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The Go-To Guide for Mamas on C-Sections

c section episode
C-section or caesarean section is one of the most common surgeries performed in Canada and the US. Guidelines aim for 10 to 15% of all live births requiring C-section.
 
However, rates of Cesarean section in the United States is 30%!
There are a lot of reasons why a person might need a C-section. Even if you have wish for an unmedicated vaginal birth, baby may have other plans. Every pregnant person should know about a C-section.
 
In this article we are going to
1. Break down why a C-section might be necessary,
2. What happens in a C-section?,
3. A Gentle Cesarean
4. The initial or early healing considerations after caesarean
5. What Early Rehab might look like
 
If you prefer audio, make sure to check out our podcast episode on all things C-section!

When is a C-Section is Needed?

There are four different types of C-sections: elective, planned, emergent, and emergency. Each of these may be done for different reasons. That also means that the rehab process might look slightly different for each. For example, emergency C sections occur when mom has already been trying for a vaginal birth. You may be healing from the surgery as well as the trial of vaginal labor. More on that later.
 
There are a variety of reasons WHY a person might get a C-section. Each are unique. Each provider has a different threshold of when they might decide a C section is necessary. Knowing your providers C-section rate may be helpful.

Here are 9 reasons why you might need a C-section.

1. You Want one
Some women are terrified of birth. There is always some fear involved but for some, this feeling is overwhelming. For example, if you had previous very traumatic birth, you may opt for an elective C-section. This is an example of a ELECTIVE and PLANNED C-section
 
2. You’ve had a C-section Before
If you are pregnant for the second time, you can opt for a planned C-section or try a vaginal birth in some situations. Trialling a vaginal birth is called a vaginal birth after cesarean (VBAC). There are certain guidelines for who might be able to trial a VBAC. Attempting a VBAC does have some risks (but it can be done!) including needing another C-section. This is an example of a PLANNED C-section.
 
3. You’re pregnant with Twins or Triplets.
When you have more than one baby, there is double or triple the chance something can happen. Trying to birth twins vaginally is possible but requires a lot of monitoring. Many individuals will opt for a C-section in these cases. This is an example of a PLANNED C-section.
 
4. Baby is Breech, Sideways or their Shoulder is Stuck .
There is a lot of controversy on this one. Some providers believe that people should be able to birth babies breech. Others know that risks are higher to baby and say “why risk it”. Wherever you fall on this topic, know that this can cause a PLANNED C-section. If baby’s shoulder is stuck, this is shoulder dystocia. It is sometimes managed with different techniques and a vaginal delivery is successful. In other instances, C-section may be necessary. This is an example of an EMERGENT.
 
5. Baby is not doing well or in distress
When you are in labor, baby is being monitored. There are times when baby isn’t doing well with labor. These are things like an abnormal heart rate or baby isn’t getting enough oxygen. This is when a C-section will be suggested to get baby out as soon as possible. This is an example of an EMERGENT or an EMERGENCY situation.
 
6. Mom has a health issue.
Certain pregnancy-related issues can increase the likelihood of a C-section. These are preeclampsia, gestational diabetes, active genital herpes infection, or certain heart or lung diseases. This can make a C-section PLANNED, EMERGENT or an EMERGENCY based on the situation.
 
7. Something happens in labor
If you aren’t progressing in labor or your body is getting tired, a C-section may be necessary. This can be when you are trying to dilate in the first stage of labor. Or this can be that you are pushing and baby isn’t progressing. For pushing, providers should let you push for 2-3 hours before thinking about a C-section (if baby is okay). When you start getting so exhausted baby can’t move, an EMERGENT C-section might be the answer. The term for this is “failure to progress”
 
8. An issue with the placenta.
This is in the EMERGENCY category. Conditions like placenta previa (placenta covering the cervix) or placental abruption (premature separation of the placenta from the uterus) can be serious. These are an emergency because there are risks of bleeding and risks to baby.
 
9. Cord prolapse:
Baby needs to come through first. When this doesn’t happen and the umbilical cord comes first, this is a cord prolapse. This causes the umbilical cord to get squished and trapped. This is an EMERGENCY situation that often requires an immediate C-section.
 
If you have one of these conditions and need a C-section, what’s next? Let’s dive into the next section to go through the steps of this surgery

What happens when you have a C-section?

A C-section is a major abdominal surgery and it can be scary! Many mamas have never even been to a doctor before their pregnancy. But now they’re getting ready for a big surgery. Knowing what to expect if your delivery turns into a C-section can be ease that stress and anxiety. Let’s break down what to expect… from getting ready to go into surgery to getting wheeled out.
 
1. They Will Numb You
They will numb you to get ready for surgery. This is usually done with an epidural or a spinal block. In most cases, you are awake for the surgery.
 
2. They will make a Horizontal, then Vertical cut
Many people just think about the scar that they can see. When you have a C-section they do a horizontal cut through your skin. But then do a vertical cut through your abs muscles and your uterus.
 
3. Baby is BORN
Next is when baby comes out! This is when your baby is born. If you have a C-section, you still gave birth.
 
4. Clamp Umbilical Cord and Deliver Placenta
 
5. Stitch you Up
They use stitches for the internal layers. On your skin, doctors will use either stitches or staples.

You can ask for a GENTLE Cesarean

Our healthcare system is recognizing that caesarean delivery can be extremely traumatic. There has been some research that has tried to make the stress around this delivery less. This is a gentle caesarean protocol. Many hospitals are starting to use these protocols. They include delayed cord clamping, early skin-to-skin contact, and a peep-through window if mom wants it. It has been shown that by using these steps, moms feel better about their birth. They also have less stress and signs of trauma surrounding delivery.

What to expect in the first days after C-Section

You will be in the hospital a bit longer after a C-section than if you had a vaginal birth. You will bleed out of your vagina after a C-section for several weeks. This is because the extra blood and tissue that’s been helping baby needs to come out.
 
Moving around in the early days can be really uncomfortable. Holding onto your belly, called splinting, can help with rolling around in bed. Using a compression garment for the pain around your scar might help.
 
Walking in the first couple days after a C-section is OK. But make sure you do not overdo it. An increase in pain, bleeding, or you are otherwise feeling unwell, are signs that you are doing too much. A little bit of walking is going to help reduce the risk for complications after surgery. Too much and you will increase pain and discomfort.
 
You can start some early rehab exercises even in the hospital if you’d like. These include deep belly breaths, pelvic floor muscle contractions, or glute bridges. You can also wait. That is completely up to you.

Early Rehab After Cesarean

Everyone needs rehab after a cesarean. We strongly encourage mamas to seek out pelvic floor physical therapy if they are able to.
 
Rehab includes
1. getting the scar moving
2. being able to move in all directions
3. getting the core strong again and
4. getting you back to movements you enjoy postpartum.
 
Before moving the scar, you want to make sure that there are no staples left and the incision’s healed.
 
In life, we have to move in all directions. These include front to back, side to side, and rotating. Go into these positions and perform big breaths and scar massage. If you are an active person, you want to ensure there isn’t a big stretch in the positions you need for your sport.
 
This is true for the exercises we use postpartum as well. We start in a neutral position. Then we add in range of motion. Then we have load.
 
Everyone’s timelines are going to be different. Some people are going to feel good for weeks after surgery others are not. Go on your timeline.
 
At the Barbell Mamas, our programs have a C-section filter. This is to help you return to CrossFit, weightlifting or powerlifting with confidence.
 
Picture of Christina Prevett, MSCPT, CSCS, PHD (CANDIDATE)

Christina Prevett, MSCPT, CSCS, PHD (CANDIDATE)

Christina Prevett is a pelvic floor physiotherapist who has a passion for helping women with different life transitions, including postpartum care and menopause.

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