Topics in Women’s Health: Considerations After a Cesarean Section
The cesarean section rate in the United States has been on the rise for years now. Statistics for 2010, report that one in three women gives birth by cesarean section. With numbers that high, it’s necessary for physical therapists to understand the ramifications of this invasive surgery. The first consideration to take note of is the incidence of infection at the incision site and/or inflammation in the womb (or metritis). Infection occurs in approximately 5-8% of women who have had a c-section and the incidence of post-cesarean metritis remains at 10-20%. Both conditions can be screened for by the physical therapist in the form of inspection of the skin and tissue surrounding the incision, taking the patient’s temperature, and feeling for pain in the area.
Another consideration following c-section is the health and mobility of the scar/incision. If there is a lot of scar tissue present, it can affect the ability of the abdominals to function properly. This is especially important after childbirth because of the demands placed on the abdominals during childcare tasks. The mother should be instructed in how to lift properly (and to not lift anything heavier than her baby for up to six weeks), how to apply an abdominal brace if needed, and how to perform appropriate core exercises to protect her abdominals and spine. Six weeks should be given for the woman’s incision to heal. However, if pain, discomfort, tightness, swelling, or any scar tightness is present after that six week period, it may be beneficial to see a physical therapist.
Physical therapy after a c-section will include a full non-invasive examination of the woman, including an assessment of her incision site, lower extremity function, posture, and overall strength. Primarily, if the woman is experiencing pain in the area of the incision, an evaluation of her incision site will be performed to determine if she has an abundance of scar tissue and/or if she has decreased scar mobility. Either of these problems can be remedied through therapeutic massage techniques that are specific to scars and with other tools such as therapeutic ultrasound. Other impairments can be addressed as well, and a home exercise program can be developed based on the needs of each individual patient.