Cesarean birth is a major abdominal surgery and a birth wrapped in one experience. But there are some things you should know about your recovery that your Ob-GYN probably won’t share.
Most parents’ thought at six weeks postpartum, especially after cesarean, is, “Wait, that’s it? Now what?” The appointment lasts about two to three minutes, during which the doctor or the nurse checks your incision and your cervix, and as long as you are not bleeding and you are still breathing, you are cleared.
I remember going to my six-week postpartum appointment after my cesarean. At that point, I was still in a bit of pain and a little anxious as I didn’t know the roadmap to full recovery after an emergency cesarean.
Read next: What to Expect at Your Six-Week Postpartum Appointment
My appointment consisted of an abdominal exam (which took about five seconds) and a simple question about what birth control options I would like. At the end of the session, I was told to check in after six months, and that was it.
I distinctly remember the feeling of confusion and feeling a little bit lost. My patients have shared the same sentiments regarding their six-week check-up postpartum.
Unfortunately, postpartum recovery and care guidelines are lacking when it comes to cesarean care research, with very few studies performed and not a set of precise data or timelines.
Based on my clinical experience and available data, we have a Belly Birth recovery program that I offer to my clients. I wanted to share things that I usually look for, which are typically missed by GYNs, and often, patients are left untreated or undiagnosed for years.
Here are a few things my patients are surprised when they hear me say when they hear saying their doctor never mentioned it to them.
1. Their bladder urgency and frequency can be caused by cesarean scar and surgery itself
The bladder sits close to the C-Section scar, and the bladder is also moved during the delivery. The close proximity to the scar and the manipulation can irritate the bladder and cause urgency or frequency of urination.
Usually, it subsides on its own in a few days, but in some cases, it can continue unless treated. Some people might have trouble emptying the bladder even weeks after the actual delivery, especially if they needed to be catheterized multiple times after cesarean.
This could be due to irritation or any trauma to the urethra or pelvic floor muscles. One study looked at postoperative urinary retention after surgery and cites anywhere between 5% to 70%.
This is mostly due to the anesthesia used during the surgery and usually returns to normal in six to eight hours after surgery. But if you continue having trouble urinating and need to strain to empty your bladder even at six weeks postpartum, mention it to the doctor.
2. The sudden sharp pain in the abdomen, pelvic floor, or around the scar can be caused by scar tissue
Many patients report having sudden pain around their incision, even for a few weeks or months with certain movements. For some is a few incidents here and there, and for others, it’s more frequent to the point that it affects their ability to move.
In my experience, this pain usually comes from scar tissue, or a muscle or a nerve fiber trapped in the scar tissue that causes sudden sharp pull with movement.
Usually, nothing shows up on ultrasound at the GYN office, and patients are either given pain meds or dismissed. This doesn’t mean that your discomfort isn’t worth addressing.
The good news? There are things you can do to help. Reach out to a pelvic floor physical therapist for support. Also, a cesarean scar care kit includes the tools to help you improve the mobility and flexibility of your scar, all while gently decreasing scar tissue.
3. Retraining your breathing muscles after a cesarean is as important as retraining your abdominal muscles
C-section is a major abdominal surgery. Due to the anesthesia, the lung capacity might be reduced, so your ability to breathe is affected. Your pelvic floor and diaphragm (the main breathing muscle) work together to manage the intraabdominal pressure.
So, if you are shallow breathing, that can also affect the pelvic floor.
Many hospitals provide a spirometer after cesarean, but some don’t, so I ask the patient to carry their own. To improve lung function, doing some breath re-training in those first few hours after surgical delivery is important.
4. Your pelvic floor is affected by c-section, and you can have pelvic floor symptoms even with cesarean
It is a myth that cesarean does not affect the pelvic floor.
One study followed postpartum moms for six years to study the effect of elective cesarean and uncomplicated vaginal birth on pelvic floor symptoms.
It reports that those with elective cesarean had more incidents of pain with sex, abdominal and pelvic pain, whereas those with vaginal delivery had more chances of incontinence and prolapse.
5. Numbness and burning around the scar and abdomen can be due to the nerve fibers trapped in scar tissue
Many people experience numbness even years after the cesarean; others might experience sensitivity, burning, or tingling pain weeks after the surgery. The most common cause of this is nerve irritation or injury.
The surgery itself affects nerves, and the scar tissue can also irritate or trap the nerve fibers. This can lead to numbness or a burning sensation around the scar.
The good news is that most of these symptoms can be helped by a pelvic floor physical therapist who specializes in cesarean prep and recovery.
A good starting point after a cesarean would be to work on breath re-training, scar mobilization, core, pelvic floor strength, assessing the pelvic floor for any kind of tightness or pain, and assessing the bladder and bowel as well.
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