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Fear of pain causes more and more women to give up natural childbirth and choose caesarean section. Is surgery actually better for a woman and a child? Is full recovery easier? We talk to Monika Krawczyk, a physiotherapist in gynecology (physiogynecology) and an osteopath, about the consequences of a cesarean section.
Edyta Kolasińska-Bazan: You are a physiotherapist, you deal with osteopathy. What is this?
Monika Krawczyk: Osteopathy is based primarily on the holistic belief that the human body is a whole, not a sum of independent organs. Osteopathy is not magic, but science based on rational principles. Only a doctor or physiotherapist can become a specialist in this field. Osteopaths differ from physiotherapists by a more advanced medical education and a broader view of the pathologies of the locomotor system. Osteopathy is a hope for patients whose comfort of life and well-being are disturbed by troublesome, acute, chronic pain and who cannot be helped by traditional medicine, also because of difficulties in making a diagnosis.
The topic of our conversation today is female ailments. What problems do women come to you most often with?
There are many reasons. Patients come with various ailments when traditional medicine is unable to help. But when you ask about female ailments, I will mention the most common ones, such as:
- endometriosis (pain related to endometriosis, coming from the intestines or from the uterus itself, related to the location of adhesions),
- nagging menstrual pains,
- discomfort during intercourse related to postpartum scar or vulvodynia or vaginismus,
- pain associated with the dissolution of the symphysis pubis during pregnancy,
- back pain during pregnancy,
- urinary incontinence
- scar after cesarean section.
Let us discuss the problems associated with the “emperor”.
There are many emotions around labor. It is natural, of course, but there are times when a woman can make more decisions about herself.
That `s bad?
From where! But it started to be a fashion and is often dragged the other way, like “emperors on request” (problem for about 15 years). Women give birth later and later (for various reasons), so there are more indications for “emperors”, because many factors predispose them to cuts (this is a completely separate topic for conversation). However, common sense (on the part of both women and doctors) is imperative. If there are no specific indications for cutting, vaginal delivery is the safest option for both the baby and the woman.
What do you mean?
From my observations it appears that most often (unfortunately) the so-called the welfare of the child, not the woman. It is natural, of course, but then the woman goes to a very distant plane, and then her first problems begin to arise.
For example?
Not reaching far – discopathy. I haven’t met a gynecologist-obstetrician to consider discopathy as an indication for a “cesarean”.
And should he?
Often yes.
Even though you are mostly in favor of natural delivery?
This is the rare exception. Let me explain. If my patient has a discopathy (documented by magnetic resonance imaging) and becomes pregnant (initially the pain is reduced because hormonal changes occur), the problem usually begins towards the end as the pregnancy progresses.
Dlaczego?
At the end of pregnancy, we have pure biomechanics – the center of gravity shifts forward, the abdomen is large, the spine is heavily loaded. After a natural childbirth, such a woman often undergoes neurosurgery and then her drama begins.
Meaning?
Double shock: not only is a difficult childbirth a sudden (because unplanned) spine surgery. The body is exhausted. Then the patient goes home and usually hardly any doctor looks after her, giving no instructions on what to do next.
And what next?
That’s a good question. Then the treatment is longer – you have to work with the postoperative spine. And this takes time, and the patient does not always come to me immediately, i.e. after removing the stitches. In extreme cases, treatment may take up to several months.
I see. And yet she is already a mom. Let us return to the pregnant woman whose delivery ends with an “emperor”. What are the problems then?
Mostly with adhesions, obviously not due to the surgeon’s mistakes, but from the fact that every cesarean section is an operation! Just. The surgeon can perform the operation very well, but the consequence of any operation is adhesions!
What are adhesions for the body?
These are tissue adhesions, scarring, which are not good for the body. Each of us has a different tissue, and some of us just have a tendency to adhesions (this is what we come into the world with), which can make our lives painful to a large extent. After cesarean, these are adhesions within the pelvis and all adjacent organs, ie the uterus (cut during surgery), but also the bladder, ovaries, small and large intestines.
How do we feel these “sticking”?
It’s pain of all kinds. If you ask about the symptoms of adhesions after cesarean, adhesions within the uterus may cause so-called painful periods or painful ovulation (which was not there before). Ovarian adhesions are painful soreness in the abdomen (difficult to diagnose), and in the intestines – severe soreness in passing the stools. I would like to add that adhesions are formed right after the operation – the physiological time for tissue healing is about 12 weeks.
When to start “fighting” with them?
Immediately after removing the stitches.
This is a post-operative scar massage?
Type of massage. These are special osteopathic techniques used on the scar, but not only. You palpate not only with the cut uterus, but also with neighboring organs. You work with the entire abdomen – from the sternum down (the entire viscera). It is important to know that after each operation the pressure is disturbed (because each organ has its own pressure) of its own organ, as well as of the organs adjacent to each other, so if this structure is disturbed, the work of the organs is disturbed, and this directly affects the health and condition of the patient .
Caesarean section most often ends with the so-called at risk of pregnancy, most of the time lying down?
Yes. This is an important and currently quite frequent topic. When pregnancy occurs mainly in the supine position (only a woman stands upright during physiological needs), then her internal organs “arrange” differently to the child growing in her. After a “horizontal” pregnancy, the body “returns” differently than after a “upright”, and therefore “walking” pregnancy. Lying women who have had a “caesarean” for most of their pregnancies have the impression that their organs “sag” – literally this is how patients describe it.
And then there is a problem with, for example, urinary incontinence?
Yes, but it does not appear immediately after the “cesarean”, but at the earliest after about a year, or even several years.
A young woman with urinary incontinence due to a “caesarean section”?
This is quite a common, but very embarrassing topic. We are also working on it in the office. I would like to add that there are other ailments, such as discopathy.
Discopathy as a result of the “emperors” ?!
The abdomen is a stabilizer for the lumbar section, and each operation involves cutting the abdomen (abdominal wall). When this structure is disturbed by the operation and the patient does not perform exercises (she does not like, does not usually exercise) in order to reduce the effects of the operation, then in the next few years, for example, discopathy in the lumbar region can be expected.
So we “work for it” ourselves?
Yes. Most often, completely unconsciously.
That is why exercises after childbirth (physiological or caesarean section) are so important and it is not just about gaining weight that we acquired during pregnancy?
Just like that. I will say more, the consequence of surgical interventions (any cuts, cracks, stitches) is the change experienced during sexual intercourse. The feeling of the deep pelvic muscles and the pelvic diaphragm, which is responsible for this intimate sphere, is changing. So if the muscles of the perineum or vagina are weakened, even in the near term, such a woman will experience erotic sensations differently. And in this particular case, the aging process will not always be affected. Another topic is discomfort during intercourse related to postpartum scar, vulvodynia or vaginismus (separate thread per interview).
Coming back to the adhesions – I understood that the sooner the osteopath enters (right after removing the stitches), the better for the patient. So a woman who had a cesarean (or other operation) a long time ago (a few or a dozen years ago), and is clearly struggling with the aftermath of adhesions – no chance to help?
Of course it does. After many years, I am unable to remove the adhesions, but I can restore organ function. I am trying to “loosen” these adhesions so much that the patient feels more comfortable and rebuild the stabilization she has lost. Some problems can be eliminated even after many years.