I’ll be honest. Talking about C-sections makes me kind of angry. Not at all because of the C-section itself (thanks, doc!), but because of the atrocious lack of education and resources for women post-surgery.
If you’re lucky, you might be told not to lift anything, not to drive, and not to exercise for six weeks. This is major abdominal and pelvic surgery. That’s it?! That’s all the information you get? No “what-to-do,” no physiotherapy, no guidelines for recovery, no specific exercise protocol. Just a “good luck and go home."
C-sections may be common, but they are not a "small procedure."
C-section rates are on the rise, and if you birth your babe(s) via C-section I want you to be confident in your recovery and in your ability to return to exercise safely and strongly.
C-section is short for Caesarean Section. C-section deliveries can be planned or unplanned.
During the C-section, the doctor makes an incision into your skin, through the fat cells, connective tissue, and into the abdominal cavity.
The abdominal muscles are then spread apart, and the bladder is moved down and out of the way in order to get to the uterus. There is an incision made into the uterus, and the baby is guided out. The placenta is taken out shortly after.
The uterus is then stitched up, the bladder put back in place, then connective tissue, the abdominals, and the skin stitched up, to varying degrees. We have a lot of layers of sutures and, thus, scar tissue that will form.
Not so fast, ladies. As you can tell by the description above, a C-section is not the gentlest of procedures on your body and organs, making adequate rest and recovery essential. You’re going to need to be patient with the process and not “push through.” There is no rush. Heal well now and save yourself issues down the road in the short and long term.
Think of a C-section as you would a surgery such as an ACL repair in the knee. The rehabilitation for this is a nine- to 12-month process. There are steps and checks along the way with the surgeon, the physiotherapist, and a set timeline of when it is safe to return to certain activities. In my opinion, this should be how C-sections are treated as well.
Although your doctor may "clear you for exercise" at six-weeks post, be certain that this means light and gentle exercise. The types of exercise that will be beneficial at this time are, for example, breathing, walking, core restoration, and bodyweight exercises.
The types of exercise that will not be beneficial at this time are, for example, running, jumping, heavy weight training, crunches, leg raises, and other traditional “ab” exercises.
We’ll chat about the specifics of the return to exercise below.
Keep in mind, the healing process is not done at six weeks. From the outside, your scar might appear healed, but the deeper layers inside still need time.
Just the scar alone is many, many layers deep — the tissues that you can’t see are still recovering. Just because my client's scar (pictured above) appears healed from the outside, doesn't necessarily mean the tissue on the inside is healed.
Although a vaginal birth can increase the risk of pelvic floor dysfunction post-birth, you still went through a pregnancy, regardless of the C-section delivery. Pregnancy in itself heightens your risk of pelvic floor dysfunction. We still must reprogram the core, which involves integration with the pelvic floor.
Here are some of the reasons why we still need to focus on the health of the pelvic floor after having a C-section:
In the early days and weeks following your C-section you’re going to be focused on resting and relaxing as much as possible with your new baby. These are the main things you will want to do in the first 6 weeks postpartum:
You’re going to want to do things yourself, but try to reign yourself in. Allow yourself to receive help and offers from your friends and family — they really want to! Your job as mama is to love, feed, cuddle, and sleep. If possible, even get people to bring your baby to you at feeding time.
Every time you go to lie down or to move from your back to a seated position, you’re going to lie to your side first. This is so we can avoid big crunching and sit-up type movements that put a ton of pressure on the abdominals and scar.
A good example of this is getting into and out of bed. Get into the habit of lying on your side and then slowly rolling to your back when getting into bed. For getting out of bed, roll to your side, lower the legs off the bed, then use your upper body strength to push yourself up to seated. If you can, get someone to help you with this as well.
Core restoration can start within the first few days postpartum. You are going to start reprogramming your core to function from your diaphragm down to your pelvic floor muscles with the Connection Breath.
On your inhale breath, feel your rib cage and your belly gently expand and relax. On your exhale breath, gently exhale to encourage gentle activation through your pelvic floor and deep abdominal muscles.
Before you do any exertion, say getting out of bed or picking up the baby, practice your Connection Breath. Start your exhale breath and then begin your movement or lift.
In the first few days, you’ll want to stay off your feet as much as possible. As you begin to heal, slowly increase the amount of walking you’re doing around the house. Monitor your energy levels that day and the next, and if you’re feeling good, you can keep slowly increasing your movement. Start with short outdoor leisurely walking and gradually increase your time. Use this as a time to breathe, relax, and move.
Within the first six weeks (or earlier) after baby arrives you should see a women's health physio, even if you’re not having any discomfort, and assuming that your doc has given you clearance. They can make sure you’re healing well, your pelvic floor is functioning on point, and start doing some really important scar mobilization.
To find a women's health physiotherapist in your area, search any of the websites below looking for terms such as “pregnancy/postpartum,” “pelvic,” or “women’s health” under specialty or area of practice:
Depending on your healing process, you may begin core restoration exercises in addition to the Connection Breath prior to your six-week check-up. There really is no magic date of when you should begin adding in more activity, as everyone heals at their own pace. Some of my clients have begun adding in the exercises below within the first few weeks postpartum.
Examples of beneficial core restoration exercises are:
The Connection Breath can be integrated into each of these exercises. You’ll want to exhale on the toughest part of the exercise, just before you move. As an example, in the Glute Bridge, you’ll start your exhale breath to lift up and inhale as you return down.
In your return to more traditional strength training (after your six-week clearance and a check-in with the pelvic floor physio) you’ll want to allow your body plenty of time to adapt to the increase in movement and a good deal of recovery time between bouts of exercise. If you have any bleeding or pain (scar, pelvic, back) at all during or after exercise, keep your intensity more mild.
Try starting with two workout sessions per week of 15 minutes duration, and if you’d like, slowly increase from there. Increase your workout duration by five minutes biweekly. Just for reference, most of the women I work with keep their workouts between 30 to 40 minutes in length and aim for three to four sessions per week. You can slowly build up to this amount if that works for your lifestyle and needs.
In your return to strength training you’ll want to use your bodyweight as resistance, as well as resistance bands, suspension trainers, and light weights.
Again, the Connection Breath can be integrated into each of these exercises. You’ll want to exhale on the toughest part of the exercise, just before you move. For example, in your squat, inhale as you squat down and then exhale to stand back up.
You’ll notice that in each of the exercises above, you’re keeping your body in “neutral alignment.” This means that your spine is kept in a long, straight line. We want to have a small arch in the lower back and a tall upper back, growing "up" out of the crown of the head. I always cue to have the “ribs over the hips” as you want your rib cage stacked right over your pelvis.
The return to exercise post C-section is very much similar to the return to postnatal exercise after a vaginal birth. Really pay attention to how your body feels during and especially after exercise. Above all, move in ways that make you feel safe, amazing, and energized during and after exercise.
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