As we all know birth does not always happen vaginally.  Many babies are born through mom's belly.

Moms who have a cesarean have many of the similar factors to consider as moms who birth vaginally.  These factors are centered around all moms were pregnant before birthing and the pregnancy itself alters our body.

However, moms who birth through cesarean have the added factor of an abdominal surgery.

Let's consider the two paths moms may on before a cesarean.

The first path is mom is laboring and pushing, but for what ever reason baby is not progressing or another medical complication occurs and for the best interest of mom and baby a cesarean is performed.

The second path is mom is scheduled for a cesarean and does not labor and push.

Each of these paths have it's own implications on the mom's body.

In the first path, the pelvis is primed for a vaginal birth, the tissues and muscles of the pelvis are stretching and widening, the uterus is contracting.  Mom may have been laboring naturally, induced or with pain medication. She may have tried multiple positions to help baby out and may have pushed for hours. For some baby is in an asymmetrical position or breech which puts strain on moms tissues where we don't want the extra strain. Baby may have been pushing into and stuck on the pubic bone.

Whatever the scenario, when mom has labored and pushed before a cesarean her pelvis has gone through a partial vaginal birth.  This means that she is at risk of long term pelvic floor dysfunction, similar but not as high of a risk to those who delivered vaginally.

A reminder of these problems are incontinence, pelvic pain, and prolapse, which Part 3 goes over in more depth.

In the second path, moms body has started prepping for a vaginal birth, but typically a cesarean is scheduled at least a week or 2 before the due date.  This is to reduce the chances of mom going into labor.

For these moms, they have the least risk of pelvic floor dysfunction.  This is a no judgement zone and I believe cesareans are absolutely needed when medically necessary, but don't let the reduced risk of pelvic floor dysfunction lull you into a false sense of security.

Cesareans are a major abdominal surgery.

Without getting into the medical component of a cesarean, which you can read more about the that in my blog post Vaginal vs Cesarean, I'm going to cover how an abdominal surgery alters the body.

Unlike cesareans of the past, the abdominal muscles should no longer be cut, however they spread and separated from the connective tissue.  So after 9 months of being stretched out they are further stretched and traumatized, regardless of how gentle the OBs are.

Especially during an emergency cesarean, OBs want to get baby out fast, so moms tissues may be bruised and have extra micro trauma that has to heal.

If you think of any other major surgery, most of us don't assume the person will bounce right back from it.  Usually there is a recovery time and rehab, sometimes A LOT of it.

When your abdominal muscles are retracted and organs are shifted some more to remove baby, the fascia and connective tissue that is interwoven through the abdomen down into the pelvic floor is involved. This means that even though baby was not born vaginally, there is still a risk of pelvic floor dysfunction, because of the interplay of tissue.

What are the major implications though of the incision?

A cesarean incision is a scar. A scar is an interruption in the normal tissue fiber, which is weaker and sometimes unpredictable.  The scar for a cesarean is multi-layered and can vary from mom to mom based on the OBs technique and how mom heals.

Some moms heal beautifully without complication and others may have extra scar tissue, infection or added complications that prolong the healing process.

In turn, a scar may visually looked healed but tactically be numb, bumpy, tight or painful.

There are two major implications that result from the scar.

1. Pelvic weakness, mainly the abdomen.
2. Pain, mainly abdominal or pelvic.

Let's take a look at each these more closely.

When any muscle is traumatized by injury or insult, such as a surgery it is weakened at a micro level.  Plus nerves are also involved causing numbness and reduced sensation in the abdomen. Combine this with weakened and stretched out abdominal muscle from pregnancy, moms with a cesarean are at a higher risk of longer lasting abdominal weakness and a harder time tuning into the Abs.

This is perpetuated by the fact that most OBs don't want mom to perform any form of exercise for 8 weeks to make sure the incision is healed, which is fair enough. However, with the guidance and expertise of a maternal pelvic health specialist there are safe exercises that can help with healing.

Abdominal weakness can lead to

• back pain
• constipation
• prolapse
• poor posture

But as I stated before the fascia that is woven through the abdomen reaches into the pelvic floor, which can result in some pelvic floor dysfunction as well and as we all know (now, from reading the series) it's not all about Kegels for pelvic floor dysfunction. So we want functional Abs too!

On the other hand the scar can cause pain. When a scar is formed the body arbitrarily adds connective tissue to the area.  Then over time the body comes back and straightens it up to match the force vectors in the tissue.

Some bodies aren't as efficient at this process or are overly efficient, meaning they don't straighten it up very well leaving nodules or bumps or extra scar tissue is created and may adhere to surrounding organs or tissues.

This disorganization or adhesions can result in pain receptors saying something is wrong, thus abdominal or pelvic pain.

For many moms this is most noticeable with activity, bowel movements, a full bladder, sex, and menses (once they start).

Long term implications if not addressed as be increased severity of symptoms, "sudden" start of symptoms that may seem out of the blue but stemming from the cesarean or complications in later births.

So as you can see there are risks for all forms of birth and we as women need to research, ask questions and feel in control of the decisions we make regarding birth.

Knowing that you are not alone, there are people who can support you through your birth and your healing after birth. There are treatments for these complications and ways to help reduce these risks. All it takes is reaching out.

We'd love to hear your birth experience. Comment below.