Let's Talk: C-Sections

 

Amy and I are the first to admit that pregnancy/delivery might NOT go as expected.

Delivery certainly has not gone the way I envisioned for either of my births and today I wanted to share more about my birth stories. As both a mama and a physical therapist, I'm also excited to share recommendations to help other mamas that will go through a Caesarean section in order to meet their little one. 

Let me back up and take you to where this story begins: 

I always envisioned a natural birth after attending women's health courses where I saw some of the most beautiful natural birthing stories. It seemed like a challenge to birth without pain medication and I was up for it.  I was nervous but excited to try a natural birth with our first baby. Well, my sweet little Brooke had ideas of her own. She was breech. From the time we knew this at 34 weeks until my C-section at 39 weeks we tried everything under the sun (including a failed external cephalic version). Alas, our snug little girl had no interest in flipping. During the cephalic version you could see her push her head back against our doctor! I experienced my first C-section. 

When I became pregnant with our second baby Avery, I again had the same nervous excitement that I did with Brooke about trying to have a natural birth. My OB was supportive of me trying a Vaginal Birth After Caesarian (VBAC). I prepared mentally as they finish line came near. Surely I wouldn't need a second C-section, right?!  Well, this time around our second baby decided she was far too snug to meet us. As we passed our due date, the risks to the baby with the plan of a VBAC increased. To be honest, I was fairly stubborn until my OB made it very clear that he and his colleagues were putting their foot down. We got to meet Avery at 40 weeks and 5 days. 

I felt robbed of my delivery experience both times. I've shed a lot of tears over this, but I know the light is that I have two beautiful and healthy girls. 

Now that I've been through the emotions, experiences, and recoveries of TWO C-sections...I knew I had insight to share. I knew that in a small way, helping others would take away some of the string. 

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Let's Talk C-Sections 

What to Expect the Day of

The morning of both my C-sections I had to be at the hospital REALLY early and then it was a waiting game. The nurses monitored my vital signs and our baby's. Next, they started an IV and had me change into a beautiful surgical gown. Once all of that was done, I was taken to the operating room and received my spinal. For me, this really didn't hurt. I felt a pinch and pressure. At the hospital where we delivered, my husband was not allowed in the room during the spinal and prep so mentally prepare for that. I wasn't. After this they positioned me and the rest was super quick! I had my baby in no time, which can be expected if everything goes according to plan.

Tips:

  1. Make sure you are an advocate for yourself. Although a C-section may be a more regimented than a vaginal birth, please still realize you have a birth and some control over your experience. Examples: For my second birth, I had a discussion with my physician about the scar and closure. After my first C-section there seemed to be a lot of scar tissue and the closure was really tight leaving excess skin hanging over. I wanted to be proactive in discussing this with my surgeon prior to my second C-section. I'm glad I did because it looks a whole lot different! Another example is planning timing with the nurses. They had to do rounds to check on both me and the baby, but I would ask them to come back if Avery was sleeping. They have a window of time to accomplish this, so the answer doesn't always have to be yes. Of course, if there are complications you get less say.

  2. When you arrive get settled in. Put things you need to reach in the TOP drawers, take your toothbrush out, put your shower stuff in the shower. This way when you get moving post-surgery it won't be as painful. Bending is the pits after C-sections, so preparing your stuff ahead of time can make a big difference! 

  3. Ask for your baby. When the baby is out the nurses immediately start doing their checks. Ask them to have your baby as soon as you can for some skin to skin time. I fed Avery for the first time as they closed me on the table!

  4. Think about waiting on visitors. It is such a special time for you, your baby, and significant other to get acquainted. If you are planning on breastfeeding, it is a learning curve and you may not want to do that with visitors. The nurses want you to feed your baby right away and then you'll be frequently be feeding your little newborn. My family is huge so I set one time for all of them to come, which also makes it special because they get to meet the new addition all at the same time. This makes it easier on me and that baby.  One benefit of a C-section is that it is much easier to plan since it is scheduled. 

  5. Hydrate and eat healing foods. I never eat the hospital food as I find it to have little nutritional value, at least at the hospital we deliver at! I have my husband and my family bring me food from the outside. ;) Along with getting proper hydration, I would highly recommend taking the laxatives that your nurses will offer you. My worst fear with a C-section is constipation. I cannot imagine how much that would hurt on top of the incisional pain that comes after C-sections. 

  6. Wear the pressure cuffs when you are in bed. At times I had to remind the nurses to put them back on. Don't do it yourself because you'll want to avoid bending that much. 

  7. Stand up when you are ready! It can be painful and scary, but it is best to get moving when you and your nurse think you're ready. Walk to the bathroom.

  8. Day 2. Move if you can. I walked both times often. I used the rocking chair in my room to feed and sit for a while. This was a lot easier to get in and out of then the bed! I would advise against low chairs. Make sure you raise the bed when you get in and out. Really you want to be thinking of everything that makes it easier on you and that surgical area. 

Helpful Products

Upspring C-section underwear: This was the only time I was happy to wear grandma panties. I couldn't wash these fast enough. The are high so they are comfortable on the incision and also large enough for the postpartum pads you'll be wearing.  

 

Abdominal Binder:  Everyone should be wearing these after pregnancy. It helps reduce swelling, expels excess fluid, reduces stresses on body and assists your muscles/connective tissue to restore to normal as quick as possible . I asked for one in the hospital and they typically keep them stocked. Just ask. They don't give them unless you ask. 

Support leggings: These sit below your bra line so you can hide your postpartum belly and make it comfortable to nurse and doesn't dig into your incision site. The fabric is comfortable and super breathable. 

 

Afterward…Now what?

What to watch for: If your incision is oozing fluid, very red, and hot contact your physician immediately . Your incision will be painful but make sure that you monitor and keep the area clean to reduce the chance of an infection occurring. 

Activity Modification

Allow yourself time to heal! It is normal for a women to want to jump right back into your routine after your baby is born, but slow your horses down ladies. It is important to realize you just experienced a major surgery. Allow yourself time to heal with allow your body the best opportunity to heal. I always tell my patients that with surgery you have one chance to heal correctly and if you rush it you cannot get that opportunity back. Transitioning to life with a baby after a C-section is hard, I'm including tips for the most difficult tasks below! Reminders: Accept help. Follow lifting restrictions.

Getting In and Out of Bed

Ouch! This tip will make it SO much better! It’s called log rolling! The name of the game is to engage the “core” as little as possible. If it's a plan C-section practice ahead of time!

Getting IN

  • Sit on bed. Position is KEY. Keep your hips in the spot they are going to be when you lay down. To determine where to sit, divide the bed into thirds and sit at the top 1/3 of your bed.
  • Scoot back as far as you can so that you are not sitting at the very edge of your bed.

  • Lower yourself onto your side. Move slowly and keep your spine straight, using your forearm. Your forearm should be under your shoulder.

  • As your body reaches the bed, lie on top of your bottom arm and place your top arm at your side.

  • Staying on your side pull your legs onto the bed. As you’re lowering your body onto the bed, bend the knees and pull your legs onto the bed.

  • As you keep your knees bent you can very slowly roll onto your back. Your shoulders, hips, and knees should stay aligned at all times.

Getting OUT

  • Bend your knees while lying on your back.

  • Move hips, shoulders, and knees at the same time to roll onto your side.

  • Your bottom arm should be underneath you and your top arm should be at your side.

  • Lift your body to a sitting position. Use your arm for support! To do this take your top hand and place it flatly on the bed in front of your chest and push through that hand. 

  • Lower your legs as you slowly raise your body to a sitting position.

 

Getting IN and OUT of a Chair

Another Ouch! Avoid low chairs and really deep chairs/couches. If you have a deep couch at home place pillows behind you so that you don't have that far to go backwards while sitting. At home post C-sections I sat on hard chairs that where easy to get in and our of. I avoided our couch like the plague. 

  • Scoot to edge of the chair.

  • Hinge hips and lean forward to stand up. Remember the cue: nose over toes ladies!

  • Maintain a neutral spine. 

  • Avoid sudden movement from sitting. 

  • Use your legs to stand upright. 

Baby location 

You will want your baby as close to you at night as possible, or ask for help at night. Getting up is hard at first. Trust me it gets better, but it is sore at first. Use proper pillows for feeding so you are not hunched over in your mid back. 

Scar Management

What is it?

Scar management helps to create the best possible healing of a scar. It is recommended that you wait 12 week to start this. You can start early if you are given the green light by your healthcare team. Often I find that no one is teaching women how to do this, so let me help!  There are SO many benefits: it reduces infection, aids skin and tissue motion.

How to do it: 

To perform scar tissue mobilization pinch the surrounding skin and surgical scar in your fingers rolling it in different directions. Up/down. Left/right. Right diagonal /Left Diagonal. You can also "twist" stubborn areas to get them moving. Use your three middle fingers and place them over the scar.  Rotate them clockwise and counterclockwise. Look for which directions cause movement restrictions when areas are stubborn! Once you find the restriction keep your fingers holding it and take 3 deep breaths. When you do this, see if the scar softens and try to  move the scar further into the restriction.  It is crazy how much more movement you can get!

Why should I care?

The scar can bind to the uterus, fallopian tubes, and ovaries making subsequent pregnancies more tricky. Also it does look nicer, so during the summer when you are back in that bikini you won't have to worry about anyone getting a peek of a scar that looks suboptimal. 

Desensitization Techniques:

Besides scar tissue management one thing that you can start right away is desensitizing the area. Often women experience sensitize skin in the surgical area. This is because they cut through your tissue and your cutaneous nerves. Cutaneous nerves are peripheral nerves that give your skin sensation. They can regrow and there are ways to help them regrow and also become less sensitive. Try desensitizing on a daily basis starting a week after your C-section. 3-5 times per day is best but something is better than nothing. 

How to do it: 

Make a little packet for yourself with different textures. At first use soft materials like a fuzzy cotton ball or a piece of silk. Later, use rougher textures such as towels, paper towels, soft velcro, corduroy, and sand paper. You will rub the C-section incision area with material. I often did these while snuggling my sweet babies or watching TV. This is so easy! Perform for 5-10 minutes at a time. At first it feels weird because you are actually slightly irritating the nerve to encourage it to heal faster. 

Best of luck ladies! Hope this helps in your recovery and healing!

-Krystle