It’s C-section awareness month! For anyone who has been through this themselves, you will know it’s not a walk in the park. If you’re going through this right now; it is a LOT to deal with, but I promise things will get easier!
It’s important to understand you’ve been through MAJOR abdominal surgery. And it can often occur as an emergency – so you have no time to prepare or process what has happened, until it’s happened. If this is the case for you, it can be really scary on a number of levels. There are normally so many events to make sense of leading up to the decision to go for c-section, and it can feel like it was all a bit of a blur (you may have even missed the birth if you had to have a general anaesthesia). The below grading system can help make sense of what happens; this is what the doctors use to categorise how quickly your c-section needs to happen.
Mental recovery
Around 3 out of 5 c-sections are planned. It is really important to acknowledge that this is absolutely the right decision for a lot of mothers, for a large variety of reasons. It doesn’t always make your recovery easier- but many women have very positive birth experience with c-section.
On the other hand, some women are left feeling scared, confused, disempowered, disappointed, or like they’ve somehow failed. Most birth centres have an aftercare listening/reflection service – you should absolutely utilise this if you feel like you have unanswered questions. Don’t feel pressure to use it straight away either; many women go many months before realising they would benefit from understanding what happened to them and their baby in more detail.
Depending on your circumstances, you may be in hospital for 1 to 3 days, or longer if you have more complications. Hopefully you will feel well supported whilst you are there, as there is a lot to take in! The thought of going home may feel a little daunting. You will need a good support system in place- if you feel like you won’t cope for any reason, talk to your midwife; there are LOADS of options and systems to put in place for extra support!
It is common knowledge that women are very vulnerable to “baby blues” or feeling tearful and low in the first few days/weeks post birth. This is primarily thought to be due to hormones, and can affect all women and is not relative to your birth experience. However, it is really important that if these symptoms last longer than 2 weeks that you reach out to your midwife/GP team for support, as it is not normal for these feelings to persist or worsen.
Postnatal depression (PND) affects 1 in 5 women in the first year after childbirth and can be linked to traumatic birth experiences – though it’s important to say having a c-section does not increase your risk of having PND. If you are experiencing symptoms of PND you are not alone – and there is help for you. It is so important that you talk about these feelings and get the help you deserve.
Physical recovery
There are SO many physical changes that occur in the 4th trimester, but many that are specific to c-section recovery. You may have never had major surgery before; now you’re recovering from that, whilst running on less sleep than ever AND looking after a newborn (and possibly other children too)?! Please remember to have some perspective and give yourself a break. Prioritise your healing, bonding with and caring for your baby above all else.
ASK FOR HELP
You NEED support. It’s not a luxury. When it’s offered, say yes. Even if you’ve got all the groceries in. Even if the house is fairly clean already. In any circumstance, when someone offers help, accept it.
If help isn’t offered, now is the time to ask for it. If you struggle with this, get your partner to ask instead! Whenever you allow visitors, ask them to bring something you need. Get them to make you a cup of tea, do the washing up, run the hoover around. Even the smallest things add up and make your life easier.
PAIN CONTROL AND ACTIVITY MODIFICATION
After any major abdominal surgery, regular pain relief and certain movement strategies are completely expected. You need to know how to move differently in order to protect your body and allow it to heal well.
REGULAR pain relief is a must. Many women misunderstand this and only take it “if they really need it” – this is NOT a good strategy! You should not be waiting for the pain to get bad in order to take something for it. Analgesia works best when it’s taken cumulatively; you will be much more comfortable if you take (for example) paracetamol and ibuprofen every 4 hours, as it has a chance to build up in your bloodstream and actually do its job. You should not just be taking painkillers “as and when” you need them like you would for a headache; your c-section recovery is clearly very different to a headache and as a result your pain management regime should be too!
A common myth/concern I hear all the time is: “I don’t want to take too much so that I’m masking the pain and doing myself more harm”. Understand this: your body is MUCH cleverer than that. You will absolutely NOT be doing yourself any harm by taking pain relief. If tissue damage is occurring, regular pain relief is not going to stop you from feeling that.
Using an ice pack regularly over the scar can be a godsend. In reducing pain, swelling and discomfort, it helps to speed up your recovery in the same way taking pain relief does. Make sure you have a stock in the freezer to keep them on rotation. If you don’t have one, someone you know will – again, ask for help!
Benefits of taking regular pain relief include less fear of movement, make you better enabled to move around little and often, and more likely to engage with exercise – all of which will help you feel more positive AND recover more quickly.
Another common concern is constipation/side effects of medications, especially whilst breastfeeding. It is a good idea to be taking a laxative anyway; you will want to avoid straining to open your bowels at all costs, as it is very important to manage intra-abdominal pressure (to protect your abdomen and your pelvic floor). Your GP can prescribe a stool-softener for you if you haven’t got one already. If you are taking ibuprofen, taking Omeprazole alongside it to protect your stomach is recommended (and completely safe during breastfeeding). Opioid analgesia, such as codeine/co-codamol, are known to cause constipation and are also contraindicated if you are breastfeeding. It takes careful consideration to decide if this is the right medication for you.
A regular regime of paracetamol and ibuprofen is better than sporadically taking stronger painkillers, so is a sensible place to start. But if you need something stronger then there are options so discuss this with your GP. Remember this is to speed up your overall recovery and will not be forever; you may only need to take them for a few weeks before you can start reducing the dose.
MANAGE INTRA-ABDOMINAL PRESSURE
Ensure you raise feet on a small step (like this one), RELAX, and breathe deeply into your belly when opening your bowels. This is the optimum way to empty your bowels, minimising the need to “push” – pushing is not good for your pelvic floor and more importantly, increases intra-abdominal pressure which we need to AVOID initially to allow your abdomen to heal well.
You should have been taught/advised to “log roll” in & out of bed, on/off chair etc. ALWAYS follow this advice in the first 6 weeks to allow tissues to heal and avoid any worsening of a potential diastasis.
Keep a towel / small pillow nearby at all times and when you feel a sneeze coming or you need to cough, apply firm pressure over your scar to make this more comfortable. You may also need to do this if something happens that you find particularly hilarious, or if you’re travelling anywhere in the car as you go over little bumps.
When lifting baby on/off a low surface – bring your body as close to baby as you can, by bending your knees and trunk, slide arms under baby and pull them really close to you, then straighten using knees and trunk at the same time. Do the same in reverse for putting baby down. IF you can – inhale as you bend and bring baby close, exhale during the hardest part of the movement (normally straightening up/bending with baby in your arms). Avoid (when you can) lifting baba with your arms out straight, as this will feel a lot harder in the first 6 weeks.
Above all else, listen to your body when it comes to staying active. Some women will feel OK to go for a short walk after a few days; for others it may take a few weeks. Please remember that everyone’s postnatal recovery is different and try to avoid comparing yourself to others- comparison is the thief of joy after all! Your body will feel different, and strange, and that’s OK for now.
HERE’S WHAT YOU SHOULD DO
“Exercise” can seem very daunting. Here’s what to focus on for the first 6-8 weeks:
- Any time that you spend upright counts. Stretch tall, lift your chin, stretch your arms- we don’t want your scar pulling and causing postural problems. If you can’t yet manage this, lie on your back, and stretch your arms as far back above your head as you can – if you can’t quite get them back all the way, rest them on a pillow behind your head and breathe into the stretch. A little pulling around your scar is actually a good sign – you are stretching far enough! But don’t force it into pain and certainly don’t do anything that will break the skin.
- Walking, little and often. Around the house to begin with, as much as you comfortably can. Build it up slowly. There’s no rush!
- Breathwork. Practice deep belly breathing, or “diaphragmatic breathing”. This will help release abdominal tension and prepare your pelvic floor for rehab.
- Gentle range of movement exercises. Test out bending movements around your spine and hips. It’s OK to work into some discomfort, but never force a movement into pain. A good rule of thumb is: if you’re having to hold your breath, you’re probably working too hard. As well as being good for your muscles and joints, movement helps prevent trapped wind – a common problem post abdominal surgery!
- Pelvic floor exercises. See my previous blog for tips on technique! For a lot of c-section mums, I find it necessary to concentrate on the RELAXATION even more than the contraction. Pay attention to the breath and get good at synchronising this with your gentle contractions AND relaxations.
- Scar massage. Once the scar has healed (no broken skin) start by gently using some bio-oil (or even just E45) to work into the superficial scar tissue. The aim here is to help make it stretchy and mobile, like warming up blu-tack. Work on all the tissue surrounding the scar as well as the scar itself. 5 minutes a day is enough! Silicone patches and gels can be used to reduce areas of redness or concern – get in touch if you have questions about your scar.
- Book your Mummy MOT! Some mums feel ready at 6 weeks, but if you feel as though you’d benefit from another few weeks of walking and generally getting to grips with your body, just do what feels right for you. Remember though that early intervention is very useful for scar massage progression, tips on abdominal wall healing, and exercises and strategies to help correct & manage any diastasis you have.
C-section recovery often takes a lot more out of you than you may have been expecting. Please above all else be kind to yourself and PROUD of what your body has been through. You will get back to what you love doing – whether that’s crossfit, pole dancing, running, chasing and throwing your toddler around, or being able to push a pram – there is a program to help you achieve it, you just need a starting point. You’ve got this, I promise!
I am always here to support you or answer any questions at whatever stage you’re at, please don’t hesitate to get in touch – and thanks for reading!