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C-Sections - Expectations, Preparation and Recovery

1/3 Births and possibly higher since that statistic was last released is via Caesarean section. Some are life saving emergency events and some are planned. When a few clients started asking for my advice around their upcoming or post surgeries and Miriam from ParentTribe asked me to write it down I knew I wanted to share some of the less widely known information and recovery tips about c-sections.

Often Caesarean sections are emotive topics - for women before and after they take place. Of course not least because they are a major operation and like any major operation the process has it's risks. It is also worth mentioning at this point that all birth has it's risks - for example it could be argued that a c-section delivery would have a protective part to play in a woman suffering from prolapse so it does depend on your unique situation as to what kind of birth is right for you.

Having had 2 Caesarean sections myself I hope through this article I am able to provide balance and knowledge from a first hand point of view of what to expect, how to prepare and how best to recover afterwards.

What to expect:

The operation has been shown to have taken place since 1879 in Africa - long before European Doctors cottoned on to the fact that washing their hands and sterilising equipment would be of great benefit to their patients. (see image below)

The average C-section is performed in around 35-45 minutes and the child being born soon after the procedure is started. The anaesthetic used is individual to circumstances - this can range from a spinal block, epidural or general anaesthetic.

It is expected that you will spend at least 1 night within hospital following the procedure (if on an enhanced recovery plan) and possibly a little longer dependent on how the surgery and your recovery goes. This is to give enough time for any post surgical issues to arise, for your general well-being to be managed, your legs to have their feeling return to them so your catheter can be removed.

You will be given pain relief following the procedure which can range from

Ibruprofen and paracetamol to stronger pain medication if required.

You will be allowed to leave hospital once the midwives and doctors have checked that you are able to pass urine following the catheter removal and are generally well and ready to leave with your new arrival

How to prepare for a C-Section:

Having had 2 c-sections I would say that I learnt a lot first time around about how to prepare and cope with the demands of this surgery on my body.

If you have enough notice to prepare ahead I would suggest that you do a few things;

Months ahead:

- Teach your elder children how to get themselves in and out of the car seat/bath/toilet/anything else that involves lifting them

- Exercise for strength in your upper body and legs to assist you when you have a weaker core

- Take daily meditation and immerse yourself in factual videos about the c-section process (you can find one on my birth preparation tips blog) so you know exactly what to expect - even second time around I felt nervous beforehand. Keeping yourself calm and informed helps your mental health following the c-section if you have the benefit of prior knowledge

Weeks ahead:

- Prepare healthy meals and build up a good supply of freezer stash supplies for the early days where you might be not feeling up to cooking. Nutrition is one of the major components for scar tissue healing so include things that provide support for collagen repair (protein/vitamin e and c to mention a few and hydration). An example of a good meal to prepare might be a chicken casserole made with peppers, sweet potato and spinach made with real chicken stock derived from bone broth

- Think about arrangements - perhaps for children/pets/driving (it is expected you would be able to drive from when you can perform an emergency stop - or from 6 weeks - check with your insurance company to see your policy and how this effects you prior to having a newborn to try to negotiate that phone call around)

- Consider whether the people closest to you might also need some more support - for example if your partner is now taking on the role of 2 adults whilst you recover perhaps consider whether you need additional help or support for them also and what this might look like

- Pack your hospital bag accordingly - you may wish to have a back up bag left in the car for if you need to stay longer than anticipated.

- Consider your clothing for post birth - even bending to put on a pair of pants (without being able to bend) can feel particularly tricky (give that a go if you feel like a challenge). So pack things that are easy to put on and you can feed in (if you wish to breastfeed having a c-section should not affect this with the right support).

- Eat as healthily as you can. If you have ever experienced having a bowel movement postpartum you will know that this can potentially be an event all of it's own. Post surgery as your internals have been moved and handled you may experience trapped wind and constipation making this event a bigger one so to speak. Eating a diet that's rich in colour, fibre and staying well hydrated do have a big effect.

Days before:

- Keep up the daily meditations - as the day draws closer it's only natural to feel nervous about the unexpected. Stay calm and remind yourself of the process.

- Keep up the healthy diet, hydration really is key!

- Stretch and move your body - pay attention to your ribs, hips and chest - the tighter these muscles are the more pull on your scarring you'll have. When I had my first daughter I was convinced they'd stitched me up too tight on my left side - when in fact I was simply tighter in that hip. Having known this for my second section my recovery was far improved and didn't feel the significant pulling as I got up because I'd stretched beforehand


Short term:

- Get up as soon as you can post surgery - this will ease a lot of your symptoms and get your bowels moving too, easing any trapped wind. You can also drink peppermint tea to ease these after effects. When you get up try to keep both legs together and stand up on 2 feet (avoiding twisting through the torso). You will likely want to hunch over a little to protect the scar site to begin with.

- Make the most of the hospital beds that are adjustable to sit you up and lie you down again - if you don't have the luxury of this at home I would recommend sleeping on an incline for the first few days (I actually slept on the sofa for the first week following my second surgery) as the sitting up and down places a lot of stress on the incision point

- Likewise be mindful of doing movements that mean you bend backwards - for example washing your hair is best done with your head down not your head back (I learnt that one the hard way!)

- Lift nothing heavier than your baby and the biggest piece of advice would be DO LESS. Move little and often but however "okish" you feel after 3 days now is not the time to beginning to do the washing or carry your toddler. The less you do the faster you will recover. I found this very frustrating but listening to this advice second time around instead of "seeing how much I could get away with" attitude I had the first time HALVED my recovery time.

- Understand that every day you should feel better (unless you've ignored my point above and had a set back) so no matter what - tomorrow is a new brighter day.

- Stay on top of your pain medication. Don't wait until you feel pain to take it or try to skip it altogether early. Keep a log of your medication so you don't forget when you last took it.

- BIG PANTS are your friend, along with any waistline that sits above your scar - now is not the time for those under the bump maternity jeans. They may feel stretchy beforehand but the scar is often very sensitive and the slightest rubbing may irritate it.

- Allow water and soap from the shower to run over the scar, don't rub too hard as the sticky residue from the plaster - allow time for that to come off

- Avoid baths until you can comfortably sit back up and down again and your scar is healed

- Always contact your health care team if your pain gets worse, your scar smells bad, starts bleeding, leaking liquid of any kind or if you feel unwell.

- Be kind to yourself - you've just given birth and you need to rest. Enjoy your newborn bubble

Longer term:

- Treat your pelvic floor as if you've birthed any other way. The pressure that pregnancy places on the body means that you still will need to provide flexibility and strength to the pelvic floor. In some case you may find that as the abdominals have been compromised that the pelvic floor takes on a larger role and needs more relaxation as well as strength. Focus on the inhale and the exhale on your pelvic floor exercises. To find an example of a good pelvic floor exercise pop across to my 7 day core rehab programme (hint doing squeezes like you are stopping yourself going to the toilet aren't ideal)

- Scar massage - It takes up to 2 years for any cut or graze to heal through all the epidermal layers and during this time adhesions can form around the scar site. These adhesions can be at best give a lack of function to the core and at worst bind organs together. Once your scar has healed it's time to begin your scar massage. For some women - particularly those who had an unplanned surgery this can feel emotively overwhelming. If you find yourself in that situation prior to the massage it's worth seeking some assistance for any potential birth trauma you've not uncovered as being able to touch and move your scar is important for long term function and health.

How to massage your scar:

Follow this video for an explanation of self massage or seek out your local women's health physiotherapist or other qualified scar tissue massage therapist for them to assist you instead;

- Move your body and address your imbalances. The feeling of moving slightly hunched over for you might take longer than ideal and this can lead to over-tight and stretched muscles. For example if you hunch forwards you may find this leads you to having back pain that otherwise may not be associated to your c-section. Equally if your pelvic floor s a little too "on" following the compromise of the abdominals you may feel the lower back flares a bit too much.

Focus on your exercise prescription being one of strength and posture not based just around weight loss or shape change. It's paramount for long term health following a c-section that you keep on top of your movements.

Even as I wrote this today my lower back was a little achy 7 months on from my youngest because my scar had tightened up and needed addressing (remember it takes up to 2 years to heal - but also I'd probably recommend doing your movement and scar work for life to maintain it's function). Certain exercises I found particular helpful for moving and loading the fascia around the hips included the Pilates 1 leg circle (SLOWLY! and without movement of the hips) , pelvic clocks and pelvic 1 leg knee folds.

Pilates 1 leg circles:

Pelvic clock exercise:

Glute strength can help assisting flexibility and strength to the pelvic floor so keeping on top of that can also assist long term. A good example exercise for this would be the fire hydrant

The fire hydrant:

Long term you want your scar to feel soft, pale and not have numbness or pain to it. Should you find that it feels tight, indented, painful or like cheese-wire it may need a little bit of work.

Example of an indented scar:

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