Returning To Exercise After A C-Section

Keep in mind, the heal­ing process is not done at 6 weeks. From the out­side, your scar might appear healed, but the deep­er lay­ers inside still need time. Just the scar alone is many, many lay­ers deep – the tis­sues that you can’t see are still recov­er­ing.

If you’re lucky, you might be told not to lift any­thing, not to dri­ve, and not to exer­cise for 6 weeks. This is major abdom­i­nal and pelvic surgery. That’s it?! That’s all the infor­ma­tion you get?

No “what-to-do’s”, no phys­io­ther­a­py, no guide­lines for recov­ery, no spe­cif­ic exer­cise pro­to­col. Just a, “good luck and go home”.

C-sec­tion rates are on the rise, and if you birth your babe(s) via C-sec­tion I want you to be con­fi­dent in your recov­ery and in your abil­i­ty to return to exer­cise safe­ly and strong­ly.

What is a C-Sec­tion?

C-sec­tion is short for Cae­sare­an Sec­tion. Sec­tion deliv­er­ies can be planned or un-planned. Dur­ing the C-sec­tion, the doc makes an inci­sion into your skin, through the fat cells, con­nec­tive tis­sue, and into the abdom­i­nal cav­i­ty.

Just because C-Sections are common does not mean that they are a "small procedure."
The abdom­i­nal mus­cles are then spread apart and the blad­der is moved down and out of the way in order to get to the uterus. There is an inci­sion made into the uterus and the baby is guid­ed out. The pla­cen­ta is tak­en out short­ly after.

The uterus is then stitched up, the blad­der put back in place, then con­nec­tive tis­sue, the abdom­i­nals, and the skin stitched up, to vary­ing degrees. We have a lot of lay­ers of sutures and thus, scar tis­sue that will form.

Cleared for Exer­cise and Healed in 6 Weeks?

Not so fast, ladies. As you can tell by the descrip­tion above, a C-sec­tion is not the gen­tlest of pro­ce­dures on your body and organs, mak­ing ade­quate rest and recov­ery essen­tial. You’re going to need to be patient with the process and not “push through”. There is no rush. Heal well now and save your­self issues down the road in the short and long term.

Think of a C-sec­tion as you would a surgery such as an ACL repair in the knee. The reha­bil­i­ta­tion for this is a 9–12 month process. There are steps and checks along the way with the sur­geon, the phys­io­ther­a­pist, and a set time­line of when it is safe to return to cer­tain activ­i­ties. In my opin­ion, this should be how C-sec­tions are treat­ed as well.

Although your doc­tor may “clear you for exer­cise” at 6-weeks post, be cer­tain that this means light and gen­tle exer­cise. The types of exer­cise that will be ben­e­fi­cial at this time are, for exam­ple, breath­ing, walk­ing, core restora­tion, and body­weight exer­cis­es. The types of exer­cise that will not be ben­e­fi­cial at this time are, for exam­ple, run­ning, jump­ing, heavy weight train­ing, crunch­es, leg rais­es, and oth­er tra­di­tion­al “ab” exer­cis­es.

Keep in mind, the heal­ing process is not done at 6 weeks. From the out­side, your scar might appear healed, but the deep­er lay­ers inside still need time. Just the scar alone is many, many lay­ers deep – the tis­sues that you can’t see are still recov­er­ing.



I Didn’t Have a Vaginal Birth, So My Pelvic Floor Is Fine.”

Although a vagi­nal birth can increase the risk of pelvic floor dys­func­tion post-birth, you still went through a preg­nan­cy, regard­less of the C-sec­tion deliv­ery. Preg­nan­cy in itself height­ens your risk of pelvic floor dys­func­tion. We still must repro­gram the core, which involves inte­gra­tion with the pelvic floor.

Here are some of the rea­sons why we still need to focus on the health of the pelvic floor after hav­ing a C-sec­tion:

  • The down­ward pres­sure of your babe on your pelvic floor mus­cles can stretch these mus­cles and their con­nec­tive tis­sues, leav­ing them more lax than nor­mal.
  • Your expand­ing uterus puts pres­sure against your oth­er pelvic organs, includ­ing the blad­der and rec­tum, and can dis­rupt their nor­mal func­tion.
  • C-sec­tion scars can be tricky for pelvic nerve func­tion, lead­ing to such things as ure­thral burn­ing, feel­ing like you need to pee all the time, and pain in the cli­toris and labia.
  • The align­ment changes that hap­pen dur­ing preg­nan­cy and post­par­tum (for exam­ple stand­ing with your bum tucked under) can affect the tone of your pelvic floor mus­cles, leav­ing them tight and short.

Recov­ery in The Ear­ly Weeks After C-Sec­tion

In the ear­ly days and weeks fol­low­ing your C-sec­tion you’re going to be focused on rest­ing and relax­ing as much as pos­si­ble with your new baby. These are the main things you will want to do in the first 6 weeks post­par­tum:

1). Ask for help. You’re going to want to do things your­self, but try to reign your­self in. Allow your­self to receive help and offers from your friends and fam­i­ly – they real­ly want to! Your job as mama is to love, feed, cud­dle, and sleep. If pos­si­ble, even get peo­ple to bring your baby to you at feed­ing time.

2). Rolling over. Every time you go to lie down or to move from your back to a seat­ed posi­tion, you’re going to lie to your side first. This is so we can avoid big crunch­ing and sit-up type move­ments that put a ton of pres­sure on the abdom­i­nals and scar. An exam­ple of this is get­ting into and out of bed. Get into the habit of lying on your side and then slow­ly rolling to your back when get­ting into bed. Get­ting out of bed, roll to your side, low­er the legs off the bed, then use your upper body strength to push your­self up to seat­ed. If you can, get some­one to help you with this, as well.

3). Restora­tive breath­ing. Core restora­tion can start with­in the first few days post­par­tum. You are going to start repro­gram­ming your core to func­tion from your diaphragm down to your pelvic floor mus­cles, with the Core Breath.

On your inhale breath, feel your ribcage and your bel­ly gen­tly expand and relax. On your exhale breath, purse your lips and gen­tly exhale to encour­age gen­tle acti­va­tion through your pelvic floor and deep abdom­i­nal mus­cles. Before you do any exer­tion, say get­ting out of bed or pick­ing up the baby, prac­tice your Core Breath. Start your exhale breath and then begin your move­ment or lift.

4). Walk­ing. In the first few days, you’ll want to stay off your feet as much as pos­si­ble. As you begin to heal, slow­ly increase the amount of walk­ing you’re doing around the house. Mon­i­tor your ener­gy lev­els that day and the next, and if you’re feel­ing good, you can keep slow­ly increas­ing your move­ment. Start with short out­door leisure­ly walk­ing and grad­u­al­ly increase your time. Use this as a time to breathe, relax, and move.

5). See a pelvic floor Phys­i­cal Ther­a­pist. With­in the first 6 weeks (or ear­li­er) after baby arrives you should see a pelvic floor physio, even if you’re not hav­ing any dis­com­fort, and assum­ing that your doc has giv­en you clear­ance. They can make sure you’re heal­ing well, your pelvic floor is func­tion­ing on point, and start doing some real­ly impor­tant scar mobi­liza­tion.

Depend­ing on your heal­ing process, you may begin core restora­tion exer­cis­es, in addi­tion to the Core Breath, pri­or to your 6-week check up. There real­ly is no mag­ic date of when you should begin adding in more activ­i­ty, as every­one heals at their own pace.

Returning to Strength Training After C-Section

In your return to more tra­di­tion­al strength train­ing (after your 6-week clear­ance and a check-in with the pelvic floor physio) you’ll want to allow your body plen­ty of time to adapt to the increase in move­ment and a good deal of recov­ery time between bouts of exer­cise. If you have any bleed­ing or pain (scar, pelvic, back) at all dur­ing or after exer­cise, keep your inten­si­ty more mild.

Try start­ing with 2 work­out ses­sions per week of 15 min­utes dura­tion, and if you’d like, slow­ly increase from there. Increase your work­out dura­tion by 5 min­utes biweek­ly. Just for ref­er­ence, most of the women I work with will keep their work­outs between 30–40 min­utes in length and aim for 3–4 ses­sions per week. You can slow­ly build up to this amount if that works for your lifestyle and needs.

In your return to strength train­ing you’ll want to use your body­weight as resis­tance, resis­tance bands, sus­pen­sion train­ers, and light weights.

You’ll notice that in each of the exer­cis­es above, you’re keep­ing your body in “neu­tral align­ment”. This means that your spine is kept in a long, straight line. We want to have a small arch in the low­er back and a tall upper back, grow­ing “up” out of the crown of the head. I always cue to have the, “ribs over the hips”, as you want your ribcage stacked right over your pelvis.
On the “exer­cis­es to avoid list” you’ll find:

  • Crunch­es, sit-ups, leg rais­es, and front planks
  • Run­ning, jump­ing, step ups
  • Heavy over­head press­es
  • Heav­i­ly weight­ed exer­cis­es
  • Any­thing with direct down­ward pres­sure on the pelvic floor, such as a bar­bell back squat.

The return to exer­cise post C-sec­tion is very much sim­i­lar to the return to post­na­tal exer­cise after a vagi­nal birth. Real­ly pay atten­tion to how your body feels dur­ing and espe­cial­ly after exer­cise. Above all, move in ways that make you feel safe, amaz­ing, and ener­gized dur­ing and after exer­cise.
Great arti­cle by Jessie Mundell —  Return­ing To Exer­cise After A C-Sec­tion



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