April is Cesarean Awareness Month, so we’re getting in under the wire here on this last week of April with our return guest Jenny Archer! She’s the brilliant Pelvic Floor PT expert we had on several episodes back and the owner of Archer Physical Therapy here in middle Tennessee.
Welcome back, Jenny!
Listeners, if you didn’t get a chance to listen to our first episode with Jenny, queue that up for your next podcast listen because it was a WEALTH of information for women of ALL ages. This is need-to-know stuff!
Today, we’re focusing on women who’ve experienced Cesarean sections (or “belly births”). So, the first question that seems obvious is:
WHY, if you didn’t deliver a baby via your pelvic region, would your pelvic floor even need attention??
(major abdominal surgery, ligaments around cervix can be tight, sex can be painful due to scar, posture??, and leakage)
Let’s talk about C-sections in general. In the US (2023), about 32% of live births are via Cesarean. The World Health Organization reports that in Latin America and the Caribbean, rates are as high as 4 in 10 (43%) of all births. In five countries (Dominican Republic, Brazil, Cyprus, Egypt and Turkey), caesarean sections now outnumber vaginal deliveries.
Worldwide caesarean section rates have risen from around 7% in 1990 to 21% today, and are projected to continue increasing over this current decade.
WHY are rates rising? Several reasons: increased maternal request and clinical factors like rising rates of obesity, multiple births, and older maternal age play a role.
Unfortunately, concerns about liability, financial incentives for hospitals, and hospital politics probably are factors, too.
The Mayo Clinic gives several reasons an OB might go this direction, and these include:
- Labor isn’t progressing normally. Labor that isn’t progressing (labor dystocia) is one of the most common reasons for a C-section. Issues with labor progression include prolonged first stage (prolonged dilation or opening of the cervix) or prolonged second stage (prolonged time of pushing after complete cervical dilation).
- The baby is in distress. Concern about changes in a baby’s heartbeat might make a C-section the safest option.
- The baby or babies are in an unusual position. A C-section is the safest way to deliver babies whose feet or buttocks enter the birth canal first (breech) or babies whose sides or shoulders come first (transverse).
- You’re carrying more than one baby. A C-section might be needed for women carrying twins, triplets or more. This is especially true if labor starts too early or the babies are not in a head-down position.
- There’s a problem with the placenta. If the placenta covers the opening of the cervix (placenta previa), a C-section is recommended for delivery.
- Prolapsed umbilical cord. A C-section might be recommended if a loop of umbilical cord slips through the cervix in front of the baby.
- There’s a health concern. A C-section might be recommended for women with certain health issues, such as a heart or brain condition.
- There’s a blockage. A large fibroid blocking the birth canal, a pelvic fracture or a baby who has a condition that can cause the head to be unusually large (severe hydrocephalus) might be reasons for a C-section.
- You’ve had a previous C-section or other surgery on the uterus. Although it’s often possible to have a vaginal birth after a C-section, a health care provider might recommend a repeat C-section.
So for one of those reasons, you’ve had a C-section or belly birth. That means that in addition to the regular post partum adjustments (mood, body recovery, fatigue, etc.), you’re having additional recovery that takes longer.
There’s typically a longer hospital stay, then a period of 6-8 wks where you’re having to avoid lifting—even having someone else hand you your baby instead of bending over to lift her from the bassinet, e.g..
You’ve got an incision that requires some attention—it has to be kept clean & dry with bandage changes, and you may need some add’l pain meds during recovery.
Just in researching C-section recovery for this conversation, we did find some mention of doing “gentle pelvic floor exercises” (with no more explanation than that), but nothing else indicative of how pelvic floor PT might contribute to a smoother recovery. (No surprise there, b/c as we noted in our last conversation, there needs to be more education and availability for pelvic floor PT!)
What are some therapies you might help a belly birth client with? And how do they differ from those you might recommend for a vaginal delivery?
We know the likelihood of C-section is greater if you’ve already had a previous one. Can pelvic floor PT increase the chance of secondary vaginal delivery?
Does pelvic floor PT help with a second C-section (if you know that’s the route you’re going to have to go)?
Other issues Jenny wants to cover?
Emotional after effects of a belly birth… Altho in some cases women might request a C-section, in many cases, it comes as a surprise and a complete change of plans mid-delivery.
A pivot like that can leave some lingering psychological/emotional fallout…. It’s not uncommon for a new mom to feel like somehow “she didn’t do it right” or “couldn’t delivery correctly,” that “her body betrayed her” in some way or that she was cheated out of a “normal” birth experience.
Do clients mention any of these sorts of things to you in the course of their physical therapy? What’s your answer?