On the third day after surgery, the mother is allowed to go home. The inner room is already made up, the bed pushed against the wall, the curtains drawn tight. Every visitor has a piece of advice. Lie still so the incision can heal, and don’t sit up too much or the stitches will burst. No bathing for a month, because water seeping into the incision will make it fester. No rice yet; wait until you "pass gas" before you eat. A mother who had a cesarean gets even stricter warnings than one who gave birth vaginally, because there is an extra line of stitches across her belly.
Worrying about the incision makes sense. But a few of these familiar warnings run against today’s guidance on care after a cesarean section, and the old traditional medicine books did not write them for cesarean births either.
The old traditional medicine books have no chapter on cesarean birth
Most of the advice Vietnamese families pass down about the postpartum "confinement" period (ở cữ) dates from a time before cesarean sections existed. The old traditional medicine books we reread have no separate section on confinement after a cesarean; their rules were written for birth through the birth canal. A verse of childbirth advice in the collected works of the classical Vietnamese physician Hai Thuong Lan Ong has the line "Lie still in one place, do not sit, do not walk", and the same verse warns against pushing too early, so it is clearly speaking to someone giving birth vaginally. The book Yī Xué (医学 / 醫學, Medicine), which Hai Thuong copied out, also says "do not leave the confinement bed".
The closest thing to a surgical incision that the old books mention is "metal wounds" (金疮 / 金瘡, jīn chuāng), wounds made by knives or blades. The Jīn Guì Yào Lüè (金匮要略 / 金匱要略, Synopsis of the Golden Chamber) records that people wounded by knives or axes lose blood, and one line warns both people with metal wounds and new mothers not to eat pears, a fruit the book considers to chill the inside of the body. So our doctors see a mother after a cesarean as two things at once: a woman who has just given birth, and a person carrying a wound made by a blade. That is our own reading; the books do not say it.
Bathing and the incision
The dressing on the incision is usually removed about 6 to 24 hours after surgery, according to the caesarean birth guideline of the UK’s National Institute for Health and Care Excellence (NICE NG192). After that, clean the incision very gently each day and pat it dry, and wear loose clothes and cotton underwear. A trial of 320 mothers with planned cesareans (booked in advance, not emergency surgery) compared removing the dressing at 6 hours with removing it at 24 hours. Wound complications were about the same (13.8% and 12.5%), and the mothers whose dressing came off early were more satisfied because they could wash sooner (Peleg 2016).
NICE also has a general recommendation for all surgery: after 48 hours, it is safe to shower. In Vietnam, the Ministry of Health’s National Guidelines on Reproductive Health Care Services (issued with Decision 4128/QD-BYT in 2016) say that about two or three days after birth, a mother can take a quick bath in warm water, and that during the first six weeks she can bathe every day in clean, warm water. These guidelines are written for all mothers, with no separate section for cesarean births.
As for letting water touch the incision, the evidence is thin. A Cochrane review (a summary of all the studies available) found only one trial, and it was in people having minor skin surgery. Bathing after 12 hours or waiting 48 hours or more gave the same infection rates (8.5% and 8.8%), and a single trial is not enough to draw a conclusion (Toon 2015). No one has studied soaking in a tub or swimming after a cesarean; waiting until the incision has healed before soaking is expert opinion.
A survey of 2,100 mothers in Hubei (China) found that bathing and washing their hair during the confinement month did not increase infections, as many people fear. But mothers who bathed often did report more back pain and joint pain, and it is not known whether they used hot or cold water (Mao 2016). Traditional medicine books worry more about cold than about water. Xia Guicheng (夏桂成), in his gynecology book, only advises against soaking in a tub during the postpartum period and recommends washing the genital area twice a day; the book never says not to bathe. Hai Thuong only warns "do not rush to comb your hair or wash your feet", meaning these things should not be hurried in the first few days.
Once your obstetrician has said it is fine, you can take a quick warm shower after a cesarean, pat the incision dry with a clean towel and put on dry clothes right away. The first time, have someone close by, because you will still be sore and bending over is not easy yet. Wind, fans, air conditioning, lying over a charcoal brazier and herbal leaf steaming are covered in our article "Our grandparents’ rule against wind, and postpartum wind in traditional medicine".
Lie still for a month, or get up and walk early
This is where cesarean mothers differ most clearly from mothers who gave birth vaginally. A meta-analysis of observational studies found that after a cesarean, the risk of a blood clot in a vein is about 4 times higher than after a vaginal birth, and higher still after an emergency cesarean. In real numbers, about 3 in every 1,000 mothers who have a cesarean develop one (Blondon 2016).
The Royal College of Obstetricians and Gynaecologists (RCOG) in the UK notes that this risk lasts for several weeks after birth. Mothers who have a cesarean during labor are usually considered for anticlotting injections for at least 10 days. Mothers at low risk should get moving early and avoid getting dehydrated. RCOG also lists being immobile for 3 days or more among the factors that raise the risk of blood clots. The information page of the UK National Health Service (NHS) advises getting out of bed and walking about as soon as possible, and once home, taking a gentle walk every day to lower the risk of blood clots, as long as you don’t overdo it.
Xia Guicheng also encourages new mothers to get out of bed early and move so the bowels start working again, as part of his advice on preventing constipation for all new mothers. Maciocia advises resting for at least one month, but rest, as he means it, alternates light activity with lying down. For cesarean mothers, our doctors follow modern texts and the guidelines on preventing thrombosis (blood clots).
Walking early does not mean giving up rest. The 2025 update from the ERAS Society (Enhanced Recovery After Surgery) puts both early mobilization and encouraging rest periods in the strong recommendation group (things that should be done), even though the certainty of the evidence for both is still low (Sultan 2025). Each time you wake up to feed your baby, you can walk a few laps around the house and then lie down again. What to avoid is staying stuck in bed in one spot for days on end.
Eat early; there is no need to wait to pass gas
Many families still keep the custom that after surgery you must wait to "pass gas" before you are allowed to eat. No traditional medicine book says you have to wait to pass gas (flatus) before eating. Hai Thuong only advises not to eat too much after birth, and to cook a thin rice porridge to eat little by little, adding a bit more each day, which is quite close to the modern approach of feeding early and moving from liquids to solids. Xia Guicheng advises a light diet, avoiding rich, fatty and sweet foods and "powerful tonic" foods.
Current guidelines do not set that condition either. NICE states that mothers who are recovering well without complications can eat and drink normally; the ERAS Society (Wilson 2018) recommends eating and drinking normally within 2 hours after surgery, as a strong recommendation. Pooled data from 20 trials with 4,584 mothers show that eating early, within the first 12 hours, helps the bowels start working sooner, shortens the hospital stay and lets mothers breastfeed for the first time sooner, with no increase in complications (Guo 2014). The Ministry of Health guidelines mentioned above also advise mothers after birth to eat enough food with enough nutrients, and not to follow unreasonable food restrictions. When to start eating, and what to eat while still in hospital, is for the obstetrician to decide based on each mother’s surgery.
Carrying your baby, climbing stairs, driving, sex, exercise
For these activities, every source gives a different number of weeks to wait, and this is where the evidence is thinnest; whatever milestone you are given today is only expert opinion. NICE deliberately sets no milestone. It only says that driving, carrying heavy things, exercise and sex can be resumed when the mother feels fully recovered, including being free of pain and able to move without restriction. The NHS page says cesarean mothers can pick up and carry their baby as soon as they are home; heavier tasks can be resumed when they feel able to do them without discomfort, which may take roughly 6 weeks.
A study measuring the pressure inside the abdomen in 30 women (not women who had just had surgery) found that climbing stairs, brisk walking, and lifting 3.6 to 9 kg from a tabletop did not raise the pressure more than getting up from a chair did; only bending down to lift about 16 kg from the floor pushed the pressure to its highest (Weir 2006). This study did not look at incisions, but it suggests that bending down to lift something matters more than how heavy the thing is. We have not found any guideline or study telling cesarean mothers to avoid stairs. If your home has several floors, just go slowly, hold the handrail, and don’t carry the baby and other things at the same time.
In Australia, 65% of cesarean mothers were told to wait at least 6 weeks before driving, but 72% drove before that point, 35% before 3 weeks, and few felt any discomfort (Sedgley 2012). The NHS also reminds mothers that they will need someone to drive them home from hospital, because they cannot drive for the first few weeks. That is about cars; for motorbikes, we have not found any data.
On sex, traditional medicine books advise abstaining for quite a long time. Hai Thuong writes 100 days, Xia Guicheng advises abstaining throughout the postpartum period (6 to 8 weeks), and the acupuncture textbook advises abstaining while there is still lochia (postpartum vaginal discharge). NICE says sex can be resumed when the mother feels recovered, and that a cesarean does not increase the risk of pain during sex; other studies give mixed results.
On exercise, the World Health Organization (WHO, 2022) advises all mothers after birth who have no reason to hold back to stay active regularly, aiming for 150 minutes a week, and to spend less time sitting or lying in one place. WHO has no separate recommendation for cesarean mothers.
If you are given a specific number of weeks, check again with the doctor who did your surgery, because that person knows how your incision was closed and how the operation went.
Does confinement need to be longer?
Cesarean mothers often get their strength back more slowly. An older study found that at 6 weeks, 72% of mothers who gave birth vaginally were back to their usual health, compared with only 34% of cesarean mothers (Tulman 1988). A US study followed first-time mothers who had gone through labor and counted the days until they were free of pain, off opioid painkillers, and felt recovered to how they were before giving birth. Half of the mothers who gave birth vaginally got there by day 20, and half of the cesarean mothers by day 27; by day 47 (vaginal birth) and day 50 (cesarean), almost all mothers (95%) in both groups had got there (Komatsu 2017). That is about one week slower, with a great deal of variation from person to person.
In China, a study of 198 mothers found that cesarean mothers had poorer physical health; in the same study, the more strictly mothers kept the confinement rules, the lower their stamina and the higher their depression scores at 6 weeks after birth (Liu 2012). The two go together, but it is not known whether strict confinement is the cause.
In Hue, a survey found that every mother kept at least one confinement rule, for about 58 days on average (Murray 2015). No study has yet compared the length of confinement by type of birth, and there is no evidence that cesarean mothers need to stay in bed longer.
Traditional medicine books set their milestones by qi and blood. Hai Thuong advises keeping the confinement rules for up to 100 days, then adds: "if qi and blood are weak, one must keep them longer, regardless of days and months". Xia Guicheng calls the first week "newly delivered" (新产 / 新產, xīn chǎn) and the first month "the small full month" (小满月 / 小滿月, xiǎo mǎn yuè). For Maciocia, the longer or harder the birth, or the more blood lost than usual, the more important rest becomes; he quotes Chen Jia Yuan, who said that illness after an easy birth is easy to treat and illness after a difficult birth is hard to treat. It follows that an emergency cesarean after many hours of labor, or with heavy blood loss, needs more careful looking after than a smooth planned cesarean: enough food and sleep, and someone to help with the housework.
When strength comes back slowly, the mind is tired too
Cesarean mothers often compare themselves with the mother in the same room who gave birth vaginally, seeing her already carrying her baby around while they still have to hold on to the wall. By the third or fourth week, quite a few mothers still feel drained, their minds noticeably slower.
Ongoing tiredness, trouble concentrating, forgetfulness and low mood should all be raised at your follow-up visit, with either your obstetrician or your traditional medicine doctor. There can be many causes, from lack of sleep to blood loss, and the doctor needs to hear your story to work them out. Family members can help a great deal by letting the mother catch up on sleep during the day and taking over the night-time tasks.
Signs in the incision that need a doctor’s check
Wound infection is not rare. In a study that followed 4,107 mothers in England for 30 days, about 1 in every 10 mothers had one (9.6%), but only 0.6% needed to go back into hospital (Wloch 2012). Mothers with obesity or diabetes are at higher risk. See a doctor early if the redness around the incision spreads, if it swells, if the pain gets worse instead of gradually easing, if pus or foul-smelling fluid comes out, if the edges of the incision open up, or if you have a fever. A cough, shortness of breath, or a swollen, painful calf means you need to be seen right away, because it may be a blood clot; this is NICE’s advice. Other danger signs after birth are covered in our article "Warning signs after birth that need care right away".
Herbs, belly massage and acupuncture after surgery
The lương y (traditional medicine practitioner) Nguyen Huu Duc, in his notes on a cesarean case on the fourth day after birth, wrote: "In the old days, after giving birth, from a normal birth, which went well, to a difficult birth, which went very badly, qi and blood were greatly depleted." (meaning qi and blood were much weakened) He mentioned that back pain after the anesthetic is common, then went on: "Remember that Western medicine has already taken very good care. But when the patient needs us…" In our view, he meant that traditional medicine can help with the parts that Western medicine pays less attention to after surgery.
Many families are used to brewing Sheng Hua Tang (Generating and Transforming Decoction) for a new mother, following the book Bǎo Chǎn (保产 / 保產, Safeguarding Childbirth), quoted by Hai Thuong, which says to give a few batches right after birth (one batch, or thang, is one day’s dose of herbs). Cesarean mothers should not start taking it on their own right away. A review in the Journal of Taiwan Pharmacy (2025) notes that mothers who gave birth vaginally can start the next day if they are not bleeding heavily, have no fever and no severe abdominal pain; cesarean mothers start only after about 3 to 5 days, and how many batches to take should be decided with a practitioner. The Taiwan pharmacopoeia (the official standard for medicines) states that people with blood heat (heat in the blood) who also have blood stasis should not use this formula.
In Taiwan, one cesarean mother started Sheng Hua Tang on day 8; three days later she had a late postpartum hemorrhage and needed a hysterectomy (Chen 2020). A single case is not enough to blame the herbs. Sheng Hua Tang contains herbs that John and Tina Chen’s Chinese herbal pharmacology book lists as possibly affecting anticoagulant medicines, so a mother who is getting anticoagulant injections after surgery must tell the practitioner before taking it. If you are breastfeeding, see also our article "Are Vietnamese folk herbs always safe? Taking traditional medicine while breastfeeding" for more on medicines.
Some families also massage the mother’s belly, following advice in Hai Thuong’s books, or tie a turmeric cloth wrap around her belly, as one line of the childbirth verse says. For cesarean mothers, do not rub or tie anything tightly over an incision that has not healed. The Ministry of Health’s technical procedures for acupuncture (Decision 792/QD-BYT) also state that massage and acupressure for pain relief after surgery should not be done while the wound is still open or the surgical area is inflamed, swollen or oozing.
On acupuncture, Liu’s analysis of 26 trials with 2,641 mothers after cesarean found that acupuncture helped reduce pain, helped the bowels start working again, and led to passing gas sooner; however, the studies differed a great deal and their quality was uneven (Liu 2025). An in-person examination is needed to assess each mother’s health in detail.
Once the stitches are out, the doctor can also check the scar with Applied Kinesiology (AK, an examination method that uses muscle strength testing), alongside the usual examination: you place your own hand on the scar and the doctor retests muscle strength, because in AK, a scar that has healed on the skin can still make some muscles of the abdomen or back weaker. How the clinic deals with that is described in our article "A healed C-section scar that still hurts, and breastfeeding".
If you are slow to get your strength back after a cesarean, have back pain after the anesthetic, sweat a lot, or want to know when you can take tonics, you are welcome to come to the clinic with your hospital discharge papers and the medicines you are taking. The doctor will ask about your surgery in detail and then treat you in a way that suits your constitution and your own health concerns.
References
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