Preparing for a Cesarean – OR – What to do Next if you Have One
I have shared the story of my daughter’s birth in previous blogs. In short: I had a fast and furious labor with no progression, full intervention cascade, 10-hour push phase, and cesarean birth. I had a lot to unpack after that and a long road to recovery ahead. But I did heal, fully, back to a level of strength and confidence much more profound that pre-pregnancy. I know now what it possible, and having lived it beyond my professional expertise, feel I have a unique window into the hints and habits that helped me heal.
Now, 36 weeks pregnant with my second daughter, I am headed to the OR again in 3 weeks, this time for a planned Cesarean. I live in a rural community with a small Level IV Trauma center, meaning, we don’t have the blood, staff, or equipment to manage a major crisis. Therefore, my hospital does not allow the option of Trial of Labor after Cesarean (TOLAC), or Vaginal Delivery after Cesarean (VBAC). Though the risk of uterine rupture during a TOLAC is very low, it can happen. Therefore, my options if I chose to attempt a vaginal delivery are to travel to a hospital more than two hours away or attempt a home birth. Neither of those options feel settling to me. Having a baby with my doctor, in the sweet birth center of my home hospital, five minutes away from my house, feels so much better in my bones. So, though I am undeniably dreading surgery, I know so much more about what to expect and how to heal. I also trust that going into surgery rested rather than 2 days deep in lack of sleep and nutrition will allow for more productive and swift healing.
A cesarean delivery is no doubt a major surgery. In the US we prescribe immediate physical and occupational therapy for so much as a finger surgery, but it is not standard practice after most abdominal surgeries including cesarean. During a cesarean delivery the incision penetrates skin, fascia, adipose (fat), teases muscle away, and moves the bladder out of the way. Therefore, restoring activation of the core, and mobilizing the scar, are of the utmost importance for full healing. Understanding how to move safely and support your healing is also paramount. But no one is telling us this in the hospital!! So below are some ways to prepare and self-advocate.
Whether you have just had an unplanned cesarean birth, or are anticipating a planned one, I want to share a few a few helpful hints.
Here is what I would pack for the hospital and have on hand when you get home:
Anti-nausea wrist bands or essential oils
High-waisted underwear: Love the All-in-One Panty from Bodily
Knee high compression socks for the first two weeks after surgery
Soft, high wasted pants with or without compression: Worth the price are Blanqi tights
An abdominal binder or belly wrap: Bodily makes a post Cesarean specific wrap
A nursing nightgown
Super soft joggers
A nursing / pumping tank
Compression free nursing bras: Check out this bundle of all 3 from Kindred Bravely or my new favorite nursing / pumping bra on the market from Larken
A gentle topical for your incision scar (Arnica, Mederma)
Additional items:
Phone, charger, headphones
White noise machine
Newborn outfit (0-3 is usually too big at first)
Pump
Something to catch hand expressed milk
Snacks
Drinks with ele
Here is what I would recommend focusing on to help yourself heal starting the day of surgery:
Have someone at the hospital take your vitals multiple times per day and request them be taken in seated, standing, and walking
Why? You ask…
Screening your exercise tolerance before you are discharged from the hospital can help detect possible cardiovascular or neurological problems
Make sure someone has screened you for a blood clot
To avoid a blood clot:
Wear compression stockings
Perform ankle pumps every hour
Get up and walk every hour or two
Exhale to exert / Blow as you go
Begin long, slow exhales as you visualize a gentle pelvic floor lift (3 sets of 10, 3 times per day in any position)
Log roll to get in and out of bed
When you get home, consider tying a strap from the head to foot of your bed to pull on
Lie flat on your back for 10 minutes or so after every feeding to allow scar to heal flat
Plan to have someone hand you the baby for night feedings
Sign up for The Bloom Method 4th Trimester Rehab Program and begin RIGHT AWAY
Use the code HEARTHHEALING10 for 10% off
Sign up for a class such as this one from Birthsmarter on Cesarean prep and recovery
Start scar mobilization right away! Here is a good timeline:
Day 0 through Week 1:
Gently touch the skin two finger widths above and below the scar
Week 2:
Make gentle circles 2 finger widths above and below the scar
Gently pull that tissue above and below the scar up and down
Week 3:
Begin desensitization: exposing the scar to different temperatures and textures
Week 4 & 5:
Continue the above techniques until the scar is closed
Then you may begin gentle circles and gentle pulling in 4 directions directly on the scar
Week 6 - 6 months:
Begin mobilizing the scar itself
Add longer, deeper, more firm pulling in all directions (firm but not painful)
Move the deeper layers of scar
Hold prolonged pressure or pull in areas that feel more dense or sticky
Continue desensitization as there may be areas of numbness for 6 months or so
A few final thoughts. If you have ANY concerns prior to leaving the hospital or before your 6-week follow up visit with your HCP, trust your gut. Reach out to a pelvic PT or your No one is living in your body but you, and you deserve answers and understanding. Remember that even if cesarean birth was not part of your plan, cesarean birth is birth. You did an incredible thing of growing a human, and your body needs time and grace to heal.
