Cesarean Section: What I wish I had known

A Physical Therapist's perspective on what to know before the birth

5 Tips to guide and support you: know before you go!

One in four first time births in Washington state are cesarean section (c-section) births

1. Get educated and make a plan

- Research shows people report a more positive birth experience when they have more understanding of what is happening and some sense of choice and control. Though none of us can control every aspect of a birth, or even choose the birth method necessarily, even something as simple as picking the music in the operating room can help decrease stress and improve the birth experience.

- Several studies, show that physical therapy improves patient satisfaction and recovery time post-cesarean section and I would posit that understanding a little bit about what a c-section is can help make the experience better for most folks, even when the surgery wasn’t “plan A”.

2. Massage your viscera (organs) and scar

C- section is a challenge for core muscle recovery: the surgery involves cutting through about 10 layers of tissue. This includes skin and subcutaneous tissue, the core muscle layer (aponeurosis of transversus abdominis, internal and external obliques as well as rectus abdominis), the uterus (three layers of tissue), amniotic sac, and if needed bowel, adhesions and bladder may be moved during surgery. From first incision to birth is usually only 8-12 minutes! It’s closing all those layers that takes 40 minutes- 1 hour on average. Clearly there is a lot to “put back together”. Working with a physical therapist who does visceral (organ) massage can really help to keep the layers of tissue moving well and support a faster recovery. Additionally, any core strength and mobility work you do during pregnancy will also be helpful for recovery after a c-section birth!

3. Rest

Rest is key to recovery- after a c-section you’ve been through a major surgery, often after being in labor (sometimes for many hours)! Your body has been through a lot and deserves some rest and TLC. Ask for and accept help with child care, meal preparation, house work and driving. It’s not one of the “push through the pain” situations- rest is best to let your body heal.

4. See a Pelvic Floor Physical Therapist

Pelvic floor dysfunction is common post c-section, both in planned and unplanned c-sections. Pregnancy itself is a challenge for the pelvic floor, regardless of how the birth happens. Pain with sex, pain with using a tampon, urine leakage, slow gut motility/ constipation and high hamstring pain (often referred pain from tight pelvic floor muscles) are all very common after c-section births. The good news is that pelvic floor physical therapy can help recover from all of these conditions.

5. Ice and Undies

High waisted comfy underwear is worth the splurge for c-section recovery. Ice pack pocket in the front is a bonus. Icing is key over that incision for pain and swelling management! Have a couple of ice packs ready so you can switch out for fresh ones when you need them.

Postpartum Prehab

Physical Therapy during pregnancy improves labor & birth and facilitates postpartum recovery.

Prehab. Maybe you’ve heard of it. Maybe you haven’t.

Prehab is rehabilitation (rehab) that occurs before a surgery takes place.

Prehab is done to help an individual both go into surgery stronger and come out of surgery stronger.

Prehab helps make the post-operative rehabilitation faster and more efficient

Prehab is required if you are undergoing a joint replacement surgery or back surgery.

Prehab is highly recommended for ACL (knee) surgery or any other planned orthopedic surgery.

Prehab is supported by research. LOTs of it that proves the benefits of early rehabilitation.

Prehab should be the standard of care for labor and birth.

Think about it, not only does your body undergo magnificent and system wide changes during pregnancy, it then births a baby!

When you go into labor and a baby is born your body does some incredible things.

- Your pelvis literally opens up. The joints gap, they shift and move.

- The muscles of your pelvic floor stretch to four times their normal length. 4x!

- The fascia lengthens

- The organs shift out of the way

What the body goes through during birth is much more physically challenging and demanding then any of these other surgeries.

Prehab should occur before labor and birth

Prehab allows you go to into labor stronger and come out of your baby’s birth stronger.

Prehab helps make postpartum recovery faster and more efficient

Prehab is highly recommended if you are going to have a baby.

Physical therapy for pregnancy, labor, birth and postpartum healing is supported by research.

What does prehab for labor & birth look like?

1. Education on anatomy and physiology

2. Strength training

3. Mobility work

4. Breath and postural guidance

5. Manual therapy

Education: Knowledge is Power

Physical therapy during pregnancy first and foremost helps you learn and understand what is happening/will happen in your body. We take it upon ourselves to help you appreciate the dance that occurs between your body and your baby during labor and birth. We also share information with you about how to support your healing in the first 6 weeks postpartum.

Strength Training: Power is Power

Physical therapy guides you to strengthen your body to support you as your baby grows and your body transforms. We also develop an individualized program that helps you build the strength and stamina you will need for labor and birth. This is a key phase of prehab as what you do during pregnancy will set you up for your postpartum healing.

Strengthen training does not equal kegels.

Actually, please stop doing kegels.

Your pelvic floor needs to lengthen and relax, not hold with increased tension.

Mobility Work

Relaxin and other hormones are magnificent in that they provide a pathway to improved mobility, but this mobility isn’t a guarantee. If you’ve ever had an injury, back pain, hip pain, tailbone pain, or pelvic pain these are signs that there may be a lack of mobility in your joints or tightness in your pelvic floor and/or pelvic girdle soft tissues. Hands on work by a specifically trained physical therapist paired with an individualized daily program will help prepare your body for labor and birth which in turn prepares it for postpartum rebuilding.

Breath and Posture

The essentials. We spend all day breathing and standing or sitting. Physical therapy can help you learn ways to both support your growing body as well as to help you learn the best breathing mechanics and postures for you to labor in. We can help you formulate a road map for your labor, birth and early postpartum healing. It all starts with breathing.

Hands On Manual Therapy

Prehab is about more than just exercise. It’s about hands-on treatment by physical therapists that are trained specifically to support you during your pregnancy and prepare you for labor and postpartum healing. There are fabulous exercise programs out there, but prehab takes it a step further, optimizing your body for postpartum healing.

How to have a baby – a training guide for every kind of birth plan

If you were getting ready to run a marathon you would have a training plan. Getting ready to have a baby is no different. You need a training plan!

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How long is labor? The average labor is 8 – 18 hours, but it’s really not about quantity it’s about quality so let’s move on.

How long does it take to train for labor? The ideal training program is 9 – 12 months long. Don’t discourage though! Even if you only have a few weeks (or even days) left to train you can still significantly impact your labor by starting training now.

Exercise during pregnancy is about training for labor; an event that will require endurance, strength, patience, grit, flexibility, softness, and stamina. Just like any physical endeavor the better trained you are the more you will enjoy the experience. The more physically and mentally prepared you are the more likely you are to be happy with your labor and to recover with greater efficiency.

Why do I need a labor training plan? The body that you bring to pregnancy is the body that you bring to labor, make sure it’s ready!

That incredible body of yours that is growing a human life has a history to it. If you stop for a moment and think about it your body has been through a lot. Perhaps you are or have been an athlete. You’ve had injuries from your sport, maybe they were big or maybe they were small. Perhaps you’ve been in a car accident. Perhaps you’ve had your appendix removed, had an abdominal surgery, or a cesarean section. Maybe you have endometriosis, gastrointestinal (GI) distress, or painful menstrual cycles. Perhaps this isn’t your first pregnancy.

You have had an awesome life and your body is a road map of where you have been and what you have done. This map is your story and it proves that the human body is capable of incredible adaptation and perseverance. However, when it comes time to have a baby all of this adaptation can get in the way of having the child birth experience that you want. That’s where the training comes in!

How do I know what type of training plan to follow? The key component to any labor training plan is that it is a training plan for labor. A labor training plan should include education about what is happening to your body during labor and is focused on movements and exercises that support a laboring body.

This is an important distinction. There are many types of fitness programs for pregnant women that are more focused on keeping you in shape and assisting you to not gain too much weight. These programs can be good, but it’s important to understand the goals of the fitness program. If you do choose one of these training plans make sure you understand how to protect your loosening joints (thank you hormones) and avoid any exercises that create doming of your abdominal muscles (diastasis, no thank you).

What type of professional is best suited to provide me with a training plan for labor? Physical therapists who have specific training in pregnancy and pelvic health are your best choice. Some chiropractors also have training in this realm.

Which type of program is best for first time pregnancies? Any program that is training you for labor is perfect for first time pregnancies. With a first-time pregnancy the educational component of the program is even more critical so make sure this is a part of your training program.

I’ve already had one baby; do I still need to train for my labor? Yes! Yes! Yes! Your body has changed as a result of previous pregnancies and deliveries. Remember that road map we discussed? Labor may be smoother the second (or third time) around as your body has done this before, but that still doesn’t mean that you don’t need to train.

What are the components of a good labor training plan?

A good labor training plan will address the following components;

1. The pelvic floor - the pelvic floor is the stop light for birth. The tone in the pelvic floor both cues the baby to rotate and the pelvic outlet (the exit) to open. Too much tone can prevent the baby from turning all the way and can limit how much the pelvis can open to allow the baby to exit. The inability of the pelvic floor to relax can contribute to a more challenging and longer labor experience.

2. The deep core – core work during pregnancy is not about strength, it’s about maintaining tone and neuromuscular control of your deep core (diaphragm, pelvic floor, transverse abdominis and multifidi). This allows you to carry your baby more comfortably (think less back pain) and is a powerhouse for helping push/breathe that baby out!

3. The mobility of the hips and pelvis - there is this hormone called relaxin that loosens up all your ligaments for birth. Unfortunately, relaxin isn’t magic and a joint with limited mobility won’t yield to it’s wonders. Your training program needs to include movements you can do to help improve the mobility of your hips and pelvis.

4. Posture – the way your sit and stand impacts the position of your baby in your growing belly. This is especially important during the last month of pregnancy when we want the baby positioned in a good birthing position with their back facing out. When we sit in a slouched position gravity pulls the baby towards your back and can cause them to rotate.

5. Physical Therapy - A women’s health physical therapist who has been trained in prenatal care can further facilitate your pregnancy and L&D journey. Working with a PT will help you better understand your body and can ensure that your pelvis has the mobility necessary to birth your baby!

Are there ways I can start training for labor right now? Yes!

Here are a few tips to get you started. We would love to partner with you on this journey and make an individualized plan thats just right for you! Let us help you have the birth you want.

Make postural changes now … sit on your pelvic floor and avoid slouching

Coordinated diaphragm and pelvic floor movement

- Sit in a comfortable position (kneeling, on a blanket/yoga block)

- Inhale – bring your breath into the sides and back of your rib cage. Relax your abdomen, relax your pelvic floor (sit bones widen)

- Exhale – draw your pelvic floor up and in, abs pull gently in

- 10 breaths making sure to fully relax with each inhale and engage with each exhale

Keep your deep core stabilizers working

Deep Core Strengthening - Hands and Knees

- Hands directly under shoulders, knees directly under hips

- Round and arch your back a few times to find a neutral spine.

- On an exhale – draw your pelvic floor up and in and draw your belly button towards your spine lifting your baby closer to your body

- Inhale and fully relax your belly letting the weight of your baby move away from you

- 10 times.

Improve the mobility of your hips and pelvis – move every day

Work with a physical therapist that specializes in the treatment of pregnant women (hint: that's us!)