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C-Section Recovery

C-Section Recovery (Cesarean)

cesarean-section-recovery

C-section recovery time requires a touch more care than a vaginal delivery, but ultimately, it does not mean catastrophe—not in the least! During a c-section the transverse cut, or bikini cut, follows the natural curve of the lower stomach, and causes minimal complications. But a C-section can create a distended belly pooch or or shelf like area around the scar. More than likely, this will go away with healing, proper core training and scar mobilization.

Around 6 weeks postpartum your body is considered “normal” in the fact that everything is back in it’s place. Your blood volume, uterus size, diaphragm etc. have all returned to their original size/place. A lot of this happens rather quickly, but as you can see your body is going through a lot of changes as you recover from major surgery.  Weight loss comes from: amniotic fluid, placenta, blood volume, breast tissue, fat storage, swelling & urination and the uterus involution (the uterus returning to it’s normal size).

ACOG’s most recent guidelines find no problems with resuming exercise quickly for vaginal deliveries. Research shows benefits in resuming pelvic floor and transverse abdominis breathing/contracting right after your baby is born [ACOG CO804]. BUT this is without surgery and/or complications. Because you had a c-section it is important that you don’t resume exercise until your doctor gives you permission around the six-week postpartum mark.  You know your body best, so be mindful of all the changes, including your wrecked sleep schedule.

C-section Birth (cesarean delivery)

actual c section photo

Is a bikini cut c-section really unnoticeable? How is a c-section performed? Does the doctor cut my muscles? What about an emergency c-section?

Many women spend most of their pregnancies assuming that they will be giving birth vaginally. But sometimes, surgery is necessary to give you and your baby the procedure that is the most efficient and safe for your situation. You might deliberately choose a C-section, or be surprised by the need for one. About 1/3 of the pregnancies in the United States are delivered by c-section (cesarean section).

How could an incision wide enough to accommodate the debut of a newborn not produce a glaring permanent mark on the abdomen? These days, a traverse or horizontal cut (a.k.a. the Bikini Cut C-Section) is popular because the scar is coverable with bikini bottoms. This incision draws much less attention and opportunity for infection than the longitudinal, or vertical, cut.

When a C-section is performed the fascia is cut horizontally, this is a layer of soft, flexible connective tissue that acts as a sheath over these muscles. Then the abdominal rectus muscles are separated from one another and moved to the side. These muscles are very rarely cut, and if they are they are usually put back together. According to Dr. Kent Snowden, within six weeks, the fascia usually claims back 90% of its original strength; within a year, it recovers fully.  More or less, within a year of having a c-section, your body is back to normal. For more information on the exact procedure a layers that are cut to get to the baby, this Mayo Clinic overview is really good! You can get a full picture of the 40-50 minute procedure.

Following a c-section, you will find certain movements can bother your incision site, so back off until you are ready.  And only do things you are completely comfortable doing. You can add a support to your abdominal area with a pillow for more comfort.

What about a Postpartum Support Band? Unfortunately, no brand of shape wear can tighten a woman’s stomach muscles; you must rely on nature and a postpartum exercise plan. A support band can release the pressure from the back and pelvic region during healing, and using it for this purpose is perfectly acceptable, as long as it doesn’t become a substitute for engaging and strengthening the core muscles.

When is the right time for exercise after a c-section?

Notice how hard your body is working in the first few weeks postpartum, it is a delicate time for your body. Then throw in a newborn’s sleep schedule and a c-section on top of that!  Within the first four to six weeks weight loss comes from: baby, amniotic fluid, placenta, blood volume, breast tissue, fat storage, swelling & urination and the uterus involution (the uterus returning to its normal size).

While blood volume increases by 30-40% and your heart rate speeds up 10-15 bpm by the end of your 2nd trimester, ALL systems decrease in activity within 2-3 DAYS of your baby’s arrival. All returning entirely normal by 6 weeks postpartum. Women have a much higher blood volume during pregnancy, higher hormones … all of this does not vanish overnight. Neither does the swelling that comes with major surgery!

You might experience numbness for a few months after birth; the nerves were cut! Your resumption of exercise will be slower, but the end result of getting back your core musculature is the same as with a vaginal delivery. In the beginning it is best to stay away from lying on your belly or any exercise that causes discomfort.

At your 6-8 week postpartum appointment, your doctor will usually give you the green light to exercise.  For step-by-step postpartum exercises download our Ab Rehab Guide or jump to Post C-section Workouts.

Exercising after a C-section should be done with caution. As long as your doctor is okay with it, you should be able to perform pelvic floor exercises – See Pelvic Floor Hold ‘Ems. After your doctor releases you to exercises around the 6-8 week postpartum mark, you can start with more traditional exercises. They should be done pain free. They should be catered to your postnatal body. If this is not the case you need to back off.

Some women find comfort in wearing a postpartum support band or belly band. I recommend these should be used for comfort. When they are used as part of a strength training program, the body tends to lean on the “support” instead of recruiting muscles to strengthen the core.

Post C-Section Workouts

You can resume exercise once your doctor gives you permission —

Vaginal deliveries – this usually happens at the 4 week postpartum appointment.
C-Section deliveries – this usually happens at the 6 or 8 week postpartum appointment.

It’s important to guage your expectations in getting your body back. Around 9-12 months postpartum you might be back to your pre-pregnancy weight. Anything before that is simply unrealistic.

Your body is remarkably adaptable, and your recovery to pre-pregnancy hormone levels, uterus size, and so on is a postpartum miracle. Your core muscles are just as adaptable, but you have to use all abdominal muscles to make them bounce back. You cannot expect them to bounce back unless you – by, you guessed it, doing core exercises. Time, proper core training and scar mobilization will help in your road to recovery!

As much as we talk about the core, strength training for your entire body is extremely important. Follow this full body postnatal program if you’ve had a c-section within the last 12 months. Now let’s talk more about the core – it was the most affected muscle group during pregnancy. Using the transverse abdominis muscle is a big part of your postnatal abs. The TA is a thick layer of muscle that runs from hip to hip, wrapping around the torso from front to back. The muscle fibers of the TA run horizontally, similar to a corset or a weight belt. These muscles are your true core muscles, and strengthening them will give you power and tone your entire body.

During pregnancy your transverse abdominis and pelvic floor support that baby. So wouldn’t it be wise to work those muscles to get your stomach to go back to the way it was? Research shows women that have had a c-section do not perform pelvic floor exercises. Although your delivery was different, your pelvic floor still supported that baby for 9 months.

Start with training the transverse abdominis and pelvic floor. This establishes core health … much needed after a c-section!  We have included five of these exercises in the video below. The bridge and clamshells are also really important for C-section mamas…these create stability to take the strain away from the incision area. We include these exercises in the video below. This gentle core workout comes form our Postnatal Workout program.

Overall, listen to your body, ease into exercise with a postnatal program and only if it can be done pain free.

This gentle core workout is great for moms who have had a c-section (6+ weeks postpartum). We built in extra challenges in the last three exercises…please only do the “extra” after completing this workout a 2-3 times.

Scar Tissue after a C-section

Many women are dismayed to discover a “shelf,” or a bulge, that protrudes over their C-section scar. I experienced this phenomenon after my first C-section, and appealed to my Ob/Gyn, Dr. Kent Snowden, for an explanation. He assured me that this “shelf” was probably fatty tissue damage, and that it was so prominent because of swelling. Once the parts of my body, inside and out, had settled back into where they belonged, the scar tissue should remain the only evidence of the surgery. With patience and scar mobilization the bulge will reduce over time.

A woman who has sustained multiple C-sections will end up with more scar tissue. Whether she chose stitches, staples, or tape for suturing should not make a difference in the amount of fatty tissue damage or scar surface area.

Normal tissue in our bodies is aligned in a nice uniform direction. However, when scar tissue forms it is kind of like your toddler played pick up sticks and tossed them all over the floor. The tissue is laid down in haphazard directions. Most C-sections are performed using a horizontal incision or bikini cut over a mom’s lower abdominal. When the scar heals, just like any other scar, it lays down tissue in every different direction. The scar tissue can cause adhesions to the abdominals, pelvic floor and surrounding muscles.

This scar tissue can cause many more problems, beyond cosmetic. When the scar tissue impacts the muscles around it, it can cause issues with the deeper core muscles firing correctly, can cause issues with incontinence, can lead to back pain and pain with sexual intercourse. So often I find that moms think that once they have a C-section scar, it is what it is and there is not much they can do about it. There is hope mommas!

Scar tissue responds very well to mobilization. I know… big words… sounds fancy but it is quite easy to do on your own. Now… I will say, if you have a thick scar that is super tender and angry, or are dealing with issues with back pain, incontinence, or diastasis recti, please find a physical therapist/physiotherapist who specializes in Women’s Health. They will be able to address your scar and other issues and get you back to being super mom much more quickly than if you just do a simple scar tissue mobilization at home.

First, you need to let that scar heal all the way. Do not get over eager too early in the game… you can pull open your incision. Wait until your incision is fully healed. Then put your fingers down along the incision and move your incision/ scar in ever difference direction. Start gently. This may be uncomfortable. A little soreness is ok, but do not torture yourself! It does not matter if your scar is 4 weeks old or 10 years old. I have gotten scars to move that are decades old. It is never too late to work those scars!

Very often I find that soon after the scar is healed or is healing it can be very sensitive. You might not tolerate pants with a tighter waistband or even having your shirt brush against it. This is called “hypersensitivity” and is not normal. Your body is telling your brain that everything is causing damage even though it is not. We need to retrain your brain and desensitize that scar. You can start with just brushing your fingers over it and gently rubbing it if you can tolerate it. Then grab a washcloth and get it wet with warm water. Run it over your scar and then repeat with it cold. Play around with different textures that you can rub over your scar. If you consistently work on your scar, your sensitivity will improve!

Most scars respond very well to mobilization. If you are still having issues after trying to work on your scar at home, please find a Women’s Health physical therapist. They have so many tricks and tools in their toolboxes and would love to help you achieve your goals.

The truth about c-sections ... a personal story

We all end up in C-sections for different reasons and different doctor’s opinions (always looking for the best result). For me it was a transverse baby, a baby with scary low fluid and a third baby who came at 35 weeks. I kinda gave up that I would have a baby the ole fashioned way. But after 2 failed IVF’s + 2 successful IVF’s + surprise #3 – I didn’t get pregnant the ole fashioned way either!

Ok, so C-Sections are scary, but they aren’t bad! For me I was in lala land trying to breastfeed my 1st baby in the recovery room…I couldn’t quite pull it together…I will get to that in a minute. I desperately wanted to fall asleep on the operating table, I was chattering, I was cold. But I felt no pain – just a little tug as that precious baby came out! The pain was covered up by drugs – although the drugs spoke for themselves as I fell asleep mid-sentence constantly.

It’s after the baby is out that the truth needs to be told. Oh the mess! Your body is working it’s way back to normal and it all comes out. You pee a lot – which is great for swelling. You bleed a lot — I am not talking about the incision, that should not bleed. And that uterine catheter comes out on day 2/3…it is a little painful coming out. Luckily (again) the drugs mask most of that.

After that catheter comes out you will be asked to stand and walk. Say what?!?! You want me to stand?!?! Oh and you want me to walk?!?! It was my first realization that the “no driving for 3 weeks” rule is in place for a reason.

As I leaned on my husband – my goal was simple – I must walk to the restroom. I will never forget the difficulty. But amazing thing, it got easier every time and by day 5 I was ready to walk right out of the hospital!

While your blood volume and uterus work to get back to their normal selves, you are left with some intense cramps. These cramps can be worse if you are breastfeeding, and tend to be worse with each consecutive pregnancy. The thing is … your uterus going from the size of a watermelon to the size of a plum. The body is amazing! It takes time, at 6 weeks your body is considered “normal” in the fact that all systems are back in place. And you are left with loose skin, extra fat, cellulite and added weight. We can take care of that – read about my post on Postpartum Exercise.

Now let’s talk about the fact that your belly was cut open. Your belly is covered with a sticky film and iodine. During the post-surgery bed bath, the nurses will scrub you and I mean scrub. But the good thing is the drugs (again) mask it. I was alone, my husband went with our newborn daughter, which was ok cause all I wanted to do was sleep. I completely failed at breastfeeding my baby so they took her for her bath, while I laid totally numb. But the clean feeling felt quite good. And finally I was coming to my senses and ready to see my baby again. It really was only about 30 minutes but it felt like forever. With each C-Section I was less sleepy and figured out the breastfeeding thing! So #2 and #3 were different experiences immediately post-birth.

The incision site, it’s a question I am asked quite often being a Prenatal Postnatal Exercise Specialist. I talk about the incision site, what it does with each consecutive pregnancy and why we all feel like we have a little “shelf” in that scar area.

And while this is embarrassing to mention…you should shave the incision area before a c-section. Otherwise you are stuck with blood, sticky film and iodine to clean up and pull off.  Ouch.

So what happens afterwards – when it’s time to get your body back?

C-section and vaginal birth ladies → Our ab muscles are affected the same way – we are all pregnant the same way. The difference is in the recovery. Check out Postnatal Exercise Program.

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