Tips for recovery after a Cesarean birth
A Cesarean birth can be overwhelming because you are recovering from an abdominal surgery and at the same time, transitioning into motherhood. In this blog, I will give you tips to help with your recovery in the hospital and when you get home. I will also give you tips on how to massage your scar, which is key in avoiding issues such as low back pain, bladder issues and pain during intercourse.
Immediately after Surgery in the Hospital
General Movement: The goal here is to avoid excessive effort on your abdominal muscles when you roll over, get in and out of bed, and sit to stand or vice versa. In order to do this, keep your trunk in a neutral position as much as possible, no twisting and no bending forward at the waist. Your hips and shoulders should be aligned. Use your legs, arms and elbows to help you move instead of using your trunk. Bend at your hips instead of at the waist when you stand. When in the hospital bed, raise the head of the bed up before you get up, and raise the height of the bed up before you stand so your trunk doesn’t have to work as hard. Don’t let anyone pull you up. Rather, get them to give you a little push from behind.
Walking: Once the catheter comes out, try to get up and walk a little (like from the bed to the hospital chair or the toilet), even if it might be painful. Your body will want to hunch forward because of the incision but it is important to straighten up as much as you can. Mobility helps all the systems in the body to function properly and to heal so it’s important that you get up and walk a little.
Abdominal Muscle Contractions: Gently contracting and relaxing the abdominal muscles also helps with healing by stimulating blood circulation to the area and mobilizing the scar. This can feel quite uncomfortable when you’ve just had the surgery so the key is to do it very gently!
Ankle Pumps: While you are in bed, do ankle pumps to prevent Deep Vein Thrombosis (a blood clotting condition that can happen after a surgery). I recommend you do 5 minutes of ankle pumps for every 2 hours that you are awake.
Bowel Movements: The first bowel movement may be very difficult because of the pain in the abdomen. You will want to take advantage of the stool softener that your health care provider prescribes. In addition, support your abdominals by holding a pillow against them and relax your pelvic floor while you are passing your bowel. A squatty potty or stools can help prop your feet up to facilitate the passage of stool. A study found that chewing gum for 30 minutes, 3 times a day can promote gut motility and bowel movements. Chewing gum can also decrease painful trapped gas after the surgery, so get chewing!
At-Home Care
Once you get home from the hospital, give yourself permission to rest and heal. In another blog “I wish I did these five things after I had my baby”, I talked about the need to arrange for help so you can have the time to recover from birth and to enjoy time with your baby. As the Cesarean is an abdominal surgery, you may not be able to lift anything heavier than your baby or walk much for the first 2-6 weeks at home. Thus, it’s critical that you arrange for help with house work and baby care during this time.
Pain: Your abdomen will probably feel sore and tender for up to 4 weeks (sometimes even a bit longer) after a Cesarean. This is normal. Take the pain medication recommended by your care provider if the pain is too much.
Monitor Your Incision: Monitoring your incision daily in the first 6 weeks after surgery is really important because of the risk of infection. Look at your incision site with a mirror every day. Monitor for signs of infection which are: redness, warmth, increased swelling and oozing, and fever. Contact your health care provider if you notice any of these signs.
Movement: Try to limit your use of stairs to once per day and avoid lifting as much as you can for the first 4-6 weeks. Your baby is the suggested maximum weight that you can lift. Encourage your other children to cuddle with you rather than have you carry them. Talk to them about this before birth if you’ll be having a planned Cesarean. You can protect your incision with a pillow when they cuddle with you.
Walking: Walking is important for the same reason I mentioned previously, but I don’t mean walking for miles. Walk for 2-3 minutes at a time, 5-6 times a day. Walking with a stroller helps to keep you balanced and upright.
Carrying Baby: When you carry your baby, keep the baby close to you, and alternate sides. Avoid bending down to lower and lift the baby. If you need to put the baby in a baby car seat, leave the car seat on the table instead of on the ground. I would not recommend baby wearing until 4-6 weeks post-op.
Exercise: For the first few days after your Cesarean, do diaphragmatic breathing to decrease the adhesions around your surgical incision. If you are not sure what diaphragmatic breathing is, imagine filling your ribcage with air, imagining it gently expanding in all directions like a balloon. You might feel a bit of a tug and pull on your incision but it should not be to the point where it causes you extreme pain.
Compression Garment: A compression garment can feel amazing post-Cesarean because it supports your trunk, which may feel quite weak from the surgery. You can wear a compression garment up to 12 weeks postpartum. After this, you want to retrain your trunk muscles to function on their own once they’ve completely healed. I have heard great things about the Baobei compression garment but you may be able to find something that better meets your budget.
Cesarean Scar Massage
Massaging your Cesarean scar is crucial to prevent adhesions that can form around and on the scar, causing distortion of the connective tissue around this area. This distortion can affect the pelvic floor because the incision goes through a fascial layer that connects the abdominal muscles with the pelvic floor. This distortion can cause low back pain, bladder issues and pain with sex.
I recommend you start massaging around your scar around 6 weeks post-op and directly on your scar around 12 weeks post-op (assuming there is no complication or infection). Start by breathing consciously and gently touching the scar until you feel comfortable massaging it in gentle circular motion. For some women, if their Cesarean was a traumatic event, touching the scar might bring up some emotion. Acknowledge what comes up for you in terms of memory and emotion and see if you can acknowledge what you are experiencing and what you went through. However, if the emotion or memory of the event is too much for you, consider stopping and talking to a therapist about what happened. In my experience, the scar tissue cannot fully release until the memory or emotion attached to the event has been processed.
For those who are interested in learning more about Cesarean scar massage, I recommend this video from Lynn Schulte, the founder of the Institute of Birth Healing.
If you still experience low back pain, bladder issues and pain with sex after trying out all the suggestions above or if you are experiencing numbness or altered sensation around your scar, I recommend you see a pelvic health physiotherapist to get these issues treated. In a previous post, “Why you should see a pelvic health physiotherapist after a Cesarean birth”, I had explained in detail why this might be necessary.
I wish you the best in your recovery and don’t hesitate to contact me if you have any question.
By Mia Dang, PT / a registered physiotherapist with extensive supplementary training in pelvic floor physiotherapy and perinatal care
