Nutrition to Support a C-section recovery
What to Eat to Encourage Optimal Recovery after a C-Section
After giving birth, women often find themselves putting others first, especially their beautiful new bub! It is a notoriously busy and exhausting time, and for many, it’s a time when grocery shopping and cooking a nutritious meal might go out the window. There is, however, a strong argument for prioritising good nutrition in those months following a C-section. A C-section is a massive ordeal for your body to undergo, not to mention the nine months of pregnancy prior to that, and your physiological need for certain nutrients will increase to assist with the repair of your body.
Iron-rich Foods
Iron deficiency anaemia is common during pregnancy, when the foetus requires increasing iron for growth, depleting the maternal iron stores. (1) This is then followed by blood loss at delivery, which is approximately twice as high in a C-section compared to a vaginal birth. (1) In fact, some studies have shown that repeated C-sections increases the likelihood of iron deficiency and anaemia in later life. (1) Iron deficiency can cause fatigue, breathlessness, and dizziness. (2)
Iron-rich foods to include postpartum are lean meat, seafood, nuts, beans, vegetables, and fortified grain products. The iron in meat is called heme iron and has higher bioavailability (meaning it is more readily absorbed by the body) than non-heme iron, which is found in plant-based products. (3) It is also important to include plenty of Vitamin C in your diet (from foods such as red capsicum, oranges, kiwifruit, broccoli) because this increases the absorption of non-heme iron. (3)
Protein
Adequate dietary protein is essential for proper wound healing. (4) Tissue levels of the amino acids arginine and glutamine have been shown to have an effect on wound repair and immune function. (4) Women need 58-60 grams of protein per day when they’re pregnant, and this daily requirement increases postpartum if the woman is breastfeeding, to 63-67 grams per day. (5) Protein is found in both animal and plant foods, with the major sources being meat, poultry, fish, cereals and cereal-based foods, and dairy foods. There is also a small amount of protein in vegetables. (5)
Fibre and Plenty of Fluids
Constipation is relatively common after giving birth, either vaginally, or via C-section. This can be caused by the mother’s lack of mobility, pain medication, dehydration, lack of dietary fibre, iron supplements, or even a fear of tearing stitches from straining. (6) To counteract this, women should be encouraged to include lots of fibre in their diets by consuming whole grains, nuts, seeds, fruits (preferably with skin on), vegetables and legumes. (6) Ensuring adequate fluid intake is also very important and should be encouraged, particularly in breastfeeding mothers. (6)
Vitamin C
Vitamin C cannot be synthesized by the human body, unlike in most other animals, and therefore must be consumed as part of our diet. (7) It is vital for the biosynthesis of collagen, an essential component of connective tissue that plays an important role in successful wound healing. (7) Vitamin C is also a very important nutrient for immune function, and increases the bioavailability of non-heme iron. Foods that should be included in the diet to increase vitamin C intake are capsicums, citrus fruits, kiwi fruit, broccoli, rockmelon, strawberries, brussels sprouts, cabbage, and cauliflower. (7)
Bromelain
Bromelain, an extract from pineapple stems and fruit, has long been used for its anti-inflammatory, anti-oedematous, pain reducing, wound healing, and anticoagulant properties. (8) Oral bromelain helps to reduce levels of plasma bradykinin, prostaglandin E2, and thrombaxin B2 in areas that are inflamed. (9) It has also been shown to decrease pain mediators in the wounded area, as well as reduce inflammatory prostaglandins. (9)
This has drawn attention to the potential for use of bromelain in C-section and episiotomy recovery. Numerous studies have demonstrated that, when compared to a placebo group, those receiving bromelain experienced a significant reduction in length of time and severity of perineal or abdominal pain and inflammation following an episiotomy or C-section. (8) Bromelain has also been shown to accelerate the healing time of soft tissue wounds. (8)
Zinc
Zinc, an essential trace element, plays an essential role in cell membrane repair, cell proliferation, growth, and immune system function. (10) Zinc deficiency can result in impaired immune function, compromised wound healing, skin lesions, and growth retardation. (10) Zinc has a major role in every stage of the wound healing progression, from membrane repair, coagulation, blood vessel development, inflammation and immune defense, tissue re-epithelization, oxidative stress, to fibrosis/scar formation. (10) For these reasons, having adequate zinc levels is essential for optimal recovery from a C-section. High zinc foods include oysters, red meat, poultry, seafood, and fortified breakfast cereals. (11)
When to eat following a C-section
Eating a meal almost immediately after a C-section is probably not at the forefront of your mind, but, according to the research, it could have some benefits. Early feeding, defined as consuming a meal anywhere between 30 minutes and 8 hours after the C-section, is now generally encouraged. (12) A large randomised controlled trial comparing early feeding to conventional feeding (within 18 hours of the operation) found that early feeding improved maternal satisfaction, ability to move about, and length of stay at the hospital. (12) A systematic review and meta analysis also supports these findings, noting that early feeding accelerated the return of normal bowel movements. (12)
References
1. Park JY, Lee SW. A history of repetitive cesarean section is a risk factor of anemia in healthy perimenopausal women: The Korea National Health and Nutrition Examination Survey 2010-2012. PloS one. 2017 Nov 30;12(11):e0188903.
2. Markova V, Norgaard A, Jørgensen KJ, Langhoff‐Roos J. Treatment for women with postpartum iron deficiency anaemia. Cochrane database of systematic reviews. 2015(8).
3. Iron Fact Sheet for Health Professionals [Internet]. 2020 [cited September 11 2020]. Available from: https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/
4. MacKay DJ, Miller AL. Nutritional support for wound healing. Alternative medicine review. 2003 Nov 1;8(4).
5. National Health and Medical Research Council. Protein Nutrient Reference Values for Australia and New Zealand [Internet]. NHMRC. 2014 [cited September 11 2020]. Available from: https://www.nrv.gov.au/nutrients/protein
6. Jones W. Question from practice: Constipation after a caesarean section. Evaluation. 2020 Jul 22;14(47):19.
7. Vitamin C Fact Sheet for Health Professionals [Internet]. 2020 [cited September 14 2020]. Available from: https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/
8. Golezar S. Ananas comosus effect on perineal pain and wound healing after episiotomy: a randomized double-blind placebo-controlled clinical trial. Iranian Red Crescent Medical Journal. 2016 Mar;18(3).
9. Baharvand-Ahmadi B, Bahmani M, Rafieian-Kopaei M. Review of the medicinal herbs effective on labor and cesarean section pain in Iran. J Chem Pharm Sci. 2016;9(1):24-7.
10. Lin PH, Sermersheim M, Li H, Lee PH, Steinberg SM, Ma J. Zinc in wound healing modulation. Nutrients. 2018 Jan;10(1):16.
11. Zinc Fact Sheet for Health Professionals [Internet]. 2020 [cited September 14 2020]. https://ods.od.nih.gov/pdf/factsheets/Zinc-Consumer.pdf
12. Macones GA, Caughey AB, Wood SL, Wrench IJ, Huang J, Norman M, Pettersson K, Fawcett WJ, Shalabi MM, Metcalfe A, Gramlich L. Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (part 3). American journal of obstetrics and gynecology. 2019 Sep 1;221(3):247-e1.
This blog was written by Clare Carrick as part of her 2020 internship with Wholefood Healing