W o m e n a n d N e wb o r n H e a lt h S e rv i c e

King Edward Memorial Hospital

Following Caesarean Birth

Delivering a Healthy WA

CONTENTS
Caesarean surgery Elective or emergency surgery Pain MANAGEMENT Eating and drinking Caesarean risks Risk prevention and reduction Rest Physiotherapy and physical recovery First few days after your operation Gentle exercises Emotional recovery Vaginal blood loss Constipation feeding your baby caring for your baby At home Driving a vehicle Visiting Midwifery Service Child health nurse visits Sexuality Postnatal check-up by General Practitioner Planning another baby Further information Community support KEMH telephone numbers Tear out Easy Reference Guide 3 4 4 6 6 7 11 12 14 16 17 19 19 20 21 22 22 23 23 23 23 24 24 25 26 27
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Congratulations on the birth of your baby!

Our aim in providing this booklet is to give you and your family information that is commonly requested by women who have already experienced a Caesarean birth or who are preparing for a scheduled Caesarean birth. The booklet is meant as a guide only and is no substitute for your doctor or midwife if you have any concerns or questions about your recovery. If you are able to have a support person present at your Caesarean birth, please ask for the leaflet titled Information for a support person attending a Caesarean birth if you have not already received one. A Caesarean birth plan is available to help you choose options that may personalise your birth experience. Please ask your doctor or midwife for a copy of this birth plan.

Caesarean surgery
A Caesarean is a major operation where your baby is born through a surgical cut (incision) made in your abdomen. The incision is usually made just above the pubic bone in the lower part of the abdomen. A horizontal line is made and goes through skin, fat and muscle layers to your womb (uterus) and then through the lower part of the uterus to allow your baby to be born. This is often referred to as a Lower Uterine Segment Caesarean Section (LUSCS). Less frequently it may be necessary for the incision to be made in the upper segment of the uterus and this is called a Classical Caesarean Section. The lower segment is preferred because: it heals stronger and bleeds less than the upper segment if you became pregnant again following a lower segment Caesarean, a vaginal birth may be possible. If you become pregnant again following a classical Caesarean, a vaginal birth would not be recommended and another Caesarean would be performed. This means more surgery and slower recovery time than a vaginal birth.

Elective or emergency surgery

These terms explain the amount of time available to prepare the hospital, the staff and the woman for the operation. An elective or scheduled Caesarean is when the decision for the operation was made: before the onset of labour before spontaneous rupture of the membranes before the performance of any induction procedure. An emergency or unscheduled Caesarean is when the decision for the operation was made: after the start of labour less than 24 hours before the operation when an elective Caesarean has been planned, but complications such as labour or bleeding occurred forcing the operation to be performed before the booked date.

Your pain control starts before or during the operation. Three main types of medication are commonly used: 1. A narcotic or opioid medication can be given through an epidural catheter in your back or into a vein via an intravenous tube in your arm or as a tablet by mouth. In some instances, this medication can be patient-controlled and this method will be explained to you. It is possible to give a single dose of this medication into the spinal area when a spinal anaesthetic is used, resulting in many hours of excellent pain relief. You are encouraged to use your epidural for pain relief up to 48 hours, after which it is generally removed for safety reasons. Strong pain relief medication can be taken by mouth. 2. Paracetamol is a medication that can be used while breastfeeding and is given regularly by mouth or as a suppository. 3. A variety of anti-inflammatory pain-relieving medications are frequently used for a few days. They are very safe but not suitable for everyone. This medication can be given as a tablet, a suppository or via an injection. The intravenous tube will be removed when: you are able to drink and eat the epidural is no longer needed. If you have questions about the safety of medications and how they may affect you and/or your baby please contact any of the following: Your midwife Your doctor Anaesthetist Pharmacist KEMH Pharmacy Help Line Phone (08) 9340 2723 8.30am to 5.00pm, Monday to Friday
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Pain management
You are likely to be offered a combination of medications to control your pain. Combining medications gives the most effective pain relief. It reduces the amount of each medication you need which may reduce your chance of experiencing possible side effects such as dizziness, drowsiness, nausea, vomiting, itch or constipation. There are several ways of getting pain control. Factors such as the type of anaesthetic used, your individual circumstances, local hospital practice and your personal preference determine the type of pain medication you will receive. Your anaesthetist will discuss with you how your pain will be controlled. A pain team (including an anaesthetist and nurse) will visit you in your room to ensure you are comfortable and are experiencing few or no side effects. If you have any problems with your pain control, your midwife can contact the anaesthetist.
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Eating and drinking

Fluids You may drink fluids immediately following your operation. You are advised to drink at least eight cups (two litres) of fluid each day. Food You may eat food immediately following your operation unless directed otherwise by your midwife or doctor. Well-balanced meals that include the five food groups are recommended. Possible reasons that you may not tolerate food are: -- persistent nausea and vomiting -- rare complications of surgery involving your bowel. Your surgeon will have already discussed this with you.

Risk of scalpel cut to the baby. Risk of the baby having breathing problems that require admission to the Neonatal Intensive Care Unit. Increase likelihood of baby having feeding problems. There are other risks from anaesthetics and the Caesarean operation which your doctor and/or anaesthetist will have discussed with you. If you wish to discuss these further ask your midwife to arrange for the doctor or anaesthetist to visit you while in hospital. After returning home you may make an appointment to meet with the staff involved in your care by phoning the clinical midwife consultant in Labour and Birth Suite on (08) 9340 2222 - page 3317.

Risk prevention and reduction

Drink at least eight cups (two litres) of fluid per day. Get moving as soon as possible by getting out of bed the day of your operation or, at the latest, the day after. Preventing excessive blood loss Expected blood loss after a Caesarean birth is less than three cups (750 mls). To reduce the risk of excessive blood loss, the anaesthetist will give you a medication called Syntocinon into your intravenous tube immediately after the birth of your baby. This will help your uterus to contract, thus reducing the amount of bleeding that can occur at the birth of your baby. The surgeon ensures that the placenta, membranes and any clots are removed from your uterus before repairing (closing) the incision. This helps your uterus to contract and reduce the amount of bleeding.

Caesarean risks
Excessive blood loss of three cups (750 mls) or more. Depending on the degree of bleeding, some women may require a blood transfusion and/or hysterectomy. Damage to organs surrounding the uterus, such as the bladder or bowel. Wound infection. Higher risk than vaginal birth of blood clots forming in the veins of the pelvis and lower legs. These are called pulmonary emboli if the clots move to the lungs and can be fatal. Recovery is longer than for a vaginal birth. Possibility of major problems with future pregnancies and/or births e.g. the placenta growing into the scar on the uterus which can lead to severe bleeding.
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Bladder protection Before the operation a catheter (tube) is placed into your bladder to allow urine to drain. This keeps the bladder empty and out of the way during the operation. The catheter is inserted in theatre after the anaesthetic has taken effect and theatre staff will be in attendance. The morning after your Caesarean your midwife will ensure you are able to walk to the toilet before removing the catheter. Following its removal the amount of urine you pass will be measured. The bladder is generally behaving normally: - when you have a normal urge to pass urine - you pass 300 - 450 mls on separate and subsequent occasions - your bladder empties completely and easily each time. After the catheter is removed, empty your bladder every two to three hours. Following the birth you will be losing body fluid that you gained during your pregnancy. This creates a lot of urine in the first few days. Keeping it empty will prevent over stretching of the bladder, aid in control of wound pain and the amount of bleeding from your uterus. You may notice increased swelling in your hands and feet at this time which is normal. Continue to drink fluids, walk and go to the toilet regularly and the swelling will go away. When resting, lie on your bed with two pillows under your heels to raise them above the level of your heart. Pregnancy, childbirth and having had a catheter in your bladder increase your risk of bladder infection. To decrease this risk the catheter is removed as soon as possible. You should drink the recommended amount of fluid each day and empty your bladder regularly. Symptoms of bladder infection are listed in the section: When should I be concerned and seek advice on the last page of this booklet. Incontinence of urine may have been a problem during your pregnancy due to the weight of your baby on your bladder and the hormones of pregnancy, which tend to decrease your bladder control. If this problem
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occurs or continues after your Caesarean, seek help from the KEMH Physiotherapy Department or your local physiotherapist. After having a catheter in the bladder some women may experience: -- stinging or discomfort when passing urine -- incontinence of urine -- lack of sensation of a full bladder. If you experience these problems talk to your midwife, doctor or physiotherapist. Preventing wound infection Antibiotics will be given during the operation to reduce the risk of wound infection. A sterile area is maintained during the operation. A sterile dressing will be placed over the wound before you leave the operating theatre. It is recommended you do not shave, wax or use hair removal cream on your bikini line prior to a Caesarean birth. Wound care Once your wound dressing has been removed: During your shower gently wash your wound with water. Gently dry around your wound with a towel. It is best to leave it uncovered to air dry. If your clothes are rubbing the wound, place a fresh sanitary pad between the wound and your clothing. You may wish to purchase underwear and clothing that have a high waistband to prevent rubbing. Staples/stitches will be removed as instructed by your doctor or after approximately 96 hours. This may occur in hospital or at home by the visiting midwife.
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To help healing: Follow recommendations for eating and drinking, as your cells need food to grow and multiply. Follow recommendations for exercise, as warm muscles encourage blood flow, cell growth and promote healing. Avoid extremes of hot and cold temperature. Moist, warm clothes and bed sheets combined with blood encourage bacteria to grow, so: -- shower daily and dress in fresh clothes -- change bed sheets when they become soiled -- cover your wound if it is oozing and report this to your midwife or doctor immediately. Preventing blood clots in lower leg veins Avoid smoking and exposure to cigarette smoke during the months before and after the birth of your baby. This will reduce the risk of blood clots forming. Pregnancy and having a young child at home are good reasons to give up smoking. T.E.D. stockings are given to you before the surgery and should be worn until you leave hospital. Keeping blood moving around your body reduces the risk of blood clots forming. After the operation, work the muscles in your legs by moving your legs and rotating your feet as demonstrated under Circulation on page 15. You should start as soon as sensation and movement returns to your legs. This activity promotes the return of blood to your upper body. If you are at risk of forming blood clots you may be prescribed blood-thinning medication (anticoagulants) by the doctor, which is given daily via an injection.

Rest
Most women feel very tired after giving birth and many are still tired months later. Having a birth by Caesarean means that you are caring for a young family, dealing with pain and your body is healing from a major operation. These factors will obviously increase any tiredness that you feel. Although it is sometimes difficult to find time to rest with a new baby, try to rest on your bed during the day. To get as much rest as possible you may like to try these suggestions while in hospital and when you are at home: Use the amount of pain relief that you require within the directions of your doctor. Use the rest period the hospital has arranged between 1pm and 3pm. When in hospital use your Do Not Disturb sign by placing it on your closed door when you are resting. Take the phone off the hook. Keep visitors to a minimum for the first 24 - 48 hours and ask they keep their visits short (suggest 15 - 20 minutes). Keep your babys cot close to your bed so you can attend to your baby with ease. Negotiate with your partner or family for some baby-sitting if you find it difficult to rest with your baby in the room. Nap during the day when your baby is sleeping. Arrange baby-sitting, kindergarten, child care etc for other children to get a quiet day at home to rest. Perhaps for the first one or two days at home your other children can remain with family or carers. Accept offers of help from your family and friends.

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Physiotherapy and physical recovery

It is important to your recovery that you are walking as soon as possible. Your midwife and health-care team will encourage you to achieve this goal with pain control and physical assistance. Physiotherapy Department For information or assistance phone (08) 9340 2790 (extension 2790 within the hospital), Monday to Friday 8.30am to 4.30pm. Goals in hospital: 1. Sitting out of bed on day one (birth day). 2. Walking to the shower and around your room throughout the day on day two. 3. Short walks around your ward on day three, in preparation for discharge. 4. Each day, increase the number of times, and the length of time you go for walks around your room and ward. 5. Do the Gentle exercises for the abdomen and back on page 16. These exercises are important to help your abdominal muscles to function and to ease or prevent back pain. Goals at home: 1. When you feel able to, take a daily walk pushing your baby in the pram. Start by walking for 10 to 15 minutes on fairly flat ground. Gradually increase your pace of walking and the length of time you walk for, as you feel stronger. 2. You can start the pelvic floor and abdominal exercises in the Physiotherapy After Childbirth brochure (provided by the Physiotherapy Department) as soon as you feel comfortable to do so (usually day four or five). If they cause you pain, stop and try again a day or two later.
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3. Start by doing light housework (dusting, light sweeping, and washing dishes). After about six weeks you can gradually progress to vacuuming a small room, etc. 4. Avoid heavy lifting for about eight weeks. Dont lift anything heavier than your baby. For example you should not be lifting loads of wet washing, toddlers, shopping bags, baby baths or baby capsules. If you need to hold your breath the load is too heavy. You are able to lift light loads such as your baby, a few garments in a washing basket, a light shopping bag etc. After six to eight weeks you may be ready to start lifting slightly heavier loads (but with caution). To protect your back and limit the strain on your scar, a correct lifting technique is essential. Remember: BEND your knees BRACE your abdominal muscles and pelvic floor BRING the object close to your body BREATHE out as you lift Good posture will reduce the strain on your back: STAND TALL WALK TALL SIT TALL It is important that you give your body time to recover and to heal. Healing continues to occur internally for several weeks so avoid strenuous activity for six to eight weeks after your Caesarean. Remember to listen to your body. If you feel tired or your wound aches, then your body is telling you to rest. Gradually increase your activity as your healing and recovery allows.

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The first few days after your operation

Its helpful to exercise, starting the first day after your operation. Deep breathing Deep breathing helps reduce the effects of the anaesthetic. Sit up in bed, knees bent, feet on the bed. Place one hand on your abdomen above your navel. Breathe out gently, then take a slow deep breath in. Your hand and abdomen should rise upwards as you do this. Hold your breath in for three seconds and then relax to breath out. This may also be done in a chair. Aim to do five deep breaths every hour. Huffing Coughing places more stress on your abdominal and pelvic floor muscles so it is better to huff to clear phlegm from your chest. Take a medium sized breath in and then force the air out through a rounded mouth as if you are fogging up a mirror. Aim for a long huff out. If you need to cough or sneeze hold your abdomen as pictured. Remember to tighten your pelvic floor muscles at the same time. Walking

Circulation Move feet up and down briskly at the ankles at least ten times per waking hour, even if sitting out of bed.

Getting out of bed after your operation

Coughing, showing the position of your hands while sitting in a chair.

Bend your knees up and roll onto your side. Keep your knees together and pulled up towards your chest. As you push up with your hands to a sitting position, swing your legs down over one side of the bed. Sit on the edge of the bed with your feet flat on the floor, lean forward and stand up.
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Walking is the best exercise. You may need someone with you if you feel unsteady. Start with frequent short walks. Progress to a full lap of the ward. Do this several times a day, resting between each lap.
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Gentle exercises for the abdomen and back

These gentle exercises help to: tone the abdominal muscles relieve backache assist passing of wind. Pelvic rocking Lie with your knees bent, hands on your hipbones. Tilt your hipbones towards your face and flatten the lower back. Hold for two to three seconds, release slowly, allowing the hollow in your lower back to reform. Repeat rhythmically five to ten times.

Emotional recovery
There are many reasons why a birth by Caesarean happens. For some women the decision for this mode of birth may have been made many weeks before the birth. Others may have experienced a labour culminating in a Caesarean. It is often very valuable to talk about your expectations, thoughts and feelings with supportive others and with the midwives and doctors who shared your birth experience. These midwives and doctors are pleased to arrange a convenient time to be with you and talk through memories and feelings of your labour and birth experience. While still in hospital you may arrange an appointment with these carers by asking your midwife, or after returning home, by phoning the clinical midwife consultant in Labour and Birth Suite (08) 9340 2222 and asking for page 3317 or the midwives from the Next Birth After Caesarean (NBAC) clinic on (08) 9340 1626. If you wish to speak to a person independent from your experiences you can ask for a referral to the Department of Psychological Medicine which has specialised staff who can offer a confidential service to help you deal with any persistent, problematic emotional reactions either while in hospital or later after you have gone home. The patient advocate is also available on (08) 9340 1559.

Knee rolling Lying with knees bent and together, pull your abdomen in. With knees together roll first to one side and then to the other a little way to each side at first and gradually increasing. Repeat six times to each side, three times a day. If you feel sharp pain whilst doing these exercises, stop exercising and seek guidance from your midwife, doctor or physiotherapist.
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Having an unplanned Caesarean birth can sometimes be distressing. Occasionally women may experience a sense of loss of control, trauma, anxious feelings or disappointment related to the birth. On the positive side, these feelings are often intermingled with a sense of relief that the procedure is over and that both mother and baby are safe. Difficult emotional reactions will hopefully start to settle within a short period of time. If they do not, members of KEMHs Department of Psychological Medicine are available to assist you for up to six months after delivery and up to 12 months after delivery if your baby was in the Special Care Nursery, by phoning (08) 9340 1521.

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You are welcome to attend a new mothers group for women who have experienced a Caesarean birth. The group is facilitated by a midwife. It is a great way to: Meet and socialise with other new mums who have had a similar experience to you. Share experiences in a supportive environment. Gain further information and education. The group meets monthly in the Parent Education Lounge. Contact the Parent Education Department on (08) 9340 1367 for more details. There are some simple things that you can do which may help your emotional wellbeing, for example: While in hospital Dress in your own clothes, do your hair and make-up. Telephone supportive friends and family. At home Accept offers of help, such as washing or cleaning. Ask for assistance when needed. Plan at least one outing or activity each day. Contact friends regularly. Join a mothers group, your child health nurse may have information and contact details. When youre feeling housebound, walk with your baby to the local park or shops - your new baby will invite others to talk to you. Write in a journal or diary. Try to plan at least one enjoyable outing or activity each day as you feel able. This could include going for a walk, visiting friends or other hobbies and activities you enjoy. Acknowledge your feelings. It is possible to feel happiness at having a healthy baby and at the same time have mixed feelings about how the birth went.
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Vaginal blood loss

1. Immediately after the birth, your vaginal blood loss will be bright red in colour and the amount should not fill a regular sized sanitary pad in less than four hours. 2. The loss over the next five days will decrease in amount and change colour. It will change from bright red to watery pink to a dark red/ brown colour by day five (similar to a period). 3. Your loss may increase slightly: -- when you get out of bed, due to gravity -- with breastfeeding, due to hormones released causing your uterus to contract -- when you get home and increase your activity. This should settle again within half an hour. Small clots (no bigger than a 50 cent piece) can also be passed at this time. 4. Sanitary pads should be changed at least every four hours as wet and warm pads can encourage infection.

Constipation
1. Your bowels should move on the second or third day after your babys birth. 2. Visit the toilet as soon as you feel the urge. Dont delay. 3. The best position for opening your bowels is to lean forward and rest your forearms on your knees, so that your knees are higher than your hips. This can also be achieved by having your feet on a footstool. 4. To prevent or relieve constipation: -- drink the recommended amount of fluid so you can pass your bowel actions without straining -- eat whole grain cereals, fruits and vegetables
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-- walk as advised in the Physiotherapy and Physical Recovery section on page 12. If pain or illness prevents this activity you should consult your doctor. 5. If you experience constipation, talk to your midwife as soon as possible to agree on a management plan.

Support services for feeding your baby Contact details can be found towards the back of this booklet. Breastfeeding Centre of WA located at KEMH Australian Breastfeeding Association Child health nurse local Child Health Clinic Ngala Your babys purple Personal Health Record and your telephone directory are also good sources for community assistance that is available in your area.

Feeding your baby

Breastfeeding Successful breastfeeding is encouraged by: Skin-to-skin contact between you and your baby as soon as possible after birth and as often as possible. Adequate pain control. Comfortable positioning of yourself and your baby. Unrestricted breastfeeding loose comfortable clothing. Allow the baby to determine the frequency and length of each breastfeed. Correct attachment when feeding. To achieve this your midwife and family can assist you to position yourself with your baby comfortably in bed or in a chair. Your midwife will encourage you to have lots of contact with and to be involved in the care of your baby. For further information please refer to the booklet Breastfeeding and Breast Care. Formula feeding When bottle feeding your baby ensure you are both comfortable and warm. The need for closeness and cuddling is important. For further information please refer to the pamphlet Formula Feeding - a guide for parents.
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Caring for your baby

Your baby will room-in with you 24-hours-a-day. The midwife will assist you as you care for your baby in your room. The assistance and advice you receive each day will decrease as you become more confident, mobile and independent. Following birth, your baby may need: Warming through skin-to-skin contact with you or under a heater. Constant observation, and perhaps treatment, in the Special Care Nursery. If your baby should need this care you and your partner will be told immediately and your contact with your baby will be assisted as each of your conditions allow.

Going home
You can expect to go home four days following a Caesarean birth. During busy times, when bed shortages exist within the hospital, you and your baby may be required to transfer to another hospital closer to your home for continued care.

At home
Effective pain relief and a supportive family remain an important part of your recovery when at home. A doctor will see you and your baby before you leave the hospital. They will discuss contraception and pain relief, providing you with medication and/or information, as you wish.
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You should continue to: take medication for pain regularly observe your wound as it heals and report any problems to your doctor have your afternoon rest exercise as previously described in this booklet ask family and friends to help with house cleaning, preparing food and care of other children.

Your care at home will be referred to the Visiting Midwifery Service if: you left the hospital before day five, or you or your baby require assessment by a midwife.

Child health nurse

You will find the phone number and address of your local child health nurse in your babys Personal Health Record. During the first week that you have your baby at home you should call the phone number and arrange an appointment with the child health nurse. If you wish to choose a different child health nurse your phone book has listings under Child Health Services.

Driving a vehicle
Austroads Guidelines state that women who have had a birth by Caesarean should not drive for four weeks or until cleared by a medical practitioner. Ask your doctor at the hospital or your GP if you are able to drive safely. You should not drive a vehicle if you are in pain or are using medication that has the warning, Care should be taken when driving or operating machinery. Generally you are safe to drive when you feel comfortable: pushing the pedals (could you brake suddenly?) turning the steering wheel turning to look over your shoulder to reverse. Most vehicle insurance companies insure drivers after they have had an operation if they follow the instructions of their doctor. If you are unsure of your insurance companys policies please phone them and check your accident coverage.

Sexuality
The best gauge of when you are ready to resume sex is how YOU are feeling. Careful positioning may be helpful to prevent pain in the wound area. A common side effect of surgery is a numb sensation around the wound that can last a year or more. Touching this area can be disturbing for some women. Breastfeeding can reduce vaginal secretions, so a water-based lubricant gel may be useful.

Postnatal check-up by General Practitioner

Your nominated GP will receive a summary of your stay in hospital and birth details. Arrange an appointment for yourself and your baby six weeks after the birth. See your GP sooner if there are any problems that you need to discuss or have treated.

Visiting Midwifery Service (VMS)

This service provides assessment by a midwife in your own home. If you are expecting a visit from VMS, please remain home until seen.

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Planning another baby

When planning a future pregnancy you should discuss your birth options and possible risks of another pregnancy with your obstetrician, doctor or midwife. Most women who have had a previous lower segment Caesarean birth are eligible to try for a vaginal birth after Caesarean (commonly referred to as a VBAC) depending on: the reason for your previous Caesarean birth whether your next pregnancy has complications. For most women it is best not to plan another pregnancy for at least 12 months after a Caesarean birth to allow the wound to heal. To discuss your options for birth after a Caesarean please contact the Next Birth After Caesarean clinic on (08) 9340 1626 for more information and support. Please ask for a Next Birth After Caesarean information package which has information and resources for women post Caesarean. Your doctor will discuss contraception with you, providing you with medication and/or information, if you wish, before you leave the hospital. Remember when you are sexually active it is always possible to get pregnant again regardless of: when you give birth whether your period has returned if youre breastfeeding.

Community support
Australian Breastfeeding Association Birthrites: Healing After Caesarean Inc Ethnic Child Care Resource Unit Inc Family Planning of Western Australia Health Direct Emergency (24-hour medical advice line) Lactation Consultants (Private) Multiple Birth Association of WA (Inc) National Continence Help line Ngala Family Resource Centre 1800 686 268 www.birthrites.org (08) 9443 4323 (08) 9227 6177 1800 022 222 Under L in the Yellow Pages (08) 9340 1536 1800 33 00 66 (08) 9368 9368 (08) 6279 1200 or 1800 654 432 (08) 9340 6882

Further information
Maternal and infant health publications and information are available from: Antenatal clinics Hospital wards Parent Education Department Women and Newborn Health Library, a consumer health library located in the Main Corridor of KEMH. Phone: (08) 9340 1100 Fax: (08) 9340 1124

Parent Help Centre

Community Midwifery WA Post Natal Depression Support Association (PNDSA)

(08) 9340 1622

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KEMH phone numbers

Antenatal Clinic Breastfeeding Centre of WA Women and Newborn Drug and Alcohol Service Diabetes Educator Diagnostic Imaging Department Emergency Centre KEMH (24 hours) Genetics Department KEMH Switchboard (24 hours) Labour and Birth Suite (24 hours) Next Birth After Caesarean Clinic Parent Education Department Patient Advocate Pharmacy Help Line Physiotherapy Department Psychological Medicine Social Work Department Visiting Midwifery Service Women and Newborn Health Library
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When should I be concerned or seek advice?

(Fax) (08) 9340 1031 (08) 9340 1844 (08) 9340 2222 (Pager 3425) (08) 9340 2163 (08) 9340 2700 (08) 9340 1433 (08) 9340 1525 (08) 9340 2222 (08) 9340 2199 (08) 9340 1626 (08) 9340 1368 (08) 9340 1559 (08) 9340 2723 (08) 9340 2790 (08) 9340 1521 (08) 9340 2777 (08) 9340 1530 (08) 9340 1100
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Contact your midwife or doctor if:

You have a fever, shivering or sweating You have stinging or burning when you pass urine You notice increasing redness, inflammation and tenderness in your wound Pus, blood or fluid leaks from your wound Your vaginal loss returns to a bright red colour, unexpectedly increases in amount, or smells offensive You experience a hard, red and painful lump in a breast that is not relieved after following advice given in the booklet Breastfeeding and Breast Care Tiredness is not improving or is getting worse You are worried

This page may be removed for easy reference

Phone Number: (08) 9340 1521 Contact the KEMH Department of Psychological Medicine if:
You experience depressive, anxiety symptoms or other emotional difficulties

Phone Number: (08) 9340 1844 Contact the Breastfeeding Centre of WA or your lactation consultant if you have:
Breastfeeding problems of any kind

Phone Number: (08) 9340 2170

Contact your physiotherapist if one or more of the following problems happen or continue after your baby is born:
Back or neck pain Caesarean scar pain Weak abdominal muscles Painful tailbone Haemorrhoids or pain when using bowels Blocked milk ducts/mastitis Loss of bladder/bowel sensation or control Urgency to pass urine or use bowels Passing urine frequently Difficulty keeping tampon in place Pain during sexual intercourse

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Day 1 (Birth Day) Day 2 Day 3 Day 4 Day 5 6 Weeks Drink
Drink at least 8 cups (2 litres) fluid each day Eat well balanced meals using the five food groups Wound is covered for 24 hours Leave wound uncovered but protect from clothing with sanitary pad Stitches or staples removed in hospital or your home after 96 completed hours Amount: Nil Colour: Nil Paracetamol as required. Other medications may be required - discuss with your doctor and midwife

Eat Wound Report concerns about healing to your midwife or doctor, see back of this page Vaginal Loss
Colour: pink to light brown Suppositories and paracetamol Amount: half fills regular pad in 2-4 hours Colour: bright red blood Patient Controlled Epidural Analgesia (PCEA), suppositories, paracetamol, anti-inflammatories Daily visit by Anaesthetic Pain Team Amount: decreasing amount each day

Pain Relief

Effective pain relief enables a quicker recovery and improves your ability to care for yourself and your family Walk
Sit out of bed Shower, walks around room Around ward area 2 - 3 times a day Increase number and length of walks each day Daily walk

Exercise Physical recovery is important to your emotional wellbeing

Start Pelvic floor and abdominal exercises in the Start Gentle Exercise for Abdominal Muscles and Lower Physiotherapy before and after childbirth pamphlet Back on page 16. provided by the Physiotherapy Department

Attend postnatal exercise class in the Physiotherapy Department

Rest

1. Use the rest period from 1pm to 3pm provided by the hospital 2. Use your Do Not Disturb sign 3. Take the phone off the hook 4. Close your door 5. Nap when your baby is sleeping 6. Restrict number of visitors and ask them not to stay too long 7. Talk to you medical team or supportive others about your birth if you found it distressing or traumatic

1. Arrange child care for other children 2. Use help from family and visitors 3. Nap when your baby is sleeping 4. Take a break - walk or just relax 5. Contact Psychological Medicine if you feel distressed, anxious or depressed.

goals for recovery

Disclaimer: The advice and information contained herein is provided in good faith as a public service. However the accuracy of any statements made is not guaranteed and it is the responsibility of readers to make their own enquiries as to the accuracy, currency and appropriateness of any information or advice provided. Liability for any act or omission occurring in reliance on this document or for any loss, damage or injury occurring as a consequence of such act or omission is expressly disclaimed.

Produced by: Women and Newborn Health Service Email: ogccu@health.wa.gov.au Website: http://wnhs.health.wa.gov.au August 2005 WNHS 0011 Rev 5 Reviewed May 2010

This information is available in alternative formats upon request

Wome n a nd N e wbo r n H e a lth S e rvice

King Edward Memorial Hospital 374 Bagot Road Subiaco WA 6008 Telephone: (08) 9340 2222

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