Recovering from a C- Section
What has happened to me?
A caesarean section is major abdominal surgery. First the doctor makes an incision along your abdomen, cutting through layers of skin, fat and connective tissue. Usually this is a low ‘bikini line’ incision. Then the muscles are moved out of the way, and the uterus is cut into to bring the baby out. After the baby is delivered and the placenta is removed, the uterus is stitched back together and the outer layers are sutured back with dissolvable stitches. A catheter will go into your bladder during the procedure and for a period of time afterwards. The bowels slow down and expect a delay to returning to normal bowel movements.
What is the recovery process?
Healing after the surgery will take at least 6 weeks, and much longer before you return to pre-pregnancy strength. Remember that it takes 9 months to grow a baby, so expect a similar time frame for your body to recover afterwards.
Ouch I can’t get out of bed! What can I do? Avoid using your abdominals. This may pull on your caesarean wound (and will be very sore if you do!) Instead, roll onto your side first and then use your arms to push yourself up into sitting for at least the first 6 weeks.
What shouldn’t I be lifting? Your new baby should be the heaviest thing you lift for 6 weeks. This is again to let your wound heal. If you have a toddler try to encourage their independence as much as you can. Be mindful of shopping bags, washing and lifting prams as well.
Toilet problems? It’s very common to be constipated early on and you may need some supplements to help get things moving again. It is important not to strain! Similarly, with your bladder you may experience loss of sensation, a feeling of obstruction to urinate, or leakage of urine without permission. These symptoms are not normal and usually can be improved with the right advice and management from your medical team or women’s health physiotherapist.
Can I drive? Driving is often restricted for 6 weeks post-operatively. You will need to check with your doctor and your insurance company if you are covered to drive before the 6 week mark.
My tummy feels weak, what can I do?
Support garments can be really useful for abdominal support. Your abdominal muscles will have been stretched through the pregnancy and you may feel like you haven’t got much muscle strength or control to support your back. Tubigrip is an excellent place to start and can be fitted by a women’s health physiotherapist, often while you are still in hospital. There are plenty of options for post-natal recovery shorts on the market from brands such as SRC, Solidea, 2XU and Hello Monday Active. These can be worn during the day for the first few weeks.
When do I start abdominal rehabilitation exercises?
There are 4 layers of the abdominal wall that need to be rehabilitated after pregnancy and having a C-Section. The deepest layer is called transversus abdominis which helps with stability for the pelvis and low back. We can start to wake this muscle up within the first few days to help support to lower back. Initially you can do this lying on your back and gently draw the skin away from the top of your undies and continue to breathe normally. Try to hold this gentle contraction for a few seconds and then release, and repeat up to 10 times. Once you are feeling more comfortable you can progress to do this kneeling on your hands and knees. A physiotherapist will be able to guide whether you are using the muscles correctly using a Realtime Ultrasound machine, and give you specific exercises suited to you.
What do I need to know about wound care?
Your obstetrician or midwife will guide you on whether or not you will need your stitches removed. In the meantime, keep the scar clean and dry. Ensure you wash your hands before and after touching it. If you are finding clothing touching the scar uncomfortable, try wearing high waisted items or placing a sanitary pad in between the clothing and the scar. There are products on the market which may reduce the appearance of the scar, such as silicone patches. 1-2 weeks after your surgery you can also start desensitization of the wound. You can Vitamin E cream or Bio-oil to gently massage the scar as well as rubbing different textured materials, such towels or cotton shirts to normalise the sensation of this area. You can also use the back of an electric toothbrush and use gentle vibration over the area.
What exercises can I do initially?
Walking is a great exercise to start to rehabilitate your body after pregnancy and surgery. The first week should be taking it easy with small walks around the hospital and at home. From week 2-6 start slowly building up your walking as you feel ready to. Start slowly and gently. Don’t push through any pain. By 6 weeks walking 30 minutes at a comfortable pace is good. Low impact exercises like the stationary bike or Cross-trainer are fine as soon as you are comfortable. Avoid swimming until you have had medical clearance to prevent risk of infection.
When can I run, play sport and go to things like Body Attack?
See a pelvic floor physiotherapist around your 6-week mark for a pelvic floor and abdominal assessment before you return to any impact exercise. They will be able to assess and tell you how strong your pelvic floor muscles are. Regardless of having a C-Section or a vaginal birth your pelvic floor will be weaker from carrying a baby for 9 months and the hormonal changes that occur during pregnancy. If your muscles are weak and not supporting underneath your pelvic organs (bladder, bowel and uterus) you are at risk of developing a prolapse (where these organs permanently sit lower), or urinary or bowel dysfunction. You may be at risk of developing pelvic floor dysfunction without realising.
My neck and low back are sore! What can I do about this? Let’s talk posture!
After carrying a lot of weight at the front with 9 months of pregnancy, and potentially protecting a sore new wound, the body usually requires a few prompts to correct good alignment and prevent stiffening of joints and straining of muscles.
For best posture:
o Bring your weight into your heels. This will encourage the weight behind your hips so you use your gluteals (bum muscles) rather than gripping through the front of the hip.
o Stand with your weight even between left and right feet. Stop hanging off one hip when you are standing at traffic lights or in the grocery line. This will exacerbate muscle imbalances and may end up causing issues later.
o Lengthen tall through the crown of the head and open your chest. Most of what new mums do is bending forward such as with feeding, carrying or pushing prams. This ends up causing a lot of tightness through the chest and can push pressure on the upper back and neck causing tension and pain.
o Look into a post-natal Pilates exercise class from 6 weeks onwards.
How do I know if I have abdominal separation?
Abdominal separation (also known as Rectus diastasis/DRAM) is very common. During pregnancy, your abdominal wall is stretched to accommodate your growing baby. Many women will feel post-natally that this stretch persists and there may be a gap between your muscles in your midline. This is usually due to connective tissue called Linea Alba being stretched. This should be assessed by a women’s health physiotherapist who can measure the width and depth of the separation and look at the timing and recruitment of muscles under Realtime Ultrasound. This is important to guide the appropriate level of exercise to rehabilitate these muscles.
What exercises shouldn’t I do?
Avoid any traditional abdominal exercises such as crunches, planks or full push ups for at least 6 weeks, but expect much longer! The time for the wound to heal is 6 weeks, but for the next few months after that it will be a steady rehabilitation process to get you back to full pace at the gym.
Any other questions?
We are always happy to answer your questions if you call us at The Physiotherapy Clinic on 9387 1011, or book in for a post-natal check-up around the 6 week mark or as soon as you feel comfortable.