Birth via abdominal incision (the cesarean)

Birth via abdominal incision (the cesarean)

Induced or planned, the surgical act of a cesarean (a birth via abdominal incision) is becoming more and more practical. But how do you prepare for it, how do you recover and what are the advantages and disadvantages?Lack of information about this operation is still common. This is why I hope that this article will inform you more about the sequence and the possibilities of recovery from a cesarean.

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Giving birth

When giving birth to a baby, it is sometimes necessary to do a cesarean, whether it is scheduled, decided upon in an emergency, or by the mother’s choice in cases of possible complications. This was my case for my two births via abdominal incision.

When giving birth to a baby, it is sometimes necessary to do a cesarean, whether it is scheduled, decided upon in an emergency, or by the mother’s choice in cases of possible complications. This was my case for my two births via abdominal incision.

Having personally given birth to two little girls by cesarean, I wished to share with you my very positive experience and how I was able to recover very well from this significant surgical procedure which has allowed me to give life to two marvelous beings.

It is very rare that there are positive testimonials from a birth by cesarean and there are numerous women who feel very bad about not having been able to give birth “normally” vaginally and they have a significant feeling of failure which makes them feel powerless after the operation. In addition, the days following the procedure can be difficult and painful and most women have not been physically, mentally and emotionally prepared.However, there are many tips that can help you through this procedure and to recover as quickly as possible physically, mentally and emotionally, so that the experience of a cesarean is not experienced as a failure or something negative.

I hope that with this article and my personal positive experience, I can help and reassure all pregnant women whofind themselves forced to have a cesarean, and that they will have an experience which is as full and as positive aspossible, having as much information as possible in order to prepare sufficiently. Also, never forget that it doesn’tmatter how you are going to, or have given birth, be proud of having carried your child to term and having offeredhim life with the means that you have or that you have been given...

Happy reading.

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An increase in the number of cesareans

In 25 years, the rate of cesareans has doubled. The rate was 10,9 % in 1981 a 20,1 % in 2007, meaning one birthout of 5. Around 1/3 cesareans are decided upon during birth when there is distress of the mother or baby, and 2/3cesareans are scheduled. The reasons for this increase are numerous, such as obstetricians currently prescribingmore preventative measures aiming to decrease the risk of fetal distress during labour, the growing number of “riskybirths” due to the increase in average age in mothers and twin births, the medico-legal pressure exerted onobstetricians and the simple fact that women today have the choice to decide how they would ideally like to givebirth.

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How does a cesarean take place?

The cesarean takes place in the operating room. An intravenous drip, an anesthetic epidural or spinal anesthesia, and a urinary catheter is placed in order to avoid damage to the bladder during the procedure

The epidural has replaced general anesthetic for most procedures, except in emergency cases or when the epidural is contraindicated. The positive consequences of this anesthetic are also psychological because the new mother is awake and can therefore welcome her baby and if the cesarean is scheduled, she can prepare herself mentally and there is less of a risk of having the impression of “missing the birth". On the other hand, the advantages are also physical because the epidural avoids the uncomfortable awakening from a general anesthetic (nausea, state of confusion and agitation, shivering). Additionally, the young mother is generally less tired and her body begins to heal much quicker .

Next , the skin of the abdomen is disinfected and a sterile operating field is placed. If the partner wishes to be present in the procedure, he will then enter and sit at the head of the patient after dressing in surgical scrubs. He can then chat with his partner without having to see anything of the procedure.

Often, a pressure is felt in the abdomen area at the moment of fetal extraction. As soon as the baby is outside, he is taken to his parents before being taken by the mid-wife (and then eventually handed to the father) for the first checks and handed to the pediatrician who is present in the operating room. The fetal extraction lasts less than 5minutes and the cesarean lasts on average 20-30 minutes.

Nausea, shortness of breath and a light malaise can be felt during the procedure but the anesthetist present in the operating room can, upon your request, make use of other products to reduce these effects.

Obviously, during a cesarean you will not be able to accompany your child as much physically at the birth as you would in a vaginal birth. However, absolutely nothing prevents you from accompanying your child mentally and emotionally throughout the procedure until your child is born with the help of your surgeon. Being as present as possible with the means that you have during the birth will come back to your child and you will bond regardless of which way you give birth. Your emotional and mental presence will have great significance for you and your child when you hear his first cries when he is born. Never forget that you will experience his birth through your state of mind.

Stressing the importance of breath during your surgery is not to be neglected. It is not because your body is numb and you lay on surgery table that breathing has to be forgotten. Inhaling and fully exhaling to empty your lungs and cleanse your body with every breath is so important during your labor, even more so if it is a c-section, as you will oxygenate your body with its most valuable fuel. The body flow stays improved and your tissues benefits massively from it to stay relaxed and not tense or congested because you are holding your breath or shallowing your breath because of the apprehension of the surgery which then tightens the skin and the fascia. Any tightness of fascia willdecelerate the healing process of a scar and cause adherences in the scar and belly area... So remind your clients of the most valuable Pilates tool, breathing. Joseph stressed a great deal on breathing with his clients and so should you for your pregnant ladies and remind them of : "JUZT BREEZE !!!" As Joe used to say with is German accent, "YOU MUST INZ ZE AIR AND OUTZ ZE AIR"...

Your bandages will next be placed and you will be monitored for 2 hours in the recovery or birthing room before being taken back to your room. Breastfeeding is then possible, as well as eating some light food.

The hours following a cesarean

Back in her room, the new mother will still have several tubes in her body : the catheter from the epidural (to ensure a light epidural for 24 to 48 hours), a drip (to nourish and hydrate the new mother and also to inject painkillers or antibiotics), a urinary catheter and a drain.

For the first 4 days following the cesarean, women will have significant bleeding, in general more abundant than after a vaginal birth. It is normal to saturate 5 or 6 special “after birth" pads in the first 24 hours. It is quite normal to have loss for 4 to 6 weeks.

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Settle in as best you can in the hoursfollowing the cesarean

How do you settle in the bed ? It is tempting to settle in a half-sitting position, supported by several pillows with the knees raised to avoid stretching the stitches.

However, this position is very bad for the back and blocks blood circulation in the lower stomach. It is better to remain stretched out flatter with a single knee bent, and the foot flat on the mattress .

When you change legs, stretch the bent leg allowing to foot glide on the sheet while exhaling, and then bring the other leg in the bent position while folding in the groin, as if you are pulling on a string attached under the knee. It is important to involve the stomach and the lower back as little as possible when you are moving in the bed. To sit up in the bed, move the two legs towards the chest, and then roll in a single movement towards the side. With the knees grouped as high as possible, push on your arms to put yourself in a sitting position.

Tip : attach a rope or simply the belt of your pyjamas to the bottom of the bed. This will enable you to hoist yourself up progressively (like a mountaineer) in a stretched out position to a sitting position.

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24 hours after the procedure

The first 24 hours following a cesarean are rarely the most painful as most women are still under the effects of the epidural or receiving pain killers through a drip

Food is generally light (tea and biscuits are given on the first day, soup the next day followed by the first meal) as the intestinal transit has not yet been reestablished. Its reestablishment generally accompanies gurgling noises and gas which is difficult to evacuate.

After a birth, you will still experience contractions. These are the afterpains : the uterus is retracting to progressively return to its original size before pregnancy (generally 2 weeks after the birth). They also compress the blood vessels to avoid a hemorrhage. This mechanism lasts between 1 and 4 days, with a maximum of 1 week, and is particularly strong the first two days. A few tips to decrease the pain of the afterpains: urinate frequently (especially before breastfeeding) as a full bladder will push the uterus towards the back and will prevent it from contracting.

As you will be bedridden for some time after your cesarean, you will perhaps be receiving some anticoagulants in the days following the procedure in the form of sub-cutaneous injections. You will most certainly be asked to get up from around 12 to 24 hours following the cesarean. The first time you get up is often painful.

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Here is some advice :

- Begin by sitting on the side of the bed with your feet placed on theground (if the bed is electric) or in a stool. Straighten yourself up byleaning on your arms. Do not look at the ground.

- Supported by a nurse, cross an arm over your stomach to support the scarwhen you take your first steps.

- Try to keep as straight as possible. Most women are dizzy when they firstget up. The more you move and walk straight up, the quicker the scar willheal and you will prevent build-up around the scar.

- If you get a spasm, lean on a nurse and close your eyes so that you can concentrate on your breathing.

The next day following the procedure, it is important to begin breathing exercises to stimulate lower stomach circulation, which is essential to accelerate the scar’s healing process. Mobilizing your scar and stomach is imperative to ensure rapid healing. The following exercises can be carried out in bed, several times per day, from the first day after the procedure :

- Pre-Pilates Matwork : Footwork
Sitting in the bed, with the legs stretched, energetically extend and bend the tip of the feet, and alternate, and then the two feet together. Repeat20 times.

- Pre-Pilates Matwork : Footwork
Stretched out in the bed, stretch the legs and do 10 ankle rotations withone leg at a time and then do the other leg.

- Pre-Pilates Matwork : Pelvis Tilts (engagement of the back muscles)Stretched out in the bed, with the knees slightly bent, press into the mattress by progressively rotating the pelvis and bringing the stomach towards the spine, and then release. Repeat 20 times.

- Pre-Pilates Matwork : Dead Bug (table top) & Femur Arch
Stretched out in the bed, bring the two knees towards the chest or one at a time (by sliding the feet on the sheet to gently lift the legs). Hold this position and breathe in completely and then release by sliding the legs along the sheet again). Repeat 10 times.

- Pre-Pilates Matwork : Side to Side
After the stitches have been removed : lie on the back, bring the knees towards the chest and then bring the knees together on one side and then the other by "rolling" on the backside. Repeat 10 times.

It goes without saying that constant discomfort and painful contractions are constantly present after a cesarean butthis entire sequence should be done without increase in pain or discomfort. If this is the case, decrease therepetitions or intensity. Listen to your body and try your best to connect to the new sensations in your abdomen and pelvis.

Cesarean: wound care at hospital

Most woman complain of tugging and itching of the cesarean wound.

These are the various abdominal walls which, when they heal heal at different speeds, tug a little at each other. On the other hand, the skin around the scar can feel numb. During the stay in maternity, the bandage around the wound will be changed on average every two days to allow the nurse or doctor to check that the scarring process is taking place as it should. In certain maternity hospitals, the wound is simply left to air without a bandage.

If the wound appears red, swollen, throbbing or oozing, there could be an infection, especially if you have a feverover 38.5°C. Self-care often resolves the problem but antibiotics are often necessary.

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48 hours after the cesarean

This is generally the most painful day due to the re-establishment of intestinal transit. Nevertheless, try to walk as much as possible and to do exercices in bed

Often after a cesarean, the new mother feels as if she has been “cut into two" (even though the abdominal muscles have been stretched and not cut). She needs to rebalance her pelvis, to regain contact with her body and to feel her muscles again.

Two days after the procedure, you can begin to exercise again allowing you to recenter, to re-energize and rebalance the intra-abdominal pressure of a part of the body which has been immobilized by pregnancy (it is important to do this exercice with an empty bladder) :

- Pre-Pilates Matwork : Single and doule Knee Fallout
Lying on the back, bend the knees, flatten the pelvis, and ensure that thefeet are flat on the ground, open one knee or both knees out to the side not moving the pelvis keeping the belly engaged (as flat as possible).

- Pre-Pilates Matwork : Lolita San Miguels Provressive Pilates BreathingPlace the hands on the stomach and feel the breathing movements and increase the lung capacity progressively. Follow inhalation and exhalation with your hands : on inhalation, the hands rise and stretch, on exhalation, they descend and come closer together. Fully fill and empty the lungs in all three dimension (front, side and back) mobilizing the ribcage by counting to 8counts and progressively expanding your breath to 12-20counts.

- Pre-Pilates Matwork : Engagement of the Centre (TA)
Try to gently draw the stomach (belly button) up and in towards your spine as far as possible by exhaling completely. Imagine wearing a tight highwaisted pair of jean that you need to zipper up.

- Pre-Pilates Matwork : Bridging
Bend the knees and imagine pressing the ground with the soles of the feet, as if you want to transcend the carpet. The pubis rises and rotates, the hollow of the back descends, the back stretches and relaxes, the stomach rises again a little, the perineum is spontaneously brought to the top and your pelvis rotates to the pubis by supporting the backside to the ground by articulating the spine, vertebra by vertebra.

- Pre-Pilates Matwork : Engagement of the Pelvic Floor
Try to mobilize your pelvic floor in the following three ways :
* Make as if you want to retain gas. The anus contracts. Release.
* Contract the lateral walls of the vagina as if you are closing the doors to an elevator. Release.
* Imagine the pelvic floor like an elevator which is closing it's doors and ascending to the penthouse. The urinary sphincter will contract and lift.Release.

How do you optimize scarring from a cesarean?

A cesarean scar is from 10 to 15 centimeters long and is invisible for others to see but it is however always present. It is an indelible relic from this fundamental moment in a woman’s life which is the day that she gave birth to her child

Halfway between a surgical act and birth, the cesarean is ambiguous. It provokes a flood of emotions with the arrival of a baby, while the procedure and the disgust faced with this scar, many women feel powerless by this scar.

Some face this procedure very well, while others have a hard time accepting it: a feeling of failure, of having«missed out» on the birth, numbness in the stomach and disgust when facing the scar are all part of the physical and psychological impact. Many do not dare to touch their scar because they do not know how to handle it. Once they are back home, they feel lost.

The cesarean has become so banal that we have the tendency to forget that it is major surgery. However, we knowthat it sometimes takes several months to recuperate.
All women are not always the same when faced with their scar. It is more a question of skin than a technique of closure; certain scar better than others, but it has been proven that regularly massaging a scar aids in good scarring.

“The impression that a part of my stomach no longer exists”. Certain women get the impression that a part of their stomachs no longer exists. Certain areas of the stomach are numb which can be very confusing. By cutting into the stomach, certain nerves are cut which takes a little time for the nerve network to reconstruct after a cesarean. But feeling comes back little by little and usually after about six months, feeling should have returned

More than a treatment, massage assists in accelerating recuperation and bringing back feeling to the skin but also in bringing back one’s body and in finding a better sensation in the stomach.

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I hope that after all this information you as a Pilates teacher can understand more precisely what a c-section means and what you can teach your pregnant ladies for their recovery to prevent any negative or apprehensive feeling associated to this, let's not forget it, often life saving option for the mother to be or/and the child when giving birth. Please keep in mind that if my recovery was successful, it was because I practiced Pilates before, during and after pregnancy. So it will be most important to teach and prepare your client to these suggested exercises before and during the pregnancy for optimal results without taking any risks. Our input as Pilates teacher is of great importance as we can truly help mothers with the Pilates technique to stay connected to the body during all these changes in 9months of pregnancy. Helping your pregnant lady staying connected to herself by applying the concept of mind-body-spirit will help her tremendously to listen to her body and it's wisdom to optimize her recovery process.

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