How Pelvic Floor PT Helps your Cesarean
September 2017, I learned that I was pregnant for the first time. Immediately, my thoughts raced into those of denial, doubt, and fear. Why? I wasn’t sure I was ready to be a mother, and I didn’t have any clue about labor, how it would go and how I should prepare. Well, fast forward through my pregnancy, I did some research and had questions for my OB at every appointment. Due to my development of preeclampsia at 28 weeks, I found myself delivering my son at 29 weeks via cesarean. The reasoning, I was told that due to my blood pressure being so high and uncontrolled, they were afraid I would stroke with induced labor, and also, with him being only 29 weeks (2pounds and 1 oz), he was laying completely transverse.
The nurses took me into the OR, and one let me hug her while they inserted the line for the anesthesia. My husband was present during the cesarean, and once my son was born and whisked off to the NICU, my husband went with him. I was alone until they let my mom join me in the postop recovery room. Eventually, I was taken to the prenatal room I started in, and then they transferred me to another prenatal room to keep an eye on me prior to being moved to the postpartum side. The night of delivery, I was completely out of it, and sleep most of the time, the same with the next morning.
Around noon the next day, the anesthesia began to wear off. They cleared me to eat food, and I was able to order lunch. My foley catheter was still in place, however it was removed shortly after. Nursing staff was in my room regularly, they emphasized the importance of me using the incentive spirometer to protect my lungs, and the importance of me calling for help when I needed to use the restroom. Outside of monitoring my blood pressure, blood loss, fundal firmness, and other vitals, there wasn’t much education or information provided to me.
At this point, I had been a Physical Therapist in the acute care setting for three years. I had treated people post op before (never in labor and delivery, because the hospital I worked at didn’t have a maternity ward). I understood the importance of getting out of bed postop, and movement to promote circulation, muscle activation, and prevent deleterious effects of bedrest. No one came to my room to assist me with these things. So, I asked my husband to write three goals on the white board for me. Getting out of the bed once per hour if I wasn’t sleeping, practicing log rolling, and completing ankle pumps/ heel slides throughout the day.
Cesarean sections are minimized to a “belly birth” or just another form of delivery, but the truth is, it is a major abdominal surgery. The surgeon cuts through 7 layers of tissues (skin, fat, fascia, abdominal muscles, peritoneum, move the bladder out of the way, uterus, and amniotic sac). This means that multiple layers of tissue need to heal from the inside out. During the operation, women are kept awake, but anesthesia is flowing throughout your system, which can lead to suppressing your respiratory system. Side effects of any surgery include risk of bleeding and blood clots.
Getting out of the bed once per hour helps with your circulation and respiratory systems; ankle pumps and heel slides help reduce risks of blood clots; log rolling is important to help protect the surgical site- preventing strain, pain, and potentially ripping the stitches.
I knew to place a pillow over my abdomen whenever I needed to cough, laugh or sneeze- which helps prevent pain and strain over the site as well. Otherwise, I was given no other instructions. As someone, who never received a cesarean before, who had never treated someone postpartum before, there was much that I could have received. You have a baby, and they expect you to care for this newborn, but not yourself. It wasn’t until I was 2 years postpartum, and attending my first continuing education course for pelvic floor, that I learned there was so much that I could have done for my cesarean recovery.
Starting immediately postpartum, you can work on diaphragmatic breathing. This will help with your respiratory system, but also allow an internal stretch to your abdominal tissues, providing minimal mobility. Once the surgical tape/ adhesive comes off, you can apply compression to the scar via silicone tape, which can help to reduce scar thickness and progress the maturation process of the scar. Around 8 weeks postpartum, you can start on cesarean “massage”, which is more like a stretch- thinking about the deeper layers of the scar, helping to break up scar tissue to allow mobility of the visceral organs beneath, and the muscles in proximity. Ensuring freedom in the abdominal area helps your pelvic floor and the rest of your body thrive.
Of course, seeing a Pelvic Health Physical Therapist postpartum can help tie all of these element together for you, to ensure that you are excelling in mobility and life, caring for yourself while you care for your new baby. Even if you are two (or more) years postpartum (like I was), it’s never too late to address these issues and get you back on track!
