C-sections are major abdominal surgery and returning to exercise takes time. Social pressure is mounting on women to “bounce back” postnatal and be back to normal life quickly. Read on to find out how to return to exercise safely after a c-section.
What happens during a C-Section?
A c-section incision needs to get through 6 layers before getting to the uterus and baby. They are:
- Skin
- Subcutaneous Tissue
- Fascia
- Rectus Abdominal Muscle Sheath
- Peritoneum
- Uterus
Not all c-sections are the same and how the birth went will have implications for recovery. Typically planned c-sections are quicker to recover from compared to emergencies. Some c-section deliveries may include forceps, and this is likely to mean increased pain and discomfort for the women with a prolonging recovery time.
Recovering from a C-section isn’t like recovering from any other surgery. You need to care for your newborn (and possibly other children), you are battling sleep deprivation, stress, hormonal fluctuations and the emotional and psychological roller coaster.
The 4th Trimester
Respecting the 4th trimester as a recovery phase is essential. That does not mean you can’t do anything for the first 3 months but the main focus of the first 3 months is rest and setting the foundation for that gradual return to exercise.
Gentle walking is encouraged as soon as you are comfortable. Slowly and gently, little and often is the mantra for this period.
I see many women over-exert themselves on one day and then can be sore for 2-3 days after. If you could focus on little and often you will pace themselves better and avoid overexertion and pain cycle.
2-3 shorter walks in a may feel better for recovery than one long walk. Gradually build up your walking speed and endurance on flat surfaces before walking on the incline is encouraged.
Signs to Slow Down or Stop Exercising:
- Signs of pelvic floor dysfunction- changes to bladder or bowel function (such as leaking, urgency or pain), vaginal pressure or heaviness
- Bleeding
- Pain anywhere, especially over the scar
- Any exercise that makes you hold your breath
- Doming/tenting of the abdominal wall
Gentle exercises such as the static bike or cross trainer can start from 6 weeks postnatal, with the advice to stop/slow down if any of the above symptoms occur. However, every woman is different.
Some women may need more time and it may take longer before they are comfortable increasing exercise.
Many postnatal-specific yoga and pilates classes can be started at 6-8 weeks post c-section, once you are comfortable getting up and down off the floor, but traditional classes in the gym are best avoided until 12 weeks as they may put too much stress on the scar and recovering abdominal muscles. This includes regular pilates and yoga if the instructor is not trained specifically for postnatal rehab.
Basic bodyweight exercises such as squats and lunges can be started from 6 weeks as tolerated. Any pain or tugging on the scar is a sign to reduce the range of motion or the number of repetitions.
High-Impact Exercise/ Running / Sport
Exercise guidelines recommend that the return to running or high-level exercise should not occur earlier than 3 months (Goon et al 2019).
Gym classes, running, and weight training are best avoided until you are a minimum of 12 weeks post c-section.
Consideration is given to strengthening and gradually building back to previous training volumes. This is especially important in women who have had multiple pregnancies in succession.
The couch to 5km app is a great place to direct women back to running as it provides guidance on gradually increasing training load and distance.
Tummy Muscle Supports
There is not great data to show that tummy muscle supports have any major effect on recovery, however, many women feel better wearing one.
Rigid abdominal binders that wrap around the waist and can adjust it using velcro can often be too tight and pull on the c-section scar increasing pain.
If a woman would like to use abdominal support a less rigid one is best, such as tubigrip Size L or K, or supportive leggings such as the recovery leggings from SRC https://srchealth.com/products/src-recovery-leggings.
C-section scar pain
C-section scar pain can continue for up to six weeks, whilst for some, it may persist for much longer. The surgeon’s hand, sleep, genetics, nutrition, hydration, the birth story, and other factors will impact the healing and the sensitivity of your tissues.
Most c-section scar pain resolves by three months postpartum, however, a small percentage (6%) of women will still struggle with this at 12 months and 2% will complain of severe persistent pain at this time (Jin et al 2016 and Nikolajsen et al 2004).
The hip muscles are often impacted by a c-section. In the early postnatal recovery phase, advise women to avoid striding out and keep walking to a gentle pace to avoid tugging on the scar. Gentle hip flexor stretches can also be helpful. The 4th-trimester section of free resources from The Bump Room has gentle movements that can help women gently stretch the area. Go to https://thebumproom.ie/free-resources/ for more information.
If scar pain persists, an assessment with a women’s health physiotherapist to assess for potential nerve entrapment post c-section.
It is also important to keep the scar and surrounding tissue hydrated to optimise skin quality and minimise sensitivity. Creams such as silicon cream, Vitamin A or D, or rose hip are great.’
C-section Scar Massage
You can start c-section scar massage when the scar is dry, not scabby, and not bleeding or oozing. This usually happens around the six-week mark post-birth. However, this varies from person to person.
Many women are not comfortable touching their own c-section scars so an appointment with a women’s health physiotherapist can help you if you are not comfortable starting on your own.
Starting indirectly is another way to ease into scar massage. You could take a clean blusher brush and gently stroke around the sensitive area, then progress to gentle massage circles around the scar before progressing to massaging the scar itself. 5-10 minutes every night is recommended.
For more information on c-section scar, massage go to www.thebumproom.ie and click on the free resources Free Pregnancy Exercise Resources (thebumproom.ie). Here you will find a leaflet on c-section scar massage and our postnatal programmes include videos for women to work along.
What is a keloid scar?
A keloid scar occurs when scar tissue extends beyond the original boundaries of the wound. Usually, it is a sign of overproduction of collagen in the healing process. This results in lumps of scar tissue forming around the incision and may restrict mobility.
Some options to improve the appearance of a c-section keloid scar include silicone scar strips or gel.
Recovery from a c-section takes time and patience. Gradual return to exercise is key.
If you want access to free short exercise and education videos suitable for the first 6 weeks after a c-section click on our link to the free resources Free Pregnancy Exercise Resources (thebumproom.ie).
