Although I’m just getting this post done in the nick of time, it’s been weighting on me for some time to write about Cesarean recovery. It only seemed fitting to share it in April, as it is Caesarean Awareness month, however, it is an issue that affects thousands of women in Canada each and every month.
For many years women were made to feel guilty if they could not have a vaginal or natural birth for some reason. Cesarean rates were (and still are) HIGH and there are definitely circumstances where a woman (and her partner) may feel pressured by their healthcare provider to opt for a cesarean when it may not be medically necessary. But much has been done in the past few years to help de-stigmatize cesarean births. There are now options for women to have a more gentle cesarean experience and accommodations are being made including immediate skin to skin for mom/baby and sometimes a clear sheet so the mother (and partner) can see what is happening.
But something that is still often overlooked when it comes to cesareans is the recovery process. Most women are told to take it easy, not to lift anything heavier than their babies and to limit physical activity for the first six weeks. But that’s about all women are being told. I want to talk about a few things you can do to help encourage a smoother recovery after a C-section as well as a few myths surrounding cesarean recovery.
One of the easiest things you can do in the early days of new motherhood is to breathe. Sure, there are a million new things that you’re trying to get the hang of, but the hope is that most women have the support they need in order to rest and recover. Lying in bed with you baby not only promotes healing but also provides an opportunity for you and babe to bond. When you’re lying (or sitting or even changing baby’s diapers) take a moment to be still and shift your focus to your breath. Feel your ribs expanding as you inhale and imagine the pelvic floor muscles softening and relaxing. As you exhale imagine (or feel if you can) the pelvic floor muscles drawing upwards-an image that I really like is that of a jellyfish. A jellyfish blossoms open and then draws together as it propels upwards. Even if you cannot feel these muscles actually engaging, visualizing this process will start to create new neural pathways in order to start retraining these muscles.
This breathing exercise reprograms the core muscles to work together as a system as they are designed to do and promotes blood flow to the pelvic floor and abdominal muscles to encourage healing. It also calms the nervous system helping you feel calmer and more grounded, which comes in very handy in those early days.
I intended to write about taking it slow and being cautious when you’re moving around and getting up and down in the early postpartum days but thought it was more fun if I talked about bowel movements here!
Straining when going to the bathroom can create quite a bit of internal pressure, which can affect your scar as well as the muscles surrounding it. We want the muscles around the incision to be soft and supple and not tense and held which can result from constipation or bloating.
Make sure you drink lots of water (if you’re breastfeeding you’ll probably notice an increased need for hydration so be sure to drink when thirsty). Prunes and other dried fruit can help to get things moving smoothly. Smoothies with added greens, lots of fruit and veggies are easy go to foods.
Belly massage works wonders on gassy and fussy little babies and guess what, it’s a wonderful tool to help you when you’re feeling backed up…and fussy;) Be careful of your incision and perform each movement 10 times. Start by drawing an I starting just above your incision, on the right side, up to your bottom ribs. And then an L, from the same starting position to your left ribs. And then a U from the same starting point to just above your incision on the right side.
Reducing the amount of pressure on the abdominal wall and the muscles surrounding your incision site feels pretty intuitive. There will be movements that just don't feel good, like curling up from a lying down position to get out of bed but there are other subtle movements that you may not think increase the pressure on those tissues.
Be sure to roll to your side and push your way up with your hand when getting out of bed and be cautious when rolling from one side to the other.
Postural habits can greatly affect the amount of internal pressure that pushes against your abdominal wall. So try to avoid sitting in a passive, bum tucked under, position for prolonged periods of time. This is obviously not that easy when you’ve got a little one who wants to be attached to you at all times! Try side lying when nursing or bottle-feeding and use pillows to prop you up so you are not constantly slouching. When you’re standing and holding your baby it may feel very natural to press your hips forward. See if you can stand with your bum un-tucked, and weight back on your heels to reduce the intra abdominal pressure.
The muscles that surround the incision will be affected by how the muscles are healing. If the tissues become tight and stiff, the muscles around it will be pulled on as well which can cause excessive tension in the pelvic floor leading to further weakness of the abdominal muscles. Visit a massage therapist or a pelvic health physiotherapist who can properly instruct you how to massage the scar starting at approximately 6 weeks postpartum. Check out the video by Anita Lambert of Holistic Health Physiotherapy as she explains the benefits and techniques of scar massage.
Find out what’s going on “Down there”
It is common for women for believe that because they did not experience a vaginal birth that they are less likely to experience pelvic floor issues after pregnancy. This in fact is not the case.
Carrying your baby for the 9 months leading up to birth has a great impact on the function of the pelvic floor muscles. Not to mention the many, many years before we actually become pregnant. Our postural patterns, breathing mechanics and many other factors (i.e., how active we are, types of activities you participate in and even bathroom habits) contribute to the strength and tone of these muscles.
It is also possible that although you had a cesarean birth, you may have also endured hours (or even days!) of labor, which does have an impact on the pelvic floor muscles. The pelvic floor muscles are intended to be pliable and supple in order to expand and allow baby to pass through the vagina with (relative) ease. But often times women experience excessive tension in the pelvic floor, which can impede the birthing process. It is possible that a woman may push for a few hours before a cesarean is deemed necessary, a prolonged pushing phase has a direct impact on the pelvic floor muscles and proper recovery is necessary. It is highly recommended that all women see a pelvic health physiotherapist approximately 6 weeks postpartum, regardless of how they gave birth.
Pregnancy and childbirth, including cesareans, take a toll on your body. Taking the time to properly heal and recover is step one and then focusing on specific exercises that restore core strength and function. We often allow the healing process to happen and jump right into an exercise routine, whether it is something we practiced during pregnancy or something we’re taking on after birth in an effort to “lose the baby weight” and “get back into shape.” It is essential to restore core strength, safely and mindfully so your body can be properly supported as you move through your every day life and throughout your movement practices and exercise routines. Stay tuned for details in my next post on how to safely return to movement and exercise after birth.