C-Sections: What You Need to Know (Part 2)

Recovery from a C-section can be very challenging because a woman is not only recouping from major abdominal surgery, but also diving into the duties of caring for a newborn. Managing just one of those tasks is challenging enough — let alone both. This is where you can have a major impact.  By teaching your clients simple recovery strategies and helping them maintain a patient and positive mindset, you can dramatically improve their healing process.  Let’s get started by first examining how the body changes after a C-section, and then we’ll discuss specific recovery strategies so your clients can focus on truly enjoying the fruits of their labor.

How the Body Changes After a C-Section

Tissues behave differently after they have been cut and stitched. For example, pre-operative skin contains sensory receptors that take in information about environmental features like pressure, temperature, and vibration. That information gets sent to the brain via sensory (afferent) nerves and then the brain decides what to do about that data. If the brain decides to tell the body to move in response to that information, it will deploy that message via motor (efferent) nerves that travel to the site of the muscles responsible for generating the desired movement.

Without knowing much about the neuro-sensory system, you can imagine how any disruption of this system can cause impaired movement. In fact, many women who have had a C-section experience nerve changes, including a loss of feeling at the incision site for some time until the nerves regenerate (although there are times when the sensation never fully returns). In addition, they often describe feeling “disconnected” from their core, and their ability to recruit it properly.  Therefore, teaching women how to activate the core is of primary importance.

The other issue to consider is that when soft tissues are traumatized, they try to repair themselves by sending in reinforcements to support the damaged structures. Overall, this is very helpful.  Think of a how a broken bone sends “help” signals and the body responds by stimulating new bone growth in the area of the break. The challenge, however, is that although new collagen gets laid down, it happens in a very disorganized way, which can lead to stiffness and a lack of elastic recoil (1).

Effective C-Section Recovery Strategies

Now that you have a picture of the dysfunction and disruption that a C-section can cause, it is time to provide solutions for effective recovery. These suggestions can be applied to clients of any stage post-surgery.

  • Mental check-in: If your client had an unplanned C-section (potentially for medical reasons), she may have negative feelings about her birth experience. We have heard women who felt like their bodies betrayed them — even if they were active and fit during pregnancy — and have many complex and unresolved feelings around their birth. By acknowledging that the process didn’t going according to plan, and helping her let go of any negative feelings, (resiliency is a hallmark trait of great athletes), she will actually heal faster. Research shows that a positive mindset is linked to faster healing after injury/surgery, especially when there is social support involved (2).
  • Scar massage: Massaging the C-section scar helps to mobilize the stiff tissues around the scar, enabling them to glide and contract better.  In addition, the more we touch an area of the body, the more precise the map of that area becomes in the brain. This is especially important when re-educating the brain about traumatized tissue. Not sure how to guide your client in proper massage?  Download this C-Section Scar Healing Guide from one of our Advisory Board members, Lindsey Vestal M.S., OTR/L of the Functional Pelvis.
  • Collagen-rich foods: Since collagen is the building block of skin and fascia, eating a diet that helps stimulate collagen growth can be very helpful. Bone broth has become popular recently as have collagen powders to add into a smoothie. Read more tips here on The Best Way to Get More Collagen.
  • Mobility work: When tissues surrounding a scar are working overtime to compensate for the traumatized tissue, they can get tight and restricted as well. Mobilizing areas that are near, as well as far, from the scar can allow the whole body to function better. For example, the obliques may pick up the slack for the TVA and, in the process, become overly tight. Likewise, the fascial lines that the anterior core connect to can also become altered, potentially resulting in more distal restrictions in the pecs and hip adductors. The broad message is that the whole body needs to be mobilized in all three planes.

  • Neutral Alignment: How she sits while feeding her baby, and moves carrying out her physical tasks of motherhood greatly impact the speed of her recovery.  Poor alignment actually increases the stress on her core muscles, so teach her how to find neutral alignment, and stay in it as much as possible throughout her activities.
  • Core Recovery Exercises: We teach a very specific Core Recovery Protocol in our Pre/Postnatal Education that women progress through over a period of several weeks or months.  While we can’t get into the detail of that in this post, here are a few fundamental techniques to teach her:
    1. 360° Breathing and 360° 2-Step Exhales
    2. Pelvic Floor Activations (PFAs…not “Kegels”)
    3. Core Canister Pump
  • Sleep….well, try: We realize this is a challenging one to ask of moms, especially new moms. However, not sleeping can delay recovery by causing tissue breakdown (catabolism), the opposite effect our clients need to recover from surgery. We fully recognize this is a time in a woman’s life when uninterrupted good quality sleep just may not be a possibility.  However, encourage your clients to prioritize it when they can.  For example, if it comes down to a choice of taking a nap or responding to emails, cleaning the house, or running some errands, emphasize the importance of choosing sleep — at least some of the time.  The long term impact on her recovery far outweighs a slightly cleaner house or inbox.
  • Refer her to a Pelvic Health Physical Therapist if necessary: If your client has a more severe case of diastasis recti (over 3 fingers and deeper/more yielding gap tension) or pelvic floor dysfunction (significant pain or lifestyle disruption), then it is best to refer her to a pelvic health physical therapist (she can often do this in conjunction to her work with you).  The other instance when you should refer a client is if you have been working with an individual consistently for 4-6 weeks and see no improvement in symptoms.  One database to search for a qualified women’s health PT in your area is: One database to search for women’s health physical therapists is www.womenshealthapta.org 

If you’re interested in learning about our specific Postpartum Core Recovery Protocol (great for all postpartum recovery — including C-section delivery and Diastasis Recti recovery), check out our education to become a Pre/Postnatal Performance Training Specialist


(1) Splichal, E. (2015). Barefoot Strong: Unlock the Secrets to Movement Longevity

(2) Broadbent, E. & Koschwanez, H.E. (2012). The Psychology of Wound Healing. Current Opinion in Psychiatry, Vol 25 (2), 135-140.