I had a C-section

About C-Sections

Recovering from a C-section is a little different than recovering from a vaginal delivery. Your recovery process will begin a little more slowly compared to the recovery process after a vaginal delivery, and you’ll have some extra precautions when beginning an exercise program. Since you had a surgical procedure, your tissue needs time to heal, and it’s very important to listen to your doctor about your restrictions and limits. Be 100% sure to get this particular program cleared by your physician before starting. You’ll also have special considerations regarding your incision and pelvic floor problems (I know, it doesn’t seem fair after a C-section!). Read on to find out more.

Starting an Exercise Program

If you’re pregnant now and scheduled for a C-section, print out the C-Section Permission Packet to bring with you to the hospital in your overnight bag. Your doctor can look at each exercise and may approve some or all of them so that you can get started with a bit more than walking in the first 6 weeks. Some physicians will even approve gentle core muscle activation after the procedure, so it’s definitely worth asking if you can add a deep abdominal muscle activation drill in addition to your C-section mini workout.

 

If you’re pregnant and not expecting a C-section, bring the Overnight Bag Permission Packet along in your bag so you can get your physician’s permission whichever way your delivery shakes out.

 

If you already had a C-section and you’re in those first 6 weeks looking for a way to start exercise before the 6-week mark, give your doctor’s office a call and find out if you can email the C-Section Permission Packet for permission to begin, or bring the C-Section Permission Packet with you to your checkup at 1-2 weeks after you deliver.

 

If it’s already been 6 weeks and you’ve been cleared to exercise, go ahead and start with the C-section mini-workout. Once that’s easy (even if it’s after the first time!), go ahead and start at Level 1.

Why do I Have to Wait So Long to Exercise After C-Section?

After a C-section, your physician will likely advise you to avoid exercise for a certain period of time after the delivery. The particulars of that advice depend upon individual factors including your own medical, physical, and personal situation, the type of incision, the reason for your C-section, whether you had an emergency C-section or a planned C-section, any complications that occurred during the surgery, and a variety of other factors.

 

Often, but of course not always, the advice will be for you to avoid exercise (except walking) for the first 6 weeks. Why the wait? Your incision went all the way through your skin, fascia (connective tissue), and uterus. All of those layers need time to heal, and your physician doesn’t want you contracting muscles that could pull the healing tissue apart. Tissue healing time is 6 weeks, and there’s nothing that you can do to speed that up.

 

With that said, your physician may allow you to do some exercises that don’t stress your incision in the first 6 weeks. I’ve designed the C-section mini-workout with that in mind, but you do need your physician’s approval to start it. Show your physician the C-Section Permission Packet after your C-section or at your 1-2 week checkup to find out if you can get started exercising with these particular exercises before you hit the 6 week mark.

C-Section Incisions

So what tissue was cut in order to perform the C-section? On your skin, you’re probably looking at a horizontal or (less often) vertical, low belly incision. From there, your physician had to cut through several layers of tissue to get to (and eventually through) your uterus. The incision you see on your skin may or may not match the incision through the tissue below. You may have a horizontal incision through your skin but vertical incisions below, so it’s important to ask your physician what type of incision you had and how that affects her restrictions on exercise after the delivery.

 

Most of the time, your doctor is able to make a low belly horizontal incision through the skin and similar low belly horizontal incisions through the layers of tissue, avoiding cutting through any of the muscle tissue. Instead of cutting through muscle tissue, the physician will make the incision through fascia, which connects your abdominal tissue layers together and to bone.1 Fascia doesn’t contract, but since it is connected to muscle tissue, contracting muscle tissue will pull on the fascia and incision. That’s why it’s so important to avoid abdominal muscle work until your physician clears you to do so.

 

Vertical incisions through the layers of tissue often require the most stringent restrictions. Because of the direction your abdominal muscles pull, vertical incisions are at higher risk for being affected by tension in your abdominal muscles. If your doctor is putting additional restrictions on your return to exercise, it could be because of the location or type of incision for your C-section— don’t assume she’s just being old fashioned.

 

The medical staff caring for you in the hospital should cover wound care for your incision before you’re discharged. Be sure you understand exactly how to care for your wound and what to watch for when looking for signs of infection. If you have any questions or you’re unsure after you leave the hospital, call your hospital right away. If you suspect you may have an infection, don’t hesitate to go to the emergency room. Infections after a surgery are serious and can be life-threatening. Your physician, the emergency room staff, anyone at that hospital, and your family (including your baby) would much rather you go in for a false alarm than stay put with a true infection. When in doubt, get it checked out!

 

Be sure to check with your physician or midwife about scar tissue massage at your 6-week checkup. As all of those layers of tissue heal, you can sometimes develop adhesions, which can be uncomfortable, and scar tissue massage can break up those adhesions. Scar tissue massage may also help the appearance of the scar. Be absolutely sure to have your physician or midwife instruct you in scar tissue massage. Each situation is different, and your own medical care provider needs to instruct you about how and when to do scar massage. Don’t simply search YouTube or Pinterest for guidance. You want to be 100% sure your tissue is healed before you begin the process, and you want to know exactly how to do the scar tissue massage based upon your own situation.

Pelvic Floor Problems After C-Section

Though you are at a slightly lower risk for pelvic floor problems (58% of those who had a vaginal delivery experience pelvic floor problems versus 44% of those who had a C-section), you’ll still need to re-train your pelvic floor.2 Although you were spared the extra pelvic floor stress of delivery, for nine months your pelvic floor carried the weight of a growing baby. If you are experiencing pelvic floor problems, visit the resources page to find a women’s health PT near you who can help. Most states allow for direct access, which means you won’t need a referral from your doctor to receive care, but your insurance company may require it for reimbursement.

Before getting started the first time, you must watch the prerequisite videos:

Ground Rules and The Basics Series. Once you’ve watched those and you have your physician’s approval (you can print out and give your physician the C-Section Permission Packet), you’re ready to go!

Here are some posts and pages that you might find particularly interesting after a C-section:

References
1. Deering S. A Practical Manual to Labor and Delivery for Medical Students and Residents. Xlibris Corporation; 2009.   2. Memon HU, Handa VL. Vaginal childbirth and pelvic floor disorders. Women’s Health 2013;9(3):265-277. doi:10.2217/whe.13.17.