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The C-Section Myth

Many women believe cesarean section will prevent common post-partum complications such as vaginal pain, leakage, and prolapse. Imagine their shock when they find themselves in my clinic.

 

I'm not anti-surgery. I'm really not! I believe that surgical intervention is a modern miracle that saves countless lives each year. Before development of the cesarean section, giving birth could be an incredibly dangerous event for both mother and baby. The amazing surgeons who perform this procedure are highly trained experts with many years of experience and practice. They make it look easy! Unfortunately, its commonplace in our society has rather dulled the severity and true invasiveness of its process, leading many women to believe it to be a simple option for preserving their vagina. I treat women with pelvic floor dysfunction as a fulltime job, and working on issues following C-section is no rare occurrence in my week. Not all of those women are immediately postpartum, either. Issues can occur months to years later, and while they may not be solely related to a history of C-section, it certainly doesn't exempt women from having problems.


So what gives, right? Well, that's actually my first point. You may not have squeezed a watermelon out of your lemon, but you still carried that baby melon for 10-ish (give or take for some of us) weeks, mama! When studying the pelvic system, we're taught to think of it like a ship in a dock: the vessel represents your pelvic organs (bowel, bladder, uterus), the ropes tying it to the dock are the connective tissues holding everything together, and the water is your pelvic diaphragm (pelvic floor muscles). Carrying and having a baby, whether by incision or pushing, is like putting that ship through a tropical storm. The ropes may be stretched out and a bit frayed, giving the ship more slack to move about in the dock. Most women, whether they know it or not, will have change in the position of their internal organs otherwise known as prolapse. It sounds terrible, but severity is graded on a scale and may have little to no symptoms at all. As long as there is still sufficient water (muscular support) beneath the ship, it remains within the doc. But imagine if the water receded with the tide, leaving the ship to hang upon its frayed and weakened ropes. Now we might have some issues. So, point number one is that pregnancy is a beautifully complicated process, and change is expected no matter how you bring that sweet buddle of joy into the world. Forgive your amazing body if it struggles a little. It didn't betray you, girl. It just made a human being!!


My second point comes again from the analogy of the dry dock: muscle weakness. The longer I practice, the more I realize that this term is much more convoluted than it seems. It's rare that pelvic floor dysfunction is purely a result of weak muscles that need to be strengthened. If that were the case, Kegals would cure everyone (and I'd be working as a starving musician). Pelvic floor muscles can fail to engage properly for a number of reasons. Most commonly, I find that women simply have no idea how to contract, relax, or bulge their pelvic floor. That's right, ladies. There's a spectrum of movement down there that's important for function! (not just on/off) I like to say the pelvic floor has a "range of motion", and just like any other joint/muscle system in the body, poor range can be from weakness, tightness, poor body awareness/knowledge of movement, nerve damage, scar/connect tissue restrictions - and a lot of times, a combo of all of them!


It's actually very common for me to perform an evaluation of the pelvic muscles in a postpartum woman following C-section to find that she has not a single clue how to use said muscles. It's also common to find painful tension which can interfere with penetration during intercourse and contraction during sneeze or a cough. Cesarean section is surgery. Surgery involves scar tissue, inflammation, pain, and a healing process that can greatly impact not only the muscles of the pelvic floor, but also the abdominal wall, the hips and low back, the organs, and the breathing diaphragm. If you read my post on breathing, you'll understand why this can have huge implications for pelvic health, continence, and sex.


SOAPBOX TIME: All of that being said, I want to make it perfectly clear that there is absolutely no shame in having a C-section to deliver your baby. I have been rather angered by ignorant mom-shaming across the internet which claims you are less of a woman if you needed a cesarean or opted for an epidural. We live in an age of modern medical miracles that allow us to experience birth with lower risk and less suffering, and it is absolutely within your right to choose those options.


The point of this post is to bring awareness to the truth surrounding cesarean recovery in the short and long-term. Many physicians are now supporting and recommending vaginal birth after cesarean (VBAC) because they also understand the implications of this invasive procedure. Women should understand that cesarean is a life saving option for baby and herself, not a cosmetic alternative to keep their vaginas good-as-new. And more importantly, should a woman require cesarean and find herself with issues thereafter, she should know that there is help out there! Check out my post on pelvic health physical therapy and spread the word, ladies!


Love your body, advocate for your health, and ask for help when you need it. We're here.

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