Kristin Revere chats with Anna Downs of Move Well with Anna about cesarean recovery tips and guidelines.
Hello, hello! This is Kristin Revere with Ask the Doulas, and I am so excited to chat with Anna Downs today. Anna is the founder and director of Move Well with Anna. Welcome!
Hi! It’s very nice to be here. Thanks for having me.
Great to chat with you today! I would love to hear not only a bit about your professional background, but also your story of deciding to work with women in pregnancy as well as the postnatal phase.
Yes. I mean, I think like anybody who finds their vocation and the thing that gets them up in the morning and makes them keep on going to work, I very much came to doing this work through my own experience of trying to find what I was searching for to help me in my pregnancy and postpartum recovery and really struggling to find anything that kind of fit the brief. And it kind of led me down a rabbit hole of doing more and more qualifications, getting more and more information and experience, and then kind of really thinking, oh my goodness, there needs to be more of this in the world. I kind of found myself falling into it by happy accident. I suddenly had people who wanted to work with me, and it’s just grown and grown over the past 12 years. It’s been a real journey of self-discovery, which has turned into a very vocationally driven practice.
I love it. And you’re a mom of two?
I am. My youngest is now 15 and adorable, communicating with a series of grunts. We are entering a new phase, which I’m not quite ready for, but yeah, that’s my 15-year-old, and I have a 12-year-old daughter, as well. So we’re just navigating the teens and the tweens at the moment.
Love it. I have a 12-year-old as well, a 10-year-old and a 21-year-old.
Wow, okay. So you’ve got the full spectrum!
Exactly. Love it. So obviously, there’s a lot of personal passion as well as just focusing on continuing your education. You have a very impressive background.
Yes, I just find the courses are so addictive. Once you’ve done well, it’s like, well, it’s just not quite enough information. I need to know more about that. And I’m sure you’ll find from being in this field, as well, that things are just changing and evolving so quickly and I feel like we’ve got this massive wave of evidence based information coming in, and it’s just so exciting to be doing this at this moment because it’s changing so fast and so needed.
100% agree. I’m 10 years into the field, and I feel the same way. It’s changing, and I learn with every client or student.
Yeah, it’s powerful stuff.
So our topic today is Cesarean recovery. I would love to start there and talk a bit about preparation in advance for a planned Cesarean, and then recovery, whether it’s a planned Cesarean or unplanned.
Yes, again a topic that we so need to keep having this conversation because I don’t know about you, but one thing I’m finding is that if you’re comparing things, like the guidelines for preparation and recovery for something like a C-section or, on the other hand, open abdominal surgery, the guidelines just don’t match on. On one hand – I mean, I’m talking from kind of UK guidelines, but the Royal College of Surgeons in the UK advocates for a four to six week break from lifting pretty much anything heavier than two to three kilos, followed by no substantial lifting for definitely 12 weeks. Yet our C-section mamas, the day after they give birth, they’re handed a three to four kilo baby who only gets heavier. So there is this massive disparity between what we’re expecting optimum healing to look like for somebody who’s having open abdominal surgery, which is what a C-section is, and somebody who’s having a C-section. And the narrative is very unhelpful, and it really does feed into so many issues with expectation and perinatal anxiety and depression. And I think we just need to keep on having this conversation with our healthcare providers and find more allies and find more support because it’s really just not good enough at the moment.
Exactly. And not everyone can afford to hire a postpartum doula or newborn care specialist or a nanny right away to help with that lifting, accompanying the parent to the pediatrician appointments, where you need to carry that car seat as well as baby, and avoiding vacuuming and stairs and other lifting. It’s just – it’s a lot.
It really is. And I was just speaking this weekend, actually, at a public health conference here in Bangkok where I’m working and practicing, and we were talking about how C-sections, how they’ve changed, how they’re being performed now in terms of – from the 1970s, we’ve had a 500% increase in C-sections being performed annually. Yet the guidelines about prehab is nonexistent, and rehab has hardly changed since the 1970s. But we’ve now got one in three births globally happening which are C-sections. So there’s this – nothing’s caught up yet. And I think as women, we’re relying very much on the knowledge of the village, of that woman to woman chat, you know, friends telling us things over a cup of coffee. Or if you are going to, say, a feeding support group or an infant massage class, just having people talking and sharing their experiences in that very informal setting. I’d really love there to be a much more directive set of advice coming down from our OB-GYNs so that their responsibility isn’t just stopping at the door, you know, at D-day when you’ve safely delivered a baby. When you’re thrown into that postpartum hormonal depression, it is equivalent of being dumped into perimenopause overnight. That makes it additionally really challenging to heal and to get the appropriate rest that you need. The odds are stacked against us, so we need to find some way of changing the narrative, starting the conversations, supporting people more.
Exactly. And so many of my clients want to get back to their passions pre-baby, whether it’s fitness, running, being active. And they want that time to be released to exercise and lift and be more active. That can be a struggle for a lot of personalities, that healing phase and lying-in.
Absolutely. And especially – again, I refer to the UK – once you’ve had your postpartum check with your OB-GYN, which is usually four to six weeks for a vaginal delivery and then six to ten weeks, depending on how your scar is healing, for you C-section delivery – once you’ve been given the all clear, then the guidelines are that you can return back to exercise. But there aren’t really many written-out clear guidelines about what that looks like and how you should address that and where you start. The whole toxic body bounce back character narrative is so unhelpful with this because people just think, oh, I’ll just start again and then I’ll be fine. The doctor said it’s fine. Actually, a much more carefully considered approach needs to be taken in order to avoid injury and to repair nine months of your musculoskeletal system completely changing and shifting and your center of balance being in a different place. So it’s very unhelpful to just be given that green light and then expect everything to work how you remember it working before.
Yes. And I feel like recovery from other surgeries has stricter guidelines. There’s more information, PT, and so on. Say it’s a shoulder or a knee surgery. But there are so many unknowns, and sometimes mothers are getting information from online communities, Facebook groups, and the information they’re given is not always accurate.
Yes, absolutely. And the really challenging thing is that there isn’t actually a catch or solution for everybody. It is an individualized process because our bodies have all responded differently to pregnancy, that have responded differently to our births, and we’ll have all had different births. All of those little factors that come into play have an impact on your body is healing and how it’s responding. It is giving out a blanket guideline of four weeks, you can start to do abdominal breathing and gentle Pilates-style exercises. For one person, that means lying on their back with their hands on their belly and just breathing in and out, and for somebody else, that’s doing half-planks and bear walks. So it’s very difficult to give a clear answer of sort of what is safe and what isn’t without there being some kind of personal contact with someone, whether that’s in a group setting or privately or just having somebody assess you in a bit more detail. Again, that’s challenging because it can be completely out of someone’s budget, especially also if they don’t have a lot of time and they’re chronically sleep deprived. That is a big challenge as well.
Exactly. So as far as working with you, what does that look like? I know you’ve got some videos and books, as well as different programs, both prenatally and in the postnatal phase.
Yeah. I mean, at the moment, I’ve just started to create a few support items, digital products online, but I’ve been mainly working face to face with people. I quickly realized that people wanted a little bit more support outside of our face to face sessions. But working with me, we always start with a very detailed assessment because me personally, my own personal journey when I had my kids, I was trying to get back into fitness. I was just thrown back into a group program, which wasn’t postpartum specific. And it did me some terrible damage because I was trying to apply the knowledge I had about being fit and active pre-pregnancy to my postpartum body. And I really valued somebody taking time, about three or four years after I had my second child, to just sit with me and explain how my body had changed and how I could nourish it with movement instead of punishing it for not behaving in the way that I wanted it to. And so I apply that principle with everyone I work with. We have a really detailed assessment; we’ll look at your posture, your pelvic floor. I’m not a physiotherapist, so this is screening verbally and then looking for certain movements in the hips and the posture to see where you might be tight or carrying tension. But it’s out of my scope of practice to deliver an internal assessment. And so I would defer on for that.
We look at your day to day movements and your daily lifestyle and your preferences and your habits, and we really build a bespoke program around what you’re going to be able to fit into your day and into your world. Also is solving the problems that you’re encountering with your healing and your body.
But I do have lots of free tips and free videos on my Instagram and Facebook feed. I have a weekly newsletter where I send out juicy tips, and a few additional products on my website. But it’s an ever-evolving feast, and there will be more things – small things coming in the new year, but I just need a little bit more downtime to make the magic happen.
I love it. And you do have a virtual book that is focused on the postpartum back, neck, and shoulder pain, and I know especially for breastfeeding moms, I mean, the posture that you have can cause so much discomfort in the shoulders and neck with nursing one baby or two.
Yes, and it’s very similar in the way that it shows up in your body as something called office syndrome, which has become very trendy for everybody to talk about and a physiotherapist to be selling programs to try and help support. I feel like no one’s really talking about this kind of nursing back and shoulders that so many new moms have, and yet it’s equally as crippling and painful and debilitating. And it’s the same thing; it’s a real tightness in the muscles in the front of the chest and shoulders. And when that’s really tight, it pulls the shoulders forward, which makes the upper trapezius, the muscle going from the shoulder up into the neck, super tight. And that’s teemed together with a bit of weakness, a bit of muscular imbalance in the back of the shoulders and the midback. So you’ve got this tightness pulling the shoulder forward, teemed with weakness around the upper back, which just exacerbates that forward curve. A lot of people also find they end up thrusting their chin forward, which creates an enormous amount of tension up from around the back of the head and scalp and into the jaw. All of these things can be massively – the intensity of the discomfort can be decreased massively by strengthening the upper back area and really stretching the front of the chest and just also paying attention to our postures. I mean, I know as a doula, you’ll have spent a lot of time coaching moms when they’re feeding their babes to have the pillows supporting them, to be thinking about stacking their posture, not craning their neck. It’s all the same principles, but just with a slightly more kind of movement focus.
That’s great. And of course with surgical recovery on top of breastfeeding or pumping, you know, again, it’s just a lot to manage.
Yes. And I think – I mean, over the past twelve years, I’ve worked with over 1300 women. And the demographic of people I’ve worked with ties into the one in three births being C-sections before I moved to Thailand. And now here in Thailand, about 80% of the women that I’m working with had C-sections. So it’s really a big demographic of people. Sorry, I digress, but the reason why I mention that is that every single one of them, regardless of whether they planned their C-section birth or not, is absolutely floored by that complete incapacitation for the first 24 to 48 hours. It’s a real shock to the system. And anything that we can do to prepare for that without – you know, while treading that fine balance between information and scaring somebody, it helps people to feel prepared so it’s not so much of a shock.
Yeah. That makes sense. I mean, preparation is everything. As doulas, we talk about the importance of preparing your body physically for birth, no matter how you end up giving birth. But also the mental aspects of it, and I love that you touch on the mental aspects in your pregnancy journal. Tell us a bit about that.
So again, I created this book of pregnancy journaling prompts because I was really finding that lots of my mommas to be were struggling with a lot of anxiety about the unknowns, about knowing which conversations they should be having with their birth providers or with their support network. And this book is just loads of different prompts. I think there are about 120 pages, and there’s a different prompt on each, where you can either work through methodically or you can just pick the one that speaks to you. The process of journaling has been well-documented in helping to allow us to make sense of something and to frame the narrative in a way that feels empowering and calming so we’ll just feel a little bit more prepared. And so, yeah, I put all these prompts together, and it’s very much designed for the mama to be preparing for pregnancy and birth and those early few weeks in the postpartum period, just to help her frame a few conversations and make sense of something that feels overwhelming.
Love it. And that journal, as well as your other virtual and in-person services, can be found on your website, Move Well with Anna. I know you’re also, as you mentioned, on Instagram and Facebook. What are the different ways that our audience can find you?
The best way to find me is probably on Instagram, and that’s just @movewellwithanna. Or through my website, which is the same. Those are the places where I’m showing up the most at the moment.
And then you mentioned that our listeners can sign up for your newsletter, and that has a lot of free information and tips?
Yes, absolutely. There are loads of freebies on my website. There’s a download about how to manage pelvic floor pain and dysfunction, another one about how to manage constipation during pregnancy and postpartum, and a list of gorgeous, lovely ideas and tips about how you can feel fit and strong and empowered after you’ve given birth. So loads of freebies on my website, as well.
Beautiful. So what are your final tips for our listeners who are in that recovery phase for their surgical birth and want to do some gentle movement and make a difference in the recovery without pushing themselves too hard?
So the first thing I would advise would be investing in a medical grade compression garment. I say medical grade because you want something that’s been designed with this specific purpose in mind that’s comfortable, that’s breathable, that you can wear 24 hours a day initially, if you wanted to. That just helps to support your scar area a little bit and take some of that pressure off. I think the guidelines are recommending at the moment that after a C-section, the compression garment should be worn for multiple hours during your waking day for about six to eight weeks, just to give you a little bit of support and a helping hand during that initial healing phase.
So you mentioned the medical grade. How do you feel about, like, the Bangkok belly binding and other binding methods?
I think they have their place. They can be wonderful if they’re done by a skilled practitioner. I mean, again, I can only really talk anecdotally here from my experience of working with people, but in some cases, if it’s done too tightly, then that can have an adverse effect on the pelvic floor by creating more intra-abdominal pressure than we want. It has to be the right tightness to support but not restrict, and I love the cultural practices here and some ancient Chinese practices where women have a much more restful first 30 days after they deliver. But that binding just – it needs to be done skillfully and with an understanding of the body and what it’s managing at the time.
Very helpful. What’s your next tip?
My next tip would be to start gentle movement from your second and third day, and I’m not talking about doing like formal exercises, but this can be as simple as belly breathing. So just being in a comfortable seated position, preferably stacking the ribs and pelvic bowl, and just allowing the belly to expand and contract gently with each breath and really focusing in on that. And then also seeing what’s happening with the rib cage because quite often, by the end of the pregnancy with our ribs flaring to make space for the baby to grow in our abdomen, our ribs kind of get locks and stuck and flared, and that’s really not conducive to getting that lovely floor of coordination between your diaphragm and your pelvic floor back. So focusing and just seeing, are my ribs moving when I’m breathing? If they’re not, if I place my hands on them, can I expand against the pressure of just pushing them together a little bit? And just really focusing on that breathing to start off with.
Then progress a little bit further on to doing gentle things like arm raises, so you’re stretching the skin and the fascia just a teeny bit because you want to be able to stimulate that blood flow to that healing area. So gentle seated side bends or raising the arms one at a time or both together and teeming that with some breathing exercises is such a delicious way to start without it feeling scary and without putting too much pressure through that area of your body.
Love it. So anything else to add?
Yes. Scar tissue massage is unbelievably important, and I’ve found that most of the doctors who are advising massage for the scar, it’s purely on aesthetical reasons, just to make the outside look a bit better. So having a silicon gel and just rubbing it on a few times. We now know that there’s so much benefit to, after the scar is healed, so at least two weeks after the last part of the wound is healed, starting to do gentle nerve training exercises. So rubbing the fingers gently above and below the scar, checking what the sensation is like, switching the object that you’re using to run across the scar to see if you can recognize the change in sensation. Because we need to reconnect with that part of our body if we’re then going to strengthen our core and reconnect with our body. And so often, I find that with my C-section mamas, there’s a real disconnect or reluctance to connect with that part of their body, with that scar, with how it feels, with how it looks.
And it could be traumatic for them, reminding them, if the birth was traumatic.
Absolutely, and that’s another thing to really know. If the thought of touching your scar or touching your belly in that area is bringing back traumatic emotions or feelings or flashbacks, then to recognize that and be kind to yourself, but also to seek some form of counsel, whether that is a birth debrief with your doula or your OB-GYN or professional help. And I know that there are lots of wonderful peer support groups for birth trauma, but also, it’s a real growing of practice in mental health and support as well. Unfortunately, I don’t really have anyone I can recommend here in Bangkok. It’s a struggle. It’s something that the doulas here are working really hard to try and find good practitioners. At the moment, we are referring out to the UK and the US.
It is helpful to have virtual therapy options, certainly.
Yeah. But yes, the scar tissue massage, and a staged progression from just gentle touch to, after 12 weeks, doing much more targeted fascia release. And again, I’ve got some videos on my YouTube which show you how to do that. There are also many great practitioners out there if you just Google it.
Love it. Well, thank you for sharing all of your wisdom with us, Anna, and we’ll have to have you back on when you get some of your future programs ready to go.
That would be fabulous. It’s been really wonderful to talk with you. Thank you.
Thank you! Have a great day.