• Lucy Marner

Exercise after C-Section (and natural delivery)



Not enough information gets given to post-natal mums for their recovery after having a natural birth, let alone a C-Section birth! There is definitely a lack of education and resources for women post-surgery in particular. 


You may have been told not to lift anything, not to drive, and not to exercise for six-eight weeks. This is major abdominal and pelvic surgery and that’s all the information you get?  No guidelines for recovery, or exercise protocol. Just a “bye, bye, off you go!”


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


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.


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 six Weeks?

Not so fast! 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 do not “push through”. There is no rush. Heal well now and save yourself issues down the road in the short and long term.


Although your doctor may “clear you for exercise” at six-weeks postnatal, I would always advise my C-section clients to wait until eight weeks to start doing any kind of body weight exercises.


Before eight weeks, I would recommend breathing exercises, walking with the pram, learning to pull in your abdominal muscles as you walk, and remembering to do your pelvic floor exercises. 


The types of exercise that would NOT be beneficial before 8 weeks are: running, jumping, weight training, crunches, leg raises, and other traditional “ab” exercises.


Keep in mind, the healing process is not done at 8-6 weeks. From the outside, your scar might appear healed, but the deeper layers inside still need time. The scar alone is many, layers deep. The tissues that you can’t see are still recovering. Just because your scar appears healed from the outside, doesn’t necessarily mean the tissue on the inside is healed.


Let’s move onto the subject of pelvic floor weakness after birth. 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 heightens your risk of pelvic floor dysfunction. We must still 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 baby on your pelvic floor muscles can stretch, 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 wee 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.





The following pointers are the main things you should focus on in the first 6 weeks postnatal, regardless if you’ve had a c-section or natural delivery:


1. Ask for help.

You’re going to want to do things yourself, but try not to. Allow yourself to receive help and offers from your friends and family; they really want to! Your job as Mummy is to love, feed, cuddle, and sleep. 


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. 

On your inhale breath, feel your ribcage and your belly gently expand and relax. On your exhale breath, 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 breathing. Start your exhale breath and then begin your movement or lift.


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.


After the 6-8 week postnatal mark, once you’ve had clearance from your doctor, you can start to do some gentle body weight exercises. Here are sone below that you can try:


Glute bridges

Clamshells

Squats

Lunges 

Marching on the spot

Tricep dips

Push ups on all fours 

If you have any bleeding or pain at all during or after exercise, keep your intensity more mild.

Try starting with two workout sessions per week of 15-30 minutes duration, and then slowly increase from there. Increase your workout duration by 5-10 minutes weekly.


Most of the women I work with will keep their workouts at roughly 40 minutes with plenty of rests in between and a cool down with stretching afterwards. 


In your return to strength training you’ll want to use your bodyweight as your main source of resistance. Resistance bands, suspension trainers and light weights are fine to build up to over time, and then eventually weeks down the line you can move on to heavier weights. 


Exercises to avoid in the early weeks are:

Crunches, sit-ups, leg raises, front planks, running, jumping, heavy overhead presses, heavily weighted exercises and 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! 


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