#170 | An Empowered Cesarean Recovery with Nicole Alfred

July 20, 2022

Nicole Alfred the @csectionrecoverycoach is a cesarean recovery coach, massage therapist, and mother of two. She has given birth two times by C-section: one emergent and traumatic, the other empowered and planned. Her different experiences opened her eyes to the abject lack of support mothers receive post-operatively. Nicole sees a need for much more emotional and physical attention. In today's episode, she shares with us the key steps she believes mothers must take, beginning immediately after surgery and through the first 12 weeks postpartum for optimizing  recovery. These steps include restoring healthy digestive function, wound & scar healing, pelvic floor recovery, and connecting with the incision scar to facilitate emotional processing and healing.


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View Episode Transcript

A woman has to be aware of what is within her control and what's not within her control. That applies whether she's having a vaginal birth or a surgical birth. I think it's a common misunderstanding and myth that women will elect to have a C section because they want to protect their vagina. They want to protect their parents, and they want to save their vagina from being altered in any way. But the truth is that a C section can have more of an impact on your pelvic floor structure than a vaginal birth. I remember telling my doctor when we were having a conversation about my birth, and she's like, well, you know, you're having a surgery though, right.

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Hi, I'm Nicole Elfrid, registered massage therapist and C section recovery coach with over 18 years experience in the perinatal field, I am here to share my story of having an empowered cesarean delivery and taking control of my C section recovery to have the best experience that I could have imagined.

Nicole, it's really wonderful to have you here because our community of listeners are all kinds of women both having physiologic birth and Cesarean birth. But many women have concerns about especially if they're planning a natural physiologic birth. What happens if I end up in the C section room? And then what does the recovery look like? So if you can start to talk to us about well, first you're gonna share your story. And then we're gonna go into what in in having an empowered C section looks like specifically, what do you do at the hospital? How do you plan for that? What are the small steps you can do to feel more empowered in that experience. And then we are really excited to hear about the difference in recovery postpartum between vaginal birth and C section birth, especially as it relates to the main difference, which is your abdominal wound.

So to look at both of my birth experiences I've had, I've had an emergency cesarean. And I've also had a plan Syrian. So my Syrian journey started when I gave birth to my son back in 2014. I was planning a home birth with my midwives, and my doula and I wanted to give birth in the water. I was told my son was going to be large, but being a doula myself, I, you know, didn't listen to them, and proceeded to go over my due dates, eventually went into labor, and then was transferred to the hospital because of meconium. And told that he was too large to birth at home, it was unsafe. So I had come to terms with that hospital birth, but I still was trying for a vaginal delivery. And after 40 hours of labor, my uterus was just exhausted. It's a muscle as you know, so it's very thinned out. And the process of them pushing him back up into my up through my pelvis and pulling him out. My uterus actually tore So can you explain why he was pushed back up through your pelvis? Were you already pushing him down for a vaginal birth and he was a pelvic outlet. He was in your vagina, his head was there and somebody said, No, we're not doing this.

So he wasn't right at the he was coming through trying to come through the pelvic outlet. I had fully dilated and I was trying to push him through and he wasn't able, I think even to fit fully through my cervix. So they had to push them back up high enough to be able to pull them out during this is Aryan. And so when during that process because he was so large, and I had been in labor for so long, my uterus split from the incision downwards, so I have a T scar in my incision. And when that happened, the severity became very life threatening and the actual birth experience itself became very traumatic for me because up until that point, I felt very empowered having midwives and doulas and just kind of knowing I had done everything, literally everything possible to avoid it. And then I had to get put under general anesthesia because they had to try to sew my uterus back up. So I was told shortly after that, that I would never be able to vaginally deliver which was heartbreaking because I believe in birth, I love home birth, I really wanted that waterbirth experience. And birth to me was like one of the most important experiences that anyone could ever go through. So when my husband and I decided we wanted to have another baby, we went through, you know, the process of having to go to a fertility clinic to see why we weren't getting pregnant, because we did have a miscarriage. And then when we got pregnant with my daughter, knowing that I was having a cesarean, I had a lot of time to prepare for it. And what I did to prepare for that birth to have a really empowered experience was go to therapy, I spoke to a birth trauma therapist, it took me six years to actually know that I needed to do that. Because I thought I just needed to move on with life. And I didn't want to feel very stuck by my birth, because I was happy that my baby was healthy and there. And then the other thing I did was I downloaded a meditation from a doula I found online. And it was about having an empowered Syrian, and she literally just referred, every part of having a physiological birth, like you were saying, to having a cesarean. So like, oh, this part of your C section when you're dealing, you know, wheeled in is, you know, active labor. And then when they're doing this, and they're hooking you up to things that's, you know, transition and, and it felt like, what I was going to be experiencing was not just surgery, and felt like what I was going to be experiencing was getting my mind ready to actually give birth to my baby, because birth is still important, no matter how you have to deliver your baby.

Birth is birth is a process. Yeah, it's not an event in the sense that, you know, you start a surgery and the surgery is over. And now that event is over. And you know, a lot of women who even have a vaginal birth, they assume all through pregnancy, the minute the baby is out, like oh, that's it. That's all I need to learn up until the moment the baby's out. It's a very big part of your birth story is what happens in the hours. And of course, the days afterwards, the weeks months afterwards. But that's interesting, because it teaches your brain that this process has begun now, can you talk a little more about that? And then what and what after the baby came out what the rest of that process was like, and what happened with bonding in her plan? Because that's yeah, C section, it's very important part of --

Yeah, it is, is very important. It actually, the whole thing really just empowered me to be able to have that conversation with my doctor, that I wanted to be walked through everything, I didn't want to just be laying there on the table while they did surgery. To me, I wanted to feel like this was a process of birth for me. And they were happy with that I requested skin to skin right away. So I made sure there was going to be somebody there to help hold the baby to me, because as you know, they don't allow partners to do it because of, you know, liability issues in the hospital. And then coming, you know, with her coming out and being able to see her for the first time, my husband, I both said like, let's do this again. And it was never something that I thought would be an enjoyable experience because it was not what I really thought was the way I should have ever birthed. But I accepted that it was the way that I had to birth and I made the most out of it. And when they brought her to me and just had her skin to skin, it was the best experience. Our bonding, you know, just started from literally the moment she came out because I was able to feel her close to me and literally did not leave me for weeks, you know, when she was born? Were you able to actually watch her come out of your body? Did they lower screen? Or how did that work? Like, I don't believe that here in Canada that or at least in Ontario, Canada that they offer that see through screen, but they do allow your partner to fit like to kind of put a camera up and film so I was able to watch it afterwards. But for me, I didn't feel like I missed out. I mean, obviously you see videos online, sometimes on Instagram or they just can pull out their own baby. I don't know any doctors here that would allow that because of the risk of infection and contamination and all that the fact they allow baby's skin to skin from 2014 is a huge change.

Yes, it's a big it's big step in the right direction. Were they able to put your baby on your chest right from your abdomen still connected to the cord or do they kind of so I did ask them to delay the cord to do delayed cord clamping so they did hold her up and then they kind of just held her around there while they kind of cleaned things up a little bit. And then did eventually deliver the placenta and then they did cuts and then they took her quickly to just clean her off and then bring her to me skin to skin with a blanket over us. I got to see my placenta after we had my husband take pictures. He's like I don't know why I'm doing this.

You got that warm wet baby put right on your skin. There's a really big difference between that and the baby that's cleaned and bundled up and handed to you. You had that experience? Yeah, I think women have. That's a big part of it just like that one wet baby on, you know, yeah, I always, I always found that strange when you see the baby's wrapped totally up. Because, to me, that's, that doesn't imitate vaginal birth. And that's the whole point. And I know, after I gave birth to my son, I asked the obstetrician, you know, I really want that if I have to do this, again, I want that. And back then even in 2014, they weren't open to that here in Ontario, that it was a way that we would be birthing through cesarean. And then studies were coming out showing that it does help with breastfeeding, it does help with postpartum depression, if you can imitate that kind of, you know, instinctual thing of babies coming out of your body and coming straight to you. So it just furthers that process, like you were talking about, of, of birthing, which is not an event, there's no end, it's like you go through the process. And then you continue down the journey of being a parent and learning about your body and your baby.

In, in sexual intercourse, the orgasm is the climax. And after that, there's another stage of that process. And it's called the resolution stage. And in birth, we need to have that process as well.

It's really about, it's really about the continuum of the process, staying in a whole thing without interruption without intervention. So anything that we can do to not disrupt the continuum is important.

And I found the difference between having my first birth, which is emergency and my second was that there was less of those stops. And it was more of that continuum, because and I find this when I work with clients that have had either a previous vaginal delivery, and then a, a C section, or it was just their first baby and was the C section is that the there are a lot of hard stops, it's like you're pregnant, and then all of a sudden, you're not. And then you have this baby, and especially people that go through the trial of labor, and then have a C section, it's like this, it's a shock to the system. And it's almost like the trauma from all of it, you know, physiologically and mentally, emotionally, they just hit the ground running. And then they just don't stop, they don't know to kind of slow it down once they get home and they get back into their safe zone and, and they just they continue that way. And then I start to see it as you know, pushing themselves too quickly after having a C section to get physical or get in shape for bounce back. Or, or it's the pressure that they put on themselves to like have to do things with a baby, like feed them or massage them or get them to sleep. And it just this hyper vigilance of like even taking care of a baby, that they lose that care for themselves. And it really discontinues that whole journey in their postpartum and just really only focuses on baby. And so I want to I want to change that. I want to tell people that that's not the way things have to be. And yes, you sometimes are put into situations where you don't feel like you have a choice. The reality is that people are put in those situations, they do have them, but they don't have to live suffering, they don't have to live feeling bad about how they delivered and they don't have to, to become a parent and mother, that child feeling not good enough or that, you know, the way they help their child start their lives was not not the right way. Because we just sometimes don't have control over things. But but you can take control by by knowing what to do to help your body recover properly, so that you don't have to live with the long term side effects of having major abdominal surgery, which is the C section.

No matter how you give birth, a woman has to be aware of what is within her control and what's not within her control. That applies whether she's having a vaginal birth or a surgical birth, when she goes into labor, etc. So just before, before we go into how to have a really good recovery, because I know in the United States, the medical community really does virtually nothing to help a woman have a good or complete recovery. And by your expression, I'm getting the sentence the same in Canada. But before we get there, can you summarize the points that made your C section a positive experience clearly knowing that it was going to be a C section The second time was your last point that you were mentally and emotionally prepared? Doctors on board, thinking of it in terms of a process, putting a lot of energy and focus on bonding. Is there any piece that we've missed that you want to mention? No, I think you got them all. I mean, I it's important to surround yourself by community of people who get who get you and that you can ask questions to and having a supportive doctor is important. Since I remember telling my doctor when we were having a conversation about my birth, and she's like, well, you know, you're having a surgery, though, right? And I said, Yes, but it's still my birth. It's still how I'm birthing my baby. And I told her that I was doing these meditations to prepare me for like the mental process of giving birth. And she was very puzzled but intrigued, she thought it was a really interesting concept. And I think that we also need to just understand that your doctor, your surgeon, is there to provide you with the safest possible way to deliver your baby via cesarean. And not to be an emotional support system for you, because they're not trained that way, ask as many questions as you can write down, get your partner to come or you just record what your doctor has to say, to really understand the process. And then also know that the advice they're going to be giving you for postpartum is limited to incision care, they just want to make sure you're not gonna get infected and that your uterus is healing properly, and that you're healing from the actual surgery, they don't care if you can get up off the couch without pain or take care of your baby properly. So know that you need to have a plan for breastfeeding, you need to have a plan for how you're going to get active again, you need to have a plan for the care system that you're going to have with like food, and how you're going to implement self care who's going to help you do laundry, like all of these things are important to to have, as a plan preparing for your birth.

So let's get into the details of what you coach people on as far as C section recovery. Yeah, so first thing is, you know, we start just moving our body while we're laying in bed. So just doing like general range of motion exercises with your neck with your shoulders, slowly sliding your legs up and down, from like, straight to then bent, not lifting, obviously up at sliding. And then when your nurse comes in to tell you, it's time to get up out of bed for the first time, you know, just understanding and getting the support from them on like proper movements, because they do this, they know what to do to help you. And then kind of learning that way, because that's what you're going to be doing for the next few weeks, right. And then, you know, having the understanding of, you know, to be able to get your IV out for the first time getting on the toilet and rocking. Once they take up the catheter rocking back and forth to allow that urine and that feeling that sensation to start coming. You know, understanding about the gas buildup that can happen in the post recovery in your chest, which is very painful, those movements are going to help the gas to not build up gas that can happen from surgery like air, air that can get trapped in when they do the surgery.

So you're not talking about digestive guests.

Well, not in this moment, digestive gas will build up later, you don't usually feel that right away, that's usually days after let's explain just a little bit to our audience, how surgery can impact your digestive system. And more a little bit more about the gas, you're talking about building up in your chest.

So knowing to avoid straws within those first couple of days. Because those contribute to the digestive gas. You know, knowing that you need to actually move your body to excel your recovery to help you with pain, you need to actually move your body. People think that if I'm in pain, I need to stay still. But actually, after a cesarean, the more you move your body in a functional way, like for example, the first time you get up, and you start to do like little knee lifts like you're marching, obviously not very high, but like very, very little marches around the room or in a spot holding on to the wall or your IV. Those types of things are kind of turning those muscles back on and your hip flexors, they're, you know, putting pressure on your organs, to allow that kind of stimulation of your whole body systems to start working again. So having having a recovery where you're just laying all the time, it does not help improve digestion, it does not help you with pain management and doesn't help you get functional. On the other hand, doing too much physical activity like lifting and walking and going upstairs, on the other hand is not good either, because they're not helping you to gain those basic functional movements that you need to be able to do everyday tasks. And that's what I focus on because we have a lot of people who are resting for six weeks and then as soon as they're released from care, they go straight into exercising because that's the only way they know how to relate back to their body and feel connected and feel strong to feel like they have purpose again and that's wrong and they can sometimes injure themselves because you need to build those daily functional activities and the strength in those movements that your body gets in your core and in your spine, from doing those everyday things like squatting, practicing lunges, what's too soon to be doing that stuff, though. I was doing them within a week, both in the first two weeks,

let's go into what you do when a mother comes home. So in the first couple of days post op, there's a nurse coming around and helping you with some of these movements that you're talking about in the hospital in the bed. Usually, a mom goes home on day three, day four, maybe even day five, what do they need to do to take care of themselves between that time and when they get their first check in two or three weeks?

So they need to be focusing on pain management. Because if they're in pain, it's going to affect their mood, that can affect their breastfeeding. And it's suffering, like why would you want to suffer? I am a very kind of natural based therapist. But I still understand that if you're in pain, you need to follow whatever protocol was given to you. And also don't think that because you're on pain medications that you can just overdo activity, but you can do things like cold hydrotherapy. So you can get an ice pack that's like in a sock that's like over the bandage of your incision to help with some of the swelling, it is a natural way of pain management's starting to move their body more and more every day. So those little knee lifts are becoming bigger knee lifts. Another thing is nourishment, making sure that they are getting enough, you know, calories and nourishment for their body to recover. And potentially if they are wanting to breastfeed, something that I found really helpful was bone broth, it can help build up the collagen, which is really helpful in tissue healing. And resting. Resting is so important. It's hard to do, especially if you have these like perfectionist to it all type of personalities, because you want to make sure that you're closing your incision, the worst thing that can happen is getting an infection and then drainage and all of these things because they will delay healing. So making sure that you are monitoring your incision, keeping it air dried. So you know, some people are looking into these wraps, or these bands in postpartum. I know in the US, they give abdominal support wraps, which I believe are very elastic and gentle. And I think those are okay, especially if you want to be up and moving. But I think the best thing to do after you've had your gauze taken off in those first couple of days, and you're allowed to air dry it and shower is that you allow warm soapy water flowing over it every single day. You take the blow dryer on the cool setting, you blow the blow dryer over that incision to air it out. And then you rest and when you're resting, you're pulling your underwear or whatever you're wearing below your incision. And you allow the air to get to it because you don't want to create that environment for infection, that moist environments you want to let it let it dry out. And then you're just keeping an eye on it. You're looking at it every day, maybe you ask your partner to check on it. And you just make sure that you're looking out for signs of infection or signs of the incision not closing properly.

How about scar Misha scar massage, you know, women feel that they should be actively doing something to help ensure that their scar is the least visible as possible or that it heals in the best way without getting some of that scar tissue that can be painful and uncomfortable and lasts a long time.

Yeah, so So scar tissue can definitely lead to chronic problems in the body with pelvic health and with pain. Also with future births and future births. Yep, it can definitely happen there as well. So the most important thing to know about scar massage is that you don't want to be starting any scar massage while the incision is still closing. You want to wait until it's actually unionized until the tissue has actually come together. And when you're starting out, you want to be gentle, you don't want to just think that you need to dig deeply right into it because the tissue is sensitive. And usually what I get my clients to do to start with anyways, especially if they had an unwanted cesarean because there can be some trauma and discomfort with wanting to touch their scar or even look at it is like get them to just place their hands over their incision and just tell themselves that this is how they deliver their babies safely and that the work they're going to be doing on their scar is to help them heal and prevent future complications.

We had a pelvic floor specialist Sarah Reardon on our podcast in May. And I remember how surprised I was when she said the first thing to do when the scars healed is just from a towel over the incision. I was surprised like how important it is to remind women to be gentle because we do a cameo to like get this scar tissue. It's kind of like the tendons See to over exercise or let me get sex out of the way. So I know I can have sex again, just like easy does it, it's a very long process and recovering from any kind of birth. And I think women really have to hear that message, just start gently, it's a month long process. You don't have to be, you know, compelled to achieve, you know, all of those exercises and practices in a short period of time. It's a process it takes Well, there's no bouncing back, there's no bounce back, right? It's a moving through, right. So get in the mentality of like, this is a process. So what you talked about was desensitizing. So first, I get them to touch it to make sure that they can be at peace with that. And then we start working with rising our wish and prayer and hope and intention and dream for every mammal on Earth, that every woman feels deeply at peace with her birth. And that's really why we have episodes like this one. We want a woman who has a surgical birth to be just as at peace as any woman with a vaginal birth, and frankly, there, God knows how many millions of women vaginally birthing a year who are traumatized and pained and feel assaulted and robbed of what could have been a better experience. So yeah, it isn't that easy. It isn't binary, to feel guilty, or it makes me feel like I failed, or it makes me feel ashamed or, you know, so then what do you tell them?

So I tell them that they they need to set an environment to you know, create a moment for themselves, they need to process their birth, we, in my program, we work through their birth story. And I don't just ask them, like write down all the bad stuff that happened. I'm like, let's point out some of the things where you did feel empowered those moments that you say, You know what, that did feel really good, then, even if it was just the way that someone smiles at you, or made you feel in that moment, you know, there has to be something. So working through the birth story, is actually the first thing that we do in my program, because I think it's like sets the precedence for how someone will take care of themselves, and how someone will interact with their can reconnect to their body, again, through scar massage. And we're not just aesthetic, superficial people, we're deep, emotional human beings,

the scar is the very least of it. Right? Have you ever heard the saying that the issues are in your tissues, like your emotions can literally get trapped in your tissues under percent. And scar massage and getting comfortable with touching the part of your body that is physically and emotionally painful, can help you to release those issues.

Imagine a woman who had a mastectomy, you can't just say, take off those bandages and start massaging your scar, it's like sit there and breathe and cry and love yourself and accept this deviation from the plan that you had at an earlier point in your life.

But the mentality of like, I got to just now keep going and putting myself last because that's what we were taught, you know, growing up in the 80s. And 90s was just like, don't do self care and things will just get better on their own and just don't talk about it while we do talk about things. So that means you do need to deal with it. And dealing with it actually does help open up more doors for you and a different path for you to live. I think that like empowering someone from that birthing stage helps them to develop into the type of mother that they want to be the present person who is not living in a body that they think has failed them or is no good. And instead in a body where they feel strong and capable and that they are worth doing the things that make them feel good filling their cup, as well as filling the cup of others around them. So skin desensitization is a great start for someone you could use any any type of texture, something that's soft, even a makeup brush, and you're going to be using that around your incision. And what that does is it helps to promote the nerve to regrow back, helping people with the feeling of numbness or burning or kind of tingling, that they experienced around an incision because the nerve was cut into during cesarean and and knowing I think one of the biggest things and you mentioned this earlier about a pelvic physio, because there's so many emotional things that happen during childbirth through cesarean that the pelvic floor responds to and especially in a way where it tightens up. And that definitely can lead to pelvic floor dysfunction like painful intercourse or leaking urine in postpartum after a cesarean. So it's important to know that that check in is also important for you if you've had a cesarean and connecting back to your core system in a way that someone with a vaginal delivery does does not look the same. The way that someone recovers from a vaginal birth. Every is not the same, the way that someone delivers for Mrs. area. And there's so many more pieces that we need to add into that plan into that program into those exercises, that is essential to ensure that you are moving your body properly, you're using the right muscles, and you're preventing long term chronic issues in your body.

So when I think it's a common misunderstanding and myth that women will elect to have a C section because they want to protect their vagina, they want to protect their perineum, they want to save their vagina from being altered in any way. But the truth is that a C section can be more have more of an impact on your pelvic floor structure than a vaginal birth.

And I think that when that mentality is taken of it being easier or less traumatic to the pelvic floor, we have to look at your body more than your pelvic floor. It's its body changing in a way that a vaginal delivery is not your body is was created in a way to birth that way. And doing a surgery to the body is not a way that the body is naturally knowing how to process of birth. So when you're having major surgery on a body, the response of that, for example, with the pelvic floor is very different because you don't go through that that same transition that you do during vaginal delivery, but it also can affect the way that you live your life long term because of the chronic side effects of all of that scar tissue and the postures and the way you move and get used to moving after having that major surgery. What I want every Syrian mom to know is that you can have an empowering Cesarean birth and you can heal fully from that scenario and not just with incision closure but emotionally and physically you can feel whole again.

Thank you for joining us at the Down To Birth Show. You can reach us @downtobirthshow on Instagram or email us at Contact@DownToBirthShow.com. All of Cynthia’s classes and Trisha’s breastfeeding services are offered live online, serving women and couples everywhere. Please remember this information is made available to you for educational and informational purposes only. It is in no way a substitute for medical advice. For our full disclaimer visit downtobirthshow.com/disclaimer. Thanks for tuning in, and as always, hear everyone and listen to yourself.

I love how you were saying like all these like hard stops and that there's a journey. I love that too. And it also it also really just resonated with me because this week I was talking with my client who was really having a hard time. Her first was a vaginal delivery and she talked a lot about the the whole physiological side of birth that happens with vaginal delivery. I wonder if she listens to your podcast because she was talking about a lot and it just it made like a lot of sense it really resonated with me in my like educational background and understanding the difference between this is Aryan and and vaginal birth. So that's cool.

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About Cynthia Overgard

Cynthia is a published writer, advocate, childbirth educator and postpartum support specialist in prenatal/postpartum healthcare and has served thousands of clients since 2007. 

About Trisha Ludwig

Trisha is a Yale-educated Certified Nurse Midwife and International Board Certified Lactation Counselor. She has worked in women's health for more than 15 years.

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