My first week Postpartum: Cesarian birth recovery and body mechanics

I welcomed my son about three weeks ago, he was delivered via a planned gentle cesarian birth at 38 weeks and 6 days due to low amniotic fluid complications. The last 8 weeks of my pregnancy were not as planned and required a lot of bed rest, anything extra took so much energy and created a lot of pain. It was challenging for me to be off work earlier than expected and to not be able to manage even gentle pool walking. Once my son arrived, I felt an immediate relief from all the pelvic pain I had been experiencing when I was able to stand for the first time.

I was grateful for an amazing nursing staff at the hospital we delivered at and my knowledge as a physical therapist for how to move without straining my incision. I realized that there was no discussion on expectations pre cesarian on pain management and recovery, all our focus was on the birth plan but not what to expect afterwards. I felt so disconnected from my body with not being able to exercise during the last part of my pregnancy and especially after receiving an Epidural.  I would like to share some bed mobility tips and gentle exercises I started in my first 72 hours after my cesarian birth. 

BED TRANSFERS

Log Roll: Going from your back to side to prepare for sitting

  • Utilize your hospital bed to your advantage and adjust the head and leg rest to help assist yourself to a semi reclined position
  • Exhale and roll to your side
  • Once in this position exhale again and use your bottom forearm and top arm hand to push yourself upright. *Exhaling with movement reduces abdominal pressure and puts less stress on your incision
  • Once in sitting scoot towards the edge of the bed, raise your bed height as high as you can go without feet coming off the floor
  • Lean forward and exhale as you focus on pushing the ground away through your feet to stand

Shifting upward in your bed:

  • Adjust the bed to be semi flat
  • Hold the hand rails or push through forearms/hands and pull or push your self upwards without holding your breath or pushing through your legs

HOSPITAL EXERCISES

  • Diaphragmatic breathing – sitting, sidelying, lying on my back 5 minutes. Focus on nasal inhale/exhale guiding my breath below my belly button, to the side of my rib cage and back of my rib cage
  • Glute squeeze – Lying on my back, squeezing my butt cheeks for a 3 second hold
  • Quad squeeze – Lying on my back, squeezing my quads to make my legs straight and rigid, for a 3 second hold
  • Shoulder blade squeeze – Sitting upright or standing, squeezing my shoulder blades together and pulling my elbows behind me, for a 3 second hold
  • Weight shift – standing weight shifts in place working on loading evenly into each foot going side to side and forward/backwards

HOME EXERCISES

*wearing my belly support wrap, here is a link to the one I used https://itsbodily.com/products/belly-band

  • Walking 5 minutes – forward, backward, side step…small steps to not pull on incision. Standing weight shifts in place working on loading evenly into each foot going side to side and forward/backwards
  • Diaphragmatic breathing – sitting, sidelying, lying on my back 5 minutes. Focus on nasal inhale/exhale guiding my breath below my belly button, to the side of my rib cage and back of my rib cage
  • Toe Yoga – Seated – focus on grounding through my feet with even weight bearing through my big toe, fifth toe and heels. Then lift only the big toe off the ground without losing contact on the rest of the foot after about a minute switch to lifting the other four toes without lifting the big toe

Continuation of Hospital Exercises *can be performed during naps or breastfeeding

Breastfeeding:

I felt like Goldielocks trying to find the right spot that felt the most comfortable for breastfeeding. I moved from the bed to the couch, sitting on the toilet or kitchen chair. I was happy I did not purchase a rocking chair or glider because I have moved around so much and found the most comfortable spot has been my home office chair and using my nursing pillow. My friend gifted me the My Breast Friend Nursing Pillow which has been great and when I attempt to nurse in bed I also use a Foam Bed Wedge Pillow.

Breastfeeding has definitely been challenging and anxiety driven, and I learn something new each day. I highly recommend a lactation consultation in the hospital, when you get home and even before you deliver to help with expectations. When my milk first came in it was painful and overwhelming. I found my neck, wrist and thumb starting to hurt, making sure he was maintaining a good latch.

Movements I started to incorporate early on to help ease this pain were:

  1. Massage to my forearm and hand

  2. Wrist circles

  3. Double hand cradle to support my sons head so that the arm supporting his body wasn’t overstressed by taking on the full weight of his head as well

  4. Thumb and wrist position – Supporting his head with both my hands allowed me to not wrap my thumb around his head

    • Try to make sure the tip of your thumb is relaxed and not pointing backwards towards your wrist, this will alleviate the stress placed on your thumb extensor tendons

  5. Mom’s head and neck position while feeding – Pause every minute or to look forward, roll your shoulders back and sit upward. Gaze along the horizon and gently draw your chin in towards your neck making a double chin and hold for 5 seconds, release and repeat 5 times with a shoulder blade squeeze

  6. Diaphragmatic breathing

    • This is a great time to practice your diaphragmatic breathing utilizing your breastfeeding pillow for feedback and focus your inhale going into all aspects of your pillow that is wrapped around you

Changing table and Bassinet lifting mechanics:

  • Just like your bed transfer mechanics exhale with lowering and lifting
  • Wearing your belly band can help support your back
  • Unlock your knees with bending and lifting and don’t round through your mid back
  • If you are not ready to lift ask for help from your partner

I hope these tips were useful. If you are looking for more one on one guidance and support, MOTI Physiotherapy has a Pelvic Floor Specialilst team that has expertise in pregnant and postpartum population. We offer in person and telehealth visits that are covered by insurance. Do not wait for your first postpartum checkup if you are starting to experience pain from the new demands of motherhood. Our Pelvic Floor Doctors of Physical Therapy can guide you through a personalized plan of care that will support you!

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