The Barbell Mamas Podcast | Pregnancy, Postpartum, Pelvic Health

Navigating C-Section Journeys | Empowering Recovery and Strength with Christina Prevett

• Christina Prevett

Share episode

Discover the transformative journey of cesarean delivery and postpartum recovery with Christina Prevett, a seasoned pelvic floor physical therapist. This episode promises insights into the complexities of C-sections, a topic affecting nearly one-third of births in the U.S. You'll gain a deeper understanding of the reasons behind planned and emergency C-sections, the physiological and emotional impacts on new mothers, and why having a doula's support can be a game-changer during labor. Whether you're preparing for the possibility of a C-section or seeking reassurance after an unexpected one, this discussion offers essential knowledge and emotional guidance.

Navigate the C-section process with clarity as we highlight differences between planned, emergent, and emergency scenarios. Christina details what truly happens in the operating room, from anesthesia procedures to managing unexpected labor developments. This episode is packed with practical advice to reduce anxiety and empower expectant mothers and their partners with the knowledge needed for a smoother birth experience. Expect to uncover ethical considerations and choices surrounding planned C-sections, ensuring you're fully informed about your options.

Post-operative recovery is crucial, and we cover the essentials of effective rehabilitation after a C-section. Learn how to listen to your body, initiate gentle pelvic floor exercises, and the benefits of early movement. Christina shares tips on techniques like scar massage and strengthening the abdominal wall that pave the way for a strong postpartum recovery. As a special highlight, we introduce our Pregnant Powerlifting program, supporting powerlifting enthusiasts through pregnancy with tailored guidance and community support. Join us as we empower mothers to embrace their journeys with strength and confidence.

___________________________________________________________________________
Don't miss out on any of the TEA coming out of the Barbell Mamas by subscribing to our newsletter

You can also follow us on Instagram and YouTube for all the up-to-date information you need about pelvic health and female athletes.

Interested in our programs? Check us out here!

Speaker 1:

Hello everyone and welcome to the Barbell Mamas podcast. My name is Christina Previtt. I'm a pelvic floor physical therapist, researcher in exercise and pregnancy, and a mom of two who has competed in CrossFit, powerlifting or weightlifting, pregnant, postpartum or both. In this podcast, we want to talk about the realities of being a mom who loves to exercise, whether you're a recreational exerciser or an athlete. We want to talk about all of the things that we go through as females, going into this motherhood journey. We're going to talk about fertility, pregnancy and postpartum topics that are relevant to the active individual. While I am a pelvic floor physical therapist, I am not your pelvic floor physical therapist and know that this podcast does not substitute medical advice. All right, come along for this journey with us while we navigate motherhood together, and I can't wait to get started. Hello everyone and welcome back to the Barbell Mamas podcast, christina Brevitt. Here and today, we are going to be tackling a very big topic, and that is cesarean delivery. 30% of babies born in the United States are born via C-section and therefore, if you are pregnant, if you are somebody that has had a C-section or you are thinking of becoming pregnant, this is an important episode when it comes to delivery of your baby. As a pelvic floor physical therapist, we, if we get individuals during their pregnancy, try very hard to outline all delivery outcomes. Even if your goal is to have a home birth or have a vaginal delivery, if you're going to try and go with medication or not, and a C-section is not on your radar, it is still extremely important that we talk about C-section. There are times when you are delivering your baby where things just don't go according to plan. We're going to talk about what happens during a C-section whether it's an emergency C-section, an emergency C-section or a planned cesarean delivery, why you might have a c-section, what occurs in your body when you do have a c-section, and then what can we expect when it comes to our rehab postpartum after a c-section. In another video we're going to deep dive into how to return to different sports after c-section, but here we're going to talk about the act of cesarean delivery and those postpartum considerations, that early postpartum phase, the fourth trimester or the first 12 weeks after a baby is born.

Speaker 1:

Before we get into the nitty gritty of a C-section, the first thing that I want to tell you is that if you had a C-section and this was not something that was in your plan. You in no way failed. You delivered that baby. I've had people say, well, I didn't deliver the baby, the doctor did. That is not true. You delivered that baby. You held that baby in your belly for however many weeks that you were pregnant and you delivered that baby. You held that baby in your belly for however many weeks that you were pregnant and you delivered that baby. You also had a natural birth. It may not be a vaginal delivery and there has been a move towards, instead of calling it a cesarean section, to call it a belly birth, to respect the fact that, whether you had a vaginal delivery or you had a cesarean delivery, you gave birth to your kiddo.

Speaker 1:

And if you are a person who is listening to this and you have this feeling like you failed or that, I had somebody tell me that they felt like they were a bad mom before they even started because vaginal birth didn't go the way that they wanted it. To Know that, one, you did not fail. And two, it is important for you to grieve that process around having your baby delivered in a way that was not according to plan. Maybe delivered in a way that was not according to plan and, if you need to, please reach out to a provider in order to work through those feelings, because they are very normal and very common. And if that is you, I hope listening to this podcast may give you the little push that you need in order to maybe seek out some help. If you have tears prickling in the back of your eyes as you are listening to me say this, please think about reaching out to a provider, or at least reaching out to somebody to talk through some of these feelings, because there are plenty of C-sections that happen, that are what we would consider emergency or emergent.

Speaker 1:

It's important for us to make sure that every pregnant person and by us I mean pelvic floor physical therapists to talk about all types of delivery. When we have a person who is coming to see us during their pregnancy, when we are doing birth prep visits, which are so fun to do, we will talk about all of the different options for delivery. It is so important because, if the birth that you had planned ends up in a c-section, the more education that you have to know what is going to happen. If this is the discussion, what are some of your options, what can you expect and what might you feel To know all of those things ahead of time, instead of being very shocked that you're going into a major surgery you had not prepared your body for and you're exhausted and you've been laboring for a long time all of these things that can happen. It's extremely powerful, and so education here is so, so powerful when it comes to these situations where you are in labor, whether you've been induced or you spontaneously went into labor, and things aren't going according to plan. It can be extremely overwhelming when physicians or midwives are discussing the option of a cesarean delivery. This is where not only you having the education about a c-section, but making sure that the partner or spouse that is in the room with you also knows what you would prefer in the event of a cesarean delivery can be extremely powerful.

Speaker 1:

Another person who may be really beneficial to have in the room is a doula. If you have very specific ways that you want labor and delivery to go, or you feel like you have a lot of anxiety and stress about labor and delivery, having a doula in the room can be so game-changing and can be so wonderful. A doula is essentially a birth support person. They are persons that you meet with before, while you are pregnant and they go through different ideas around what you want when you go into labor. What that means is is that when you go into labor and you are starting to get into more active labor, your doula will be there and they will be there with your provider. They are not birthing the baby. They are there to help you getting you things, potentially doing counter pressures, helping you change positions, but then also being your advocate to help you make decisions when you are in those situations where a decision needs to be made relatively quickly.

Speaker 1:

You know C-section rates in the US are at about 30%, so one in three almost babies are delivered via C-section. That is really high. The World Health Organization has a standard where in nations, their national average that they have discussed, based on medical need for cesarean section, is between 10 and 15%. Some estimates say that it should be upwards of 19%. Irrespective of what that top limit number is, the United States right now is exceeding that. There is a lot of reason for that. It's kind of complicated. There's a lot of people who are pointing fingers as to why that C-section rate is higher. Some of this finger pointing is warranted, some of it is not. But really understand that it is complicated, and if you are a person who is trying to avoid a C-section, you can ask your provider about their C-section rates and what is their common triggers for C-section. How likely are they to ask you to perform a C-section under different circumstances? You have every right to ask those questions and they are going to give you their honest answers and then you can figure out if that provider is the provider for you.

Speaker 1:

When it comes to types of C-sections, we have three that we really talk about. There's kind of four actually, so there is a planned C-sections. We have three that we really talk about. There's kind of four actually. So there is a planned c-section. That is, that there is something going on within your pregnancy. It can be a complication. Sometimes this is done for individuals who are pregnant with multiples, so twins or triplets. This is sometimes done for individuals who have had multiple C-sections in the past, and the idea is having a vaginal delivery after cesarean can sometimes be complicated, depending on the reason why your C-section happened in the first place, and so if you had a previous C-section, they may say okay for your next delivery. They may give you the option we can trial a vaginal birth or we can do a repeat C-section.

Speaker 1:

In those types of situations a C-section may be planned For some individuals after breach. If their baby is breach or bum down instead of head down, then again C-section may be warranted and planned. That again is kind of controversial and we're not going to go into that, but reasons why potentially a C-section may be indicated and planned. There are also kind of some more controversy around this where individuals are opting for a elective cesarean, which means that they have never had a vaginal birth or a c-section before and they are asking for a c-section because they do not want a vaginal delivery. Some physicians you know there's a lot of ethical back and forth about that because a c-section is a major surgery but those are both kind of under the planned camp.

Speaker 1:

Then we have two other variations of a C-section emergent or emergency. I really want to separate those because when you hear emergency you think baby is dying right now and that is often not the case. There are signs that baby isn't doing as well in the trial of labor and therefore thoughts around cesarean are coming up For individuals who are having a c-section that is emergent or emergency. They are individuals who have trialed a vaginal birth. They were going through labor. They were waiting to see if their body was dilating and there may be a plethora of reasons why a c-section may be indicated.

Speaker 1:

When we are thinking emergent circumstances can be things like you have been in labor for a really long time, you have been pushing for a long time, your body is getting extremely tired, baby is not progressing and they don't know how long it is going to take until baby comes out, or mom is going to get too tired and we may not have a successful vaginal delivery. That is by no means an emergency, but it is emergent in that the plan was a vaginal birth and now they're changing that trajectory and a C-section is on the plan for the way to get baby out, that belly birth plan for the way to get baby out that belly birth. When we're thinking emergency, that is when baby is showing signs of distress or mom is showing signs of distress. That can be things like blood pressure on mom's side going really erratic or starting to get really high For baby. It can be that their heart rate is showing signs of abnormalities or there's abnormalities on the fetal tracing that are not stabilizing and are picking up in intensity, and that might be a much faster decision and wouldn't be in that emergency camp.

Speaker 1:

When we are thinking emergent, this is oftentimes where individuals are having conversations with their birth providers, so and so this is not going very well. We can try it for another hour, if you want. This might be something that would do better with a c-section. What are your thoughts? Discussions are had, individuals are making those decisions together with their team and their partner and their doula if their doula is there etc. And coming to a consensus and then moving to C-section. This is not something that has to happen like immediately, like they're rushing You're thinking kind of Grey's Anatomy style like running down the hallway. That is not where we are at. Our emergency situations can potentially be there where there isn't a time to deliberate. The force of the recommendation from the provider is stronger, the language is stronger, the need or the discussion is much shorter, because there is something that could potentially risk mom's life or risk baby's life, and that would be where we would be in that emergency category when a C-section has been decided on.

Speaker 1:

No matter what type planned emergent emergency, there are certain things that we are going to expect and we want you to be aware of. If this is you, the first thing I'm going to tell you is to not Google C-section in isolation and put that into YouTube, because you are going to get surgical videos that are telling you or showing you the surgery, unless that is something that gives you peace of mind, but for many of my clients it can feel very unsettling and you will have a drape over your chest so that you cannot see that aspect of the surgery. It really, in my mind, doesn't help most of the time and isn't necessary. When you are doing a C-section, if it is not an emergency, if you are going unmedicated and they need to get in to get baby out right away, they may put you under anesthesia, but that is not the norm. The norm is that it is done via the epidural. When you have an epidural done, that is gonna numb you from the chest down. That will enable you to stay awake during your C-section. Your partner is able to be there in the room with you.

Speaker 1:

When you have a C-section, they are going to bring you into a sterile surgical suite and this is where individuals can feel really afraid, because it does not have a homey feel, and the reason why is because they're trying to reduce any risk of infection and so, because of that, everything has to be clean, everything has to be wipeable and cleanable. And so you are going into a surgical suite. That is where many of my clients say that they felt the most amount of anxiety and fear was going into that pretty scary room. So just know that that's going to happen. If you are having a c-section, so you will be numb from the chest down, heart will be by your head and the surgery itself is a major abdominal surgery. So they are going to do a horizontal incision, most of the time in between your hip bones, to cut through your skin and your fat. Then they're going to do a vertical incision and this is really important. We're going to talk about this later. A lot of people just think about the scar that they can see. So there's a horizontal scar between your hip bones, but then there is also a vertical incision that goes up that cuts kind of that six-pack line called your rectus abdominis, your linea alba. It cuts through that and then you have a vertical incision that goes into the uterus. So they can if your water hasn't broken, they can break your water and then with that vertical incision they take baby out, cut the umbilical cord, give baby to you, and then they do suturing for that vertical incision and then they oftentimes will staple across the skin to close you up.

Speaker 1:

When it comes to decisions that you can make in your c-section, number one you can have music playing. Have your partner put on a playlist that makes you feel better. If you have thought about this for your labor playlist, bring that into the surgical suite with you. You can absolutely do that, and it can make those feelings of stress coming into this type of situation be significantly reduced. It can help with anxiety. It can make you go to a different place, if that is something that you need to bring that fight or flight heart rate response down. I've had people who have described things like feeling like they're about to have a panic attack in those moments, and so it's important to try and think about ways to bring your stress down, to make that experience feel a bit gentler on you. And then there are other things that you can do to give you a like they're starting to call it a gentle cesarean.

Speaker 1:

So after a vaginal birth, we are really advocating many times for things like delayed cord clamping and early skin to skin contact. There has been a move in cesarean deliveries to try and allow individuals, via c-section, to also have those experiences. What I mean by that is that you can ask your physician who is performing the surgery to delay cord clamping to try and flush all that last good piece of nutrients and help from mom to get that into baby to help. And you can also advocate, if baby is okay and there is no complications that happen with baby after delivery, to have some of that skin-to-skin contact while they are getting you stitched up, or allow dad or partner or your spouse or whomever is in the delivery room with you to have that early skin-to-skin contact. And so those are some ways for us to bring that experience down. And there is a really cool study that was published a couple of years ago that showed that women who experienced a c-section and had that early skin to skin with their baby in the delivery room or in the surgical suite were, they reported less feelings of stress and trauma after their cesarean delivery. And that's powerful, right. We want women to feel supported, at peace and happy with what occurred during their labor and delivery stories.

Speaker 1:

Other things that we want to make sure that you're aware of that can happen is one this adrenaline rush that happens as you get into the surgical suite because of fear and stress and anxiety, and so having some coping mechanisms to bring that adrenaline down can be extremely helpful. And then many individuals will have shaking because of the epidural, the stress, the surgery, and so some individuals will experience this overwhelming whole body shake. That's almost like you're extremely cold, but you can't stop yourself from shaking. For a short period of time it can be unsettling, but it is by no means abnormal and it is something that your body will have very temporarily. And again, knowing that this is something that may come up can really reduce that fear response that many individuals can report having when they've had a C-section. That's the delivery itself, so things that you're going to expect going into delivery, how that delivery occurs, and then we are on the other side. So we are on the other side of that c-section and we are trying to learn how to be a mom, or be a mom again and recover in the early days after a c-section.

Speaker 1:

What are some of the things that we know? First, I truly believe that every single person needs rehab after a c-section. It is a surgery and that means that we are going to have certain considerations that we need to take into account when we are coming back to activity, and that can be activity like cleaning the house, that can be activity like holding your baby, that can be activity like return to running. I really truly believe that everyone needs rehab. As early as one or two weeks postpartum, you can be seeing a rehab therapist that is going to give you an idea of is everything okay, is everything healing the way that you want it to, and what does that look like for you going forward?

Speaker 1:

Sometimes you can have things like infections and abscesses. That can happen, that are a blip on the radar if you catch them early, and so you want to make sure that you are just looking at your incision. So that's going to be my number one recommendation after a c-section, start thinking about looking, or start looking at your surgical scar. Individuals who had a c-section, who are not expecting to have a c-section, may have a very hard time looking at their stomach. This is part of your healing journey, and the more you can look at your C-section scar, the more desensitized you will be, and that's way oversimplified with the amount of emotions and stress and trauma that can happen when things do not go according to plan, but a early part of rehab that is going to be an important part is to be able to look at your scar and have it feel like it is something that is a new part of you as part of your postpartum journey. So taking a look at your scar is important.

Speaker 1:

The second thing is that it is very normal to have either differences in temperature or feelings of numbness around the scar, and even upwards of six to eight months after delivery. What can happen is when they cut the skin or cut through some of the layers, they can get some of the little tiny branches on the skin, the nerves, and they can cut them. It's not bad. It's just that those nerves take longer to recover than a you know like, than your skin would, and so it can take a little bit longer. So if you feel like there's a part of your um, there's a part of your scar that is really cold, or there's a feeling of numbness around your scar, that is completely normal and it should recover with time. So it's not something that you need to be worried about per se, because it is something that can happen as just a consequence of the surgery.

Speaker 1:

When it comes to your recovery, something that individuals may not know is in that early postpartum period. Something that people may not know is that in that early postpartum period, you are going to bleed out of your vagina just like a person who had a vaginal birth, and that is because you are not bleeding after a vaginal birth because of the stretch to the opening of your vagina. It is because all of the cells and the blood and the lining of your uterus that is really plumped up in order to support baby needs to come out, and so that will happen in the form of bleeding. Early postpartum guideposts or flags that we are looking for is one any increase in clots in your vaginal blood, especially if it's bigger If you're my Canadians, a loonie or, some people say, a golf ball I feel like I would want it even a little bit smaller than that. I would be telling my client to go talk to their provider to make sure everything is okay. If you are having an increase in clots with movement, that is a sign that you are doing too much for what your body is currently ready for.

Speaker 1:

From your scar perspective after a C-section, you are thinking about any throbbing, any extra sharp or sudden increase in pain or any increase in bleeding around your incision site is your body's way of telling you that you need to slow down a little bit and be able to rest as much as possible, depending on what your circumstances are when able. The other thing that just sometimes I see with some of my clients is that, especially with a planned cesarean and no trial of labor, is that your milk might come in a little bit later after a c-section than an individual who had a vaginal delivery. I think that has something to do with the hormones and reflexes that can happen after a vaginal birth, but something to think about that it may just take a little bit longer I mean a couple of hours longer to a day or two longer for really you to get full milk production. So that's something to think about and a reason why individuals will do things like simulated pumping and all that type of thing when it comes to movement very early on. So talking, the early days after a c-section, walking is absolutely okay. Actually it is encouraged After almost any surgery. Some amount, some of early ambulation or walking is encouraged because it helps reduce risk of things like infection and is an important consideration for that early healing phase Listening to your body, absolutely Looking at those guideposts with respect to how your incision is feeling completely.

Speaker 1:

But you do not need to be afraid of walking in that very, very early postpartum period when it comes to early rehab, even when you are still experiencing some of that pain, you have those staples in your scar. You can start with things like pelvic floor muscle contraction. So trying to do some Kegels you don't need to do a ton, but start them and doing some big deep belly breaths with some tiny contractions of the muscles of your abs to get that scar moving, expanding and contracting in a way that is very gentle and very gradual. As you get further away from your delivery date, you're gonna be able to do more and more and that is going to be a great way for you to start when it comes to C-section recovery, the movement of your scar after that initial healing phase, in that first three to four weeks you're really trying to get that incision to close, to no longer be bleeding, to have those staples be able to come out and heal. After that we're going to start working on that movement of your C-section scar because you need to be able to move around in different directions side bending, rotation, extending your back, flexing forward and you don't want to have that tightness around your scar to be stopping you from moving in any of those directions.

Speaker 1:

Early ways that we do that after you kind of looked at your scar and you feel okay, looking at your scar is to do some gentle touching of your belly. That can be further away at the beginning, right, you can start at your rib cage or your belly button and slowly work your way down. You can start on your thighs and slowly move up to your scar and then be able to just move up to your scar and then be able to just touch different parts of your c-section scar. After that starts to feel comfortable, we are going to do some massage scar. After that starts to feel comfortable, we are going to do some massage. You're going to start with you on your back and just trying to give in different directions some pushes and pulls on that scar so you can do little circles across the scar. Again, you can start further away and then move towards your scar. You can move it in different directions up and down and we don't only want to focus on the scar that you can see. Here's one of my big points. Yes, we have the scar that we can see, that we want to be able to move. But you also have a scar up and down right In the C-section surgery part of this podcast we talked about how you have this horizontal scar and then they cut vertically as well to cut through your linea alba and into your uterus to get baby out.

Speaker 1:

So we want to do some of that massage across the scar that you can see and then we want to do some of that massage upwards to work on some of that movement as well. Upwards, to work on some of that movement as well. Many of my clients say, you know, it's really funny because it doesn't really feel like the stretch was at the scar itself. It felt like the stretch was on that six pack and that is why it's because we have that other scar on the inside that we can't see that has to be able to move as well. So that C-section scar rehab isn't just that horizontal scar, it's that horizontal or vertical scar as well.

Speaker 1:

After we get comfortable in neutral, then we're going to start taking some of that massage into our extended positions. What we mean by that is spending time on your belly and pressing up In yoga. This is that cobra pose In CrossFit you're going to be having to come back into that kipping position or GHDs. In life you may be extending backwards as you're holding your little one in your arms to counteract their weight, for example, and so you want to be able to feel comfortable, a bit extended, and not have that pulling sensation on your c-section scar. That's going to be one of our early c-section goals is to have the ability for that scar to move in a bunch of different directions. And then our core rehab is going to really try and strengthen your ab wall in a bunch of different directions.

Speaker 1:

So we start in that early postpartum period in neutral, so we keep your rib cage pinned over your pelvis, we do things like bird dogs and dead bugs and side planks and pale off presses. But then we really want to start moving you in different directions as well, and this is not just post C-section, this is post any birth. But it's important that we don't just stay in a plank position and get strong with a neutral position, because that's just not real life and we have to put our baby into a crib and we have to hold on to a car seat where we're kind of flexed to the side and walk potentially long distances. There is just so many ways that we are loading our body in different directions that we need to be strong in that are outside of this neutral spine, and so our programs at the Barbell Mamas really do try and introduce all of these different types of core training to keep you strong, and we implement them in all of our programs.

Speaker 1:

So whether you're in postpartum CrossFit, crossfit low equipment, powerlifting or weightlifting, we put a lot of this into our programs on purpose to make you feel strong and supported, whether you had your C-section six weeks ago or six years ago, because momming requires fitness and our moms who have had a c-section are recovering from a very major surgery. So I hope you found all of that helpful. I really tried to break down the 101 of what you need to know about a cesarean delivery and hopefully you got some nuggets out of that that are helpful or explain some of the things that either you are feeling or things that you are worried about if you are pregnant or are recovering from a cesarean delivery. And if you have any other questions, please feel free to reach out to us and let us know, and if you have any follow-up questions, I am going to do another episode on cesarean delivery, but focusing more on exercise considerations and getting back to high intensity movement. All right, that is it for our episode for today.

Speaker 1:

If you didn't see, we just launched pregnant powerlifting. We have a new program on the docket. We have been asked for this for so long. We finally got all of our ducks in a row to get it launched, and it launched around Mother's Day. So if you are listening to this after Mother's Day, it's not even going to get released until after Mother's Day. Know that we just launched Pregnant Powerlifting and we are so excited about it. You can head to our website, thebarbellmamascom, and check out all of our programs. Otherwise, have a very wonderful week.

People on this episode

Head Shot

Christina Prevett

Host