Postnatal C-section mom with baby

A Cesarean birth can leave you with more questions than answers: How LONG does C-section recovery take? When can I start walking again? When can I exercise after C-section?

I gotchu.

Cesarean sections are the most common surgical procedure in the United States. In fact, nearly a third of babies born in the United States each year are born by C-section. And if you’re reading this, I’d say there’s a pretty strong chance that YOU experienced a Cesarean.

What happens during a C-section?

C-sections are major abdominal surgery (but I don’t need to tell you, right?). To birth your baby, an OB had to make an incision that spanned SIX layers of your body’s tissues. Organs were pushed around. A baby was removed. In most cases, the only muscle that is cut is the uterus. 

Once your baby is born, you will be stitched back up. Multiple layers of stitches mean multiple layers of scar tissue. The area around your scar may feel a little restricted since the scar tissue is tough and adhesions can form between the layers of scar tissue.

Check out this great demo of what happens during a typical C-section:

What does this mean for your post-Cesarean recovery?

The pressure that builds inside your abdomen when you breathe or do a physical task, creates stability around your spine. It’s not so different from the pressure that supports the flimsy walls of a coke can.

When the can is in good shape, those thin aluminum walls are STRONG. You could stand on a full can of pop and it would hold your weight.

On the other hand, if you nick the can?  You’ll find that the can is super easy to crush.

Now visualize your innermost core like a pop can. The top of the can is your diaphragm, the bottom is your pelvic floor, and the walls of the can are your abdominal muscles. This so-called “core canister” creates the stable platform of of which you do all of your physical work. It’s your Powerhouse.

Diagram of inner core muscles showing parallels with a soda can.Your innermost core (diaphragm, transverse abdominals, pelvic floor and multifidus) functions like a pop can. Permission to use copyright image (left-hand image) from Pelvic Guru, LLC

When you give birth by Cesarean, the incision creates a nick in the can. A leak in your Powerhouse.

For the sake of your long term strength and function, you’ll need to rebuild the strength and integrity of your core.

C-section parents are disgracefully underserved.

Now, if you were having an ACL surgery- you’d be discharged from the hospital with a lengthy treatment plan. You would be prescribed months of specialized physical therapy. If you’re an athlete, you’d be advised on a 6-12 month return to sport action plan.

That you don’t receive the same post-surgical recommendations after Cesarean is a major gap in postnatal care. It leaves you, the patient, spending hours with Dr. Google trying to hack together your own recovery protocol.

How long does it take to recover from a C-section?

Well, a common C-section recovery timeline is 6-12 weeks. BUT… everyone’s trajectory is different. And we also know that scar tissue can continue to remodel and strengthen for 6 months to a year or more.

Odds are you’ll be feeling pretty good by that 6-12 week mark, but know that you still have room for continued healing over the next year.

The first 6 weeks will be the most intense with regards to discomfort and recovery.

Here’s a peek at what that first 6 weeks might look like:

0-4 weeks after C-section:

Rest and recover.

Please ask for (and ACCEPT) as much help as you can as you try and care for yourself and adjust to parenting. 

For the first two weeks, stay in bed or lay on the couch, most of the day. Have your partner do the lifting, the cooking, the diaper changes.

You can start walking a bit as you feel comfortable (I’m talking 5 minutes here and there!) as long as it doesn’t increase pain, induce swelling or create any other obvious symptom.

I urge you to wait to increase activity until AFTER you are off your pain meds. It’s pretty easy to overestimate your pain tolerance while your’e on them.

Prior to 4 weeks, stick to core and pelvic floor breathing-based execises (e.g. the Connection breath). 

4+ weeks after C-section: 

Introduce gentle mobility work.

For mobility work, consider:

1) Back-lying connection breath. Pay extra attention to activating the muscles below and surrounding your scar.

2) Back-lying pelvic tilts

3) Cat-cow

3) Half-Kneeling Hip Flexor Stretch with Side Bend

5) Knee rolls

Scar Desensitization:

You may find that as your incision site heals, it is quite sensitive to the touch. Around 4 weeks postpartum, you can begin to do some scar-desensitization. Try brushing fabrics of varying textures (e.g. feathers, cotton balls, a soft washcloth) along your scar. 

6+ weeks after C-section:  

Once you’re ready to pick up the pace, check-in with a PT and take a slow-is-fast approach to returning to exercise.

C-section Scar Mobilization:

After your 6 week check-up, you can begin doing self-massage on your scar. Only perform scar massage if your incision is fully healed and you can comfortably tolerate sustained touch.

3 different ways to perform C-section scar massage
3 different ways to perform C-section scar massage. Permission to use copyright image (left-hand image) from Pelvic Guru, LLC

There are a ton of options for massage. Some popular options include:

1) Push and pull: Place your fingers either directly on, or just above or below your scar. Gently move your scar left and right and work along the length of your scar. If you find a spot that feels more restricted, hold that spot for a few seconds.  

You can also do the push & pull going up and down along the length of the scar.

2) Circular: Move your fingers in a circular pattern over and around the length of your scar.

If you find spots that aren’t moving well, hold for a few seconds until they release.

3) Skin rolling: “Pinch” a section of your scar (parallel to your scar) and gently roll into between your fingers towards your head and towards your toes. If you find it’s restricted in one direction, hold until it releases. And work along the length of your scar.

Scar massage might be somewhat uncomfortable, but should not be painful. Check in with a pro if you’re feeling pain when working with your scar.

Check in with a pelvic floor physical therapist around 6 weeks postpartum or later.

I highly recommend checking in with a pelvic floor PT to get some individualized instruction. Also know, pregnancy is an independent risk factor for pelvic floor conditions; just because you didn’t give birth vaginally doesn’t mean you’re off the hook for pelvic floor issues (sorry!). A PT can help you determine if and when you’re ready for certain exercises and activities.

The big question: When can you begin exercising after your C-section?

After your 6 week check-up with your OB or midwife, you can begin doing bodyweight and lightweight reistance training.

Once you are cleared for exercise, begin with body weight and low-resistance exercises. Examples include: glute bridges, clamshells, bodyweight squats and resistance banded rows.

Increase load (weight), volume and intensity slowly and progressively.

Initially, you’ll want to avoid a few specific types of exercise.

During your early months of recovery, avoid tradtional abdominal exercises (planks, sit-ups etc.). In the early days, you can begin building abdominal strength with heel slides and knee drops and progressing to heel taps and Pallof presses.

Initially, you should also avoid running, high-impact exercises, high-intensity exercise and working with heavy weights. Once you spend a few months building a good foundation of core strength and stability, you’ll be able to begin re-introducing this stuff.

I’m sure you’re wondering exactly how long it will take to return to the higher intensity stuff- But your exact timeline will be unique to you. A postnatal coach can help you determine a safe return to exercise strategy.

As you do more and more, keep an eye out for these symptoms:

As you become more active, keep an eye out for the 5 P’s.

Pain… anywhere, and in particualar around your incision, vagina or in your pelvis.

Pressure… through your abdomen or pelvic floor.

Pee… no leaking!

Peaking… doming, peaking or coning through the midline of your belly.

Pulling… through your incision site.

If you do notice any of these symptoms, check in with your friendly neighborhood pelvic floor PT.

Where do you go if you need a little help?

As you progress on your healing journey, you might find yourself at intersections where you require more guidance. Perhaps it’s a symptom you can’t troubleshoot. Or you just don’t know how to progress your exercises. 

I will always recommend are pelvic floor physical therapy and qualified postpartum coaches. Pelvic floor PTs are THE medical professional most qualified to assist you with scar management and symptom troubleshooting once your incision is healed.

For help returning to exercise, seek out a qualified postpartum personal trainer or coach. I offer 1:1 consultations and online personal training to support return to sport post-C-section. I can also help you find a qualified in-person coach near your home.

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My mission is to make sure that having a baby is not a reason why you can’t do all the things.

Contact me if you have questions about exercise or pelvic health pertaining to pregnancy or postpartum. I also offer personal training services and consultations to folks locally (Seattle, Bellevue, Redmond, Kirkland) and online.

Certified Prenatal & Postnatal Coach, Pregnancy & Postpartum Athleticism Coach and Postnatal Fitnesses Specialist.