Every fifth childbirth in Russia, according to statistics, is carried out by cesarean section. Therefore, the issues of recovery after such an operation are important for women.
In this article, we will talk about how long the bleeding lasts after surgery and what a woman needs to do to prevent complications.
Causes and characteristics of discharge
Postpartum discharge indicates the reverse development of the female reproductive organ. During the period of gestation, the uterus grew 500 times, the vessels of the placenta firmly connected with its own blood vessels. This allowed the baby to receive the necessary nutrition and oxygen during intrauterine development.
With surgery, the woman's uterus is more injured than with natural physiological childbirth. First of all, we are talking about the incision of the tissues of the uterus itself, through which the surgeon gains access to the baby. Suturing the uterine incision is another factor for increasing discharge after a cesarean section.
The doctor separates the placenta manually after the baby is removed. In this case, the vessels connecting the "baby's place" with the uterus are injured, which is the reason for the subsequent bleeding.
The enlarged uterus, when the need for such a size disappears, begins to shrink, and in a relatively short time it will have to take on practically the same size. This process also proceeds with increased secretions, which doctors call lochia.
Discharge for the doctor is a sign of reverse involution of the uterus. According to them, an experienced doctor will be able to determine with great accuracy how this process proceeds, how well the recovery is going after the operation.
In the first three days, blood usually predominates in lochia, which comes from the damaged vessels of the placenta and the wound surface in the area of the incision. In a laboratory study, a large number of red blood cells in the secretions are determined. Blood clots in the discharge during this period are also completely normal.
By the fifth day, lochia begins to contain serous serum, ichor. If you examine it under a microscope, you will find that the discharge contains a huge number of leukocytes, and dead cells of the uterine epithelium can also be observed in them. By the end of the first week after natural childbirth, cervical mucus appears in the secretions. After a cesarean section in the same period, particles of surgical threads can be found in the lochia, with which the cut wall of the uterus is sutured. These threads are self-absorbable, but their ends, which did not enter directly into the uterine tissue, are separated as the rest of the threads are absorbed and leave the uterine cavity in the traditional way - through the vagina.
If we compare with natural childbirth, then the bleeding in the first days after surgical delivery is much stronger. You should not be afraid of this, because the area of damage to the uterus after the operation is much larger.
The total blood loss depends on many factors - the presence or absence of complications, the woman's weight and height.
After natural childbirth, according to the BME (Great Medical Encyclopedia), a woman loses up to one and a half kilograms due to discharge of lochia and contraction of the uterus. After cesarean, this amount may be higher.
Recovery time
After the operation, a woman is recommended early motor activation, since the faster the postpartum woman takes an upright position, the more efficiently the blood and clots will drain under the influence of natural gravity.
After surgery, you can get out of bed after 12 hours, but this should be done gradually. Excessive zeal and careless handling of the seams can lead to the divergence of the latter.
During the first three days, it is recommended to change the postpartum lining (sterile, maternity hospital) every 3 hours. This is important not only for hygiene reasons. Since the area of damage to the uterus after surgery is larger, the risk of infection is higher.
Exactly because of this reason it is not recommended to use commercial pads in the first few days - they are not sterile.
By the time she is discharged, which occurs on the fifth day, the woman no longer has scarlet blood secretions, erythrocytes and mucus are present in the lochia. The period of discharge lasts quite a long time - on average, up to 8 weeks. This is how much time it takes for the uterus to contract (after surgery, it contracts more slowly), as well as for healing and scarring of the incision area in the uterus.
During the first days, in order to avoid complications, the woman is injected with reducing drugs. Oxytocin accelerates uterine contractions, and after an injection for 10-15 minutes, a woman may notice that the discharge has become stronger.
In addition to monitoring lochia, medical workers must monitor the body temperature of the postpartum woman, since it is its sharp increase that sometimes is the first signal of inflammation and infection. On the bypass, the doctor palpates the uterine area through the anterior abdominal wall, and before discharge, it is considered mandatory to conduct a control ultrasound examination, which should confirm that the uterine cavity is clean, and the contraction occurs normally.
A small amount of blood in the urine in the absence of complaints of pain during urination during the first five days after surgery is allowed.
Norm and pathology
After discharge, the woman controls the discharge herself. Caring for a child, of course, will take a lot of time, but you must not forget about your own health.
Normal discharge is considered to be moderate, homogeneous after 2 weeks of staying at home. With normal involution of the uterus, after about a month and a half, the discharge becomes mucous, yellowish, and then colorless. The mucus is replaced by a normal vaginal secretion after 2 months of the recovery period.
Pathological discharge should definitely be a reason for visiting a doctor. These include the following situations:
- profuse bleeding, which began suddenly after discharge from the maternity hospital, after the stage of serous lochia;
- increased bleeding or blood "daub" against the background of high body temperature;
- earlier cessation of discharge (after 4-5 weeks);
- prolonged discharge (after 9-10 weeks from the date of surgery);
- heterogeneity of discharge, clots, "curdling" after discharge from the hospital;
- any abdominal pain combined with bloody discharge.
A woman in the postoperative recovery period needs special attention to be paid to the color of the prominent lochia. If the discharge has become bright pink or orange, injury to the internal tissues formed in the dissection zone is not excluded. This can happen if a couple begins to have sexual intercourse too early, despite prohibitions and restrictions, if a woman lifts weights.
If the discharge has become green, gray, brownish, has an unpleasant odor, additional signs appear in the form of itching of the genitals, it is imperative to be examined for infectious lesions. Yellow-green discharge can be a sign of endometrial inflammation. Liquid watery discharge during the recovery period is also an alarming sign, which indicates a complication of the recovery process. In any of these cases, a woman should definitely visit a gynecologist to find the true cause of the problem and begin treatment.
How to behave - memo
Discharge after a cesarean section is an inevitability that you will have to accept.
If a woman follows the recommendations, then she can easily avoid complications. This is important for the subsequent planning of pregnancy, for the preservation of reproductive and not only reproductive women's health.
Don't lift weights
For a woman who has undergone a serious abdominal surgery (and a cesarean is just such an intervention), the concept of heavy should change radically.
The first days after the operation, it is not recommended to lift even a child if he weighs more than 3.5 kilograms. Up to six months during the recovery process, a woman should not strain the front abdominal wall, carry bags with groceries, or lower the stroller with the child on the stairs on her own. The weight allowed for lifting is no more than 4-5 kilograms.
Limit your intimate life
Until the moment when the lochia is completely over, sex is contraindicated. Such a ban is primarily associated with the likelihood of infection. Even opportunistic microorganisms that can get into the genital tract of a woman in the early recovery period can cause serious consequences for her health. Mechanical damage to the incision area on the uterus may also occur, since during orgasm and sexual arousal, blood flow to the organ increases.
If you do not follow this prohibition, a scar on the uterus may form inadequate, which will become a serious obstacle to carrying a subsequent pregnancy.
Follow the cycle
From the moment the lochia ceases, a woman needs to use condoms to protect against the ingress of foreign microorganisms and against unplanned pregnancy. When the menstrual cycle is established (the average time for this is 2-8 months after the operation), you need to consult a doctor for a choice of contraceptive methods, since it is not allowed to get pregnant again for 2 years after surgery on the uterus.
If the lochia has just ended, and then menstruation has begun, it will be quite easy to distinguish them from menstruation. Postpartum discharge by the time the uterus is restored will not be profuse and bloody, while menstruation will begin almost as usual, except that there will be fewer clots in the discharge (due to the relative thinness of the endometrium after childbirth). Periods after CS are sometimes more scarce at first than before, but gradually their nature, duration and intensity return to those individual indicators that were characteristic of a woman before pregnancy.
Practice good hygiene
While there is postpartum discharge, you need to wash yourself at least 2 times a day, change the pads 4-6 times a day (depending on the intensity of the discharge).
Douching, the use of tampons instead of pads after a cesarean section is strictly prohibited. Also, a woman should not use vaginal suppositories, gels and creams.
This and other nuances of recovery after a cesarean section, see the next video.
