Caesarean Recovery

Chrissie Gallagher-Mundy

Carroll and Brown 2004 ISBN 1 903258 72 3

I bought this book because (sadly) the caesarean rate in my area is between 22% and 28%, and every postnatal class I run includes at least 2 or 3 mums (sometimes more), who have had a caesarean. Therefore I feel there is a need for accurate and up to date information to help mums recover from surgery which is increasingly (and alarmingly) routine, but no less traumatic physically, and possibly emotionally.

When I initially read this book, I realized that I was vaguely unhappy with some of the information I was reading but did not have the time to check whether my concerns were substantiated or not. I then saw a National Childbirth Trust review written by their Caesarean Birth/VBAC Co-ordinator, which expressed doubt about some of the factual information given.

Most of my review focuses on the sections of this book relating to post caesarean exercise. The book starts with information about elective and emergency caesareans, the operation itself, the first 24 hours and first week, breastfeeding (The NCT reviewer comments that "some of the breastfeeding pictures show poor positioning"), and moods and depression. The section on scar appearance and care is good but would have been improved by some photos of real scars as a guide, or at least the suggestion of looking at the caesarean website There is no section included for further resources, information and reading which is a pity. The section on healthy eating and weight loss is practical, although stating that breastfeeding uses up 800 calories a day; my La Leche League reference book says 500. There is good advice for getting in and out of bed and supporting the scar area when moving around, however, remembering (after 16 years!) how I felt after my own caesarean, I winced at the suggestion that deliberate coughing was a good idea to stimulate the area around the stitches. I remember coughing, sneezing and laughing as being the most painful post operative experiences, so would rather have seen sensible advice for managing this.

The exercise programme is broken down into sections according to post operative time. Days 1 to 4 suggest ankle circles and breathing exercises, however I feel that the method described is likely to encourage inefficient breathing patterns.

The initial progression of suggested exercises unfortunately does not include the importance of good posture and back position (neutral spine) and introduces twisting movements (hip rolls/knee drops) far too soon, in days 4 to 7. No guidance is given as to the optimal intensity for pulling the lower tummy in. I would also like to have seen emphasis on the importance of rolling to the side when getting up and down. Posture, neutral spine, pelvic floor and relaxation information are relegated to the end of the book in the section "return to normal", "6 months after your operation". This is a shame because I feel that it is essential to introduce these elements at an earlier stage. The pelvic floor section is clear, with correct emphasis on the importance of these exercises even post caesarean. Three separate sections cover exercise suggestions for post operative weeks 2 to 6, 7 to 12 and 13 to 24. Unfortunately, these sections contain several inaccuracies, in particular that the "stomach muscles have been cut", the implication that a gap of as little as 1 finger width is a problem, and that the post caesarean check is performed at 12 weeks - in my area this is now at 6 to 8 weeks and has been for several years.

I was interested by the choice of exercises, as no explanation is given as to why these should be particularly suitable post caesarean. My opinion is that the suggested exercises shown are mainly much too advanced in level. The weeks 13 to 24 section uses the baby held by mum as an additional weight. I like the idea that babies should be included, however some of the exercises selected would not have been my choice, and I wondered about the safety of performing moves like grapevines and jumping jacks holding a baby! The section on stretching is pictured outside using a baby buggy, where again I wondered about safety issues, and the mother pictured is wearing inappropriate footwear. No upper body stretches are shown at all.

I found this book a disappointment. What a wasted opportunity!

By Moira Clark - Pregnancy and Postnatal Fitness Instructor (2005)

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