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International Cesarean Awareness Month

April is International Cesarean Awareness Month (CAM). It is important to note that the idea of awareness globally around this topic is not just to help educate on overutilization when unnecessary but also that there is a lack of access to this procedure when it is necessary – both scenarios causing an increase in morbidity. According to research, 25 percent of countries underuse cesarean sections, while 60 percent of countries were found to overuse the procedure (Wiklund, I., 2018.). Some of the goals of organizations such as iCAN and CAM are to bring education, awareness and advocacy in order to:

  • Lowering the rate of preventable cesareans is vital to improving maternal-child health
  • Policies do not override a persons’ right to informed decision
  • VBAC bans are unethical and unenforceable for hospitals to People have the right to informed refusal, which includes declining a cesarean.
  • For most people, VBAC carries lower risks than a repeat
  • A healthy birth incorporates emotional, physical, and spiritual well-
  • When a cesarean is necessary, it can be a lifesaving surgery, and worth the risks

As a pelvic floor therapist, I can help play a role in these aspects especially physically and emotionally in preparation for delivery, recovery and in many cases attempts with trials of labor after a primary cesarean. As a cesarean and VBAC mom myself, I want to share both personal and professional aspects of cesarean awareness all month long. Stay tuned!

Tips for Preparing and Recovery for a Cesarean

While I am a big advocate for minimal intervention vaginal birth as a preference, it doesn’t always happen and I would like to start by saying no birthing way is wrong. Where the “wrong” comes in is when mom isn’t informed about her rights or her options, her consent is coerced or her voice has been silenced out of convenience.

With that being said, even if you are planning a vaginal birth as so many mamas know, there is that chance that it will end in cesarean surgery. If I can say anything that stays with you in this post it is that moms even in today’s medicine are not prepared prior to or post delivery for how significant this is. Your cesarean is a major abdominal surgery and nothing less!

  • some hospitals have it as protocol to issue a support belt to be used during the first week or so (I would recommend asking what your OB/Midwife/hospital protocol is)
  • Utilize good body mechanics – like in pregnancy, it is probably challenging to just pop up out of bed. After surgery, it is even more critical to use optimal body mechanics including log roll techniques when getting in/out of the bed/couch etc.
  • Listen to your lifting precautions – if you aren’t given any for some reason, I would stick to the rule of nothing heavier than the baby for the first six weeks or so (that means just the baby – not the carrier!)
  • Start gentle scar mobilization early – I will include an entire post regarding this information, but your pressure should be very light in the beginning and as your incision heals your depth/pressure can increase to improve extensibility between the layers of tissue.
  • HYDRATE!! The last thing you want is to have issues with constipation or straining for your BMs postpartum and if you are taking pain meds there is a greater risk of You may even want to consider a stool softener (I know with my c-section it was prescribed to me)
  • And finally, start our breath work early! This is important across the board but can really help with abdominal mobility and healing the connection with the pelvic floor.

Cesarean Scar Mobilization

Why is scar mobilization or massage so important? There are so many reasons why and this is a conversation that I have so many times over especially with my cesarean moms but also with laparoscopic and other abdominal surgeries and similarly in the orthopedic population with joint replacements and laparoscopic surgeries.

When the scar is not addressed, adhesions can be present around organs especially the colon, ovary, uterus and bladder. Restrictions can also reside in the fascial layers of the body. The issues that I see frequently related to abdominal scar restrictions include low back pain, bladder issues including frequent urination and pelvic pain/pain with intercourse to name a few. Additionally, scars can become hypersensitive and scar mobilization can even help with de-sensitization of the area.

When scar tissue begins to lie down, it is very haphazardly without regard to the alignment of any of the soft tissue configurations. The goal of scar mobilization is not to “break up” the scar tissue but to help realign and when done in the early stages help prevent the adhesions from forming at all or as significantly.

The first few weeks are a great time to start focusing on desensitization. Taking a variety of fabrics – soft cloths, tulle, baby blankets etc can help bring awareness and appropriate sensation to the area. Start moving more around the area and as it becomes more tolerable you can move closer to the incision.

Between three and six weeks, the tissues can begin mobilization focusing on the more superficial layers of the skin. Think of moving the area in multiple directions to help improve alignment in relation to the layers.

Progression from 6-12 weeks, it is important to start moving deeper into the tissues. First in the muscles/fascia and then to the organs. Again moving around the area of the incision then more directly on the incision.

Doing this around 5 minutes a day and working into your connection breath routine can make a tremendous difference in healing process and long term functionality.

If you are having difficulty with this or feel that you are not getting a response from the work you are doing, it would be helpful to reach out to a pelvic floor therapist to help guide you through the process and build a safe and functional progression.