Cesarean Child birth; complications and rehabilitation

CESAREAN CHILDBIRTH

A cesarean section is the delivery of a baby through an incision in the abdominal wall and uterus rather than through the pelvis and vagina.31,50 General, spinal, or epidural anesthesia may be used. Cesarean section (C-section) delivery is now at an all-time high in the United States. In 2004, the rate was 29.1% of births, totaling 1.2 million deliveries Pregnant women need to be informed as to the risks and benefits of each choice in order to make informed decisions. These statistics are the focus of much discussion within obstetrics, and because of this high incidence and new trends, physical therapists must be prepared to address these issues with all pregnant patients Women who have had Cesarean delivery may still require pelvic floor rehabilitation. Many women experience a lengthy labor, including prolonged second stage (pushing), before a C-section is deemed necessary. Therefore, the pelvic floor musculature and the pudendal nerves are not always spared the stress of labor. Also, pregnancy itself creates significant strain on the pelvic floor musculature and tissues. Postpartum intervention for the woman who has had cesarean delivery is similar to that of the woman who has had a vaginal delivery. However, a C-section is major abdominal surgery with all the risks and complications of such surgeries, and therefore the woman may also require general postsurgical rehabilitation.

CESAREAN CHILDBIRTH


Suggested Activities for the Patient Following a Cesarean Section Exercises

Instruct the woman during her pregnancy in all appropriate exercises, if she is able. Instruct the woman to begin preventive exercises as soon as possible during the recovery period.

• Initiate ankle pumping, active lower extremity ROM, and walking to promote circulation and prevent venous stasis.

• Initiate pelvic floor exercises to regain tone and control of the muscles of the perineum.

• Deep breathing and coughing or huffing is used to prevent pulmonary complications .

Progress abdominal exercises slowly. Check for diastasis recti and protect the area of the incision to improve comfort. Initiate nonstressful muscle-setting techniquand progress as tolerated, based on the degree of separation. Teach posture correction as necessary. Retrain postural awareness and help realign posture with indicated therapeutic exercise. Develop control of the shoulder girdle muscles as they respond to the increased stress of caring for the new baby. Reinforce the value of deep diaphragmatic breathing techniques for pulmonary ventilation, especially when exercising, and relaxed breathing techniques to relieve  stress and promote relaxation. The woman should wait at least 6 to 8 weeks before resuming vigorous exercise. Emphasize the importance of progressing at a safe and controlled pace and not expecting to begin at her prepregnancy level.

Coughing or Huffing

Coughing is difficult because of incisional pain. An alternative is huffing. A huff is an outward breath caused by the upper abdominals contracting up and in against the diaphragm to push air out of the lungs. The abdominals are pulled up and in, rather than pushed out, causing decreased pressure in the abdominal cavity and less strain on the incision. Huffing must be done quickly to generate sufficient force to expel mucus. Instruct the patient to support the incision with a pillow or the hands and say “ha” forcefully and repetitively while contracting the abdominal muscles.

Interventions to Relieve Intestinal Gas Pains

Abdominal massage or kneading

Have the patient lie supine or on the left side. This is very effective and typically done with either long or circular strokes. Begin on the right side at the ascending colon, stroking upward, then stroke across the transverse colon from right to left and down the descending colon, then finish with an “S” stroke along the sigmoid colon.

CESAREAN CHILDBIRTH


Pelvic tilting and/or bridging

These can be done in conjunction with massage.

Bridge and twist

 Have the patient maintain a position of bridging while twisting her hips to the right and left. This position may also facilitate air embolism and therefore should be used with caution in the early postpartum period.

Partial abdominal curl-up

 Avoid strain to the linea alba.

Scar Mobilization

Cross-friction massage should be initiated around the incision site as soon as sufficient healing has occurred. This will minimize adhesions that may contribute to postural problems and back pain.

 

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