Exercise After C-Section

Working Out After C-Section

Congratulations on having your baby! Before we jump into exercise talk, it’s important to remember that you’ve had abdominal surgery.

It’s very likely—and unfortunate, if so—that you were given little advice on what to do (or no advice at all), no recommendations for physiotherapy, and no rehab program. On the way out you might have been told, “Just don’t lift anything, and don’t exercise for six weeks.” Great.

It’s also very likely that you really want to get back to your workout routine. Maybe you’re an advanced athlete, so you think you’ll be fine. While every woman’s body is different, and your recovery from C-section will depend on various factors, including your fitness pre-pregnancy and during pregnancy, the wisest advice is to resist when thinking about working out after C-section is the urge to jump back in right where you left off. No matter how fit you feel, your body is healing from surgery.

Paula Radcliffe, current women’s world record holder in the marathon, maintained a very active pregnancy and had this to say in an interview, when talking about going back to her running too soon after giving birth:

“I was back running about 12 days after giving birth to Isla, which was too soon. I was really excited and probably built the miles up too quickly, which is how I ended up with a stress fracture in my sacrum (a bone at the base of the spine). I hadn’t recovered from the trauma of the birth—an agonising 27 hours in labour—so there was a lot of bruising, and I ended up not being able to run for three months afterwards…”

It may be hard to rehab and slowly work back, and much easier to focus on what you’ve lost and on getting back to where you once were as quickly as possible. That’s not going to end well. It’s important to realize what you’ve gained from this recent experience and that recovery will take some time.

C-Section Recovery: What To Avoid

At this point in your recovery from C-section, you may be feeling a bit fed-up with all the no-no’s, but you’ll be glad in the long run. Exercises to avoid immediately after a C-Section and up to six weeks postpartum (and even beyond in some cases):

  • Direct ab work like crunches, sit-ups, leg raises and front planks
  • Plyometric exercise like running, sprinting, jumping, burpees and similar aerobic exercises
  • Step-ups
  • Heavy overhead presses
  • Heavily-weighted exercises
  • Anything that places direct downward pressure on the pelvic floor, such as a barbell back squat

For at least the first six weeks of your C-section recovery you should avoid intense exercise, exercise classes, and anything that causes pain. In fact, you should avoid anything that causes pain, post-C section or not. This is not the time to push through things. If you feel that there’s something “off” during an exercise, then there probably is and you should avoid that exercise. Other red flags for an exercise include: a sensation of “pulling” at your scar, pressure on your rectum or bladder, leaking urine, and difficulty breathing. If any of those happen stop the exercise.

Just like you wouldn’t do jump squats on a torn ACL (knee ligament) or swim with a recently separated shoulder, it isn’t recommended that you do exercises that put too much stress on areas that are still recovering from pregnancy and surgery. The three areas that are particular vulnerable to stress during recovery from C-section are:

  1. Your pelvic floor: Even without a vaginal delivery your pelvic floor has had to support the equivalent of a ten-pound bowling ball for the last month, so it needs time and the proper exercise progression to heal and regain proper function.
  2. Your abdominal connective tissue: Your abs were stretched as the baby grew, and the bit of connective tissue that keeps the left and right side of your six-pack together (linea alba) gets stretched too. Direct abdominal work and other exercises too soon can re-stretch this tissue while it heals, making recovery longer.
  3. Your incision site: You had abdominal surgery to deliver your baby, which you carried for nine months. The scar from the incision needs time to heal properly.

You are in the rehab phase of your workouts and that’s okay. With a strong foundation you’ll be much better off in the long run.

Post C-Section Exercises for Strengthening: First Six Weeks After a C-Section

For the first six weeks after your C-section recruit as many people as possible to help you. Yes, this may be hard if you’re used to being independent and want to continue doing things yourself. It’s normal to struggle with asking for help, but doing doesn’t make you a bad mother or incompetent. Rather than focusing on laundry, cooking, or sending out birth announcements, your focus should be on resting and relaxing as much as you can—even if you feel pretty good. Hang out, feed and bond with your baby. You’ve been waiting a while to the little one. Ideally, someone can bring the baby to you for feeding time.

Getting Out of Bed

In a few months you’ll watch your baby learn how to roll over, but for now you’re the one re-learning how to roll over and get out of bed. Now that you have no belly and can see your toes, you may be tempted to go back to doing a big sit-up to get up and swing your feet over. Don’t do it. Getting up with a crunch or sit-up uses all those muscles that were damaged during the C-section and the surrounding tissue.

Instead, roll to your side and push yourself up with your arms to a seated position, then swing your legs over the bed to stand up. To get into bed do the reverse. Sit on the edge of the bed, slowly lower yourself to your side using your arm for support. Once you’re on your side, you can roll onto your back.

Yes, this is tedious, but it reduces stress on the area you’re trying to heal. You can also recruit someone to help you up.

Restorative Breathing

During the last stage of your pregnancy, your diaphragm got used to working with limited space, your ribcage was pushed upward, and your deep abdominals and pelvic floor had to deal with a lot of stress. With the restorative breathing, called a “core breath,” you can start rehabbing these muscles and reprogramming your core to function again. When it comes to post C-section exercises, this is a crucial first step.

Begin with an inhalation, feeling your ribcage and your belly gently expand. On your exhalation, purse your lips and try to gently contract your pelvic floor and deep abdominals.

Before you do any exertion, say getting out of bed or picking up the baby, practice your core breath. Start your exhale breath and then begin your movement or lift.

Walking

After a few days or a week, you can slowly increase the amount of walking you do around the house. Pay attention to how you feel the next day. If you’re feeling good and have energy, increase your indoor walking a little. You can progress to outdoor walking after a few days of indoor walking if your feel that you have enough energy. Keep your outdoor walks short and slow. Just like the indoor walking, increase slowly and pay attention to how you feel each day.

Find a Pelvic Floor Physiotherapist

It’s important to see a pelvic floor physiotherapist within the first six weeks after your baby arrives (or even while you’re pregnant). If you’re not familiar with this specialized physio, you’re not alone.

Pelvic floor physiotherapists are trained in postpartum rehab and can help you recover as quickly as possible. This includes getting your pelvic floor and deep abdominals working properly, and teaching you how to do scar tissue mobilization that will improves scar healing.

Proper scar healing is more than just cosmetic. Since C-sections involve cutting and sewing several layers of tissue you have several scars—one at each layer. These scars can get stuck together, impeding the different layers from gliding across each other and inhibiting proper movement. This can even irritate pelvic nerves, leading to symptoms like urethral burning, constantly feeling like you need to pee, and pain in the clitoris and labia.

A pelvic floor physio will be able to assess you and give you post C-section exercises to help you recover. These exercises will vary depending on your stage of recovery.

Post C-Section Workout Plan: Strength Work After Six Weeks

You’ve just had your six-week check-up and your doctor gives you clearance to exercise. Now you can get back to those heavy squats and deadlifts, or run off to baby boot camp for burpees and crunches, oh my! Right?

Nope. Sorry. Once you’re cleared to exercise, the goal of your post C-section workout plan is to start rehabbing from incubating a small human for 40 weeks and having surgery. You need clearance for exercise not only from your doctor but also your pelvic floor physio—and you need to start slowly. Give yourself plenty of time to recover.

Once you’re cleared you can start with two 15-minute sessions (or shorter if you’re not feeling up to it) per week. You may be tempted to do more because you’re feeling great, or because you really want to get back in shape. Please don’t. While it’s absolutely frustrating, it’s important to focus on the big picture. In the long run trying to push too hard too soon can lead to injury or delay healing.

If you have any bleeding or pain (scar, pelvic, or back) during exercise dial back the intensity. Every two weeks you can increase your workouts by five minutes depending on how you’re feeling. Once you get to 30 minutes a session you can add a session (going up to three times a week). Keep slowly adding to your workout time every two weeks, and back off if you notice you’re not recovering. Chances are you’re not sleeping much so doing more while not completely recovering is going to impede your progress.

When you return to strength training use light weights, if any at all. Beneficial exercises that Jessie Mundell, GGS advisory board member, suggests include:

Focus on your core breath when you do all these exercises, so you can properly engage your core muscles. Exhale on the hardest part and inhale on the easier part. Don’t hold your breath. Doing so will put more pressure on your pelvic floor and scar.

Also, make sure you’re in “neutral alignment.” Most women tend to hyperextend. That means they curve their low back, which gives them ‘Donald Duck butt.’ Don’t do this. Instead think of keeping your spine long and straight, keep your ribcage down. Another way of thinking about it is to keep your ribs over your hips.

Exercising After C-Section: Continuing to Make Progress

Every woman’s body is different, and your rehab progress after your C-section will be unique to you. When you begin exercising after C-section, go at your own pace. As you move along in your rehab and training, pay close attention to your body and how you’re feeling. Pay particular attention to your body before and after exercise. Are you feeling run down? Energized? Relaxed? Are you feeling any pain?

Remember your goal is to feel better after exercise, not worse. Don’t ignore minor pains or feel you should just push through exhaustion.

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