Preparing for the c-section birth

[bisous]

I'm just putting this out there. I think this is a long shot. I am preparing for a 4th c-section. Unlike "regular" labor, there are no coaching programs, no exercises given to us mamas who will deliver via surgery. I think this just might be because maybe there really isn't anything to be done that can prepare a person for having their abdomen cut into. But I'm just not sure that I'm doing everything that I can to make my recovery faster. I really recover poorly and I'm SO not excited about having a 4th section.

I just wanted to let you know that I plan on grilling both of my OBs and I'm still in touch with a great physical therapist who helped me tremendously with a very old knee injury that I thought would never heal up so I'm going to ask him too. I'm going to get their opinions on what a c-section mom can do and I will report back. If you have ever heard of any kind of physical exercise that can help prepare a patient for a c-section, I'd love to hear about it. I'll report back later!

Thanks!

Jen

[Fairy]

Jen, what are you specifically concerned about that you want to prepare for? Is it abdominal muscles or is it more pain? I have to hand it to you, I had only one c-section, and my body will never be the same. It warn't so great in the first place, but man, what a change. I'm really interested in this, even though it's nine years later for me, I'm intrigued. You've got a hell of a lot more experience, as you've done this two more times than I have, so my suggestions are not likely to be very helpful for you, but I'm interested.

[petesgirl]

Hmm, my sis is a physical therapist, I'll have to ask her!

[Pilotbaby]

If you have already had three then you probably already know this advice but I was told to get up and walk a little bit as soon as possible. I also had a difficult recovery and was in significant pain for awhile. Even though it was painful to walk, I was up the next day because I really wanted the catheter and staples out quickly because those both freaked me out! I think it helped to get up and walk to the bathroom each time even though it was painful. I was also advised to take the pain meds on schedule even if I didn't need them. I didn't want to take them but found when I didn't, almost like clock work the pain was really bad so I went back to the schedule they gave me and it helped. Also, planning on having hubby or someone there to help with lifting baby, etc would be great.

[westwoodmom04]

If you have already had three then you probably already know this advice but I was told to get up and walk a little bit as soon as possible. I also had a difficult recovery and was in significant pain for awhile. Even though it was painful to walk, I was up the next day because I really wanted the catheter and staples out quickly because those both freaked me out! I think it helped to get up and walk to the bathroom each time even though it was painful. I was also advised to take the pain meds on schedule even if I didn't need them. I didn't want to take them but found when I didn't, almost like clock work the pain was really bad so I went back to the schedule they gave me and it helped. Also, planning on having hubby or someone there to help with lifting baby, etc would be great.

I guess I would give the opposite advice re pain medication. I've never taken anything stronger than the 600 mg superdose of tylenol after either of my c-sections (have a reaction to stronger pain killers), and I think it helps your recovery not to be in a narcotic haze. I do agree that the sooner you are up and walking around, the better.

[specialp]

I guess I would give the opposite advice re pain medication. I've never taken anything stronger than the 600 mg superdose of tylenol after either of my c-sections (have a reaction to stronger pain killers), and I think it helps your recovery not to be in a narcotic haze. I do agree that the sooner you are up and walking around, the better.

I agree with westwoodmom, although I was constantly told to "stay ontop of my pain." I do better without and have recovered much quicker from both csections and other types of surgeries which I think is in part because I want off the pain meds so bad. I know it is different for everyone and I certainly would stay on if I was in a lot of pain.

[BabyBearsMom]

I only had one C-section (DD2 was a vbac) and I agree with the advice of just taking the super dose of ibuprofen vs. percocet. I get really sick from narcotic pain killers but I also think they keep you down longer. I was up and walking within 8 hours of my c-section and I highly recommend it. I also think it is important to get enough rest. Is someone going to be helping you for the first couple of weeks after the baby? My mom was there for me which was a big help so I wasn't getting up and down a lot and I wasn't on the stairs. My DH is also a huge help with the babies so that helped with my recovery. I don't think there is much you can do at this point, but if you were getting pregnant again, I would say work on getting your abdominal and back muscles really strong before pregnancy and try to maintain core strength via yoga during pregnancy. That way you have a lot of other muscles to rely on when your abdominal muscles are out of commission while healing.

[egoldber]

I do take the narcotics, so YMMV, but I completely agree to be up and walking around ASAP. That is probably easier to do with 3 other kids. ;)

My youngest was my only planned section and I did have a doula for her birth. I knew she would be in the NICU and I wanted DH to go with her to the NICU. My doula stayed with me in the OR after he left. She also got me set up to pump in the recovery room and helped me pump the first couple times.

I would consider whether or not you had good reactions to the meds used in other sections. Personally, I react strongly and oddly to many medications, so I had a lot of specific requests for that planned c-section.

1) I get nauseated from the epidural/spinal and warned them ahead of time so they could give me IV anti-nausea meds that would NOT make me woozy/lightheaded. That is one thing I hated from my first section with older DD.

2) They also often routinely give a light/twilight sedative/anti-anxiety med (typically Versed) during the stitching up section of the surgery (which usually takes the longest amount of time) and I requested not to have that. They weren't eager, but again I HATED feeling out of it with my oldest's section.

3) Although I take the oral Percocet (it does not make me lightheated like it does some people) after the surgery, I have a STRONG itchy reaction to the morphine typically used in the epidural/spinal for a c-section for post op pain control. I asked for light morphine but still had itching. I am also sensitive to the Benadryl they typically use to counteract the itching and so I asked for something else.

And I think it's a terrific idea to have a plan in place for post-op recovery.

[Fairy]

Now that I've seen replies, i feel like doof, as I read this wrong. seconding walking around as soon as you can. And I think you should stay on top of your pain in whatever way you need to. If you need narcotics, take them, if you're good with Advil, do that. But DO stay on top of the pain, cuz that, for me, was the most debilitating. I also think whatever you can do to strengthen your core before the section is good advice.

[cuca_]

I don't know of any exercises to prepare for a c-section, but agree with the advice to walk ASAP. I have had 4 sections and getting up and walking quickly helped a lot. I think the medication thing depends on how you are feeling. I did not take much with my first three sections, but with the fourth I ended up taking meds because I had a lot going on and I did not rest as much. I don't remember all that well whether I took prescription strength motrin or percoset, but I do remember wishing I had stayed on top of the pain. That was once I was home, and only lasted for a couple of days.

[Tea4two]

I've had 2 c-sections. I'm not sure about how to prepare, but I have a tip for recovery. A midwife recommended massaging my scar and the areas around it. After it healed of course. Massaging helps prevent scar tissue and adhesions. You can search YouTube for instructions or ask your nurses. A binder can also help post surgery but I really couldn't stand to wear one. The pressure drove me nuts. I also used silicone scar strips to decrease my scar's sensitivity. I'm on my phone, so can't link but they are sold in Amazon. GL and hope all goes smoothly!

[bisous]

Now that I've seen replies, i feel like doof, as I read this wrong. seconding walking around as soon as you can. And I think you should stay on top of your pain in whatever way you need to. If you need narcotics, take them, if you're good with Advil, do that. But DO stay on top of the pain, cuz that, for me, was the most debilitating. I also think whatever you can do to strengthen your core before the section is good advice.

Fairy, you are not wrong. That is what I was asking for! The other advice in this thread is great. I always appreciate that. I did not know, for example, that others had such a positive experience staying off the stronger meds. I've only read that it is advisable to keep on top of the meds (percocet, etc.) and I've had a pretty good experience with that. But I'm grateful for the conversation and I'm sure it will help someone.

I do think it is interesting that for a c-section, the only preparation is knowledge on how to recover. In contrast, there are exercises for the "marathon of labor" in a traditional birth. This does make sense. I don't have to do anything but lie there during my c-section. I'm just wondering, since there seems to be a huge disparity on how people recover from c-sections, if there is some kind of conditioning that can be done in advance that help speed a good recovery. I have read on here of women 1 week postpartum taking huge dogs on walks (inconceivable to me!) and others like me that have really had really painfully, uncomfortable sections. I generally have a high pain tolerance so I think there is more than just personal perception of the experience.

I'm wondering if people in excellent physical shape (cardiovascular? muscular?) or if it has to do with weight gain (I tend to start out thin and gain a lot of weight with each pregnancy). Much of my discomfort is not in the form of incisional pain but rather in a general stomach "looseness" that I also experience during pregnancy. Would work on my transverse abs do anything at all to help? I don't know! I've NEVER heard this discussed anywhere! And I think it would be wonderful to know what to do. I know it is best not to plan on having a c-section but when you're on section number 3 or 4, it is best to be prepared!

So thanks to all who have contributed. I heard back from the OB NURSE of one of my doctors and she had some generally helpful exercise info about how exercise helps reduce weight gain, etc. but nothing to my specific point. I have an appointment on Friday with one OB and the week after with the one who will be delivering me. She pretty much lives in the OR (which is why I like her for my surgical births) so I am anxious to see if she can shed any light on the process and how a patients physical condition can affect it.

I haven't heard back from my physical therapist either. He isn't obligated to answer me but I have never known someone so "up" on the research in the field. I'm hoping he'll come through!

THANKS!

[DualvansMommy]

Everyone is different in handling their own pain tolerance and to meds, so having said that i found being out of bed fairly soon after my section really helped. My DS was born around 6am, and i was brought in my room around 8am and already had my cathera taken out by 3pm. That's when i took my first bathroom trip that evening before i had visitors, and kept getting out of bed every chance i can. In addition, taking my meds for 2-4 days while in hospital really helped and once i was home, i stayed downstairs as much possible with only one trip upstairs for bed at night.

good luck!!

[KrisM]

It's been a number of years since I read this, but there is this book: http://www.amazon.com/The-Essential-C-Section-Guide-Everything/dp/0767916077/ref=sr_1_1?ie=UTF8&qid=1378261782&sr=8-1&keywords=c+section+recovery+book that I thought was useful.

I recovered easily and quickly from mine, so I'm not sure how much help I am. But, I did think moving around is key. I felt so much better when I was sitting in a chair instead of lying in bed.

[KrisM]

I do think it is interesting that for a c-section, the only preparation is knowledge on how to recover. In contrast, there are exercises for the "marathon of labor" in a traditional birth. This does make sense. I don't have to do anything but lie there during my c-section. I'm just wondering, since there seems to be a huge disparity on how people recover from c-sections, if there is some kind of conditioning that can be done in advance that help speed a good recovery. I have read on here of women 1 week postpartum taking huge dogs on walks (inconceivable to me!) and others like me that have really had really painfully, uncomfortable sections. I generally have a high pain tolerance so I think there is more than just personal perception of the experience.

I'm wondering if people in excellent physical shape (cardiovascular? muscular?) or if it has to do with weight gain (I tend to start out thin and gain a lot of weight with each pregnancy). Much of my discomfort is not in the form of incisional pain but rather in a general stomach "looseness" that I also experience during pregnancy. Would work on my transverse abs do anything at all to help? I don't know! I've NEVER heard this discussed anywhere! And I think it would be wonderful to know what to do. I know it is best not to plan on having a c-section but when you're on section number 3 or 4, it is best to be prepared!


So I am one of those that recover well. DS2 was born at 4:30am. I had the catheter out at 3pm. I left the next day at 11am. So, just over 24 hours in the hospital. When he was 5 weeks old, I had him in a Moby wrap and climbed up Sleeping Bear Sand Dunes. When DD was 1 week old, I walked with the double stroller into town for a playgroup - 1.5 miles each way. I was slightly overweight to start with both and gained about 35 with DD and 25 with DS2. I did read the book I referenced above before DS2, but I don't remember what I did from it. With DD, I had not read the book, so I'm sure I did nothing special. I honestly think there is just something that helps me recover in my genes. My brother recovers well too.

[TxCat]

The conventional wisdom in the surgical/OB community is that the better physical shape you are in pre-surgery, the easier the recovery will be. If it appeals to you, doing exercises that strengthen your core, such as yoga and Pilates, would probably help in recovery as well.

I'm in the camp that generally recovers quickly and easily from c-sections. I was in pretty good physical shape before my first - worked out at least 3-4x/week until I was put on bed rest at 34 weeks. I was off pain meds completely, including ibuprofen, by the 4th or 5th day after surgery. The second c-section took me a little longer to recover from - I took pain meds (ibuprofen and Vicodin) until about the 9th or 10th day after surgery. But I hadn't exercised as regularly with my second pregnancy, which I think was partially responsible for my longer recovery. With both sections, I was up and walking pretty quickly.

In the first 24-48 hrs after c-section I'm a big believer in staying on top of pain, so I took my ibuprofen and Vicodin around the clock as scheduled, whether I was in pain or not. After the 48-72 hr mark I try to just take the pain meds as needed. I also try to alternate between the ibuprofen and the Vicodin at that point - they are metabolized differently and that way I can give my kidney and liver little breaks here and there. I also much prefer Vicodin to Percocet for my narcotic - Percocet is way too strong for me - I fall asleep instantly.

[egoldber]

I've had 3 sections: 1) unplanned, non-emergency, at 37 weeks, 2) unplanned, emergency under general anesthesia, at 40 weeks, and 3) planned at 34 weeks.


The conventional wisdom in the surgical/OB community is that the better physical shape you are in pre-surgery, the easier the recovery will be. If it appeals to you, doing exercises that strengthen your core, such as yoga and Pilates, would probably help in recovery as well.

While there are no guarantees, I do believe this. I was in by far the best physical shape with section number 2. I exercised regularly until about 36 weeks and I was in the best physical shape of my life before that pregnancy. And despite it being a traumatic birth under GA, I did have the easiest physical recovery. My worst recovery was with section #3 and I was on bed rest the month before that section. I definitely think that played a part. I was also ages 32, 36 and 38 (respectively) with those sections, and I do think being older probably did not help either.

[AngB]

I've had 3 c-sections and each one has gotten easier then the previous. If they make you have an epidural or epi/spinal combined, I asked them to remove that ASAP, it bothers my back far more then the meds helps. (If they would just let me get a spinal that would be even better, but I doubt they will go for that after multiple c-sections.) I am not sure if any doctors are STILL using staples but I would be adamantly against that as well! My friend and I were comparing notes and her doctor did staples while I only have had dissolvable stitches- she had stitches the second time (different doctor) and said that was MUCH better. An abdominal binder helped me after my first and second c-sections, I really didn't need it much after the third. I personally like alternating ibprofen and tylenol for pain management after the first day.

[TxCat]

I've had 3 c-sections and each one has gotten easier then the previous. If they make you have an epidural or epi/spinal combined, I asked them to remove that ASAP, it bothers my back far more then the meds helps. (If they would just let me get a spinal that would be even better, but I doubt they will go for that after multiple c-sections.) I am not sure if any doctors are STILL using staples but I would be adamantly against that as well! My friend and I were comparing notes and her doctor did staples while I only have had dissolvable stitches- she had stitches the second time (different doctor) and said that was MUCH better. An abdominal binder helped me after my first and second c-sections, I really didn't need it much after the third. I personally like alternating ibprofen and tylenol for pain management after the first day.

I've had my c-section closed with both staples and suture and both have been fine. If anything, I think that the staples healed a little nicer/more quickly. That's one of those areas where I prefer to defer to my physician's expertise and comfort level though - good cases can be made for closing with either suture or staples.

[egoldber]

That's one of those areas where I prefer to defer to my physician's expertise and comfort level though

I've also had both and definitely let the surgeon do what they feel most comfortable. I had staples twice and sutures once and the only time I got an infection and a small sore in the incision, it was with sutures.

[KLD313]

With my first c-section they used sutures and my second they used surgical glue or whatever it's called. It was much better than the sutures for me but I would imagine they use what they're comfortable with.

[bisous]

KrisM, TxCat, egoldber and others thank you so much for sharing your experiences from section to section. All of that is really helpful to me. I have been really pondering this and have decided that core strength and cardiovascular fitness makes a difference. I'm trying a mini experiment. I'm going to try to be as fit as possible in the next two months in preparation for my c-section. It seems almost counterintuitive to work out your tummy before someone cuts it open with a knife but in my heart of hearts I feel like the "looseness" I feel after my c-sections will be diminished if I have some strength there, despite the fact that it will be cut into, if that makes sense. I just checked out Julie Tupler's Maternal Fitness from the library. The whole thing is really geared to preparation for labor. But I'm finding that my biggest and most annoying post c-section symptom (the looseness) feels better when I work my transverse abdominals and her program is great for that.

Just an aside, my worst c-section (of the three) by far was the one that used sutures. I guess it is just anecdotal but interesting that it seems to be consistent with what others have experienced.

One thing that I'm going to be doing this time around, similar to what I did with my last birth is to take a megadose of Vit. C (Emergen-C) shortly before my scheduled section. I don't think that the medical evidence is currently favoring this practice (I don't think it is opposed so much as not shown to be of any benefit) but I must say my 3rd section looked AMAZING all healed up. Every practitioner that saw it remarked that it is the thinnest, prettiest line they've seen. The way the scar healed so nicely is also one of the reasons that I've chosen to go with my OB from last time around. She's actually kind of a jerk and I don't enjoy her bedside manner at all but MAN can she cut and sew and that's what I'm looking for, lol. It is actually difficult to get a hold of her or go see her because she is always in surgery. Not the kind of person I'd look for for my first birth experience but perfect for a repeat C.

[PearlsMom]

I don't know much about prepping, as both of my c's were surprises, but I found a binder (really just TIGHT Flexees support undies) after the birth really helped me move around comfortably. And I think it helped my hips go back to pre-baby super fast, too. Also, this is kind of random, but I had a bad cold and cough when I went into labor the second time, and coughing with a recent incision was awful! But come codeine cough medicine really helped right away. Good luck!

[abh5e8]

i think getting as much exercise as you can tolerate before the section will help your recovery. also the best nutrition you can get. healthy fats, plenty of proteins and vegetables. both now and after the birth, will generally help your body to recover from the surgery. i think the vitamin C and expert surgeon are also a great idea!

[bisous]

Just a small update. I talked to OB #1 and she mentioned that many women stretch out their "fascia" (sp?) which is a soft tissue band that envelopes the abdomen. That sounds consistent with what I am experiencing! Also, my profile as a pregnant lady is that I gain more weight than I "should". I start out small. With DS1 I was 120 pounds and ballooned up to 190! Lost it all after DS1, lost all but 10 pounds and pretty much stayed there after DS2 and DS3. That's a huge increase of the middle section and it would make sense that I feel extra stretched out. My hypothesis right now is that avoiding large weight gain might help avoid the stretching out of the fascia. Of course, it is too late for me but this might help someone, lol.

Also, I have been working my transverse abdominals and I have seen some positive results. In the middle of the night the other day I found myself on my back. My insides hurt and felt loose. So loose that turning to the side was difficult. But I remembered the counsel to "engage my transverse", did it and it worked perfectly as I was able to roll over without pain. The looseness relented and I had good control. What remains to be seen is whether the toning of the transverse muscles will be effective after the c-section. I asked my OB once how a c-section works. She mentions that a horizontal cut is made through the skin, the muscles are NOT cut but pulled apart vertically, then the uterus is cut horizontally. Obviously the muscles have to be majorly manipulated in order to be pulled apart enough to get a baby through them! I will let you know if my transverse muscle training ends up being effective after a c-section or all that work is lost from the trauma of the surgery.