In the United States, just over 30% of individuals deliver via cesarean birth each year , which makes cesarean delivery the most common surgical procedure that females or people bearing children experience (Martin et. al, 2021; Sherrod, 2021).
Despite the prevalence of cesarean birth, many people feel in the dark about management after this major surgery.
April is cesarean awareness month.
Did you deliver via cesarean? Are you trying to help a loved one out? Follow these guidelines to start feeling your best after cesarean birth.
Mental health is just as important as physical health
Yes, cesarean delivery is common, but it’s normal to not to feel so okay about it.
Maybe you envisioned a non medicated home birth? But things got a bit scary, and you ended up in an emergency situation.
Do you feel frustrated that labor didn’t “progress” quick enough and you and your provider opted for cesarean?
Conversely, you can feel no negativity around your cesarean delivery experience, and that’s okay too.
What’s not okay? Repressing grief or feeling alone and upset about your delivery experience.
Postpartum depression is extremely serious and one of the most common complications after delivery (Silverman et. al, 2017).
We will teach you all about physically healing from your delivery, but if you’re still struggling with the emotional piece of delivery or depression, please seek help.
We get it. You’re a new parent, you’re tired, and not to mention there’s a whole pandemic going on.
Perhaps look into telehealth therapy. Many healthcare systems offer telehealth services from your home, or try a service like better help or Valera.
Talk to your primary care, OBGYN, or midwife. These providers should help coordinate your care and provide you with mental health resources you can turn to.
Scar management
You may see a small scar on the surface but underneath are layers of tissue and muscle that require some TLC to start working optimally again.
A healthy scar should move with the body rather than the body adapting to move around a painful or tight scar.
Scar management starts from day one to facilitate healing. Keep the incision clean and dry. Any oozing, heat, or other signs of infection or delayed healing, reach out to your provider right away.
Once your incision is healed and free of residual stitches and glue, you can begin to get that scar moving. This is usually around 6 weeks post delivery, pending good healing.
Check out our scar massage videos below for techniques to safely mobilize your scar.
An indirect technique is a bit gentler than direct. With an indirect technique, you work around rather than on top of a scar to get tissue moving. If you have a pretty recent or very sensitive scar, this may be the best technique for you to start with.
There are various techniques to mobilize a scar Image used with permission from Pelvic Guru®, LLC www.pelvicglobal.com
You can gently use indirect techniques during that initial healing phase as well.
Direct techniques are working right on top of that scar and detailed in the video. If you feel a bit more comfortable touching or your scar is a bit more mature, you can try direct techniques.
A scar can take anywhere from 6 months to 2 years to mature. Ideally, perform scar massage 2-3 times per day for 5-10 minutes per session.
Check out our handout here for more details on scar massage and techniques to desensitize your scar.
Managing constipation
Those first postpartum bowel movements can be a terrifying thing. Sitting and straining is the last thing that you want to put a fresh abdominal scar through.
Hydrate, incorporate fiber, and gentle movement to keep your GI system in check. Talk to your provider about safe supplements you can take in the hospital to keep your stool soft.
Keep your knees higher than your hips using a stool or a squatty potty if available and exhale as you bear down.
Working your “core”
What does “core work” look like after cesarean birth?
Your core muscles are more than six pack abs. Think of your core like a canister with your diaphragm (breathing muscle) on top and your pelvic floor at the bottom.
The “core” is really like a canister as seen here where the diaphragm forms the lid and the pelvic floor, the bottom.
Permission to use copyright image from Pelvic Guru LLC
Initially your provider will have you on strict lifting and exercise precautions for several weeks, but in the meantime, you can start building “core” strength.
Core work starts with the breath. Try umbrella breathing.
For this exercise, envision your ribcage in 360 degrees. As you inhale, let your ribs open from front to back and side to side and exhale, collapse the umbrella.
Umbrella breathing safely and gently starts activating your deep abdominal muscles and your pelvic floor. As a canister, these all move together.
Traditional kegels may not be the answer for everyone, especially if you’re experiencing pelvic pain, but getting your pelvic floor moving is important for both improving strength or lengthening your muscles.
Try pelvic floor active range of motion. Instead of squeezing as hard as you can, take a gentle inhale and on your breath out, gently pull your muscles in like you had a marble at the vaginal opening that you want to close and lift. Take a big inhale and release any tension in your pelvic floor.
The idea is to get those muscles moving up and down rather than strengthening at this point.
Cesarean recovery isn’t easy. Let our pelvic health specialists at Hudson Valley Physical Therapy help you after cesarean birth.
Martin, J. A., Hamilton, B. E., & Osterman, M. (2019). Births in the United States, 2018. NCHS data brief, (346), 1–8.
J.A. Martin, B.E. Hamilton, M.J.K. Osterman, A.K. Driscoll. (2021). Births: Final data for 2019. National Vital Statistics Reports, 70 (2), 1-51
Sherrod M. M. (2021). Fifty Years of the Rise in Cesarean Birth in the United States and Opportunities for Improvement. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN, 50(5), 515–524. https://doi.org/10.1016/j.jogn.2021.05.002
Silverman, M. E., Reichenberg, A., Savitz, D. A., Cnattingius, S., Lichtenstein, P., Hultman, C. M., Larsson, H., & Sandin, S. (2017). The risk factors for postpartum depression: A population-based study. Depression and anxiety, 34(2), 178–187. https://doi.org/10.1002/da.22597