So you’ve had a C-section and your ready to get back to exercise…But how do you do it safely??
The first thing that you need to know is that a Cesarean Section (C-section) is the delivery of a baby through a surgical incision in both the abdomen and the uterus. This surgery involves the use of epidural or spinal anesthesia in most cases. The key thing to remember with regards to a C-section is that it is major abdominal surgery which requires healing across multiple layers of tissues. I repeat…it is major abdominal surgery. The procedure generally lasts about 30-45 minutes and the baby is usually delivered in the first 5-10 minutes. The incision is along the bikini like in a slight curve usually about 14-18cm in length. The surgeon will manually separate the linea alba (which connects the abdominal muscles together in the centre of your body), the abdominal muscles and will move the bladder out of the way. A small cut is made into the peritoneum (membrane which lines the abdominal cavity), followed by a horizontal cut in the uterus. Through this incision in the uterus the baby is lifted out and the mother will often feel a strong tugging sensation. Following delivery of the baby, the incision is closed layer by layer using dissolvable stitches.
C-sections can be elective or non-elective. An elective C-section is agreed upon in advance and often takes place before labour begins (usually around 39 weeks). This situation often occurs if the baby isn’t presenting in the head down position, if the woman has had a previous C-section or there are other medical conditions present that may cause harm to mother or baby during labour and/or delivery. These procedures are usually calm and slow and women feel much more prepared for them as they have all the steps explained to them prior to surgery. Non-elective C-sections can occur due to a variety of factors but they are not planned ahead of time. Non-elective C-sections may feel very chaotic and frightening for the mother (and their partner) as they are usually expecting and hoping for a vaginal delivery in these situations. Often women will have already been in labour for many hours before a non-elective C-section takes place. Women in these situations may feel exhausted, frightened and disheartened, like a failure, disappointed, distressed or even traumatized. Processing a non-elective C-section can take some time for a new mother and if you are having feelings like those mentioned above remember to give yourself grace and speak with your partner, family, friends or a medical professional about your feelings.
Recovery from a C-section depends on many factors including the birth circumstances (elective or non-elective), previous fitness level, care taken during recovery, support at home during recovery and timeliness of pain medication. Different women will also experience different amounts of pain where some may suffer severe pain and discomfort and others may only experience mild discomfort with exertion. In general, pain typically decreases over the first 5 days and most women no longer require pain medication 7-10 days after birth.
As a general note there are so many benefits to exercise in the postpartum period including enhancing your cardiovascular health, lipid profiles, aerobic function, may reduce body fat and improve metabolic rate and may help children form more regular physical activity habits. It also has a positive effect on mental well-being, improves mood and body image, reduces rates of postnatal anxiety and depression and so much more. Exercise postpartum is key for so many not only for physical health but also for mental health whether or not you have had a C-section.
Generally, following a C-section many medical professionals will advise women at their 6 week checkup to start gradually increasing their exercise as they feel able. However we must remember that a C-section is a major surgery and most musculoskeletal injuries (think muscle tears) take 6 months to a year to fully heal. Because a C-section has resulted in incisions (cuts) in muscles and deeper layers of tissue although the surface scar may appear healed, the deeper layers of tissue will take more time and they are not fully healed at 6 week post C-section. This does not mean that you cannot do any exercise at all. For many women as they heal from a C-section (or other injuries) it is actually okay to move their body in ways that are no more strenuous than the tasks they do everyday (tasks of daily living). Gentle movement can actually encourage healing throughout the entire postpartum process.
Remember that when you are recovering from a C-section everyone’s experience will look different. Always ensure you are following your medical providers advice. Some women will heal rather quickly and some may take longer to recover. Other things like pain, incontinence during pregnancy, length of labour/delivery, multiple births, ect can impact a woman’s ability to return to exercise. In GENERAL, C-section moms are delayed about 2 weeks when compared to moms who gave birth vaginally, with regards to exercise timelines. This is provided that their C-section scar is healing well. This is a very general recommendation and there is a good chance that your experience may not mimic this timeline. You may find yourself taking more time or you may find yourself taking less…and you need to remember that either option is okay.
Scar tissue massage after 6 weeks should be encouraged in all patients provided their scar is healing well. This massage should be done on a daily basis and clients may be able to start touching the scar or around the scar before the 6 week mark. A pelvic health physiotherapist can help guide this process as well.
Women can begin practicing their connection breath immediately postpartum as with a vaginal birth to help re-connect the core and pelvic floor. If this causes any pain at all (as it may with some C-section patients) stop, wait a few days and try again. When you feel able, you can begin taking a walk. Start with just 10-15 minutes on fairly flat ground at a leisure pace. As strength increases and provided there is not discomfort or pain following these walks, you can gradually increase the pace and duration of these walks over time. After 6 weeks housework tasks can start to increase as well. For the first 6 weeks keep these tasks lighter.
I’m starting to sound like a broken record here but a C-section is major abdominal surgery and you will not be able to just jump up and continue your life as it was right after. Give your body the time it needs to heal and before you know it you will be back to doing many or all of the tasks you were doing before. It can be hard to be patient, but you are still able to start your breathing and short walks very soon after a C-section so you are still able to start on your road to recovery. Be patient, give yourself grace and remember that you are a strong and powerful mother!
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