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Some women have children, while others don’t. Maybe you gave birth via a cesarean section (C-Section) or maybe your best friend just created her birth plan and will have a C-Section in a few months from now. It really doesn’t matter if you personally have had a C-section or not, as women I think it’s our responsibility to have a general understanding of the proper care following this rather big surgery so you can either help yourself or your friends, sisters, aunts, cousins etc. get the proper care they need.
A recent statistic I came across states that in 2020 31.8% of live births in the United States were cesarean births. However, most women only get one post-partum check-up with their OBGYN and are very rarely referred to pelvic health physical therapy. Things are a little bit different over here in Israel where I currently live. Around 25% of births in Israel end in cesarean section, however, even though the rate is a bit smaller, I’ve noticed that very few of my patients are actually referred to pelvic PT via their primary health care provider or OBGYN. Most of my patients who see me in the clinic for post-surgical care are referred by their friends or even read about the rehabilitation process online/social media.
What actually happens during a C-section?
During the procedure, the surgeon typically needs to open and pass through 6 layers of tissue to access the uterus and fetus. The six tissues include:
1. Skin
2. Subcutaneous tissues
3. Anterior abdominal fascia: which is comprised of 2 layers
4. Rectus Abdominis
5. Parietal peritoneum
6. Uterus: which is comprised of 3 layers
Following the birth, the surgeon will use dissolvable stitches to close the uterus and either staples or a surgical needle and thread to close the skin. The staples or thread will need to be removed about one week later.
Post-surgical care and physical therapy
Just like following a knee replacement or rotator cuff repair surgery, cesarean sections also require optimal post-surgical care and rehabilitation. In physical therapy, you will be introduced to a comprehensive rehabilitation plan to help promote healing and proper movement function!
What to expect on the first visit….
1. The best time to start physical therapy following a caesarean birth is about 6 weeks post-partum. Of course, it’s important that you are also evaluated by your OBGYN to check for other possible complications, but generally this is a safe time to return to exercise.
2. When you arrive for your first physical therapy appointment, your PT will take the time to ask you a few questions. She/He will want to know the history of the birth and pregnancy and if you are experiencing any pain. It’s also important to share with your PT if you have already returned to exercise, if any specific movements are painful/dysfunctional, and your overall goals for therapy.
3. After all the talking and questions (which can take some time during the first appointment) your PT will check the scar tissue to make sure that the tissues are healing correctly and that there’s no sign of infection. She/He will also check the sensation of the scar tissue and surrounding skin. Given that everything is OK, your PT can begin scar tissue mobilization. It’s important to start scar tissue mobilization 6 weeks post c-section to avoid adhesions in the fascia or skin that can later on cause pain or reduce abdominal movement and function. You will also learn how to properly massage and mobilize the scar at home during this session!
4. Next, your PT will most likely check for Diastasis Recti Abdominis (DRA). DRA occurs when there’s a separation of the two pillars that make up the rectus abdominis and it is pretty common both during and after pregnancy. Since, the rectus abdominis was cut during the c-section it’s also important for your PT to check the strength and function of your abdominal muscles.
5. At the end of the first visit your PT will give a series of abdominal strengthening exercises you can complete at home.
In follow up appointments you can expect…
1. Continued scar mobilization and management
2. Sensory retraining to the scar tissue
3. Hip and low back mobility exercises
4. Progressive abdominal and lower back strength exercises
5. Pelvic floor exercises
6. Education on how to properly hold your baby to prevent pain and injury
7. A plan to help you get back to regular exercise (ie. strength training at the gym, yoga, swimming etc)
Every physical body is different, so the length of treatment can vary from woman to woman. Typically, between 5-10 sessions is enough to help you reach your goals post caesarean section!
For more information or if you have any questions feel free to reach out via the contact section on my site!
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With light and love,
Dana