What You Need To Know About Returning To Exercise After A C-Section

When it comes to c-section recovery, the amount of solid and helpful information is seriously lacking!  And if you’re looking for the right kind of information regarding c-section exercises to heal and flatten your stomach…that’s even worse!

Upon leaving the hospital, you’ll probably hear very general guidelines like try to limit the number of times you have to go up and down the stairs, no driving, no lifting anything more substantial than your baby, and no exercising for at least six weeks…that’s about it! 

No guidelines on what to do for the first six weeks postpartum, no instructions on what to do following your 6-week check-up, no mention of checking in with a pelvic floor physio, no specific guidelines for healing your core, and no particular guidelines regarding any exercise protocol.  It’s merely “good luck with everything, and we’ll see you in a few weeks!”

More and more women are having a C-section for one reason or another to birth their babies, so we need to do better for these women!  If you are a C-section mom, I want you to have some better guidelines in terms of core recovery and your ability to return to exercise safely and confidently!  

Sound good?  Alright…let’s talk a little more in-depth about  C-sections so that you understand why’s behind what I am recommending for you.

What is a C-section? 

 

A C-section, or cesarean section, is an operation to deliver your baby that can be either planned or unplanned.  The procedure is performed with either an epidural or spinal anesthetic, where the lower part of your body is numbed. Barring any complications, the procedure usually takes 45 minutes to an hour to perform.

The operation usually involves making a horizontal incision (generally near the bikini line) into the skin, fat cells, connective tissue, and finally into the abdominal cavity. The abdominal muscles are spread apart (not cut…that’s a myth) and your bladder is moved down and out of the way so that the doctor can get to your uterus. Once the uterus is exposed, your doctor makes an incision into your uterus then gently pulls the baby out headfirst. The placenta is removed shortly after that. Your bladder is then put back into place, and your uterus is closed with stitches that will dissolve during your recovery. Your abdominal muscles usually fall together by themselves, but they can be guided back by gently tying them together at spots along their lengths.  

 Next, the fascia or connective tissue is put back together with more durable and thicker sutures. Then, the fat layer is permitted to “fall” back into place by itself, or it can be gently placed back together with absorbable sutures, if necessary. Lastly, your skin is gently brought back together with either staples or “invisible” stitches that dissolve over time. 

 After your C-section, you will be monitored closely for the next 24 hours to make sure that you don’t develop any complications. You will receive pain medicine, which is safe for your baby, even if you’re nursing. 

 You will likely be encouraged to begin walking short distances within 24 hours of surgery. It is usually very uncomfortable to start walking, but the pain will decrease in the days after the delivery. It is so important to get up and start walking as soon as you can to prevent any complications from occurring, and to allow for optimal recovery and healing. 

The typical hospital stay after cesarean delivery is about three days. You can feed and care for your newborn as you feel able. Before going home, you’ll receive post-surgery instructions, including warning signs of complications. It can take four weeks or more for a cesarean incision to heal, and it isn’t unusual to have occasional pains in the area during the first year after the surgery if your incision and the area around the incision isn’t massaged and managed well.

Do I Really Need To Worry About My Pelvic Floor If I Had A C-Section? 

 

While it is true that a vaginal birth will cause more trauma to the pelvic floor, and increases the risk of pelvic floor dysfunction post-birth, you still are at risk for pelvic floor dysfunction simply because you were pregnant.

 

Pregnancy in and of itself places a lot of pressure on the pelvic floor. Your growing uterus, growing baby, and the weight of your pelvic organs place a lot of demand on the pelvic floor muscles. Your pelvis also becomes less stable as a result of pregnancy hormones swirling around in your body. And all of the postural changes that occur during pregnancy affect the strength and integrity of your pelvic floor muscles.

 

Lastly, your C-section scar can interfere with pelvic nerve functioning and affect how well these muscles function.  Therefore, we C-section mamas aren’t exactly out of the woods here either! We need to make sure that we also put in the work to restore and reintegrate our core from the inside out, which also involves restoring function to the pelvic floor as well. 

C-section Recovery Tips: Day 1 – 6 Weeks Post Delivery  

A. Day 1 through Six Weeks 

C-sections have become so prevalent in our society that mamas may forget it’s a major operation. For the first six weeks after your C-section, your primary focus needs to be on your own healing and recovery, along with caring for your baby. This is NOT the time to push your body too far and too fast. If you try to jump back into strenuous exercise or a chaotic life routine as soon as possible, you will set yourself up for more setbacks. 

    1. Wait the right amount of time to get up and move around.

You won’t start doing laps around the room as soon as your baby is born. First, your anesthesia will need to wear off so that you can feel your legs. Secondly, your catheter will be removed. Depending on whether your C-section was emergency or scheduled, you may be tired from any time you spent in labor before the procedure. When you first get up, you’ll probably just be walking around the room, maybe to the bathroom and back. 

    1. Rest As Much As You Can. 

Getting enough sleep will help you recover from your C-section. Your body needs the downtime to heal itself, so rest and catch up on your sleep as much as you can. Limit the number of visitors to your hospital room as much as possible. If the baby isn’t sleeping well between feedings, or if you can’t rest because the baby is in the room (this is common!), ask the nursing staff to take the baby to the nursery while you rest.  You’re still a good mom for doing so, not a bad one! You’re allowed to have needs, too. 

Once you’re home, your two jobs are caring for the baby and caring for yourself. When the baby sleeps, do something restful for you. If you can’t sleep (some of us will always stink at napping), watch TV that makes you smile, read a book, or catch up with a friend. 

    1. Ask for help both at the hospital and when you get home.

When you’re in the hospital, the nursing staff is there to help you; don’t be afraid to ask for help with your baby. Shortly after surgery, you’re likely to be in a fair amount of pain, which will make it hard to move around and care for your baby. Take the pain meds, and let your family, friends, and the staff bring the baby to you. It can be painful to hold the baby against your stomach and incision while breastfeeding, so ask about more comfortable positions for nursing like the football hold, or propping baby up on some pillows to protect your incision area. 

When you get home, recruit help from friends and family as much as possible.  Caring for a newborn is stressful enough; recuperating from major surgery as well can make a stressful situation awful. All parents need different support, and that’s okay. You may want someone to come over and hold the baby, so you can take a shower, change your clothes, eat something, take a nap, or so whatever you need to make yourself feel a little more like a human again. The key here is to understand what you need and communicate it to the people around you. 

    1. When you are able to walk, EASE into it 

The reason that it’s so important to walk after surgery is that being active jump-starts your body to resume its normal bodily functions. The activity also decreases the chances of postoperative complications like blood clots, pneumonia, or constipation. 

Don’t think, however, that you’re going to get up and sprint around the hospital. Short walks up and down the hallways, a few times a day are a great way to start. At home, get outside and go for short walks, like to get your mail. Try to walk every day and try to walk a little further every day. Slowly, increase the amount you walk. The increased physical activity will promote better blood circulation to the tissues of your body and helps you heal, and the fresh air and sunshine can help improve your mood if you are experiencing the baby blues. 

If you feel like you are experiencing postpartum depression (“PPD”), PLEASE ASK FOR HELP. Especially for those who did not plan their C-section, PPD is frighteningly common. I suffered from this myself; there is help out there. You do not have to suffer alone or in silence. 

    1. Just say yes to the pain meds

Your C-section incision will hurt (it’s major abdominal surgery!) for a while, so don’t be stoic or prideful by avoiding taking your meds. If you can stay on top of your pain, it’s less likely to get out of control and enable you to function more easily. Your pain will hit you like a ton of bricks if you try to skip taking your medication. Being in pain will make it harder to rest, harder to breastfeed, harder to care for yourself or your baby, and make PPD more likely. Don’t make early parenthood harder than it needs to be. Take the meds. 

The uterus will start shrinking back to its original size and can cause you to experience some cramping within the first two weeks after the baby’s arrival. Your incision can also make these cramps more intense, so it’s still a good idea to keep up with your pain medication after you return home. 

    1. Expect a decent amount of bleeding 

 Even though you didn’t deliver your baby vaginally, you will have postpartum vaginal bleeding. The bleeding you experience after delivery is part of the healing process in your uterus. The blood comes from the area of your uterus that used to be attached to the placenta.  Expect the bleeding to be heavy for the first few days, and then to gradually taper down over the course of the next few weeks. 

    1. Eat lots of fiber 

Constipation is a big issue for mamas that have had a C-section. Your bowels can get backed up from any type of abdominal surgery and anesthesia. Gas can also build up, and show itself in the form of aching shoulder pain. When your bowels are bloated, this can irritate the diaphragm, and that irritation will manifest itself in the form of pain in the shoulders. 

Be sure to take stool softeners and anti-gas meds until you have your first bowel movement. The first bowel movement post-C-section can be very uncomfortable. Eating foods high in fiber like fruits and vegetables and drinking lots of water and fluids will keep your bowels moving.  Lastly, don’t be shy about passing gas—it’s more painful not to! 

    1. Care for your incision and the area around it 

Hold a pillow over your incision when you cough, laugh, take deep breaths, or need to stand up or sit down. This will support your belly and reduce your pain. 

We will talk about massaging your scar in a bit, but that needs to wait until after your 6-week check-up. Clean your incision in the shower by letting soapy water drip on the wound. DO NOT scrub the incision or the surrounding area. Pat it dry. DO NOT pull off the surgical tape, let it come off by itself or let your doctor remove it at your check-ups. 

Within a week, your wound should be healed at the surface. Keep an eye out for the following signs for a possible infection: 

      • Any fever (even if your incision looks fine). 
      • Warmth, redness, swelling, or oozing at the incision site.
      • Worsening pain or sudden onset of pain. 
      • Foul-smelling vaginal discharge. Your vaginal bleeding and discharge should be diminishing over time, though it may last up to six weeks. It should gradually turn from bright red to pink and then yellow-white. 
      • Pain or burning when urinating, the urge to pee frequently when not a lot comes out, or urine that is dark and scanty or bloody. 
      • Any possible signs of a blood clot, such as severe or persistent pain or tenderness and warmth in one area of your leg, or one leg that is more swollen than the other. 

 And don’t worry yet about scarring. You’ll have a scar, and there’s no way of knowing exactly how it will look once it heals. On the surface, your wound should look like it is just about healed six weeks after your C-section. Within the deeper tissues of the body, however, there is still some major repair work going on, so allow yourself to be patient and kind with your body. 

    1. Roll over

 Every time you go to lie down or to move from your back to a seated position, first roll to your side, then push yourself up to sitting with the assistance of your side abs and your arms. This avoids any big crunching and sit-up type movements that can place a lot of pressure on the abdominals and scar region and can also keep diastasis recti from healing well. 

For example, when getting in and out of bed, carefully lie on your side, and then slowly roll onto your back, keeping your head relaxed and down throughout the roll. Getting out of bed, roll to your side, keeping the head relaxed and down, then slowly lower your feet to the floor. Then use your upper body strength to push up to a seated position. 

    1. Begin with core connection breathing & core + pelvic floor restorative exercises

You can and should begin rehabbing your core and pelvic floor within the first few days postpartum with some core connection breathing.  It’s so important to start reprogramming your core to function properly again, and that is accomplished through synchronized breathing and gentle contractions of your “inner core.” This type of breathing also helps promote oxygenation of the tissues in the core pelvic floor to encourage healing. 

Once you get the hang of core connection breathing, you can then incorporate it into some gentle core restoration exercises like:

The core connection breath can and should be integrated into all of these exercises. 

B. C-section Recovery: 6 Weeks Post-Delivery 

 

So you’ve hit the 6-week mark. You’re ready to get back to your old exercise routine, but hold off just a bit! Just because you’ve made it to the 6-week check-up, this doesn’t mean your healing process is over. The deeper tissues in your core are still repairing themselves, so getting the green light from your doctor to start exercising again does not mean that your body is totally healed and ready for more rigorous activity.  

A postnatal body (especially one that’s been through a c-section) takes at least one year and up to two years or more to completely heal from pregnancy and delivery, so let’s think conservatively as we get back into the swing of things!  

Along with the following information, you will want to continue with core connection breathing, possibly abdominal wrapping (for a few more weeks), and rolling to your side to get up and down from any position where you are lying on your back: 

    1. Caring for your C-section scar: Scar mobilization isn’t discussed very often, but it can change the course of healing and deeply affect how well your core functions long term, as well as other bodily functions in the pelvic region. The general timeline for a C-section incision to heal is: 
      • Stage One (Week 1) – Inflammatory Stage: This is the active phase where heavy tissue repair begins and when you truly do feel like you just had surgery. 
      • Stage Two (Months 1-3) – Proliferative Stage: This is the first rebuilding period where new collagen and capillaries form and swelling may still be present. You may begin to start feeling a bit like yourself again, but you still need to take it easy. 
      • Stage Three (up to Year 1): – Remodeling Stage: This next stage is when new collagen has reformed, and your C-section scar is “settling” in. At this time in your C-section recovery phase, you may feel occasional soreness around the scar after active days or sudden pain around the area when you move a certain way. 

Scar tissue is not inherently bad for us. It’s a fibrous tissue that helps keep incisions and injuries from reopening. The problem is that scar tissue doesn’t stretch, and it can continue to grow even after an injury has healed. It does not lie down as “neatly” as normal tissue and is less flexible. If you can imagine it, scar tissue lays itself down more like a spider web surrounding an injury, and it attaches itself to anything in the surrounding area to the injury like skin, muscles, and connective tissues.  

This can then cause adhesions, which basically means that the scar tissue has attached itself to healthy tissue that has nothing to do with the injury.  So when you move, the fibrous scar tissue pulls on other healthy tissue and limits its ability to move freely. This creates unwanted tension in your body, and it can affect both healthy tissue and organs surrounding your scar as well as other areas up and down the body because it’s all interconnected. This unwanted tension also creates an imbalance in your body that can show up as other physical symptoms like: 

      • Pelvic, back, hip or knee pain 
      • Constipation 
      • Sense of urgency or like you have to pee a lot
      •  Fecal or urinary incontinence 
      • Irregular menstruation 
      • Painful sex 
      • Numbness or tenderness around your scar
      •  Lumpy or hard spots around or on your scar 
      • A “pulling” feeling around your scar 
      •  You can’t feel your abdominals working
      •  Struggles with infertility after a previous C-section  
      • Irritable bowel syndrome or digestive issues
      • Trouble with breathing
      • Limited or restricted movement.  

Walking and exercising at a moderate intensity is encouraged because it promotes healing and helps prevent blood clots and other complications. Massaging your incision can help to keep existing scar tissue as soft and mobile as possible, improve circulation, and speed up healing time.  It doesn’t have to take a lot to massage your scar and loosen adhesions in and around the area. I offer a free guide that shows you how to massage your incision area for just 5 minutes a day. However, I still recommend that you find a professional in your area that specializes in C-section scar mobilization!

    1. Returning to strength training after your C-section: As your body continues to feel stronger each week, and you’ve received the clearance from your doctor to return to fitness, you’ll want to allow your body plenty of time to adapt to the increases in movement and intensity that come with strength training.  A good starting point is to focus on getting in two strength workouts per week that last anywhere from 15-30 minutes with lots of rest between sets.  You can gradually increase your workout time and the number of workouts per week depending on your energy levels, your schedule, and how well you are recovering in between workouts.

As you return to strength training, you will want to focus on bodyweight movements first (you MUST learn to regain control of your own body before adding on more load), and then you can progressively add more resistance by starting with resistance bands, suspension trainers, mini bands, and light weights.  The following are some good exercise examples you can use to start easing back in strength training:

Again, make sure you are using the core connection breathing technique with each and every one of these exercises. 

As you work your way back into strength training post-C-section, you’ll want to “avoid” these exercises until your core is strong enough and better able to manage intr-abdominal pressure while doing these exercises:

      • Crunches, sit-ups, leg raises, and front planks
      • Running, jumping, step-ups, box jumps, jump rope
      • Heavy overhead presses
      • Heavily weighted exercises
      • Ballistic exercises like KB swings and Olympic lifts
      • Anything with direct downward pressure on the pelvic floor, such as a barbell back squat and barbell deadlifts.

The return to exercise after a C-section has to be a very systematic and progressive approach!  Just because your doctor tells you at the 6-week mark that you are cleared for exercise, it doesn’t mean that your body is ready to jump right back into a full-blown exercise routine!  And be sure that you do your research and make sure that many of the classes in your area geared towards new moms aren’t packed with all kinds of aggressive core workouts, jumping exercises, and loads of exercises that take your alignment, breathing techniques, and core strength! Most of all, move in ways that make you and your body feel safe, amazing, and energized during and after your workout!

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