“I had a cesarean section…now what?”

More than 103,000 cesarean sections (c-sections) were performed in Canada last year, making it the most common inpatient surgical procedure in Canadian hospitals. As c-section rates continue to rise, it is pertinent for pregnant women and health care providers to be educated on the implications of this major abdominal surgery. While the cesarean is often viewed as a mode of delivery that spares the pelvic floor, the Society of Obstetricians and Gynecologists of Canada (SOGC) still recommends against elective cesarean. This post will explain and explore what a cesarean section is, what it means for your recovery postpartum, and how pelvic physiotherapy can help you.

1) What is a c-section?

A c-section is an abdominal surgery which requires an incision made through the layers of the abdominal wall and the uterus in order to deliver the baby. The most common type is called a lower segment cesarean section (LSCS), which occurs approximately 2 inches above your pubic bone or at the top of your pubic hair. Most often you will be given a regional/local anaesthetic, but a general anaesthetic may be recommended for emergencies. Once the baby and the placenta have been delivered, dissolvable stitches will be used to close the uterus and abdomen (sometimes your surgeon may close your abdomen with staples). A urinary catheter will be removed approximately 12-24 hours post surgery and you usually remain in hospital for 2-3 days.

2) What does recovery look like postpartum?

Once you return home, it takes approximately 6 weeks for the incision to fully heal. During this time, it is important to avoid heavy lifting and housework to prevent the incision from re-opening. Some other activities to be cautious of include: vigorous stair climbing, carrying a car seat, driving, sit ups, running, jumping etc. It is safe for your incision to get wet in the shower, as long as you make sure to fully dry it after to prevent infection. Although the incision usually heals after 6-8 weeks, there may be scar adhesions which can result in restricted movement of the abdominals and surrounding muscles. Often women will complain of ‘intense pulling/stretching/tightness’ indicating restriction in the layers of the abdomen. Everyone’s experience post c-section is different, but you can expect to have pain and numbness in the lower abdomen ranging from weeks to months. Lastly, while the incidence of urinary incontinence is lower in women who delivered by c-section compared to vaginally, it is still higher compared to women who have not had children. It is important to recognize that pregnancy and labour still affect your pelvic floor, even if you don’t deliver vaginally.

3) How can pelvic physiotherapy help me?

Research shows that physical therapy can help manage post-operative pain, reduce adhesions, reduce diastasis rectus abdominus (DRA), and promote a quicker return to activity. Some of the things a pelvic physiotherapist may assess you for are DRA, c-section scar mobility/restriction, and muscular activation/coordination of the pelvic floor, transversus abdominus, multifidus and the diaphragm. The physiotherapist will educate you on body mechanics and precautions to safely return to function and exercise. Even two weeks after c-section, you can start working on desensitization of your scar, as long as there is no seepage or scab. Desensitization involves gentle touching of the scar, as it can be quite sensitive post-operatively. The therapist will likely then progress to soft tissue mobilizations after about six weeks. They will include it in their treatments with you, and also educate you on how to mobilize your scar at home. It has been found that soft tissue mobilization is effective at treating chronic pain following a c-section with just four sessions.

In summary, c-sections can be an excellent and safe way to deliver your baby when there are complications or risks associated with a vaginal delivery. However, it is important to remember that it is a major abdominal surgery. Pelvic physiotherapy is a great resource to learn how to promote healing and return to activity safely after having a c-section.

 

References:

1. Nygaard I, Should women be offered elective cesarean section in the hopes of preserving pelvic floor function Int Urogynecology Journal (2005)16:253-254

2. Effects of Conservative Physical Therapy Management Following Cesarean Section: A Randomized Control Group Design. Laura LaPorta et al

3. McMahon, M. J., Luther, E. R., Bowes Jr, W. A., & Olshan, A. F. (1996). Comparison of a trial of labor with an elective second cesarean section. New England journal of medicine, 335(10), 689-695.

4. Rortveit, G., Daltveit, A. K., Hannestad, Y. S., & Hunskaar, S. (2003). Urinary incontinence after vaginal delivery or cesarean section. New England Journal of Medicine, 348(10), 900-907.

5. https://www.cihi.ca/en/c-section-rates-continue-to-increase-while-birth-rates-decline

6. https://www.babycenter.ca/a160/caesarean-section-basics

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