A caesarian delivery is major abdominal surgery and postpartum reconditioning must be delayed until you have made a complete medical recovery. Generally, it takes about 4 to 6 weeks for your stitches to heal and if you’ve experienced no other complications, your doctor will give you the “green-light” for exercise after this time. If you’ve had a “C”, consult with your doctor before starting postpartum exercise.
All new mothers are encouraged to walk as soon as possible after a caesarian delivery. Walking increases blood flow circulation, which helps to speed healing. In the initial days after a C-Section, when you feel up to it, try to walk for a short time—start with about 15 minutes, or what your body is ready for—daily, or on most days of the week. When walking with your baby, use a stroller rather than a front pack or sling, which can stress your abdomen or incision.
C-section moms who were fit and active during pregnancy often bounce back very quickly from a “C” can begin fitness walking (brisk pace) as soon as they feel ready.
Tips for Caesarian Recovery
- Delay abdominal reconditioning until 4 to 6 weeks postpartum.
- Avoid lifting and carrying heavy objects.
- When rising from the floor or getting out of bed, always use the “log roll” technique to prevent abdominal strain. View video demo on page: Diastasis Rectil
- After six weeks, start post C-section massage to reduce Adhesions and ease discomfort.
- If you develop a cough and /or sneezing from allergies or a respiratory illness in the few months after a caesarian delivery, place a large pillow across your belly and gently press it into your abdomen to provide support for your scar and to help ease discomfort.
Scar tissue is very strong and after your stitches have healed you may begin postnatal abdominal conditioning exercises without fear of injury to your incision site or to your abdominal wall.
Safe Rehab Moves for Post C-Section
The following activities are safe in the first six weeks after a C-section:
- Walking with your baby in a stroller
- Kegels, seated on chair or large exercise ball (the pelvic floor can loose tone from the weight of your uterus, even if you didn’t go through the pushing phase of labor)
- Diaphragmatic breathing
- Abdominal compressions: seated, standing, or supine (on the back)
- Abdominal compressions with pelvic tilt: standing or supine
- Postnatal Constructive Rest
- Gentle Hamstring Stretch: supine, (on the back) with a strap
- Ankle Circles/Flex and Point: supine, (on the back) one leg at a time
About Abdominal Compressions
Abdominal compressions isolate the deepest abdominal muscle, the Transverse Abdominis, or TvA, which along with pelvic tilts reduce strain (tensile force) on the internal and external incisions, and increase blood flow to the area, speeding healing.
Here’s a standing variation of an abdominal compression:
- Stand about six inches away from a wall, bend your knees, and using your hands for support, rest your pelvis, back of the ribs, and head against the wall.
- Inhale deeply, and on the exhale, pull your belly inward as much as you can (don’t move bone). Hold the tummy contraction for a few seconds as you breathe normally.
- Then, on another exhale, try to tighten up your belly a bit more. As with the first contraction, breathe normally as you hold your tummy as tight as possible.
- Repeat step 3, trying to deepen the contraction one last time. Maintain the contraction while breathing normally for a few moments, exhale and allow your abdominal wall to relax.
- Repeat 3x to make one set. Do two or three sets of this exercise daily.
When you first start abdominal compressions after a C-section, you might feel as though there is not a lot of “there-there.” This is normal. Keep at it, and in a few days you’ll find that you can begin to engage your TvA with more clarity. After you’ve learned how to engage your TvA, you can add on a pelvic tilt to the exercise.
Postnatal Constructive Rest
The constructive rest position utilizes a simple posture that eliminates/minimizes mechanical stress on our joints, ligaments, vertebral discs, and muscle groups. This allows for chronically tight muscles, particularly the hip flexors (iliopsoas muscle), and lower back muscles and shoulder/neck muscle to release chronic tension. Because the hip flexors play a direct role in the inclination of tilt in the pelvis, releasing this muscle (and others) after pregnancy helps to realign the spine, reduce strain on incisions, and relieve pain.
Postnatal Constructive Rest:
- Lie down on your back in a neutral spine position, with your lower legs resting on the seat of a padded chair or ottoman. Your lower back will have a small arch off the floor. You don’t want to tuck your pelvis or flatten you lower back into the floor.
- If you are tight in the upper back, or have a deep chest, and your head rotates back (chin points to the ceiling), then place a 1” – 2” paperback book under your head. Roll your chin closer to your chest to lengthen the back of your neck.
- With your arms by your side, rotate your upper arms bones outward, so that your palms end up facing the ceiling. Draw your arms out to the side, until you feel a stretch in your chest and/or arms.
- Breathe deeply and slowly, expanding your ribcage to in all directions. Pay special attention that your back ribs expand as much as your front ribs. Hold the inhalation for a moment or two. Exhalation, relax completely, allowing your rib cage to drop into the floor. Breathe normally for four inhalations/exhalations, then repeat the deep, slowly breathing with rib expansion.
- Spend five to ten minutes per day after a C-section to help relieve pain and speed recovery.
- Use the “log roll” technique to rise from the floor.
Post C-section Adhesions
Adhesions, a type of scar tissue, that form in your abdomen or pelvis after surgery, are a common complication of C-sections and other types of abdominal surgery. It’s estimated that 93% of people who have abdominal surgery develop adhesions in response to the trauma of surgery.
Adhesions can form between muscle layers, bone, connective tissues, and internal organs, causing them to stick together. Adhesions prevent the normal gliding of tissues during movement and digestion, causing pain.
During a C-section, the peritoneum (a membrane which wraps around all your internal organs) is cut in order to expose the uterus. After surgery, the peritoneum becomes inflamed, and this inflammation causes the formation of adhesions.
Complications due to Adhesions
Pelvic or Abdominal Pain
It is estimated that 38% of women who have abdominal or pelvic pain, back pain, or pain during intercourse are suffering from adhesions.
Scar tissue can form around the small intestines, either partially or completely obstructing your bowels, preventing them from eliminating waste products. Side effects, such as severs nausea, vomiting and pain can ensue. Because bowel obstruction can occur either directly after a C-section or years later, symptoms of surgical adhesions should never be ignored.
When scar tissues form around the bladder, this prevents the organ from expanding normally, causing the feeling of needing to urinate too frequently and loss of bladder control.
Rarely, adhesion can form around your ovaries and fallopian tubes, and prevent the egg from entering the tube, or block the tube so that sperm cannot fertilize the egg.
While post C-section adhesions cannot be entirely prevented, you can significantly reduce your risk of developing adhesions with peritoneum repair as a part of your C-section. Typically, the peritoneum is not stitched back together during surgery as it was once believed that this helped to prevent adhesions. But recent studies have shown the opposite to be true. In one study done at Stanford University, found a seven-fold decrease in the likelihood of developing adhesions when the peritoneum was repaired.
Certainly, if you need a cesarean delivery, you should discuss peritoneum repair ahead of time with your OBGYN.
Post C-section Massage
The importance of postsurgical massage cannot be overstated. Unfortunately, most women are only advised to monitor the outside appearance of their scar, checking for signs of infection. Most OBGYNs in the USA do not discuss adhesions, before of after surgery, or massage therapy with their patients, leaving women to suffer, sometime for years, in pain.
Once you get the “green light” from you doctor, usually about four to six weeks after delivery, you’ll want to begin massaging your scar, daily. Massage breaks down adhesions which releases stuck tissues, eliminates pain, and restores normal tissue functioning.
Scar massage techniques are done in three layers, with increasing intensity and depth. Start your scar massage gently, staying on the superficial skin layer. If your scar is tender, gently massage around the scar, using your fingertips, feeling for places that do not move freely. Move your fingertips up and down, side to side, and in small circles. When you find an area that does not move freely, gently press into the tissue until you feel it release.
Intermediate Depth Massage
After a few weeks of scar massage, you can begin to press more deeply into your abdomen, working on the muscle layer. Once your scar is no longer sensitive, you can hold one end of your scar and massage along its length, gently stretching the tissue. Most women find one end of their scar more sensitive than the other. Gently work mobility and release on your more sensitive side.
Once both sides of your scar are pain free, you can gently pick it up and gently roll the scar along its length, releasing it from tissues below. Make sure to massage your entire lower abdomen on this second layer, as adhesions can form anywhere in your abdominal cavity.
Deep Tissue Massage
Deep tissue massage should be done lying down on the back, with the knees bent, or with the lower legs supported on a low table or ottoman. Relax your abdominal muscles and try to in press deeply, so that you’re below the muscle layers, to massage your internal organs. Massage of the deeper tissues is critically important for those with back pain, and deep pain caused by adhesions on internal organs. Treatment from a Physical Therapist who specializes in this type of deep tissue release is recommended for women with adhesions surrounding their internal organs or for whom self-massage is not a viable option.
Knowledge is Your Ally
Knowledge about C-section recovery, about what to expect, what’s normal and what is not, will give you the skills to make informed decisions about your health care. If you believe that your pain may be caused by adhesions, respectfully demand that you receive proper diagnosis and therapy. No women should suffer the pain and disability, possibly for years, due to post-surgical adhesions.