Cesarean Section: Birth is Birth, Safe is Safe, Surgery is Surgery

April is Cesarean Delivery Awareness Month.

If you are wondering, “What is a Cesarean Delivery?” 

A Cesarean section, also known as C-section or Cesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the birthing parent’s abdomen. It is often performed because vaginal delivery would put the baby or birthing parent at risk. A Cesarean can be planned, unplanned or emergent.

I’m super sweet and easy-going until someone says something I do not like or agree with. If you want to see me get spicy real quick, starting a conversation about Cesarean sections is a really good way to go.

My first soapbox would be when people refer to vaginal deliveries as a “natural birth.” You may be thinking, “What is the harm in that?” If we stick to calling a vaginal delivery “natural,” it insinuates any other form of delivery is unnatural. Therefore,  that would imply a Cesarean is an alien, abnormal or irregular event. It is not an “unnatural way” to deliver a baby.

There are so many ways to deliver a baby including vaginal unmedicated, vaginal medicated, vaginal assisted, planned Cesarean, unplanned Cesarean, and emergency Cesarean. We cannot decide that one is more natural than the other because no one can plan the safest way to birth a baby for each baby and birthing parent duo. Cesarean delivery is not uncommon with the incidence in the US being 32.1% of births. Yeah, America is on the higher end for this type of delivery, but some babies do need to be delivered surgically for the safety of the birthing parent or baby. 

My second soapbox is that many people have the misconception that a Cesarean delivery is the “easy way out.” A Cesarean delivery goes through seven layers of tissue, including skin, fat, fascia, abdominal muscles, peritoneum, the uterus and the amniotic sac. It is a major abdominal surgery. It is not the most terrible outcome for a birth or delivery, but it is by no means “the easy way out.” 

Let’s imagine a person having a knee replacement or a shoulder surgery. A therapist would come to see you bedside in the hospital to help you get up and move every day that you stayed there. Outpatient physical therapy would be ordered for 3x per week for a minimum of 4 – 6 weeks. That would be the standard protocol for an orthopedic surgery, regardless of age, gender or fitness level. Now imagine if we expected these patients to take over the care of a helpless puppy or kitten. We would not expect that at all!

But here we are, a society that looks down on a person for not being able to get a baby out of their vagina for whatever reason. They then are expected to care for this baby, potentially feeding the baby with their body. So no, this is not the easy way. A person who delivers a baby any potential way is considered a badass in my opinion, but one who has a major surgery and then jumps into parenthood is pretty darn tough!

My third soapbox is that a Cesarean is the worst case scenario and something to be dreaded. I had a Cesarean. It was not my plan. It was not my goal. I tried really hard to birth my baby through my vaginal canal, but it was not in the cards for me. The thing I was not really prepared for was that the pain was manageable. It was hard to move the first few days, I was sore and needed to take pain medicine, and I definitely felt if I overdid it. But honestly, I was feeling pretty human one week after delivery. I was walking the boardwalk (slowly and holding a stroller) by my 10th day postpartum. Whenever I teach or coach parents expecting a baby, I try to alleviate this fear people have of this delivery type because coming from first-hand experience, an uncomplicated Cesarean delivery was not the worst thing.

My fourth soapbox is the climate and attitude surrounding pelvic floor therapy referral post-Cesarean. As much as no birthing person is readily recommended to pelvic health, Cesarean deliveries have even less likely odds of getting therapy. If you would like to hear my thoughts on why a postpartum visit is so important, please check out The Post Partum PT Check Up: Do Not Pass Go, Do Not Collect 200. 

There is the first misconception that once a person delivers their baby, things like urine leakage, abdominal muscle separation, pelvic and back pain will be the new normal, and that there is nothing that can be done. This simply is not true. There are pelvic health specialists that spend tons of time, money, and energy learning to take care of these issues, as well as many more. 

The second misconception is that a person who does not deliver a baby through their vaginal canal  would have no need for pelvic floor therapy. Pregnancy causes a lot of changes to a person’s body. It changes the abdominal canister, including the rib cage, diaphragm, abdominal muscles, low back curvature, pelvic bones, and pelvic floor muscles. The way a baby is delivered does not alter these changes much. If a Cesarean happens, there are MORE alterations to the abdomen due to the surgery. People also assume that since a baby does not come out of a vagina, there should be no pelvic pain, no leaking of pee/poop, and no pain with sex. But this simply isn’t the case. 

With a Cesarean, there is a surgical incision. The birthing person may have chosen to lactate to feed their child, which affects the hormones. This can cause more joint laxity and possibly vaginal dryness. There are the regular changes from pregnancy, like stretching of the abdominal muscles, and changes of the diaphragm and ribcage. There may have been trauma (physical, emotional, or both) during the pregnancy, labor, or delivery. Just because this is the method of delivery does not mean the pelvic floor will have no issues moving forward.

As a person who experienced a Cesarean birth, I would love to share my top 5 tips.

1. Mindset. This may be something you chose from the start. It may be something that became necessary during your pregnancy – for example high blood pressure or a breech baby position. It may become an outcome after labor is initiated,  such as if a cervix becomes stubborn and will not dilate, OR baby gets distressed during delivery. Regardless, a Cesarean can be life saving for both the parent and baby. Birth is fierce and empowering no matter how you do it, so do not allow yourself or others to make you feel “less than” because of the way your baby was delivered. 

2. Rest. Many Cesareans come after a long labor. If planned, the parents typically arrive bright and early. Either way, allowing yourself to rest does wonders to heal after your procedure. You don’t need a clean house. You don’t need to be a super hero. You need to keep yourself alive and HELP your support system keep your baby alive. You do not need to do all the things. 

3. Breathe. Any abdominal surgery can affect a person’s breathing. It is really important to learn how to take deep breaths and to remember to practice this regularly. Breathe when moving, and breathe when trying to have your first pees and poops. Breathe when you lift your baby or bend to tie your shoes. Need help? Try this intro to breathing video.

4. Get Comfy. Find comfortable underwear and clothing that does not cut into your incision. Do not be afraid to try a few types. Use ice over your incision to help with your pain control. Don’t forget to take your pain meds.  

5.Move Carefully. Your belly and back will thank you if you move carefully and with help. Your pelvic health provider can help guide you in this, and do not be afraid to ask your partner or medical providers for help with moving in those first few days!

Here is some feedback from our Practically Perfect Community members who have birthed a baby via Cesarean section. 

“ My favorite tip to give is to keep walking! It helps you heal so much faster and hold a pillow over your stomach when you laugh or sneeze Healing can be so hard and have many ups and downs, but it will end, and you will be able to look back and say “wow I did that!” As for a small win… the best win will always be after your first postpartum poop ”

“For C-section mamas – These were the only surgeries in my life where I was expected to stand so quickly, walk so quickly, and care not only for myself but for another. You are a warrior badass. The fact that we survived the first week in itself is incredible. Then so many of us chose to do it again!”

“Just like fed is best, born is best, don’t stress over what you can’t control. One day it will be the birth story you love and tell people how your tiny human entered the world, embrace it I never really thought Julia would be my last baby, but I spent the last 10 weeks of it crying and dreading and trying to avoid a C-section that was unavoidable. The only regret I have is not enjoying my last pregnancy.”

“Scar massage once healed. Recovery, I thought, was better than expected. And 100% agree with – born is best – safe is best – let THAT be the PLAN.”

“Yes, they are are scary, it is okay to be scared. Tell them you are scared and they will take care of you….. also tell them if you feel nauseous because they can fix that in seconds! GIVE SOMEONE YOUR PHONE TO TAKE PICTURES. My partner said, ‘Don’t peak & ask for a chair.

If you can plan it, ask for glue and not staples or stitches if they can (way easier to heal).

Also aftercare (if you can plan) compression leggings and while you are still in the hospital every time you rest put those squeezy leg things on. You will swell, so do not expect your shoes to fit when you leave. IT IS MAJOR ABDOMINAL SURGERY. You are recovering from major abdominal surgery!!! Take your pain meds, take it slow, no lifting, no bending, no laundry. Cesarean birth is real birth, anyone who says otherwise can step on a Lego. Also, just because they didn’t exit that way you still might need to see a PFPT ”

“As far as recovery, my biggest piece of advice for C-section as well as being a mom is to be okay with letting things go. Reframe your mindset and allow yourself grace for the outcome. I had a hard second C, and was instantly regretful bc I chose it for a few reasons but it was by far worse than my first recovery. I had to allow myself to let things go or receive help from those I didn’t really want help from. My body wasn’t in shape for my second pregnancy and it reflected in my recovery.”

“You will stand up straight again, even if the first time you get up it doesn’t feel like it!

Don’t worry about that scar…it brought life into the world.”

“Just because you had a Cesarean it doesn’t always mean you can’t have a vaginal birth next time!”

“Get the binder from the hospital and ask the nurses to put it on you as soon as you can. And have them teach your partner how to put it on you since they will be the ones putting it on you. Live in it! I took mine off to shower and that was it. I also recommend walking and doing a lap in the hallway as soon as the catheter is out. It’s going to suck, I assure you, but the sooner you start moving the better!”

“My C-section was 27 years ago. I remember using Percocet for 1 week, then followed my doctor’s advice in terms of not lifting anything heavier than my daughter, and after 2 to 3 weeks I felt really good. It was my first child – I imagine it’s harder if you have older children at home – then enlist help if you can!”

“Take your time sitting up and listen to your body. Don’t be afraid to ask as many questions as possible. And I’d like to add to the “just because they didn’t exit part”…. YOU still GAVE BIRTH. Don’t let anyone try to take away that part because some look at it as the “easy” way out when in fact no matter if it’s natural or cesarean, you birthed your baby and it is all hard. Be kind to yourself, we all recover and heal differently Take as many stretchy mesh underwear as you can, lol, those things were so comfy, at least for me.”

“My first was frank breech, so C-section it was. By my 2nd, I felt like a true pro! Best tip for recovery – get up and move! Make small goals, take lots of Advil, and just take the baby for walks in the stroller. Don’t push yourself to where it hurts, but it hurts more to lay around. Also, I depend on Depends at night. Wore like underwear, and you threw them out anyways. Much more comfortable than wearing a giant pad in your pants. Ice pack also for more comfort. Can also look into the Mederma scar strips. I felt it help from things pushing on my scar. you got this mama!”