ABout the C….

So ABout the Cs…. It’s the end of April. My youngest son was born in April last year. April is C-Section Awareness month. I wouldn’t be here if it wasn’t for cesarean sections…..

Did you know? The history of caesarean section dates back as far as Ancient Roman times.

It has taken a little courage to write about this as it is a subject close to my heart – in fact it’s taken the entire month of April. Back in 2015, like a lot of first time mothers, I hadn’t really considered a c-section. I was fortunate to have had an energetic, active, low-risk pregnancy. I listened to hypno-birthing podcasts and envisioned a midwife-led birth at the fancy new birthing unit (complete with mood-lighting , birthing pools and cellphone-integrated surround sound) at our local hospital in London. Technically my birth plan was not to have a plan – I am Type-A personality (with a 16 year military career behind me) and I knew that if a plan wasn’t followed ‘to the dot’ that I probably would be unhappy with that! However, on my antenatal class instructor’s advice, I did prepare extensive birthing canapés….

In this blog post two other fabulous local Fredericton moms, Ann and Angela*, have kindly and openly shared their thoughts on c-sections, and have provided their top-tips for mommas who are new to c-sections. Both of these fabulous mommas have one-year-olds who were born here in Fredericton by unplanned c-section.

C-Sections are portrayed negatively - the “easy” way out, unnatural (it’s a vaginal birth, not a natural birth, one of my pet-peeves now!) and like c-section mom’s missed out on a magical experience that’s an integral part of motherhood.
— Ann, Fredericton

I have read a huge number of social media posts from mothers sharing vaginal birth stories; and, having worked in the pre and postnatal exercise industry for some time now, I recognise a form of ‘stigma’ (like Ann has pointed out) attached to delivery by c-section.  ‘Too posh to push’,  ‘natural birth’ etc… so many negative comments about a delivery by c-section. Where are the positive stories?? I understand that a vaginal birth is, of course, the most preferred outcome for mother and baby. But for those of us that don’t get that far - or who have a choice - where are the positive and honest stories for us that don’t stimulate ‘failure’ or ‘shame’ or other words I hear new mothers use?

Last year 28.2 per cent of hospital births in Canada were performed by c-section up from 26.7 percent 10 years ago
— Canadian Institute for Health Information

I had a lengthy (20 hour or-so) drug-free labour with my eldest son which culminated in a scene from ER and an emergency caesarean. I was discharged from hospital within 24 hours of leaving the OR. My body was not recognisable to me and I was in shock post-birth, as many new-mothers (irrespective of delivery type) are. When I became pregnant with my second and youngest son, I spent 9 months worrying about his birth as a consequence of my first experience. On reflection, what I should have been focussing on was the fact that I had done my best - and a safe and healthy outcome for both of us was in fact a huge success and not a failure. And to reassure any moms-to-be, my planned c-section was a totally different and wholly positive experience to my first labour, hence I am able to reflect on both of my birth stories with pride, fondness and warmth.

Bust the Myth! You can still have abdominal separation and pelvic floor weakness after a c-section. In fact so can women who have not had children…. and men.

I had, unfortunately, not talked to anyone about their experience with a c-section; and I hadn’t been provided any information by my then health care providers about it either. I had planned to have a ’natural’ birth and because I was overall healthy in my pregnancy, it was simply something that was never covered during any of my appointments.
— Angela, 2019

In reflection, I don’t think my antenatal classes actually strayed from the subject of vaginal births and I am also aware that many of the new mothers I work with, postnatally, don’t have much guidance about recovery and safely returning to exercise after a c-section delivery. Some guidance can be found later in this blog.

I am, of course, eternally grateful and privileged to be the mother of two healthy little boys.

Healthy mom, healthy baby that’s the goal.  Every mother has a birth story.

Photo by  Nikhil Mitra  on  Unsplash
I really wish I would have known that my understanding of c-sections and why they happen were completely wrong. There can be so many reasons why a c-section is a good decision for a mother and a baby, and that there is definitely no shame or wrong way to bring a tiny human into the world. I would have also loved to have known the details around recovery time for a c-section (6 weeks unable to drive or lift anything more than my baby), that my breastmilk may not come in for 4 days so my child may be starving and need formula, and also that there would still be so much bleeding!
— Angela, 2019

From the heart and experience of two fabulous Fredericton C-Delivery moms:

From Ann:

-        Don’t do too much too soon, take recovery very slowly!  Ask for help!  About 10 days post-surgery, I felt well and did some light housework.  I ended up pulling something and it really set back my recovery, I was basically back on the couch for several days.  The same goes for starting back to exercise, take it very slowly with short walks and build your strength and endurance over time.  Enlist the help of experts like Sarah and/or a pelvic health physiotherapist!

 -        Ask for help!  It goes with the point above, but enlist help from any friends or family that you can.  For the initial recovery, when the baby woke in the night, my husband would get the baby out of the bassinet, change him and then bring him to me to nurse, bring me a glass of water and then get baby settled again when I was done.  Getting in and out of bed was a struggle, so this was a HUGE help.

-       Take care of yourself!  Drink lots of water, eat nutritious meals and snacks and get as much sleep/rest as you possibly can (recognising that you have an infant!). I had stocked the freezer in my last few weeks of pregnancy and made sure I had easy, health snacks on hand.  I also had a basket that I carried around the house with me that had some commonly used supplies in it: water bottle, a few snack (nuts, banana, granola bars.etc…), nipple cream, breast pads, lip gloss, a couple of diapers and a pack of wipes.

PS. My main goal in birth was to have a healthy baby by whatever means necessary and that’s what I got.

 From Angela:

-         Wear the giant pads (or even depends underwear) and the giant underwear. Be comfortable and don’t worry about trying to look sexy in the underwear you wore before you welcomed your baby (now is not the time for that).

 -        Take time to learn and listen to your postpartum body. It’s so important to know that you need to adjust things you’ve been used to doing (like how to get up out of bed).

-        I wish I would have known then that outside of the traditional hospital care system, there are lots of ways that I could have found support (such as a doula) that could have truly helped our family during my recovery.

 -       Celebrate yourself for being able to bring a wonderful baby into this world! 

Post-C-Section Recovery and Returning to Exercise:

-       Do not underestimate the need for recovery after a c-section – this is major surgery and you should rest. Rest now so your body can heal. Enjoy baby snuggles, give yourself time to bond with your baby and recover from childbirth.

-       Before you are discharged from hospital ask for an OB/Gyn physiotherapist to give you guidance specific to your birth and recovery.  i.e. gentle and safe breathing core/pelvic floor exercises.

-       Do not lift anything heavier than your baby (and not in a car seat) for at least the first 6 weeks.

-       Prepare to not drive for 6 weeks, or longer, after birth and check with your auto insurance when you do start driving.

-       After 6-weeks, and the 6 week GP/OB check, – conduct the ‘Rec Check’ and test for abdominal separation. My previous blog post ‘At the Core of It: An overview of abdominal separation’ found here can help you.

-       Avoid all sit-up type movements:

To get up from lying avoid a ‘crunch’ and try this:

  • Bend your legs

  • Keep your knees together

  • Engage your core/pelvic floor muscles

  • Roll onto your side using your arms and core and keeping your knees narrow

  • Place your hands under your shoulders and walk yourself up via your side

  • Swing your legs over the side of your bed

  • Push up to a standing position

-       If you had a caesarean delivery, it takes longer for you to recover so, according to the most recent guidelines from the Guild of Pregnancy and Postnatal Exercise Instructors, it is advisable to wait eight to ten weeks before returning to exercise. However, you can still start on your pelvic floor exercises. Pelvic floor exercises are a really good way to start to regain stability and strength in your spine, pelvis and abdominals. (For more detailed guidance visit the Guild of Postnatal and Pregnancy exercise instructors here)

-       Invest in a good feeding pillow like a Fredericton-made @lunababypillow to help improve/support posture and, if nursing, investigate different breastfeeding positions (such as the rugby ball position) to help you.

-       C-Scar Massage: All new moms should have a pelvic health check-up with a qualified Pelvic Health physio (this may be covered by health insurance). Your pelvic floor can still be dysfunctional after a c-section delivery and hopefully you will be provided with some advice on c-section scar massage.

-       When you do want to join an exercise class make sure it’s suitable for postnatal women and that your instructor is qualified to at least Level 3 in pre and postnatal exercise. Always listen to your body: if you are tired or feel any pain, stop and rest. Gentle walking is where you should be starting at around 8/10 weeks IF you have had a good recovery and your healthcare provider is content with your progress.

-       If you have ANY health concerns consult your doctor or healthcare provider immediately.

PS. If you are pregnant and reading this, please try not to worry and, if possible, enjoy your pregnancy. Oh, and consider this: just by reading this very blog post you are now more prepared for a c-section delivery than all three Fredericton c-section moms who have contributed to this post and delivered 4 babies by c-section put together! If you are a new mom: well done, let your body rest and recover, and talk about your birth story with pride. Hugs xxxx

*Real names of contributors changed

 For more useful advice visit: The Guild of Pregnancy and Exercise Instructors here.

This post is designed to be informative and is no way intended to replace the professional guidance of your GP, OB, GYN or Midwife. If you have any concerns about your health seek medical advice soonest and it is imperative that you speak to your healthcare provider before returning to exercise.