In the United States, about 1 in 3 births are via Cesarean section. So, you had to have (or have to have) a C-section...you are not alone! Many women may elect to have a C-section due to past difficulties with vaginal deliveries, some may occur for emergency reasons to get your baby out safely, and some may attempt a vaginal delivery but end up giving birth via C-section for various reasons.
I am here to talk to you about recovering from a C-section. First things first, your body just went through 9 months of pregnancy and then an abdominal surgery. Your body needs time to rest, heal, and recover. Make sure to give yourself grace in this season. Caring for a newborn is hard. Recovering from a surgery is hard. You can do hard things, mama! I hope some of the things we talk about in this blog can help make your recovery feel a little easier. I always recommend working with your local physical therapist postpartum (also during pregnancy) to help individualize your treatment plan. Everyone has a different pregnancy, a different birth story, and different symptoms and goals. Working one-on-one with a physical therapist (either in-person or virtually) will provide you with the most benefit in your recovery.
First, let's talk about the actual surgery itself. There are two options in terms of the surgery: to have an epidural or to be put under general anesthesia. During the surgery, there are many layers of tissue to go through & muscles/organs that need to be moved in order to get to the baby:
Skin
Fat
Fascia
Abdominal muscles
Peritoneum
Bladder, uterus
Amniotic sac
BABY!!!!
Think about this! I'm not telling you this to scare you, but knowledge is power. This is a major surgery and we must rehab our bodies accordingly. If a football player had to have abdominal or back surgery, they wouldn't just have the surgery, rest for 6 weeks, and then go right back to playing football. They would have a gradual reintroduction to exercise and spend HOURS, DAYS, WEEKS rehabbing and strengthening their entire body to be ready to get back on the field. Postpartum women and in this case, post C-section, need a proper rehab and strengthening program to be able to perform daily tasks like carry car seats, pick up your baby, get up and down from the floor, cook, clean, etc without pain or other symptoms! And if you also want to return to some form of exercise such as running, Crossfit, yoga, etc. we need to appropriately progress you to get you back to the things you love safely and pain-free!
Now, let's get to the recovery! I'm going to share with you some information about scar healing, exercise, and tips to help you as your body recovers during those early weeks postpartum.
HEALING TIME -- Most scars are fully healed between 6-8 weeks. Some may heal faster and some may take longer. Every person heals differently. You should wait until your scar is fully healed before practicing scar massage directly over the scar. If you experience increased redness/inflammation, sensitivity/tenderness, experience fever/chills, or notice any discharge or fluid with a foul smell coming from the incision -- please call your provider as these are signs of a possible infection!
EXERCISE -- In the first 6 weeks postpartum, it is a good idea to start with short walks (5-10 minutes) at a time and gradually increase time or distance as tolerated. You can also begin diaphragmatic breathing and pelvic floor exercises as a way to start reconnecting to your deep core. I always recommend seeing a physical therapist before beginning any exercise. A postpartum specialist or pelvic floor therapist can evaluate your scar and do a full assessment to help determine an individual plan for you.
BOWEL/BLADDER -- For the first couple weeks, try to ensure you are emptying your bladder every 2-3 hours to prevent it from becoming too full as this could cause increased pressure in the area of your scar. Some tips for bowel movements in the first few weeks include: stay hydrated, take or ask for stool softeners from your provider (you can also use Miralax or prune juice), try to avoid straining for a BM, elevate your feet on a stool or books so your knees are above your hips, and perform diaphragmatic breathing during a BM.
GETTING IN/OUT OF BED OR OFF COUCH -- CUE THE LOG ROLL. The log roll is going to be a much easier way for you to get in/out of bed or off the couch during your recovery rather than sitting straight up. The log roll will help protect your scar as it heals and your low back. Basically, you bend your knees (also can bend only one knee) and roll to your side first. Then, push up to a seated position using your arms. To get back in, you will do the same thing but in reverse. First, lie down onto your side using your arms and bring your knees up to the bed/couch keeping them bent. Then, roll gently onto your back.
BLEEDING -- All postpartum women, regardless of delivery, will experience vaginal bleeding. This is normal and can persist for 6 weeks postpartum. A tip for my C-section mamas is since you will be wearing pads...buy high waisted underwear that goes over top of your incision to prevent irritation over the scar.
SUPPORT -- Have a support team at home to help you with household chores as your body needs time to heal and rest in those first few weeks. Whether it is your spouse, family members, significant other, or a postpartum doula...ask for help so you can recovery fully! If you notice you are sore or have increased pain or bleeding, you likely did too much and need to back off a little.
SCAR MASSAGE/MOBILIZATION -- Once your scar is fully healed (typically around 6-8 weeks), you can begin massaging and mobilizing the scar and tissues beneath and around the scar. This will help prevent your scar from adhering to muscles and organs beneath it such as the bladder or uterus. This will also help you better be able to activate your lower abdominal muscles (transverse abdominis), which can play a role in the function of your core. I recommend seeing a physical therapist to help teach you various methods to help you get that scar moving! It's never too late...even if you're 2 years postpartum and never were instructed to touch or get your scar moving, please see a PT to help!!
I hear from many women that try to return right back to the exercise they were doing either pre-pregnancy or during pregnancy after their 6-week check up. I am not going to be the one to tell you not to exercise because there are so many benefits to exercise and I am all about helping people do the things they love!
But, before you return to heavy weight lifting, running, or your HIIT class...I suggest you spend some time rehabbing and strengthening your deep core (diaphragm, deep abdominals, low back stabilizers, and pelvic floor) as well as following a progressive strength training program. Our bodies went through A LOT when it comes to 9+ months carrying a baby and then labor and delivery. We need time to rest and heal, then time to rehab and reconnect to our muscles, then time to progressively load and strengthen our bodies before jumping back into our normal workout routine. I promise you, your body will thank you for spending time working with a PT to help you get back to the exercise you love feeling stronger than ever without pain or peeing your pants!
Contact me on my website, through my instagram (@restore.physicaltherapy614), or email me at: restore.physicaltherapy614@gmail.com ! I'd love to hear from you.
Kaitlin Hartley, PT, DPT, PPCES