C-Section Healing: Scar Care, Core Strength, and Emotional Wellness S6|4

C-Section Healing: Scar Care, Core Strength, and Emotional Wellness S6|4

Get ready for a conversation that will transform your C-section recovery. My talk with Nicole Alfred, a registered massage therapist and cesarean section recovery coach, was packed with valuable insights. What you can expect to learn today is how C-section recovery is not just about physical healing but also emotional processing.

And we talk about that emotional journey and what recovery looks like. We also look at how early mindful movement is crucial for proper healing and also preventing long-term issues. And then we learn about specialized breathing techniques, scar massage, and core strengthening exercises that can aid in recovery.

And I was amazed to learn a simple technique to start strengthening core muscles for long-term recovery involves a breathing and Kegel-type exercise. Don’t miss this valuable advice. Nicole’s expertise will empower you to take control of your physical and emotional healing.

So if you’re a mom who’s had a C-section or you are planning to have a C-section, this conversation is a must-listen. Welcome to Sense by Meg Fora, the podcast that’s brought to you by ParentSense, the app that takes guesswork out of parenting. If you’re a new parent, then you are in good company.

Your host Meg Fora is a well-known OT, infant specialist, and the author of eight parenting books. Each week, we’re going to spend time with new moms and dads just like you to chat about the week’s wins, the challenges, and the questions of the moment. Subscribe to the podcast, download the ParentSense app, and catch Meg here every week to make the most of that first year of your little one’s life.

And now, meet your host. Welcome back, moms and dads, to Sense by Meg Fora. I am Meg Fora, and I am delighted, as usual, to have you join me here today on the podcast.

And today, I am super excited to have Nicole Alford join us all the way from North America. She’s in Canada, which I think would probably be quite chilly at the moment. And Nicole is a registered massage therapist and a C-section recovery coach.

And so today, we’re going to have an incredible journey. She is the creator of the C-section recovery method and a well-known expert in the field of postpartum care and recovery. So a huge welcome to you, Nicole.

Thank you for having me. Your groundbreaking approach has helped so many women navigate the challenges of C-section recovery and reclaim their health and well-being. And I don’t know how much context you have about South Africa, which is where most of my listeners are from, but we have the highest C-section rate in the world in our private sector.

So we have a private and public health care system, and we have about a 75% C-section rate. So you are speaking to a very warm audience. It is very, very high.

Okay. Wow. That’s unfortunate that it’s that high, but also I’m hoping that it just means that you have amazing surgeons there to save lives.

But those numbers are a little high and concerning for sure. And I’m assuming that North America is very similar to South Africa and that there’s no rehab or care for moms after they deliver via cesarean. It’s just kind of like, here’s your baby.

See you later. Have a great life. That is exactly what it is like.

And I think for a lot of women, first of all, many of them have not planned to necessarily have a C-section because interestingly, we did a poll recently on our app and we found that actually only about 20% of C-sections were in fact planned. And then about 20% of birds were natural and the rest were unplanned cesarean sections. So in addition to dealing with the healthcare changes and the shifts and everything that comes and recovery, a woman’s often also dealing with the emotional side of having had a C-section that she hadn’t really planned on.

So yeah. I know that to be true. The emotional side is something that a lot of people don’t talk about and a lot of moms just push down and minimize because the focus is on this brand new baby.

And so many moms are minimized by family members as well. Because when you start to talk about your birth, it’s like, well, at least you and the baby are healthy. That’s all that matters.

And then so when a new mom is hearing those types of comments that as long as your baby’s alive and healthy, she should just be thankful, really makes them feel very alone and very isolated emotionally to be sharing how they felt about the way they delivered their baby. But I know for me with my first, I wanted a certain type of birth experience. And I think that women are allowed to want that and to advocate for that and also have the realistic side that it doesn’t always go the way you want it and be prepared for kind of everything.

But I think that a lot of moms with that emotional side, it never gets dealt with for some for years. And maybe that’s a very good segue to start off with is when you’re dealing with moms who have had a C-section and we’re talking about recovery now, obviously the first thing that jumps to mind is scar recovery and health recovery, but maybe the kickoff with the emotional. Is there a journey that a woman goes through and how do you assist moms? And what advice can you give to my moms around the emotional journey after a C-section? I’ll share a little bit about what I went through just to give you some context.

So I’ve been a registered massage therapist for 20 years here in Canada and a mom for 10. My first was born 10 years ago and he was, and I’ve always had a special focus in my practice in perinatal health. So helping women while they’re pregnant during birth, I’m also a doula.

And then in postpartum helping them recover from like a pelvic health perspective and going through my own cesarean delivery, which was an emergency after 30 hours of labor, my uterus tore during surgery. And so I was told you’ll never be able to deliver vaginally because of that tear that you have now. It’s like a T in your uterus.

And so I was not only healing emotionally from the fact that I didn’t get my home water birth that I had hoped to have. I also was now dealing with the fact that I would never be able to try for a vaginal birth after a cesarean, which is a V-back. And that news is really hard to come to terms with.

And I think for me, I’m a very independent, strong woman who runs her own business and clinic and all this stuff. And, and I’m a doer and I’m a go-getter, but having a baby in general is it really throws you a curve ball because it doesn’t matter what kind of personality you have. When your baby comes, they require a hundred percent of you emotionally and physically.

And you’re so not only just healing physically from major abdominal surgery, you’re also in postpartum. So you’re trying to learn all these new bits and pieces of you that don’t feel normal. And then you’re also dealing with that emotional side of becoming a mom the first time or even more.

And for me, it was my first time. And that was hard, that sense of myself and the moms that I find experience trauma. And I know I went through this too, is this feeling of lost, like you’ve lost something.

And I’ve heard from moms who have delivered vaginally and have had really great birth experiences from their first to their third. And it is a very common thing, I think, for moms to have that lost feeling, that loss of sense of self because you’re a mom. And so it’s like, how do I fit that back in there? But then there’s also the part of, you know, going through an experience that may have been traumatic and trauma can happen, not just from a physically traumatic experience.

Emotional trauma can happen from a vaginal delivery that could be textbook that, you know, I would say, look, that sounds like a great birth. Maybe it wasn’t to them. And so the trauma is really a perceived feeling by that individual.

So nobody can tell you, oh, you don’t feel that way or you shouldn’t feel that way. That’s how you feel. And you have to understand that, like, it’s not just going to go away with time.

It gets less intense, but sometimes things will trigger you. It could be words. I know for me, it was words used about cesareans.

The word C-section, which is so funny because I call myself a C-section coach and my program is the C-section recovery method, just because it’s easier to say than cesarean, right? Less syllable. But that word C-section was really invalidating to me at the time when I first had my baby because I knew I gave birth. I gave birth to a mother and to a baby.

And saying the word C-section felt so cold. It was like just surgery. And I know a lot of obstetricians look at cesareans as just a C-section.

And if you talk about your birth to them, they’re like, yeah, but you’re having surgery. It’s like, yes, and I’m also giving birth, right? So you really have to advocate for that to keep that birthing piece in there because they are very focused in surgery. And so you’re not going to get it most of the time, not going to get that emotional support from the surgeon themselves.

And so a lot of moms I find will go to different friend networks or family networks or even online to different forums. And it’s surprising the amount when I do pull my following on Instagram, when I say like, have you ever had birth trauma? Have you actually dealt with it? The amount of people that actually have never dealt with it. They just keep pushing it aside, thinking it will just get better.

If I have another birth and it’s a vaginal birth, I’ll be able to reclaim that confidence again and that power. But it doesn’t, there’s nothing to replace what you went through. You have to literally walk through it and it’s uncomfortable and it can take longer for some than others.

And I know therapy is really helpful, seeing a psychotherapist to help you process it. I think being a part of a community of people who have been through what you’ve been through really can make you feel less anxious about what you went through. But in those quiet nights, two o’clock in the morning when you’re feeding your baby and it’s dark, that’s where a lot of these thoughts will come in for the moms because they’re finally not busy, running their whole day.

And they’re finally sitting down as quiet and that’s when these thoughts start coming in. And the way that I see that emotional trauma affect women and their bodies is, there’s a couple of things. One is rushing too quickly back into exercise because they want to gain like a power control back.

Another one is focusing on the aesthetics of their body and ruminating about that. Oh, I don’t like my belly shelf, which is where your belly kind of hangs over the incision. Or I don’t like my incision.

Or like avoiding mirrors, avoiding certain clothing, avoiding being touched, avoiding intimacy. Some people avoid going out to social gatherings because they don’t want to talk about their birth because their friends all got to have home births or no one in their family understands. And so it’s really interesting how that really affects every individual person.

But I will say that one of the common things is really rushing back into exercise and rushing back into trying to get some kind of normal that you used to have when it’s really like you’re not who you used to be. You’re a different person because you’re a mom and your experience also changed you. So what can we do to work with that and kind of walk through that together? And I think one thing that really that I work with my clients in our program is journaling, is writing out your birth story and not just kind of like brain dumping it, but like answering questions.

You know what certain questions that will get you thinking about certain aspects of your birth because it’s so easy to focus on the negative parts and the hard parts. But then to think about the good stuff that happens because there has to be moments that were good too. They seem so little and so far away.

And so but getting asked questions about certain aspects of your birth, like when did you feel empowered? When did you feel that you were loved and supported in that process? Right. And you know, for me, it was in the middle of the night when my doula and my midwife were hanging on the bed rails because I was trying to actually deliver first. And my husband was across in the chair and everyone was just sleeping.

And I kind of woke up and everyone was just there supporting me with me, you know, and like that was a time where I felt really loved and really and there’s a picture of it, too. I think my doula kind of took a picture like this of us all sleeping and she pretended to close her eyes while she was doing it. But it’s a memory now that I can see and I have.

But, you know, I didn’t look at my birth photos for like years and I didn’t actually deal with my own trauma for years. And I kept just saying, I don’t have time to deal with this. I don’t want to get sucked into that.

I’m strong. I can deal with this. And, you know, I just need to move on.

But when I actually was preparing to have my second baby was when I actually really started processing what I went through and did some therapy and then had like an amazing birth experience with my my second and my third baby. So it it definitely was full circle for me and and for me as well, like finding a purpose. It’s so hard for people to find purpose in things that are difficult or traumatic.

And for me, just to inspire others, my purpose was that I was meant to be here on this earth to help moms through cesarean recovery and making them feel empowered when they’re preparing and when they’re recovering so they can feel normal again and confident, because when I was going through that experience, there was nothing. And every postpartum or perinatal professional I would speak to didn’t understand cesareans or the recovery of it or even the emotional side of it. And I really want those listening to know that cesarean recovery is more than just ab rehab.

It’s more than going to see a pelvic floor physiotherapist. It’s it’s emotional. Yeah, absolutely.

Well, I mean, I think you’ve covered off the emotional so beautifully there. And, you know, I do think that when things don’t go according to plan, particularly nowadays where many of us lack control and predictability and a C-section will throw you a big curveball. We also have in South Africa.

So, I mean, a great percentage of our moms have unexpected or unplanned cesarean sections for one reason or another. But there is a fair amount of moms. There are a fair amount of moms who actually do have planned cesarean sections as well.

I think about 20 percent of our births are planned cesarean sections. So if I have moms who are listening to us now and who are going towards a C-section that they’re expecting or they’re right at the end and they’re listening to this kind of in the labor ward, what would you suggest that people could actually use to prepare themselves for a smooth recovery from a C-section? This episode is brought to us by ParentSense, the all-in-one baby and parenting app that help you make the most of your baby’s first year. Don’t you wish someone would just tell you everything you need to know about caring for your baby? When to feed them, how to wean them and why they won’t sleep? ParentSense app is like having a baby expert on your phone guiding you to parent with confidence.

Get a flexible routine, daily tips and advice personalized for you and your little one. Download ParentSense app now from your app store and take the guesswork out of parenting. What would you suggest that people could actually use to prepare themselves for a smooth recovery from a C-section? Right, there’s so many things.

So I think the first and foremost is the mindset. So get into the mindset that you are also giving birth, you are not just having surgery and then the opposite, you’re not just giving birth, you’re also having surgery. So whichever side you’re on, just recognize that you’re going through two things, not just giving one.

And that’s what makes C-section moms very different than someone who delivered vaginally. And then the second thing is that, you know, preparing your home is important. Preparing your network, your support network, who’s going to help you with everyday tasks like cooking and cleaning and laundry and helping you lift the baby those that first week and things like that is really essential and really important because you don’t want to do anything that’s going to compromise your incision from closing.

Because for those listening may not know this, but there’s seven major layers of scar tissue that of tissue that is being cut into. And what happens is your body heals the outside first, closes that off to protect from infection and all that, and then it starts healing from the uterus up. And if your incision opens for any reason, you’ll notice that it’s going to take a very, very long time to heal because now you’re waiting six to eight weeks, which is normal tissue healing time to come all the way from the bottom up to the top again.

So try your best to not do anything that’s going to compromise that incision from closing. And that’s don’t lift anything. Don’t move too much.

Don’t do stairs too much. Like really focus on mindfulness practices with your posture and how you move your body. So the one thing that I did with this last cesarean I had in 2023 in October was, you know, as soon as they let me get out of bed and go to the washroom, I was up every two hours on the dot.

Like I would set an alarm on my phone and I would get up and I would, you know, start small, eventually just, you know, you get out of your bed, you go back, you eventually go around your bed, then you go to the bathroom, then you go to the end of the room, then you maybe can walk into the hallway, but like everything is just like adding on, right? And what I would do is I would march on the spot. I would hold on to my IV. If I was still attached to IV, I would march on the spot, lifting my knees, getting my hip flexor muscles working again.

I would do some squats, some gentle squatting, getting that positioning, bringing my bum all the way back, making sure the knees aren’t going over the toes, like really trying to practice the form so that once I was back home and I was, you know, building on those things, I could eventually get back to my normal activities. I know there’s a big concern, like what if you have other kids and you don’t have someone to help you with the kids and you are forced to be lifting and doing all these things? Well, this is what you need to do. This is why practicing the marching and the squatting is so important.

So can I ask you, because when you were first talking, I was thinking that recovery, it would be so important to lie low for a long time. But what I’m hearing you now is saying you actually need to get into movements. How do you balance that? Well, it’s mindful, mindful movements, purposeful, right? Not just like, oh, I’m just going to get up because, you know, I’m trying to perform tasks.

It’s, I’m going to get up because I’m teaching my body how to move again. I’m teaching my muscles how to turn on again. It’s not, you know, your six days postpartum and you’re going to go down the stairs and cook everyone dinner.

Like, I mean, some people have to, it’s their current situation. And, you know, that’s a very, you know, small population. I think most people have some kind of support and help either from a family member, a friend, a neighbor, anyone, right? But I think that if you can just be more mindful with how you’re moving your body and when you are moving it, you’re doing it for a reason because you’re trying to build back certain muscles or certain movements that you’re performing every day.

That’s why I love squats because you would use the squat to pick up your baby. Eventually you’ll use the squat to get in and out of a chair. You’ll use the squat to like bend down to the dishwasher, or if you have a freezer drawer at the bottom, that sort of thing.

Because what ends up happening, if you don’t do those things, what I see is moms at like eight weeks postpartum or even six months postpartum with terrible posture, because now their body has been performing those tasks repetitively throughout the day improperly. And they have sometimes back pain. They have scar tightness because when you’re healing from a cesarean, a lot of moms are very forward flexed because they don’t want to extend their torso.

They don’t want to compromise the incision. It’s a sore area. So a protective posture would be to kind of hover over it and kind of close off their chest and hover down towards the incision.

But some people don’t get out of that, especially they know it’s a trauma sign as well, is that we kind of protect. And so with practicing those movements, you’re doing it for a reason so that you can eventually perform those tasks independently or pain-free. You know, going for, are you guys miles or kilometers there in South Africa? Kilometers.

Okay, so are we here too. But you know, going for even like a one kilometer walk at two weeks postpartum is a lot for someone who just had surgery. But maybe what you’re doing is if you feel well enough to go outside of the home, maybe you just walk down to the end of the, you know, your property or you walk around your property or you walk to the end of the streets or you know what I mean? Like you’re slowly building on movement.

You want to rest though in between, you know, and one thing that I didn’t experience with this last cesarean was pain. I actually was almost pain-free by day seven, which is crazy. Like I had major surgery like anyone else, but because I was so adamant on my movements and you know, I took all my pain meds at the beginning, but I was making sure that I was taking a lot of supplements to help me with my digestion.

Cause that’s another one that can cause pain when you’re really bloated with gas or constipated, that incision area can feel even more sore. So it was really good on taking a lot of supplements that was recommended to me by my naturopathic doctor, which for me was high dose vitamin C, magnesium citrate, arnica was something else that is really helpful with swelling. Those are the things that I took.

Did you use the arnica topically? Did you rub it on the outside or did you take arnica pills? No, I took the pills. Yeah. So I took the pills and I didn’t put it topically, um, like on my incision.

If I had an, if, if I was, I didn’t have bruising, but let’s say I had bruising, I would have put it maybe around the bruising, but I, I, I wouldn’t put anything on the incision until it’s closed. Even calendula is another cream I like, but I don’t put that until it’s like scabbing already. Cause I just, I don’t want to compromise it.

Right. So talk to me, I mean, we started to touch on the wound itself. Um, do you touch on scar care and wound healing with your moms? Absolutely.

So one thing that I would say is like keeping it clean is essential. Um, and that is letting warm, soapy water run over it. No scrubbing, no touching.

Um, if you have a shower head that comes off, use that to spray it. That’s great as well. And then if you have a hairdryer, put it on the cool setting and let that air out your incision after you shower every day.

And, and then another thing with the resting, like we were talking about, how do you balance that? Well, if you’re up on your feet all the time, how, and you have a little bit of an overhang over your incision, how is your incision airing out? So definitely be laying down, allowing just the air to get to that incision so it can air out, um, and not being bound up tightly by any kind of corsets or wraps. There are some wraps that I do like. Um, most of the, most of them I don’t like, um, in the U S they get a wrap at the hospital.

I don’t know if, if in South Africa, they give the moms anything there when they leave the hospital. Some, some doctors do, but most actually don’t. So what do you, what prep do you recommend? So, so there’s a study that I saw a few years ago that, uh, uh, elastic abdominal binder to is made out of cotton to cover around just like that lower incision area, almost like a back support belt.

Um, they, the study found that that was helpful with post-operative pain and blood loss. Um, and again, if you’re looking at how long that would be used for probably only two weeks, right. Um, and so that’s something that they’re, they’re given usually in the U S and Canada, we’re not given anything.

There’s a couple of countries that are countries, a couple of companies that I like, um, that baby belly band is one really good one. Um, there’s a belly’s ink one they’re based here in Canada. Um, but the one that I really like from belly’s ink is I like it because it’s, it’s, it just covers around like that lower back and the incision area.

I know when I had my first C-section, I felt like everything was just going to fall. Like I felt like my insides were going to fall out of my incision. It was just the weight that was so sensitive and the weight of everything.

Um, and so I, I was wearing like at the time, a tight tank top when that, like a spandexy pregnancy one, and that was really helpful, but you can find, you know, um, shorts support shorts, which may or may not, depending on your mobility be hard to put on. Um, but I like the wraps because when you are getting up to move around your home, it, you can stand up and put it on and then you could take it off as soon as you sit down and lay and lay down. Whereas with the shorts, you can’t really do that.

So, um, or the top. So, um, so yeah, anything that’s just going to cover that lower area, nothing that’s covering the full entire torso or squeezing internally and putting a downward pressure on your pelvic floor. Like, I mean, Amazon has tons of those and I just hate all of them.

And, and really anything that’s being marketed to you through social media, even that it’s going to help make your tummy look smaller. Yeah. Well, cause they’re all there.

They’re, they’re marketing to the moms to say, Hey, I know the most insecure part about your body after a baby, the belly, your belly, the place where your beautiful baby was grown is now your most insecure area of your body. And we’re going to market this product to make you think that you can shrink your area with this wrap. And that’s not how it is.

It’s the strength is built from the inside out. Right? So, so yeah, keeping that incision clean, don’t put anything on it until it’s starting to actually heal and maybe even scab air resting enough so that you’re not compromising the tissue from joining together on, on, in the incision. And yeah, air the hairdryer on the cool setting to cool, to, to dry it out.

Sometimes you get a little bit of oozing. That’s normal. Even like panty liners or gauze or whatever you have just to soak that up.

But you’re, you know, a lot of moms have their partners or their husbands helping them medically care for their wounds. And that could be helpful too, because they can help you keep an eye on things. I did my own, I take pictures every day, you know, seeing what it looks like just so I can track its progression.

So that’s just kind of the things that we recommend. Interesting. And then I think one thing we must touch on, because you’re right, the biggest insecurity for women after having a baby, and this goes from natural deliveries or vaginal deliveries and cesarean sections of which I had two vaginal and one cesarean, but across the board, the anxiety comes around your belly.

And are you ever going to get your body back in shape? It’s really, you know, and it never will be the same, but particularly after a C-section, you’ve also got to start to think about not disrupting the tissues where you feel like you should be not disrupting the tissues internally as they knit. So I guess the question is how long do those internal layers of muscle take to knit? And at what point can you actually start to do some sort of exercise? And how do you grade towards core exercises? So the way that my method works is we make sure that you are healing those first six to eight weeks internally, which is tissue healing. And then after that, we’re focusing and even during it, you can start working on your core, right, and building back that core strength.

How would you do that? So we do it through breath work, really focusing on rib cage expansion, like laterally, not this like chest breathing or belly breathing that you’re taught, even in yoga. It’s really just focusing on that lateral expansion. I think it’s called core breathing or 360 breathing.

There’s a lot of terms now for this type of breathing, but basically you practice the breathing through this area of your rib cage first. And then once you kind of got that understanding on where you should be expanding your breath and letting it out, then you start incorporating the pelvic floor. So you’re doing not a squeeze or just focusing on contraction of your pelvic floor, which for those of you who don’t know what that feels like, it’s like holding in your pee or holding in if you have to fart, just hold it.

That’s you contracting your pelvic floor. So what we’re doing is we’re pretending to be picking up something like a marble or a blueberry and you’re picking it up. It’s almost like you’re kind of zipping it up into your abdomen or you’re like sucking in through a straw or you can picture like an elevator going up.

So what you’re doing, because your core is a pressure system, what you’re doing is when you inhale your muscle in your rib cage called diaphragm, it pushes everything down and the pelvic floor accepts it all. So everything goes down. That’s when you relax your pelvic floor, right? That’s during your inhale.

And then when you breathe out through your mouth, that’s when you do the pickup. Right. And it becomes this kind of synergistic movement where you have to coordinate.

So it’s not like, Oh, I got it right away. Like it takes time to understand how it’s done. And we have public floor physiotherapists here in Canada that a lot of people will go see just to get that feeling and understanding is able to release the muscles in the pelvic floor if you’re tight.

And, but that’s how you build the core first. And then once you have that connection going, I would definitely recommend scar massage. So first we’re desensitizing the scar.

We’re working that, that numbness that everyone has around the scar using different textures, like a makeup brush or a cotton ball. And you’re just gently rubbing it for a few minutes a day. And again, it’s just increasing that nerve growth in that area.

And there’s studies that actually back that up to be beneficial. Your, your nerve in your skin can grow even past one year. So if you’re listening to this and you’re already a year.