Deborah Howell (Host): A cesarean is major surgery. So, how can expecting mothers prepare for a C-section? Today, we'll hear from Dr. Drue Webb, a family medicine physician at Pullman Regional Hospital's Family Medicine Residency Center, about what to expect before and after a cesarean section. Welcome, Dr. Webb.

Drue Webb, MD: Hello.

Host: So glad you're with us today to talk to us about cesareans. It's a C-section and it's a major surgery. Why is it considered such?

Drue Webb, MD: So when we do a C-section, it involves opening the abdomen to get to the uterus to take the baby out of the uterus. And in doing so, we go through a bunch of different layers, including muscle and other tissue. We're also operating close to other organs, such as the bowel, the bladder, ureters. So, all of those things increase risks that can be associated with. the surgery and elevate it to that major surgery level. It also will require more recovery time because it is an open surgery.

Host: Let's talk about that. What does the recovery timeline look like for a normal C-section, and how does that timeline differ from vaginal deliveries?

Drue Webb, MD: Yeah, so for a normal C-section, most women will stay in the hospital two to three days after the surgery. And compared to a vaginal delivery, most women are discharging after a day or two in the hospital. So, it adds about a day, maybe two, in terms of recovery time in the hospital. And then for recovery time outside of the hospital, most women who have had a vaginal delivery will get back to their usual activities within a week or two depending on how sore they are. But with C-sections it usually takes them more time, usually two to four weeks, before they're feeling like they're back to their usual self.

Host: Okay. Between two weeks and four weeks. That's good to know. And who performs a C-section?

Drue Webb, MD: So, these are usually done by obstetricians obviously, but also family medicine physicians who have trained in cesarean sections can do those procedures as well.

Host: Okay. What should a woman do and not do post C-section? When can they return to all normal activities?

Drue Webb, MD: So in the hospital, we always encourage women to get up and walk around. That can help with the pain management aspect. It's kind of like a sore muscle after working out. If you stay too still, it actually gets more painful. So, we do encourage early ambulation in the hospital and on discharge, but we want them to be careful about how much they're lifting. So, most people will say if you're lifting more than the baby weight, you're at risk for interfering with the healing of the incision site. Some surgeons will recommend that patients not lift more than 13 to 20 pounds for at least two weeks, but some give recommendations up to four to six, because some of the data we've seen, that's when you start to completely heal on that internal incision.

Host: That must be tough for women who have, you know, 14-pound babies.

Drue Webb, MD: Yes. That's when you enlist some help your partner or your family.

Host: Yeah, for sure. And what does incision care involve?

Drue Webb, MD: So in the hospital, it will be covered for the first 24 hours. And then, we usually take the dressing off. And then, it's mostly just keeping it clean and dry. And so, washing with soap and water is fine. And then, keeping the area dry. If it gets too wet, it can heal improperly or sometimes it can open after the surgery. So mostly, we just want to make sure that it's clean and dry and they tend to heal pretty well in that way.

Deborah Howell (Host): Okay, that's post-surgery. Now, pre-surgery, are there any things expecting mothers can do to prepare for a C-section?

Drue Webb, MD: Yeah. So if it's a scheduled C-section, obviously, we know that that's going to be happening around 39 weeks. That's usually when we do scheduled C-sections. And the most important things are just following the standard prenatal care, so maintaining a healthy pregnancy weight can help minimize risks during the procedure. If women are staying active, it's always better before a procedure if you're staying active and not being too sedentary, but that goes along a little bit with that pregnancy weight. And then, just making sure that you're going to your prenatal appointments as recommended, following up with the screenings as recommended. Those are the biggest things.

Host: Yeah, for sure. Now, I'm sure some women listening are thinking, "Can I go ahead and have a second child vaginally after a C-section?"

Drue Webb, MD: So, it is possible to do a vaginal delivery after a C-section in some cases. Usually for that to happen, you have to be evaluated for what your risk factors are, because there are risks if you do vaginally deliver after a C-section, so the surgeons will need to assess that and see where they think you're at in terms of risk factors.

The other aspect that plays into this is there's a higher risk associated with that, therefore not all hospitals are covered for those types of deliveries. Just like Pullman Regional Hospital here, we don't do vaginal deliveries after C-sections. So, those would go to Spokane or a larger hospital that is able to do those deliveries. But it is possible to have a vaginal delivery after C-section as long as it's deemed that there's low enough risk that they can trial that.

Host: Okay. And so, say you want two or three kids, can you have two or three Caesarean sections?

Drue Webb, MD: You can. The risks with cesarean sections, mostly on healing additional pregnancies, goes up with the more number of pregnancies that you have and C-sections. But two, three C-sections, that would be... within the realm of safe and no concerns. However, if you start getting to four, five, six, seven C-sections, complications, rates and risks go up.

Host: All right. Well then, thank you,, Dr. Webb so much for being on the podcast with us today to bring us up to speed on all that's entailed with C-sections. We do appreciate it.

Drue Webb, MD: Yeah. Thank you so much.

Host: And you can learn more about this subject, providers and services at Pullman Regional Hospital at pullmanregional.org/birthplace. This has been the health podcast from Pullman Regional. I'm your host, Deborah Howell. Thanks for listening and have yourself a terrific day.