April is Cesarean Awareness Month! You may be wondering, do I need pelvic floor therapy if I’ve had a cesarean birth? Do I need to massage my scar? Can I work on my scar even if it has been a few years?
The answer to all of the above is yes! Our bodies go through changes during birth AND pregnancy, so all postpartum moms can benefit from pelvic floor physical therapy following a cesarean or vaginal birth. Below we delve into all things cesarean in honor of Cesarean Awareness Month!
Pack the ice packs
If you’re reading this before you head to the hospital, and you know you’re going to have a cesarean birth, pack all the ice packs. If you’ve had or are planning to have a cesarean birth, ice will also help alleviate any postpartum soreness in the abdominal or pelvic region. Ice helps reduce swelling, decreases pain and discomfort, and speeds up the healing process. I also recommend wearing pants with a soft waistband and using the packs over the incision site for the first week after birth.
Should you use a belly binder?
Following a cesarean birth, you are recovering from major surgery. The first few weeks should be focused on recovery. It’s important to keep in mind that belly binding is not a universal postpartum recovery step that every woman should take. Often if the abdominal binder is too tight it can cause pressure down on your pelvic floor, which has already had a lot of pressure on it after pregnancy and childbirth. However, I do recommend soft abdominal binders for some women with significant diastasis recti, cesarean births, hernias, or a mom of multiples who has a distended abdomen. Compression shorts or pants by BaoBei or SRC are great options in lieu of a binder. What’s super important is once healing is complete, to start training the abdominal and pelvic floor muscles to engage during recovery to help decrease pain and regain strength (which a Pelvic Floor PT can help with).
Your first postpartum poop
Pooping postpartum can be tough after surgery and even if you haven’t had surgery! Following a cesarean birth, I recommend applying pressure over the abdomen with a pillow as you gently exhale and bear down during bowel movements. This pillow supports the healing incision while you poop, and helps regulate intra-abdominal pressure during defecation so your stitches or staples stay intact. You may also find it helpful to use the pillow over your incision under your seat belt when riding in a car or when coughing.
Massaging your scar
I strongly recommend massaging your cesarean incision after it has completely healed to decrease scar tissue restriction, which typically occur between 4-8 weeks. Believe it or not, your scar can contribute to pelvic pain, painful sex, constipation, overactive bladder, incomplete bladder emptying and scar sensitivity. Get confirmation from your doctor that your scar has healed and work with a pelvic health PT or do an online session with one of our therapists to learn how to massage properly. Also please remember it’s never too late to work on your scar, even years later!
When can I return to exercise?
If this is top of mind, unfortunately your answer is probably not anytime soon.
Start slowly by getting out of bed to walk every day which can begin on day 1 after birth. Make sure you stand upright and avoid slouching to allow your abdominals muscles to elongate and not restrict at the incision site. You should also roll over onto your side to get in and out of bed instead of sitting straight up. Perform belly breathing when you are lying down to relax your abdomen. After a few weeks, then progress to performing gentle pelvic floor muscle/kegel contractions to initiate regaining muscle strength and function. You’ve probably heard that six weeks is usually the go-ahead, but you’ll want to get the clear from your doctor, and preferably a Pelvic Floor PT, before continuing additional higher intensity exercise.
What about a VBAC?
I couldn’t write a blog post about cesarean sections without mentioning a VBAC. VBAC stands for a Vaginal Birth after a Cesarean. Research shows up to 60-80% of women who go through a trial of labor to attempt a VBAC are able to have one. This is great news as many women unexpectedly have a cesarean birth and may want to try a vaginal birth the next time around. So the research is in your favor. Benefits include shorter recovery, decreased risk of surgical complications, decreased cesareans if you plan to have lots of babies, and the opportunity to experience a vaginal birth if that’s your jam. ⠀
What will decrease your chances of having a VBAC?
Two prior cesarean births
The mother’s age
Going past 40 weeks
Having a cesarean within 18 months prior
Vertical uterine incision
Measuring a large baby
Whether you’re preparing for a planned cesarean, planning a VBAC, or recovering postpartum, it’s important to educate and empower yourself with information and build a support team around yourself (including a Pelvic Floor PT).
Interested in more tips on how to prevent or overcome Pelvic Floor Problems?
Download this free guide for some simple, do-able, totally-not-weird tips to take better care of your down there.
Sara Reardon PT, DPT, WCS is the owner of NOLA Pelvic Health and founder of The Vagina Whisperer, a resource for online pelvic health education and therapy to help women worldwide with pelvic health conditions. She is a board certified women’s health physical therapist with a special interest in treating pelvic pain and pregnancy and postpartum conditions. She is a mom, wife, Saints fan and wanna be yogi.
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