A Cesarean birth (or C-section) is major abdominal surgery. However, when we compare it with other major surgeries (like hip, knee, or shoulder), it’s shocking to see the difference in post-operatives procedure or guidance. For most orthopedic surgeries, there is a regimented rehabilitation process, which includes physical therapy. For a C-section, you’re pretty much given your baby, perhaps told to rest and not lift anything heavy, and bid “good luck.” In this piece, we hope to fill some of the gap in guidance and get you started strong on your path to recovery.
What Happens During a C-Section?
C-sections are medically necessary about 10-15% of the time, though about 32% of women in the U.S. get one (1). During the procedure, the doctor will anesthetize you from the waist down so that you can remain awake (as opposed to general anesthesia, during which you’d be asleep). The doctor most often makes a horizontal incision at your bikini line, cutting through skin, fat, and fascia — moving muscle, and then cutting into the uterus to remove the baby and placenta. Moving abdominal muscle also affects your pelvic floor since the abdominal and pelvic floor tissues are so intricately connected. Many women think that because they didn’t have a vaginal delivery, there is less stress to their pelvic floor muscles during a C-section, but in many cases, the exact opposite is true.
Once the baby is out, then the stitching of several layers of tissue begins. If you can tolerate the graphic nature of a video documenting an actual C-section, watch this C-Section Video, as it will bring to life the actual scope of the surgery.
How Your Body Changes After a C-Section
Cutting and stitching of tissues causes some disruption in the neuro-sensory system. For example, many women experience nerve changes, including a loss of feeling at the incision site for some time until the nerves regenerate (although sometimes the sensation never fully returns). In addition, women often describe feeling “disconnected” from their core, and not being able to recruit their muscles properly.
The other issue to note is that the C-section scar can lead to adhesions below the surface of the skin, making it more difficult for the layers of muscle and skin to move. This could cause pain or sensitivity around the scar, or a feeling of stiffness or movement restriction (making bending forward, lifting, or reaching upward uncomfortable). It could also lead to incontinence, pelvic or low back pain, and other core-related issues. This is why scar massage is such an important component of proper recovery, which we’ll discuss now.
Effective C-Section Recovery Strategies
Now that you have a picture of the disruption that a C-section can cause, let’s talk about solutions for effective recovery. You can apply these strategies at any point of your post-surgery recovery. Of course, the sooner you start, the better.
- Mental check-in: If you had an unplanned C-section, you may be dealing with some negative feelings about your birth experience. We’ve spoken with so many women who say they felt like their bodies betrayed them, or that they felt like a “failure” because they did all the right things and trained so hard for a vaginal birth. We always emphasize the importance of adaptability during labor because there are so many factors outside of our control. Perhaps the process did not go as planned, but resiliency is a hallmark trait of great athletes, and letting go of any negative feelings will actually expedite your healing process. Research shows that a positive mindset is linked to faster healing after injury/surgery (2).
- Scar massage: Massaging your C-section scar increases blood flow to the area to expedite healing and also helps to break up the adhesions discussed above, which enables your tissues to glide and contract better. In addition, the more you touch an area of your body, the more precise the map of that area becomes in your brain, thereby improving your brain-to-core connection. Here is a helpful video on 3 Ways to Perform a C-Section Scar Massage by physical therapist and PROnatal Advisory Board Member, Dr. Sneha Gazi. If you feel a bit uncomfortable touching this part of your body, here is an alternative option showing a Hands-Free Scar Massage with Ball by pelvic floor occupational therapist, and PROnatal Advisory Board Member, Lindsey Vestal of The Functional Pelvis.
- Collagen-rich foods: Collagen is the most abundant protein in the human body. It is essential in increasing the strength and elasticity of tissues in the body, which can help with scar healing. Eating a diet that helps stimulate collagen growth can be beneficial. 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.
- Neutral Alignment: This one can be tough in those early (sleepless) postpartum days, but poor alignment increases the stress on your core muscles, thereby slowing your recovery. One tip that can dramatically expedite your healing is to focus on neutral alignment during your everyday movements and while seated (especially given how much time you spend in this position feeding your baby). Watch this neutral alignment video to learn how to find and move in neutral.
- Core Recovery Exercises: It’s important to work on progressively rebuilding your core from the inside out. Begin with these 5 Postpartum Core Recovery Exercises. These strengthen the deepest core muscles and are safe to begin doing as soon as you feel comfortable following delivery.
- Sleep….well, try: OK, we completely recognize this is easier said than done with a newborn, but not sleeping can delay recovery by causing tissue breakdown (catabolism), the opposite effect we need to recover from surgery. While uninterrupted good quality sleep may not be a possibility, try to prioritize it whenever you can. For example, if it comes down to a choice of taking a nap or responding to emails, cleaning your house, or running some errands, choose sleep (at least some of the time!). The long term impact on your recovery far outweighs a slightly cleaner house or inbox.
- Work with a Specialist: Given how important proper recovery is to your long-term health, strength, and quality of life, working with a specialist in this area can be instrumental in ensuring the most effective recovery. Consider working with a PROnatal Personal Trainer. You can also work with a women’s health or Pelvic Floor Physical Therapist, especially if you are in a great deal of pain or discomfort. You can use this PT Locator to find a qualified women’s health physical therapist near you.
If you are looking for a self-guided program that you can do on your own time, explore our 8-Week Core Recovery Program. This program is great for healing from a C-section, repairing Diastasis Recti, and establishing a solid foundation of core strength that lasts.
If you are a professional looking to earn your specialization to work with prenatal and postpartum women, explore our education to become a Pre/Postnatal Performance Training Specialist.
(1) Gibbons, L., Belizán, J.M., Lauer, J.A., Betrán, A.P., Merialdi, M., & Althabe, F. (2010). The Global Numbers and Costs of Additionally Needed and Unnecessary Caesarean Sections Performed per Year: Overuse as a Barrier to Universal Coverage. World Health Report, Background Paper, 30.
(2) Broadbent, E. & Koschwanez, H.E. (2012). The Psychology of Wound Healing. Current Opinion in Psychiatry, Vol 25 (2), 135-140.