrief.
Based on NICE NG192 (Caesarean birth), WHO statements on caesarean section rates and ERAS Society guidelines for caesarean delivery. Educational content: follow local protocols.