C-Section Recovery : What Happens in the PACU!

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c-section recovery, what happens in pacu, c sections

Alright, rolling out of the OR into the PACU (PACU stands for Post Anesthesia Care Unit)! If you’ve read my previous post about what happens DURING your C-Section (which you totally should!), I promised I would be writing this follow-up article about C-Section recovery! The truth is, having a C-Section is a very difficult and lengthy process, and therefore should be covered in multiple posts!

So, the doctor has said his final goodbye from the operating room, we’ve dressed your surgical site, and moved you from the OR table to a much more comfortable postpartum bed. The nurse anesthetist who was hanging out with you near your head during the entire procedure now says her final goodbye as well.

Most hospitals have a separate little area called the PACU where you go for a few hours to recover after your surgery!

This is where you will stay for approximately 1-2 hours with your L&D nurse (depending on your facility, the timing may be different, but we always stay with our patients for the FULL 2 hours), after which you’ll transfer to your postpartum room.

Once we get to this area, I’ll hook you up to some monitors that will take your vital signs frequently and do a short head-to-toe assessment. You may have been on a little bit of oxygen (a little tube that’s connected to your nose) during surgery, and I’ll take that off as long as your oxygen levels are fine.

It’s also important to monitor your temperature coming out of the OR. Oftentimes you’ll be a bit cold because you’ve lost quite a bit of blood from surgery, but we want to make sure you aren’t TOO cold.

Side note : I’m writing this post to those ladies who stayed AWAKE during surgery. AKA, you had an epidural/spinal placed, and you were just numb from the waist down. There are some cases in which you would need to go under general anesthesia for a C-Section (you go to sleep during your surgery), but that’s a post for another day!

Once I’ve got you settled and hooked you up to a bunch of beeping monitors, I’ll start monitoring your bleeding. This is the not-so-fun part, unfortunately.

Sooooo….even though you didn’t have a baby through your vagina, you’re still going to have some BLEEDING through your vagina.

I know that sounded dumb, but I’ve actually had a few women wonder that, so I think it needs to be said! Yes, you will still generally have the same *postpartum bleeding experience* as a woman who had a vaginal delivery.

When you have a baby (regardless of whether you deliver via C-Section or vaginally) your placenta detaches from the inside of your uterus. Think of your placenta as a huge SCAB (yuck, I know). When you lose a scab off of a wound, it bleeds, re-scabs, bleeds some more, heals, re-scabs, bleeds some more, etc. until it’s fully healed. You get the idea. Well, this is what happens inside your uterus, and why you have all that postpartum bleeding!

The inside of your uterus is regenerating, and “re-scabbing” over and over until it’s completely healed!

One of the ways we assess this bleeding is by doing FUNDAL RUBS. Basically I’m just taking my hand and rubbing the top part of your uterus, which is located right around your belly button. I push down on your stomach pretty hard, and this can be unpleasant, especially after you’ve just had surgery.

While I’m pushing on your stomach, I’m feeling to see how firm your uterus is (I want it to be EXTRA HARD) and seeing how much bleeding comes out on your pad.

If your uterus is HARD and your bleeding is MINIMAL, then that’s a really good indication that your body has gotten the signal that you’re not pregnant anymore, and your uterus is starting to shrink back down to normal size.

I’ll be assessing your bleeding by doing these fundal rubs every fifteen minutes while you’re in the PACU. It’s important to monitor your bleeding frequently. If there’s any indication that your uterus is a little lazy, you can lose quite a bit of blood in a short time, and WE WANNA BE ON TOP OF THAT. So, belly rubs every fifteen minutes!

Since you’ve just had a C-Section, you’ll also have a big dressing over your incision. Along with these fundal rubs, I’ll also be assessing your dressing, just to make sure you don’t have any new drainage that’s appearing from your wound. Occasionally your incision will be a bit oozy from surgery and leak a bit onto your bandage. I’m just making sure this drainage isn’t getting much bigger, because this can signify that you weren’t properly closed up, or the wound has re-opened. Don’t sweat though, this is a very rare complication.

Your legs will be very, very numb once we enter the PACU (you probably won’t even be able to move one toe!), but over the next two hours, you should slowly regain the ability to feel and move them. You’ll still have compression devices on your legs from surgery (used for circulation purposes), and these will stay on until you are able to get out of bed and walk.

You’ll also be receiving PITOCIN through your IV line. This medication helps with decreasing that postpartum bleeding I talked about, and that will be running for a few hours after surgery as well.

Also…,a heads up, some women don’t realize until much later…you’ll have a catheter in your bladder! This was put in during your surgery, and this usually stays in until the next day post-op (depending on your facility). I’ll be checking your urine output as well during your PACU stay.

Most women do not feel much pain RIGHT after surgery in the PACU, just because you’re still fairly numb. Occasionally some women do have incisional pain, and require a bit of narcotic pain medication to get that under control.

You’ll be able to have a few ice-chips in the PACU with me, and usually by the end of our two hours I allow my patients to have a few sips of water as well, as long as you aren’t nauseated or have any active vomiting. Once you transfer to your postpartum room, your postpartum nurse will slowly let you introduce clear liquids (sprite, apple juice, ginger ale), followed by foods. This is usually done slowly over the course of a few hours.

If all goes well with baby, most hospitals nowadays encourage baby to stay with mom. So, unless baby had to go the special care nursery or NICU for medical reasons, your sweet little one will be by your side in the PACU!

This is a great time when I encourage (and help) mom and baby with that first breastfeeding session (if you decide that’s how you’ll feed baby). I also love to keep baby skin-to-skin on your chest as much as possible during your PACU stay, because let’s face it, you need some baby snuggles after that surgery you’ve just had! Skin-to-skin contact also is very beneficial to baby as it regulates their temperatures, steadies their vital signs, and promotes bonding. 😊

As our two hours is coming to a close, you’ll start to regain some feeling in your legs, and I’ll start unhooking monitors from you. Once we leave for postpartum (in your bed), the only remaining things hooked up to you are your IV line and your catheter.

You’ve made it through recovery! Now on to postpartum. 😊 My job as your L&D nurse has officially come to a close. Some smaller facilities do have the same staff for postpartum, so it is entirely possible that your nurses will be the same through your postpartum stay as well. The hospital I work at, however, has split staffing so you’d have a separate postpartum nurse taking care of you after that 2 hours is up.

What questions do you have about C-Section recovery? I think the main question I get is “When can I EAT?” Ha! Soon, girl, soon…

Happy Delivery Day! 🙂


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