C-Sections: what you need to know

In honor of c-section awareness month (thanks April!!!) let's talk about what a c-section is, expectations of healing, and how to optimize that healing.

Let's first take a moment to recognize that a c-section birth is beautiful, amazing, takes courage and resilience and strength, just as a vaginal birth does. Your birth experience is yours and it is important, regardless of delivery method.

PSA: c-sections are not only for child delivery! They may also be used for

  • Hysterectomy
  • Myomectomy
  • Some uterine prolapse surgeries

Just because this is a routine procedure does not mean that it's an easy recovery. It is often painful to move, difficult to carry things, and awkward/uncomfortable to pee/poop. The recovery is slower than you're expecting. You may continue to have abdominal swelling for up to 9 months and your body will continue to build up scar tissue around your incision site for 2 years. I'm not saying this to scare you, but rather to help you set expectations of what your recovery journey may involve. Most women I treat after this procedure wish they knew what to expect.

A c-section is a large incision that interrupts the skin, subcutaneous layer of fat, abdominal muscle (transverse abdominis & rectus abdominis), fascia, uterus, and amniotic sac if you have one. That's a *ton* of connective tissue that is normally there to give you support and maintain abdominal pressure, something that is important for lifting, carrying bending, and absorbing ground forces (when your foot hits the ground, a force goes from the ground all the way up through the body, 2x/body weight).

When this system is compromised by a large incision and then scar tissue development, it's super important you give it the love and care it needs to heal well so you can start to return to more normal activity.

Your doctor will tell you that you're all healed and ready to go at 6 weeks post-op. From their perspective, you are. Your scar is healed over, the incision looks good, you don't have any outstanding complications, you're good to go have sex and run and jump to your heart's content from a tissue healing perspective. HOWEVER it is *highly* (almost definitely) likely your abdominal and pelvic muscles, fascia, and uterus are all still recovering from the surgical trauma you sustained.

So, if the muscles, fascia, and organs still aren't functioning with mobility and strength, is it reasonable to ask them to do things they haven't done in months or perhaps a year?

If I were them, I'd say "no thanks!" and would definitely resent it if I were asked to then support your internal organs and sustain a contraction through running or jumping. None of us perform well when we're given a big job to do that we are entirely unprepared for. Typically, it results in a job poorly done, and who could blame us? We just started here after a long (necessary) hiatus and the first day back we're expected to operate at 100% capacity as if we've been doing this all along? No way.

What could happen if you do too much too soon?

Unfortunately, a lot. When the muscles aren't prepared for the activity we ask them to do, our body finds a way, and it may not be pretty but it works...for a time.

Typically it results in:

  • Lower back pain
  • Increased severity of menstrual cramps
  • Knee pain
  • Hip pain
  • Scar tissue sensitivity
  • Stress incontinence (peeing with laughing, sneezing, jumping)
  • Urinary frequency
  • Urinary urgency
  • Pelvic floor hypertonicity (increasingly tense muscles that become painful/dysfunctional)
  • Painful or uncomfortable sex

So, how do you prepare for returning to normal activity to avoid all of the above? First, we have to set some goals.

Goals for c-section healing:

  • Reduce scar tissue development
  • Improve scar tissue mobility
  • Improve abdominal and visceral fascial mobility
  • Increase abdominal strength
  • Reduce pelvic floor hypertonicity/sensitivity
  • Tolerate high impact activity without pain or incontinence

With goals, we know what we need to focus on, and these will guide how you progress.

What you can do immediately post-op:

  • Compression
  • Deep belly breathing
  • Go for short walks

After day 3 add:

  • Gentle stretching of the hips, quads, and hamstrings
  • Gentle seated spinal twists
  • Abdominal muscle activation in side-lying
  • Start to increase the length/distance of your walks as tolerated

3 weeks post-op:

  • Start using your hands to move the skin above and below your scar tissue. Move the skin up, down, and side to side.
  • Use a soft material (silk, cotton balls etc) to gently glide along your scar. This will get the scar tissue used to touch and help to desensitize it. Scar tissue is highly innervated and high sensitive tissue that needs touch, pressure, and movement to decrease the sensitivity.
  • Practice standing on one leg to re-learn how to use your core for stability when standing up. Start with a goal of 30 seconds and build up to 1 minute.

4 weeks post-op:

  • Now you can start to use your hands to move your scar directly, as long as the scar is healed over. If there is still significant scabbing wait until that has gone down.

There are many, many, many other things you could or should be doing during this time, however to recommend the best ones for you that are also safe would require a physical assessment. Often, women wait to go to physical therapy until after their 6 week post-op appointment, however visiting PT 2 or 3 weeks post op could get you doing things that would accelerate your healing and function, better preparing you to get back to doing the things you want/need without pain or discomfort.

As you can see, healing takes time, energy, effort, and patience. Give your body grace and appreciation for every amazing thing it does for you.

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