C-Section Recovery

C-Section Recovery: A Journey to the Core
Recovering from any type of surgery is not always easy but recovery following a c-section has its own set of very specific challenges that women have to overcome.

First of all, you don’t get to recover on your sick bed, with people looking after you and easing you back to health. Nope! You have a little ‘bundle of joy’ who is crying for you to feed, change, cuddle or comfort. You have to hit the ground running (not literally!); you have to look after this little one who is depending on you for everything!

How do mums do it?
I remember working on a surgical recovery ward in hospital when I was a young and junior physiotherapist. I would go to the end of the bed of a patient who was day one post-op and chat to them to promote the positives of getting out of bed, mobilising and at least getting to the bathroom. It was always a challenge and I felt I needed a ‘carrot on a stick’ to motivate them to even sit on the edge of the bed. But then, two years later as a more senior physiotherapist I found myself working on the maternity wards and I can distinctly remember being astounded by how there were women walking around a short while after their c-section, standing and carrying their babies and sauntering (sometimes waddling) to the bathroom to get a shower so they could feel the reviving benefits of the warm water on their bodies. I was amazed! What was so different?

The benefits of positive psychology
The psychology of the c-section is very different to that of an operation to remove or deal with a painful or life threatening problem within the body. A c-section is often the exciting end point of a long pregnancy. Some are the end of a traumatic labour and the relief of birth, whatever the method, it is clear to see on the faces of all involved. But as a mum, there is no sick leave, no time off, it’s work as usual. There are all the checks and visits, advice and leaflets, the excited visitors and endless text messages and social media ‘congratulations’. The mind is almost over stimulated with the happiness this new arrival brings. And for the new mums, there is the daunting feeling of trying to get the feeding right, how to change a nappy, how and when to bathe and so on. But all the time, there is this lovely little one that you can’t take your eyes off, this one that fills your whole self with happiness.

But what about mum?
And this is the difference. It’s positive in the majority of cases. And the emphasis is on the baby. But what about mum? It’s great that your mobilising quickly, you were out of bed before the midwife could even get the physiotherapists out to you! But physically, your body is affected in the same way as any other surgical intervention to the abdominal wall. Your abdominals are one part of your core cylinder, and at this early stage, it is so important to protect that core. Lifting the baby is fine but lifting the car seat too? What about the pram? Or the hoover? Well, the visitors are coming around, I don’t want home to look messy, what would they all think? It is so tempting to think, ‘I’ve just had a baby, I’ve got to get on’. No you don’t! It’s so important to protect your core.

Follow the advice
Try not to expect too much too soon. Take a look at the following link to a very useful booklet written and provided for download by the Pelvic, Obstetric & Gynaecological Physiotherapists group.

In a nutshell
1. Take pain relief as and when you need it according to the prescription guidelines
2. Avoid lifting anything heavier than your baby for the first 6 weeks (I’m looking at you who says, It’s been a couple of weeks, I’m sure it’ll be fine)
3. Gradually increase your activity levels within your pain and fatigue limitations – Listen To Your Body!
4. When coughing, sneezing or laughing, apply firm pressure to the wound to protect it and to prevent it from feeling too sore
5. When home, if your friends or family come to visit, accept offers of help where possible. Each visitor could help in some way:
a. Meals prepared and stored in your freezer
b. Hoover the downstairs
c. Put your bins out
d. Take the washing out of the machine – or even sort your washing out completely
e. Do a batch of ironing
f. Walk the dog
g. Cut the grass
The list could go on and on and depends on what you need. In South Wales, there are companies such as PEARL and Smooth Starts that will charge an hourly fee to help out around the home and even walk the dog. It’s worth looking into, for the early days at least.
6. If your body is tired, allow it to rest. Don’t feel guilty.
7. Get some good nutrition down you! Nutrition is the foundation for healing. So often once the baby arrives, it’s snatch what you can, when you can. A piece of toast here and a packet of crisps there, takeaways and missing meals. Either accept help from friends and family, prepare meals for the freezer while you are still pregnant (they’ll keep for 3 months!) or use companies like Cook (in the Cardiff area) for healthy ready meals. Avoid snacking and high sugar diets, it really won’t help you to heal! And neither will caffeine, try some substitutes and definitely invest in a smoothie maker – a good smoothie can really set you up for the day and can be drunk while breastfeeding.

Bridget Jones’ Pants (No Joke!)
Wearing supportive underwear in the first 6 or so weeks can be very comforting and useful. Again, we’re looking at protecting the core. A good pair of ‘hold-in’ knickers, supportive leggings or even a pair of EVB sport leggings (www.evbsport.com) can really change the way you feel about your tummy.

Restoring your core
So now you have begun to protect your core, let’s look at starting to reactivate it and restore it so you can get on and enjoy being a mum. We need to be realistic here, your whole core has undergone a huge amount of change over a long period of time. It’s unlikely to spring back in a week! And if it does, you might not want to shout about it at your next NCT class for fear of being lynched by those mums mourning the loss of their toned tummies!

Stand tall (whether you’re 4’10’’ or 5’10’’)
First of all, you need to think posture. A mum’s posture is often the last thing on a mum’s mind. Once the firm baby bump has disappeared and your left with a jelly belly, it’s not easy to stand up straight, sitting slumped is often the go to position and baby on hip with weight through one leg is so common, it’s frustrating! Aim to stand tall, keeping equal weight through both of your feet (in standing) and seat bones (in sitting). Gently activate the abdominals and try to tuck your tail in under you, as if lifting your pubic bone to your chest. Don’t just suck in though, it’s important to breathe at the same time. Practice this in sitting and standing, with or without the baby in your arms – practice makes perfect and soon you will be feeling taller, stronger and more upright.

The booklet mentioned earlier has some useful exercises in it. They can be performed on a daily basis over the first 6 weeks. You can progress through them as you feel able. Don’t forget your pelvic floor exercises though, you may not have delivered naturally but they still need work!

Start on the inside
Working your deep abdominals and pelvic floor muscles can be tiring initially, so find your most comfortable position (usually lying down) and practice little and often through the day. The aim is to tighten around your back passage, as if stopping yourself from passing wind. You should feel a squeeze and lift sensation. Pull this forward as if trying to bring your back passage up to your pubic bone. At this point, if you are able, try to pull your belly button down to your spine. Instead of sucking in, imagine putting on a pair of trousers that are too tight, pull your lower tummy away from the trouser belt and feel the tension increase around your scar. Aim to hold this for 5-10 seconds and repeat 5-10 times in a row – this is just a guide, you need to go on how you are feeling at that time.
Simply doing this exercise will not help you to get back to normal though. Sorry! You need to build this exercise into every day activities. For example, try bracing those muscles whenever you lift the baby. This helps to restore the protective actions of the core and reduce the risk of back pain, abdominal separation and pelvic floor muscle dysfunction, incontinence and/or prolapse.

The Mummy MOT
The Mummy MOT is a great way to find your way back to normality after a c-section or any type of delivery. This specialist physiotherapy assessment is ideally placed at 6 weeks post delivery but could be started at any time and even if you are 6 years or more after delivery and have concerns about your core, book a session to find out what your physiotherapist can help you with. There are over 80 Mummy MOT practitioners across the UK and a couple overseas too! Find your local practitioner at www.themummymot.com.
If you have delivered by c-section and want to find out more about protecting and restoring your core in the South Wales area of the UK, contact me: info@gillianmccabe.co.uk .
From the basics to beyond the basics
Once you have gained that ability to restore your core, you’re ready to move on. It’s time for Samala. It’s time to push the boundaries and explore where your body can take you. Being a mum is a full time job, it’s active and strenuous. You need to be ready for every challenge that life will put in your path. Be ready and follow Samala’s excellent program to reach your core potential!