Cesarean birth is the most common surgery performed in the US.
What is it?
A surgery to assist in delivering a baby that cannot be delivered vaginally for whatever the reason may be.
Why do they do it?
Cesareans can happen for a variety of reasons – due to medical complications involving mom and/or baby, prior to or during labor/delivery (ie. placenta previa, blood pressure issues, infection, decels, and many other reasons); failure to progress during labor (use of doula support or midwife support significantly lowers this risk); position of the baby (common with breech or transverse presentation – again, some providers will still attempt vaginal delivery with these presentations); or electively due to a previous cesarean, previous high grade perineal tear during vaginal delivery, multiple pregnancy (twins, triplets, etc). Cesareans can be emergent, nonemergent, or elective – and should be a decision made by you with your care team and support system.
How do they do it?
Some of this depends on the reasoning why you are having the cesarean in the first place – emergency vs nonemergent vs elective.
But, the general concept is that they disrupt 7 layers of tissue in order to get to baby and deliver them through your abdomen – skin, fat, fascia, abdominal muscles, peritoneum, uterus, and amniotic sac are all cut through. In today’s practice, the incision is usually transverse (meaning horizontal) along the lower abdomen, just above the pubic bone – there may be other reasoning why a vertical incision or incision higher up may be necessary.
At the end of the day, cesarean birth is major abdominal surgery and needs to be treated as such. It is also the only major abdominal surgery that you are sent home with a new human to take care of. There is a lot of fear surrounding cesareans, but if we can be better educated on reasonings as to why they happen, what to expect when it is happening, and what to do after – there is so much power in that. Also, just because you had one cesarean does not mean that you HAVE to have another one. So if you wish to try for a vaginal birth after cesarean (VBAC), have a conversation with your provider on what that would look like.
Things you should know prior to labor and delivery to prepare for the possibility of a cesarean:
- The single most important thing you can do to minimize risk for cesarean delivery is to look up the cesarean rate at the hospital you are planning to deliver at – data on 95% of hospitals are accessible on www.leapfroggroup.org You can also inquire about individual provider rates at their office. A lot of state sites will list data as well with a quick Google search.
- The cascade of intervention (induction, epidural, some medication use, etc) and sterilized environment (cold, bright lights, etc) could impact the progress of your labor and increase risk for delivery ending in a cesarean – this is where doulas and midwives can be very helpful in minimizing risk of these being contributing factors and assuring that interventions are being used optimally and not just to increase the speed of labor and delivery.
- In some cases – non-emergent and elective situations – you may be able to ask for a “gentle cesarean” where you are able to visualize baby being born and in some cases can assist delivery out of your belly with use of your hands to push on the belly or assist in pulling baby out
- Unless there are medical complications with the baby, skin to skin should be able to happen immediately with you. If there are some complications involving you, skin to skin with a doula, partner, or family member should also be available.
- Again, unless there are medical complications with the baby, delayed cord clamping or lotus birth should be possible in this setting if that is part of your birth preferences.
- Your spouse may or may not be able to be in surgery prep with you, but will be able to be at your side during surgery in most cases
Things you should know after a cesarean birth:
- Use your abdominal binder in the immediate post-operative phase – I’m not usually one to promote “bracing”, but this one is important in the immediate post-operative phase. Eventually you want your muscles to do the work and that is where an obstetric/pelvic floor PT can come in handy
- Advocate for a physical therapy assessment to monitor your vitals at baseline/rest AND with physical activity – assessing your response to “exercise” and physical activity can significantly decrease your risk for being re-admitted for a medical complications
- Lay flat as much as possible whenever you are not caring for the baby – this helps with optimizing lymphatic flow to decrease swelling in the belly
- Do some light swelling massage on your belly – working from pubic bone towards heart
- Utilize ankle pumps, quad squeezes, glute squeezes, and breathing as muscle pumps to get swelling out of your legs and belly as well
- Use bracing techniques on your scar during bed mobility, standing up from sitting, coughing/sneezing, and pooping in the early days to decrease pain – check out our post on bracing here
- You can carefully start working on your incision day one – check out our post on different phases of scar care post-cesarean here.
Side note the cesarean “ledge” comes from scar tissue but also static lymphatic fluid aka swelling that doesn’t clear out – when we have chronic swelling like this, the body will actually lay down fatty tissue
While, of course, the goal is to always avoid a surgery, much more importantly is you growing the family you feel lead to grow and keeping yourself and your baby safe during delivery. C-sections are normal and while they can result in some complications, applying these tips and establishing a Primary Care Pelvic Health PT to assess and help you progress post partum and for the rest of your life can help you return to a normal life without any limitations compared to someone having not had a c-section.
Pelvic floor physical therapists are here to help you in your postpartum and post-operative recovery. Our goals are your goals and we are here to assist you in tapping into your resilience to forge forward in caring for yourself, your family, and reaching any other goals you may have. You can schedule an appointment here.
We are here to journey along with your in your motherhood health and fitness. Our goal is help you take care of yourself so you can take care of your kids and others!
Happy momming!
Dr. Cassie McDonald Ross, PT, DPT
Pelvic Health Specialist
Mom of 2 boys!
