C-section Complications and Runners

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Becoming a mother can get complicated.

With cesarean deliveries accounting for about one in every 3 births, many of us soon-to-be or new running moms will find ourselves facing a return to running after a c-section. It is my goal to help you make your running comebacks as soon as and as smoothly as possible!

Last week, I questioned the standard c-section recovery recommendations, which require 6-8 weeks off running.  I believe it is acceptable to at least question this advice if you are a seasoned runner and have an uncomplicated c-section.

This week, I want to discuss how other factors about your c-section may affect your return to running.

***Of course, I need to first mention that this is not official medical advice and you should consult with your own healthcare provider when determining when to resume running after c-section. Always tell your doctor about your plans to return to running so she can help you with any specific issues you might have.***

That being said, let’s discuss some general information about c-sections. I use footnotes on these posts, so you can also access the resources I rely on.

TYPE OF C-SECTION: Scheduled or emergency?

The type of c-section you have can impact your recovery.

Scheduled c-sections happen in a controlled environment.  The woman is not in labor, hence the uterus is not yet contracting.  The OBGYN is not in a hurry to get out a baby in distress, and is able to proceed in a calmer, more meticulous manner with the surgery.

Emergency c-sections happen in an emergency (no surprise there) such as danger to the life of mother or baby.

Some professionals further classify emergency c-sections regarding degree of urgency, meaning some are extremely urgent, while other “emergency” c-sections are not so urgent. My own c-section is an example of an “emergency” c-section that was not so urgent.[i]  I was in labor with a breech baby, but neither my life nor my baby’s life was in danger. In these cases, theoretically, the c-section should go a little smoother.

The discrepancy between emergency and scheduled c-section is important for us as runners.  Emergency c-sections have higher complication rates for several things, the worst of which being increased risk of poor outcomes for baby. That is devastating. It is not the topic of this post, but I wanted to mention it to help keep our priorities straight.

Muscle damage is nothing compared to loss of a baby, but it is the topic of our post so I will dwell a little more on that. Emergency c-sections have higher risk of severe bleeding and accidental injuy to muscles or organs.[ii]  These complications definitely delay return to physical activity since the body has undergone much more trauma!

INCISION TYPE

Exactly where your abdominal muscles are sliced open certainly affects recovery!  There are three types of uterine/abdominal incisions: low transverse (most common type, the kind I had), low vertical, and classical incision.  If you would like to see (graphic) images of each, follow this link.

Looking at those images, you have probably correctly guessed that the classical incision is associated with higher rates of wound dehiscence[ii], the surgical wound breaking open at the suture site.  This opening can be superficial, like just the skin opening up, or can be deep and very dangerous, extending through the muscle layers and uterus.

Certainly runners who have this type of incision have higher risk of bad outcomes with a return to physical activity, and should exercise the utmost caution.  Personally, I would even question a return to running 6 weeks after surgery if I had a classical incision; I would be inclined to wait longer. If any Salty bloggers have had this type of incision, I would love to hear about your experience!

OTHER RISK FACTORS

Infections. One of my favorite runner girlfriends had a post-operative infection at her c-section incision site. She said the infection was more painful than the surgery itself! In 2007, the c-section infection rate was 8.9%,[iii] so these happen not uncommonly. Infection can cause a wound to open up, in which case you should not be running until the area is completely healed.

Other. Other risk factors for poor wound healing include:

  • Your baseline health status (diabetes and obesity are two examples of things that impede wound healing)
  • Any medications you are taking (corticosteroids as one example)
  • Surgical error
  • Wound closure type
  • And more.[iv]  There are too many factors that can complicate recovery to mention in this brief overview.  

In other words, it is best to consult with your healthcare provider when returning to physical activity, since so many factors can slow recovery.

I hope the last two posts were helpful for discussing what surgical aspects can complicate a return-to-running.

Have any of you Salty Readers had any of the above complications? How did your return to running go?

***

REFERENCES

[i] Berghella, V. (2015). Cesarian delivery: preoperative issues. Retrieved online from Up-to-Date on 1 Oct 2015 from

http://www.uptodate.com/contents/cesarean-delivery-preoperative-issues?source=machineLearning&search=emergency+c+section&selectedTitle=1%7E150&sectionRank=1&anchor=H24#H24

[ii] Mowat, J., Bonnar, J. (1971). Abdominal wound dehiscence after caesarian section. Br Med J May 1; 2(5756): 256-7.

[iii] Opoien, HK, Valbo, A., Grinde-Anderson, A., & Walberg, M. (2007). Post-cesarian surgical site infections according to the CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand 86(9):  1097-102.

[iv] Elizabeth, R., & Kitchen, C. (2009). Wound dehiscence after cesarian section. Retrieved online from http://www.healthguideinfo.com/labor-and-delivery/p47402/ on 6 Oct 2015.

I am a 30-something new mother (pet mother too), marathon and ultramarathon runner, healthcare professional, and outdoor enthusiast. I'm working on completing a marathon in all 50 states. I will be blogging about motherhood, running, and any random running-related rant I might come up with.

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