This resource is going to cover:
· What a c-section is
· Allowing healing time and progressively returning to exercise
· Why your pelvic floor still matters
· Scar tissue massage
· Suggested exercises to get started with
What a c-section is:
A caesarean section (C- section) is a very common major surgery that some women have to deliver their baby. It involves a surgical incision through several layers of skin and connective tissue to the uterus, movement of your bladder and removal of your baby and placenta from your uterus, then all these layers are individually sewn up again. Scar tissue will then form through all these layers as they heal. It is important to remember this is MAJOR surgery and healing will take time, please be patient and ask for help when needed to minimize any stress on your abdomen and incision site. But there are still things you can do to help your recovery, read on….
Allowing time for healing
In the first six weeks it is important to rest and gradually increase your activity level again over this time. Holding a pillow as a splint over your scar when you stand up is usually helpful to feel more stable in your core and reduce pain. You can also brace with a pillow for coughing/sneezing etc.
When sitting up in bed be sure to bend your knees up and roll on to your side to then push up with your arms so you don’t put extra pressure on your scar, basically don’t do a ‘sit-up’ movement. Use your arms to swing your legs over the edge of the bed, lean forward and stand up. And do this in reverse to lie down.
During the early weeks you can work on your breathing and reconnecting with your core system.
Returning to movement
Returning to movement and exercise post c-section is different to returning to exercise post vaginal delivery. Evidence suggests for ladies post c-section, delaying adding more intense exercise programs by two or more weeks than you would a normal vaginal delivery, or even longer if there are concerns with healing or other complications. Before you increase the intensity of your exercise your scar should be visibly healed on the outside, with no surrounding redness or oozing from the site. However, this does not mean the healing process is complete, the outside may appear healed but the inside layers will still be healing. Lastly, judge how you are feeling, if an exercise or movement is not feeling right, stop doing it and try again in another week. Think about recovery after any other surgery, healing then progression is the key and often doctors checks and physio is required. Essentially the same goes for c-section, however women are often left to their own devices without any of these checks or advice, and that’s where I come in.
During your first six weeks of recovery, doing ‘nothing’ can be hindering, general daily living gentle movement and light household chores are generally ok and can help your healing process. You may initially feel more comfortable in a bent position, however try to spend time in upright aligned positions so the scar can heal in this position rather than a restricted position. Too much time in a bent position can cause restriction of your scar and shortened core muscles. By maintaining optimal posture your abdominal and pelvic floor muscles will be in the best position to function effectively.
You should take regular daily gentle walks to help prevent blood clots in your legs (DVT). Breathing and gentle mobility and stretches will also be beneficial to help you reconnect with your body and reduce aches and pains. Be sure to monitor how you feel with the movements you make and don’t overdo it.
Be sure to keep things gentle, no long or intense walks and any large or heavier movements. You will likely have been told not to lift anything heavier than your baby, stick with this guideline and gradually progress with caution when it is suitable to start lifting heavier items from around six to eight weeks once that scar is visibly healed on the outside. When you do start lifting heavier items, be sure to use proper lifting and engaging techniques which you can learn in my Re-energised Postnatal Recovery Program.
Think about what functional movement you do and what you could gently start to train ie squats, (light) bending or hinging at the hip type movements (bending lifting your baby into the bassinet etc). The concern with lifting heavier objects post c-section is due to concern about increased intra-abdominal pressure on the scar, however learning and using your core connection breath will help support you with this. Even just standing up from a chair exerts pressure on your core, so incorporating the core connection breathing with standing can help also. There is a sample program timeframe of gentle movements you can start to incorporate at the end of this article.
If you have ongoing concerns consult with your GP, midwife or women’s physio.
Pelvic floor
You don’t want to forget about your pelvic floor just because you have had a c-section. Pregnancy and/or attempted vaginal birth can still put a lot of stress on your pelvic floor, for the following reasons:
· Gravity, pressure and hormonal changes from your growing baby in pregnancy cause down pressure and stretching of your pelvic floor muscles.
· The pressure from your growing uterus will have put pressure on your pelvic floor and therefore can alter pelvic floor function
· C-section scars can alter nerve function to your pelvic floor
· Pregnancy posture and alignment directly effects your pelvic floor tone and length
Therefore pelvic floor muscle exercises should be incorporated in to your programs, start with the core connection breath and you can learn more about connecting effectively with your Pelvic floor in my Re-energised Postnatal Recovery Program, there is more to it that just kegals.
Scar tissue massage
As already discussed your scar maybe still healing and all those layers are likely adhered and blended together with building blocks of collagen all in different directions (imagine layers of wax paper and someone putting a hot curling iron on them melting them together).
Scar tissue massage is proven to be helpful in scar pain, sensitivity, altered sensations and can help reduce any mobility restrictions. By applying gentle massaging force to the scar it becomes more mobile and reduces pain.
Prior to six weeks post-partum you can work on the sensitivity of your scar by brushing a variety of textures across it such as a cotton ball or facecloth, gradually progressing in coarseness of texture but being sure not to disturb any scabs/scars.
After about eight weeks you can start with scar massage.
How you can do it:
1. Ensure you wait six weeks to allow for adequate healing so you don’t disrupt the healing process. Ensure your scar is healed at least on the outside, with no surrounding redness or ooze.
2. Using moisturizer gently pinch your scar up between your fingers pushing and pulling in different directions to mobilise the layers of tissues. Focus on areas of the scar where you feel restrictions. Try circles, skin rolling all in a variety of dirrections.
Perform scar massage daily for 2-5 minutes. As time progresses past eight weeks post partum you can get more aggressive with your massage.
Please note: if there is any redness, bleeding or oozing from your scar lasting more than 2-3 hours please see your healthcare professional.
Exercises you can do (gently) prior to six weeks post-partum
You may be ‘cleared’ for exercise at around the six week mark but that does not mean the same exercise you were doing pre-pregnancy. It is also important to get moving (unless contraindicated) during these first 6 weeks, exercise that is generally safe to perform in the following time frames can be tried.
In the early days
· Ask for help from your family and friends support network so you can rest and care for your baby
· Rolling over; when lying down/getting up be sure to lower yourself or push yourself up from your side to avoid a crunch/sit-up like movement which puts pressure on your abdominal muscles and scar.
· Restorative breathing using the Core connection breath.
· Walking; when you feel ready, start with short walks first!
The following information must be guided by you and how each exercise feels for you, if it doesn’t feel right please stop. Perform only 10 repetitions of each exercises before resting as required and repeat another 1 or 2 times. Please don’t overdo it with the hope of speeding up your recovery,you must allow time for rest.
See the bottom of the resource for some nice upper body stretches to relieve your upper body tension from holding/feeding baby frequently.
From week one:
The number one goal in the first week at least is rest and recovery however you can start with some gentle breathing and movement. From the first few days post-partum you can start some breathing exercises, incorporating your core and pelvic floor muscles into your breathing to get your core and pelvic floor muscles activated, see Core connection breath.
When you feel ready you can start some short walks, start short so you can get back home easily if you fatigue or get sore quickly. If you have increased soreness this is a sign you may have done too much, so next time cut back the length of your walk and progress again from there.
Be sure to include some gentle stretches throughout your day such as:
Floor angels x 10
Shoulder rolls x 10 forward and back
These two upper body active stretches are great for everyone from day one postnatal and in particular new Mums who are constantly holding/feeding their baby and can become very stiff in their upper body.
From about week two:
You can start adding in Body weight squat to chair because you are doing this as part of your everyday routine, so best I teach you how to do this safely and effectively by incorporating your core connection breath in.
From about week four:
You can add in some exercises that will help you re-activate your deep core stability muscles incorporating your core connection breath exhaling and activating your core muscles during the hardest part of the movement:
From about week five:
Glute bridges Please make sure you have mastered a good technique in core connection to incorporate into your glute bridges.
If your scar is healed externally you can start to add in some Lying leg extensions
From about week six:
Provided your scar has healed appropriately on the outside at least, you can start adding in a gentle strength exercise program to your routine. I suggest you start with short 2 x 15 minute sessions per week and progress in time and intensity from there. Check out my Re-energised Postnatal Recovery Program for a more in-depth program which is available online or a in person private sessions with me at our private studio.