Preparing for a Cesarean Birth & Recovery
April is Cesarean Awareness month, but I wanted to get a jump start on helping Moms prepare for a cesarean birth. Let's be real…we need to support ALL Moms more postpartum. But this blog is specifically for Moms who are planning a cesarean birth, want to go into labor prepared for all outcomes or moms who are doomscrolling in the hospital after a c-section wondering what to do next. We are looking at support for the first two-ish weeks post cesarean.
Pain Management for Cesarean Births
A lot of the things we mention below will help decrease pain and increase wound healing postpartum. These are general recommendations and it is best to talk to your provider to make sure these recommendations are appropriate for you. If you have hypertension, blood loss, diabetes, or cardiovascular disease, blood clots, leg swelling or pain, then these recommendations may not work for you yet. Your provider will be able to ensure these supports are safe for YOU.
Abdominal Binder after a Cesarean
This is probably the number one recommendation I see providers and mamas agree with because it truly is helpful. Cesarean birth is a major abdominal surgery and quite literally cuts through skin, fat, muscle, fascia, and the uterus! We don't think twice about wrapping an ankle sprain for support, and the abdomen deserves that support as well. I recommend that new moms wear an abdominal binder as much as they need, BUT as little as possible. Try to wear it only when you are up and moving and remove it when you are at rest. If you have increased pain with breastfeeding, wearing the abdominal binder while breastfeeding can also decrease pain and discomfort. You'll want to put the abdominal binder on from bottom to top with a slightly upward pressure.
Lie On Your Stomach after a C-Section
Lying flat on your stomach can be super helpful after a cesarean. I know that most mamas don't like the idea, but it can be helpful for wound healing. The incision naturally has tension or pressure on it postpartum simply by sitting, moving and having your hip bent. Lying flat helps reduce that tension to help the wound heal. New mamas also tend to have a LOT of gas pain and discomfort postpartum and lying flat increases the pressure in the abdomen in a good way and allows the intestines to naturally push gas downward to be released as a fart.
Gas Pain and Cesarean Recovery
Gas pain postpartum can show up as physical gas pain and also as shoulder pressure., In addition to lying flat, having gum and mints available can help reduce gas pain.
Move.
Unless there’s a contraindication, one of the best things you can do in the early postpartum is MOVE! I'm not talking about going out and walking a mile. Simple exercises like breathing, hip, pelvis and mid-back mobility exercises, hip circles, trunk rotation, heel slides, and gluteal activation can help increase blood flow to promote wound healing. Just as we have moved to early movement after an ACL surgery or hip replacement, we want to do the same for cesareans.
Physically using the Restroom/Chair after a Cesarean Birth
Getting up and down from the toilet can be a new adventure all on its own and that doesn't even touch actually going pee and poop. First, let's look at your toilet. For some people, they need shorter or taller toilets to help meet their physical needs. Now, if buying a whole new toilet isn't in the budget, you can look into a portable camping bucket for less than $25. If pooping in a bucket is a no-go for you, then we can also support your body! First, you can stand with your legs wider than your hips when you go from sit-to-stand or stand-to-sit. This helps give you a wider base of support so you require less abdominal muscle work. You can also hold a pillow to your abdomen as you move for additional support.
Getting In/Out of Bed After a Cesarean
First things first, what does your bedroom set-up look like? Do you have a super low bed that feels like you're plunging into the deep end of a pool or a bed so high you might as well be a pole vaulter? Is your bed on the second floor of the house, away from a restroom or easy food access? If so, you may need to find alternative sleep arrangements. This may look like temporarily removing a box spring or moving to the couch temporarily. When it comes to physically getting out of bed, the log-roll transfer is the gold standard for movement. The log-roll transfer is affectionately known as the rotisserie chicken movement…your entire body rolls as a unit with your shoulders and hips moving together as you roll to the side and then use your bottom arm to push yourself upwards into the sitting position. If you have pelvic pain, it may help to place a throw pillow between your knees while you roll. If you notice increased abdominal pain, holding a pillow closely to your abdomen can help decrease that pain and discomfort.
Getting In and Out of the Car After a C-Section
Similar to the moves above, getting in and out of the car can be difficult. For a lot of new mamas, moving their body as a whole can be beneficial to not over-stretch the incision. Now is the time to accept help so you can use someone else to help pull yourself up in order to get out of a car.
Ice and Cesarean Wound Healing
Ice can be fantastic at decreasing pain and swelling. It is generally recommended to use for 10-15 minutes once an hour for the first 2-3 days post cesarean and then move away from ice. While ice is great at reducing pain, excessive use can also reduce wound healing so it is best to use for short-term relief only. When using ice, make sure you have a small washcloth or paper towel between the ice pack and your skin. The last thing you want is to turn your cesarean recovery into a Christmas Story adventure where instead of your tongue sticking to a pole, you have an ice pack sticking to a fresh wound. A nice alternative to this is using a frozen pad-sicle over your incision by placing the sticky side on the inside of your shirt and the pad portion over the wound. Padsicles warm somewhat quickly and are effective at reducing pain and still allow healing.
Breastfeeding Post Cesarean
Along with an abdominal brace to wear during breastfeeding, changing your position can help support both breastfeeding and cesarean recovery. A few ways to support breastfeeding is to find a position that is comfortable to breastfeed. I wish this was a one-size fits all, but the best position is the one that works for you and your baby at the moment. This may change as both of you change, adapt and heal. Typically, the cross cradle and cradle holds can be helpful positions. However, these require the baby to go over the abdomen and can increase pain. Switching to a football hold, side-lying position or laid-back position may decrease that pain. In the side-lying position it's common to need additional pillows between your knees to support your hips or to gently slide your top knee behind your bottom knee. You may also need additional pillows so the baby doesn't make direct contact to your incision in the early days.
Preparing Your House for Cesarean Recovery Support
I wish everyone could have a support team to help with cesarean recovery. In the event that isn't possible, I want you to be able to set yourself up for success. This includes stations set up around the house in all of the main areas you will be including the bedroom and next to your favorite chair. At those stations I would love for you to have an extra long phone charger that can be reached without reaching, full water bottle, lip balm, anything breastfeeding related you need (nursing pads, silverettes, nipple cream), baby needs (burp cloth, butt paste, diapers and wipes), and nutrient dense snacks. The number one thing I recommend if you don't have a support team is a bassinet to ensure that you have a safe place to put the baby when you are tired and both need rest without moving a lot.
High-waisted postpartum underwear
That's literally the recommendation. Underwear that goes over/under the incision and not on top of the incision are likely to be your new BFF. Companies like Kindred Bravely and Bodily have super soft, flexible underwear that are designed for cesarean mamas.
Incision Sensitivity After a Cesarean
After a c-section it is common for mamas to experience incision sensitivity – meaning they have numbness, aching, burning or shooting pain around the incision. This sensitivity can be relieved through both movement and scar tissue work. In the immediate postpartum, this can look very different than people expect. Movement can be as simple as being in table top position – just resting on all fours (hands and knees/shins) and breathing or doing a very gentle cat-cow movement that doesn't push into causing pain. In the immediate postpartum period, scar tissue work is usually desensitization, or helping the sensitive nerves to be less sensitive to touch.
Farts and Poops After a Cesarean
Farting and pooping postpartum can be intimidating due to pain, discomfort and not trusting that a fart isn't secretly a shart. My number one recommendation is making sure you are properly hydrated. If you are at all dehydrated, it will make bowel movements hard and require more pushing which can increase abdominal pain. The next best thing is using a squatty potty to support your legs and knees while going to the restroom. In addition to hydration, making sure you have fiber is another key. If fiber is new to your diet, start small and slowly add more.
Comfort Measures Postpartum
Birth, surgery and caring for a newborn can all be overwhelming. One of the best things you can do is utilize comfort measures and supports to make sure your sensory needs are being met. Some ideas include weighted blankets, heating pads (on back and neck), favorite smells, reading, music, fidgets, etc. The best thing is to remember to nourish your sensory needs so you can meet your baby's needs.
Cough, sneeze, laugh, oh my (How to handle a postpartum cough or sneeze)
In the past I have seen people recommend new moms simply don't cough or sneeze postpartum. And that advice is basically as helpful as wiping before you have a bowel movement…because really, who can control when they cough or sneeze? If you feel a cough or sneeze coming on, take a deep inhale and gently exhale right before you cough or sneeze. This will help your abdominal muscles start to move inward and provide additional support. It's also helpful to keep a pillow nearby so you can place it over your abdomen for outside support. If you're in the unfortunate time of being newly post-cesarean with a cold or flu, compression underwear and clothing can be helpful to provide additional support.
When things aren't normal…headaches, migraines, midback & CHest pain after a cesarean
I frequently see mamas that have a history of migraines, headaches, chest pressure, dizziness or low back pain. While these may be from simple things like dehydration, exhaustion, or hormonal fluctuations, it's important to never ignore them in the postpartum period. If you experience any of these, call your provider and go to the ER.
Postpartum PT/OT/chiro for Cesarean Birth
I wish everyone could have postpartum support. If you are struggling with numbness, tingling or pain that prevents you from enjoying your newborn, please reach out for additional support. Someone with the training to support you postpartum will be able to provide bodywork or additional support you need to fit your body's needs.
TLDR;
Diaphragmatic breathing
Lie flat on stomach for 10 minutes every 2 hours
Abdominal binder for as much time as you need but for as little as possible
Use ice sparingly
Move
Make sure you're hydrated
Use a squatty potty