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 gaps 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 birthing people in the U.S. get one (1). During the procedure, the doctor most often makes a horizontal incision at your bikini line (you can see the location in this scar image) — cutting through skin, fat, and fascia — moving muscle, and then cutting into the uterus to remove the baby and placenta.
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
The cutting and stitching of tissues causes some disruption in the neuro-sensory system. For example, many individuals 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). Many 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 scars (of each layer of tissue cut and sewn) can lead to adhesions below the surface of the skin, making it more difficult for the tissues 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. Therefore, scar massage is a critical component of proper recovery. We will discuss this more in the following recovery strategies.
Finally, moving abdominal muscle also affects the pelvic floor since the abdominal and pelvic floor tissues are so intricately connected. You may think that a C-section causes less stress to the pelvic floor muscles, but in many cases, the exact opposite is true.
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 demonstrating a few scar massage techniques.
- 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).
- 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.
- Consider a wrap if you are in pain: While we do not recommend a belly wrap to heal DR or shrink your waistline after baby, they can be helpful temporarily if you are in pain. They can also offer support if you are engaging in more strenuous activities like long walks or wearing your baby. Read this article on Postpartum Belly Wraps to understand the conditions for which a wrap may or may not be beneficial. You’ll also find guidance here on how to select, and wear, a wrap.
- 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.
Resources to Support Your Recovery
Given how important proper recovery is to your long-term health, strength, and quality of life, it’s a good idea to do some specific recovery work. Here are a few different options, depending on your needs and budget:
- Pelvic Floor Physical Therapist: Ideally, it’s great if you can work with a pelvic floor physical therapists (these professionals focus a great deal on pre & postnatal). You can use this PT Locator to find a qualified women’s health physical therapist near you.
- Work with a Specialized Personal Trainer: Another option is to work with a certified personal trainer who also specializes in pre & postnatal (and who has worked with C-section clients). If you’d like, you can schedule a consultation with a PROnatal Personal Trainer. All of our trainers work a great deal with C-section recovery, and many have successfully recovered from their own C-sections.
- Follow a self-guided program: These can be a great option if you may not have access or budget to work with a professional. Explore our postpartum training programs. You can select the full training program, or just the core recovery program. , You can also work with a women’s health or
Interested in Coaching Pre & Postnatal Clients?
If you are a health & fitness professional interested in learning how to coach pre & postnatal clients, explore our Pre/Postnatal Professional Education. We offer a Specialist Course for trainers & coaches looking to specialize in this population. This course goes into great detail on helping clients prepare for, and recover from, a cesarean birth. We also offer a Mini Course for group fitness instructors who just need the basics and simple training guides to get you started.
(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.