C-Section Recovery
I’ll start this off by saying that any version of giving birth is difficult. There is no “easy way”, whether vaginal or cesarean delivery. There is so much variability within those two modes of delivery themselves, and so many factors that contribute to an individual’s rehabilitation, that it’s impossible to say one is easier than the other. Given the choice, I would’ve wanted to avoid c-section, to be able to have a little bit more movement available to me right away and not to miss any aspects of my daughters birth. Unfortunately, I felt them cutting into me with the epidural and I had to be put under general anaesthetic and be intubated. I ended up missing the first 30 minutes of her life and Caleb needed to provide the skin to skin contact. That being said, C-section saved little Rose’s life (cord was wrapped around her neck twice), and a vaginal delivery would’ve been quite impossible. In the end, I’m just grateful my daughter and I are both safe and sound, so my “birth story” ended the best it could’ve!
My other preface to this blog post is that I myself have been incredibly fortunate to have my husband be taking paternity leave so that he can help take care of me and Rose, and that I was able to continue being active and exercising all through pregnancy. Obviously, being a physio is also helpful in terms of pacing my recovery and understanding the procedure/healing times. Still, there isn’t a ton of research out there on c-section specific rehab, and as per usual I think the 4-6 week guideline is quite vague; and challenging for the average person to figure out. To go from 6 weeks of presumably doing nothing to being given a green light for everything at the end of that, isn’t the best recipe for success. I don’t treat any post-op patient that way at the clinic. I think there’s valuable movement that can happen within that 6 weeks, and after that 6 weeks it should be a logical progression to your previous activity level- not a free for all.
I think physiotherapy has a massive ability to address rehab in this recovery time frame, but also in women’s health in general. Between labour and push education, prenatal fitness strength and conditioning, diastasis recti rehab, pelvic floor rehab, and c-section recovery, this area is huge and under served. C-section in particular has limited good quality research available on early post op recovery and guidelines in that 6 week frame. One area of research that we do have a good chunk of data on is return to running and fitness postpartum… and this one breaks my heart. A recent study in the British Journal of Sports Medicine by Moore et al in 2021 stated that only 36% of women (881 were questioned postpartum) actually were able to return to running. I think a lot of women tend to get discouraged and accept “it’s just the way it is” after birth and deal with leaking, pain during sex, or other bothersome symptoms. I hate that this area is so under served and guidelines are so vague, because I think it’s contributing to the mentality of “this is just what having a baby looks like”. It’s no different than any other injury I see in clinic— do you actually have “a bad back/shoulder/ankle ____ etc” or have you just had your rehabilitation plan really poorly explained and delivered to you? We just don’t know what people are capable of until we fully explore this area. With that being said, I thought using myself as a case study but also explaining the process of pelvic floor rehab and c-section delivery (yes, even if you have a c-section you very likely still need pelvic floor rehab) would hopefully be helpful to someone out there.
Without further ado, here is my own personal rehab.
Days 0-3 were the freaking worst. With being intubated, you have a sensation of choking afterwards that comes out of nowhere, and you need to have a coughing fit. Coughing is one of the most painful things after C-section. With any abdominal or thoracic surgery, in physio we always recommend splinting (squeezing a pillow into the area of discomfort) at the same time you need to cough, laugh or sneeze. This helped a bit, but I still felt like hot garbage. When I woke up (emergency c-section was at 1:30ish-am on August 8th, Rose was born at 2:01am, I was holding her around 2:45, we all went to sleep around 3:30) at around 7am I paged the nurse to remove my catheter and IV. I wanted to move freely as soon as possible. There is some research to back this up, but I knew from physio experience the sooner you can get up and walk the better. We know this decreases the risk of blood clots, and improves GI motility, and usually decreases pain. Pain was definitely still there but I felt so much better mentally and emotionally when I could move myself and get to the bathroom on my own.
I had a horizontal incision, which is the more common one. While the cut through skin, fat, fascia, is horizontal, the rectus abdominus are split vertically through the linea alba still. The linea alba is what is separated during pregnancy causing diastasis recti. Sometimes this gets stitches as well, sometimes not. Usually once the incision is made in the uterus, the upper abdomen is pressed to encourage delivery of baby. The very first thing I noticed upon waking up was my diaphragm was insanely sore and trying to breathe into my stomach was painful. This is the first thing I started to work on, was belly breathing and try to connect pelvic floor with it. I then tried to do this in sitting, standing, and walking. This was difficult and probably took about a week to get good at.
The hospital usually tries to keep you for 48 hours, but I really wanted to get home. I kept up on Tylenol and ibuprofen for about 4-5 days, but then found movement and ice/heat as needed was more helpful for me. In the hospital when the pain as really bad I tried dilaudid (hydromorphone), but it really didn’t feel like it made that much of a difference for me to want to be on it. Caleb brought beers to the hospital and that was more helpful in my opinion J. We happen to live on a park that has a little loop right outside our door. On Day 4 I managed a very slow loop, Day 5 a very slow 2 loops, and progressed from there. My main pain symptoms were a feeling of tightness in my incision, ache in my low back, and pretty intense tailbone pain. The tailbone pain is a really common postpartum symptom women come in with all the time- all my labour pain was in my tailbone. Between the painful tailbone and the difficulty getting into a posterior pelvic tilt (you spend most of pregnancy in an anterior pelvic tilt to offset baby weight), I had to do quite a bit of sacral rocks and movement combined with my breathing. So, in addition to my daily walks, my mini rehab in those first few days looked like (video on instagram reels for further explanation)
· laying on my back, knees bent. Rocking my knees slightly back and forth for as long as I needed
· pelvic tilts: starting to move my hips back towards my face, like I’m starting to do a hip bridge
· moving my pelvis slightly to the left, and driving my right knee forward and vice versa for the other side. This is a “self mobilization” for SI joint that I teach to patients, or I do it for them in clinic.
· stretching deep hip rotators
· diaphragmatic breathing, pelvic floor activation
· gentle desensitization on abdomen (this literally looks like me tracing my fingers over my abdomen, no pressure applied.
As soon as I was up and moving a bit more consistently pain dramatically decreased for me, and I found I didn’t have to take anything and standing/walking/navigating felt much easier. I worked up to about 30 minutes of walking by day 6/7, and now as I’m at 2 weeks I can walk for anywhere from 1-2 hours. One of the other most common complaints for postpartum pain is upper back discomfort while breastfeeding and pumping. While working on pecs and traps can feel pain relieving, it doesn’t necessarily fix the issue. The amount of “dose” of you being in a hunched position while holding your baby increases dramatically once you start feeding, and the capacity for your body to hold you upright likely isn’t trained for it. My strength rehab programming that I started at day 10 mostly consists of postural support and mid back strengthening to counteract this.
I hope this is a somewhat helpful account of my own journey but also the value that rehab can play in recovery. It really isn’t much different in my opinion from any other post-op guidelines… Yes, we need to protect the surgical site and allow appropriate repair. However, we have other body parts and areas that can be challenged and logically WILL be challenged in day to day life. Postpartum recovery has a major rehabilitative need and it should be addressed, but we also should be addressing movement that can safely happen to decrease pain and optimize rehab. Again, everyone’s postpartum journeys are so different and I have been extremely lucky so far. For me, the greatest gift I could give myself is sanity that my body is starting to move for myself again, and while my exercise is much less than it was, it’s enough that I feel good about myself.