A new post-C-section therapy program is providing extra TLC and training for patients who need Cesarean sections — one of the most common surgeries in the U.S.

Thanks to support from physical and occupational therapists before new parents leave hospitals, C-section patients can better care for themselves and their babies once they go home.

Post-C-section therapy began in the UCHealth system when physical therapists at Poudre Valley Hospital in Fort Collins piloted a program there in 2020.

“We want to prepare every patient so they feel more confident and are prepared to transition from the very supportive environment in the hospital to the challenges they may face when they go home,” said Katie Federer, a phsyical therapist who started the program at Poudre Valley after learning about the model at a national conference.

“We’re setting patients up for success so they’re not having to be readmitted, are better controlling their pain and are healing better after birth,” Federer said.

Following the Fort Collins pilot, therapists at UCHealth Memorial Hospital Central and UCHealth Memorial Hospital North in Colorado Springs started doing visits in 2022 with each patient who had welcomed a new baby via a C-section.

The programs have been so popular among patients and caregivers that the model is now spreading to other UCHealth hospitals. And colleagues at leading institutions around the country are working to establish their own programs. Currently, only about 55 of 2,158 maternity hospitals around the U.S. are offering post-birth specialized care from physical and occupational therapists, according to the advocacy group, the Pelvic Health Network.

A new post-C-section therapy program

Patients and caregivers in Colorado have found that a post-C-section therapy visit has many benefits, including:

• Reducing pain and infections.
• Reducing the risks of dangerous post-delivery strokes and cardiac events.
• Improving mobility.
• Decreasing the length of hospital stays.
• Boosting confidence and comfort for new moms.
• Helping with breastfeeding and improving mother-baby bonding.

Starting in June, patients who had C-sections at UCHealth University of Colorado Hospital have received visits from a physical or occupational therapist about 12 to 24 hours after the birth of their babies. And therapists in northern Colorado also have launched similar programs at UCHealth Greeley Hospital and UCHealth Medical Center of the Rockies.

Kirsten Prue is an occupational therapist who helped launch the new program at University of Colorado Hospital in Aurora.

She recently visited a new mother hours after the birth of her baby.

“Hi. I’m here to teach you about C-Section recovery, including your lifting precautions, proper body mechanics and how to move efficiently to reduce pain,” Prue told the woman. “My goal is to answer any questions you may have and help you feel supported before you go home.”

The patient responded in a way that brought tears to Prue’s eyes as she thought of the encounter hours later.

“I already feel supported just by having you here,” the new mother said.

Prue was thrilled.

“That’s why we wanted to start this program. It shifts some of the focus to moms and sends the message that their health and recovery are important too.”

Dual challenges: helping moms care for themselves post C-section while also caring for their newborn

Prue and her colleague, Gillian Brown, learned about the programs in Colorado Springs and worked to establish similar protocols in Aurora after colleagues from Memorial shared their pioneering work with rehabilitation experts throughout the UCHealth system.

One of those colleagues was Nikki Pfeifer, a physical therapist at Memorial Hospital Central who has been doing post-C-section therapy visits since the program launched.

Following other abdominal surgeries, many patients receive post-surgical support from physical or occupational therapists. But until the new program launched at Memorial, therapists only saw a fraction of patients who had to have C-sections even though the surgery is much more common than other abdominal procedures.

Recovering from any surgery can be challenging. And aside from C-sections, most patients can focus on themselves and take the necessary time and precautions to heal well.

New mothers, on the other hand, must focus on their newborns when they go home, and some also have older children. As a result, some patients who have had C-sections struggle with pain and poor health, recovering slowly and having trouble caring for themselves and their newborns.

Necessary C-sections save lives, but they also can lead to complications, and patients who have had C-sections are at greater risk for medical challenges including infections and dangerously high blood pressure, which can lead to strokes or other serious cardiac events, including maternal death. (Learn about another program that offers specialized care to reduce maternal mortality for patients at risk of cardiovascular complications.)

Pfeifer said the new program to provide specialized visits from rehabilitation pros has been popular and has yielded great results.

“It empowers women to be more confident after a C-section so they can better care for themselves, their newborns and other children at home,” said Pfeifer, who has been working at the hospital for 10 years, first as a tech before later becoming a physical therapist.

For years before becoming a physical therapist, Pfeifer assisted with newborn screening programs and used to see C-sections patients who were struggling.

“This is a great program. We help these patients navigate their days and we emphasize self-care,” Pfeifer said.

How post C-section physical and occupational therapy works

So, what do rehabilitation specialists teach new parents? How can patients who have had C-sections recover faster and decrease their pain?

Jenna Humphrey is a physical therapist in Colorado Springs and also has been supporting new moms since the program started at Memorial. She joined Pfeifer in sharing the team’s work during a rehabilitation conference that inspired others throughout UCHealth to duplicate their programs.

To answer frequently asked questions, we asked Humphrey and the other rehabilitation experts to share their insights, tips and tricks.

How do patients get help? Do C-section patients have to request a visit with a therapist after the birth of their baby?

Patients can request help if they need it. Visits with rehabilitation specialists are now automatic at both Memorial Hospitals in Colorado Springs. At University of Colorado Hospital, since the program is still new, therapists are focusing on seeing patients who have had their first C-section. Managers hope to continue expanding the program in the Denver metro area.

When do the patients receive help through the post-C-section therapy program?

“The nurses usually have the patients standing up by about 12 hours after the C-section, so we’ll try to see them on Day 1 if we can,” Humphrey said.

The therapists have found that the patients do best if they see them as soon as possible — between 12 and 24 hours after the birth of the baby so they can encourage new moms to start moving as soon as possible.

What’s the first thing a therapist will focus on?

“We want to reduce pain as much as possible, protect the incision site and help with mobility,” Humphrey said.

“I always ask if this is their first C-section, how they’re doing with the pain, how the recovery is going and how they are doing with mobility,” she said.

Then, she teaches patients simple but really valuable tips, like how to get out of bed and how to use a helpful device called a binder.

What are the common restrictions after a C-section? 

Restrictions are common after any surgery. Therapists, nurses and doctors ask all patients who have just had a C-section not to lift any object that weighs more than about 10 pounds. Of course, that’s just the size of a typical newborn baby. So new parents who’ve had a C-section need to be very careful about how they lift their babies. The restrictions on lifting heavy objects are aimed at protecting incision sites.

Therapists encourage C-section patients to be very careful about lifting heavier objects like a baby that’s in a car seat. And if there are older children at home, new moms who have had C-sections will need to avoid lifting them up. Of course, it’s vital to hug and show love to the older children. Parents can use tricks like having a toddler climb up onto a surface like a bed and getting a hug. Or spouses and partners can bring older kids to the patient’s lap. As long as the mom is comfortable and has protected her incision, it’s fine to have a toddler sit with a mom and hug her and the new baby. (Remember never to leave toddlers alone with newborns as they can accidentally smother them with hugs.)

Humphrey said it’s also OK for a woman who’s had a C-section to cradle a toddler on her hip as long as someone else lifts the toddler up.

“Each parent is different. You know your kids. But being held on a hip is fine. It’s the picking them up and setting them down that can be hard,” she said.

So, new parents should ask for help. And if a toddler is particularly squirmy, new parents should be careful. They don’t want an older child to accidentally kick them in the belly.

What’s the best way to get out of bed after you’ve had a C-section?

Simply standing up can be difficult and really painful after a C-section because we use core muscles to get out of bed, and that’s precisely where patients are most sore after an abdominal surgery like a C-section.

Humphrey, Pfeifer, Prue and others teach a method to get out of bed called the “log roll.” And they encourage partners or spouses to learn how to safely lift their loved ones to help them stand up.

To do a log roll, patients gently use their knees to help them roll toward the side of the bed. Then, rather than using core muscles to get up, they use their arms to push themselves up out of bed.

If loved ones are available to help the patient stand up, therapists teach them how to do what’s called a “bear hug.” Rather than pulling the C-section patient out of bed — which many, many people try to do — the therapists teach loved ones to clasp the patient in a big bear hug and lift them. That means the patient won’t be using her core muscles and risking hurting the incision site.

“Getting out of bed is a big challenge at first. We don’t want patients to hurt themselves. That’s why rolling is much better than a big sit-up. And significant others always seem to want to yank the person up. That puts too much pressure on the core,” Humphrey said.

What is a binder (or C-section band), and how can it help patients recover from a C-section? 

A binder is a compression device that fits around a person’s belly.

Therapists say there’s extensive research that shows binders help women feel much better supported after a C-section. Using a binder for at least a week or two and up to six weeks after a C-section can help with pain prevention and can help protect the incision site.

“The binder wraps around the belly and supports the core,” Humphrey said. “Some people have never heard of them, even if they had a previous C-section. We provide a binder and we show the patients how to put them on. It’s designed for when you’re up and moving around. But you can also wear it when you’re laying down.

“In all of my sessions, if the mom is open to trying a binder, I help her get it on, and we see how it fits,” she said.

“I would say 98% of my patients love the binder. It should feel good. It should not feel painful,” Humphrey said.

For a handful of patients, the incision site may be super sensitive, and some patients don’t want additional pressure on the site.

In that case, therapists will encourage the moms to massage their incision sites and try the binder a couple of days later.

“With the right fit and techniques, the binder will give them more support and help them feel better. For most patients, it’s a game changer and can help with recovery and pain control,” Humphrey said.

Fit and placement is key.

Some new moms wear the binder too high up over the C-section incision site.

Humphrey and the other therapists say it’s vital to put the binder on just beneath the incision site.

Most new moms who have had C-sections find that the binder gives them a lot of support and makes it much easier to stand and move. Some find that regular use of a binder allows them to reduce the use of pain medications.

Is it good to move after a C-section? And what about stairs? 

After any surgery, it’s best to start moving — albeit carefully — as soon as possible. That’s why nurses and therapists always work to help patients stand up and get moving again as quickly as possible.

Using a binder helps most C-section patients feel much more supported as they get up from chairs or beds. Wearing a binder makes it much easier to move and recover.

Therapists say more movement is more when it comes to recovering from a C-section as long as patients protect their incisions and their core muscles.

“A lot of times patients are afraid to move both because it hurts and they worry that they’re going to tear out their stitches. They’re really fearful. But we tell them, ‘Walking is not going to hurt you. We want to give them a mindset that movement is good,’” Humphrey said.

She begins each appointment by helping the new mom to get out of bed.

“I try to walk patients at least to the bathroom or the door. If they’re feeling good, we can practice walking in the hallway. And some are comfortable trying stairs,” Humphrey said.

The therapists encourage all new moms who have had C-section to ask for help. When they are first trying to navigate stairs, it’s really important not to be carrying their newborn babies. Instead, it helps to hold onto the rail and navigate one step at a time. Many people will find it more comfortable to face the rail and the wall and walk up the stairs sideways, tackling just one step at a time.

Can deep breathing exercises help with stress relief, relaxation and pain control following a C-section?

Yes. Deep breathing is a wonderful tool in many circumstances. It’s a great way to reduce pain and help new moms manage the stresses of recovering from surgery while also caring for a newborn.

Therapists teach breathing techniques to new parents. They also underscore how important it is not to hold your breath when you’re exerting yourself.

“I have found it super helpful to teach people to work on breathing as they stand. I tell them, ‘You’re going to automatically want to hold your breath when you’re moving, but that makes it more painful.’

“So, we teach people to blow out as you move,” Humphrey said. “We also recommend breathing out as they take a step up. And when you’re getting out of bed, blow as you’re rolling. It forces the body to relax and calm down a bit.”

Do therapists also check to be sure new moms are not dealing with dangerous high blood pressure?

Yes. High blood pressure can be dangerous for women both when they’re pregnant and for new moms after they’ve given birth.

Since new moms spend a great deal of time in bed after the birth of a baby, it can be tricky to detect spikes in blood pressure that can surface when moves get up and move.

Nurses and therapists will check blood pressure both when moms are relaxed and after they’ve worked on walking and moving.

The new visits with therapists are helping some moms to be more aware of the potential dangers of high blood pressure.

“Before we implemented this program, we saw a few moms come back with strokes because their blood pressure was too high,” Humphrey said.

All of the medical providers work hard to educate all new parents to carefully monitor their blood pressure. That’s especially true for those who had a history of preeclampsia during pregnancy. Therapists and nurses can send new parents home with blood pressure monitors if they don’t already have them at home..

“Sometimes blood pressure creeps up unexpectedly when moms go home,” Humphrey said. “A lot of times patients are asymptomatic and they feel fine. I had one mom who was walking around and doing laps in the hallway and talking to me. You wouldn’t think anything was going on, and it turned out that her blood pressure was really high. We were able to get her help before she ever left the hospital.”

What’s the best way to care for a scar after a C-section?

Many patients who have had C-sections are understandably nervous about their scars. That’s normal, of course.

But the scars can get even more sensitive over time if patients avoid touching them.

So Prue, the Aurora occupational therapist, educates patients about how best to “desensitize” the scar.

“A lot of women avoid touching it because it’s painful and uncomfortable. But once it’s healed (about six weeks after a C-section) they can gently touch it and massage it so it won’t be painful and sensitive,” Prue said.

Who pioneered the post-C-section rehabilitation programs in Colorado Springs?

Former UCHealth therapists, Rebecca and Jenna Seagraves, started the programs in Colorado Springs and have done research on postpartum care.

For those who want to learn more, here are links to their research:

• Reducing Maternal Morbidity on the Frontline: Acute Care Physical Therapy After Cesarean Section During and Beyond the COVID-19 Pandemic – PubMed (nih.gov)
• Maternal Health Disparities in Acute Care Rehabilitation – PubMed (nih.gov)

What is the key message that medical providers want to deliver to new parents who must have C-sections?

Like doctors and nurses, the therapists emphasize how hard it is to recover from surgery while also taking care of a new baby.

“I always give them encouragement,” Humphrey said. “You’ve just had major surgery, and you’re in the thick of it right now. The first 24 to 48 hours after surgery are the worst. You’re feeling like you can’t move.”

Challenges after surgery can be especially difficult for new moms who hoped to have a vaginal birth but need a C-section.

“I say, ‘Give yourself some grace. It will get better,’” Humphrey said.

“I tell them that they look great, and they’re doing great. You look better than you feel. And it’s going to keep getting better.”