Early C-Section Recovery
Cesarean, or C-section, recovery will look different than vaginal birth recovery. Some c-sections are planned, some are unplanned – either way this is a major abdominal surgery! After a c-section, there are a number of things you can start to work on that will help support your body’s healing process. These are general guidelines. If the suggested timeline looks different than how you are feeling, don’t stress! Start when you are ready.
Anatomy of a C-section
A c-section incision goes through 7 layers of tissue:
Skin
Fat
Fascia
Abdominal muscles
Peritoneum (a membrane that lines your abdominal cavity)
Uterus
Amniotic sac
With any surgery on any part of the body, scar tissue forms to close the incision. Sometimes, as the scar tissue forms, adhesions can develop which cause some areas of stiffness and restrictions along the scar and the surrounding tissue layers. Scar tissue adhesions can be numb, tight feeling, or hypersensitive and painful. It can also impact how efficiently we are able to connect with the muscles of the core – which are so important for helping us heal postpartum! The good news is scar tissue restrictions or adhesions can be addressed - even years later!
Remember, do not worry if you aren’t on the same timeline. Give yourself grace to heal on the timeline your body needs.
Disclaimer:
The purpose of this blog is for general education. Always follow your OB’s guidelines for incision care and healing. If you have any concerns at all it is always best to consult your medical provider.
Incision Care
Infection awareness – doctors do an amazing job of helping to prevent infection! It is still important to be aware of any signs or symptoms that may warrant intervention. Research has shown that most infections are found 4-7 days after surgery(1). Do not hesitate to reach out to your doctor if you notice any of the following or you have any concerns.
If you develop a fever
Worsening redness at the incision site
New drainage (white, green, brown, or yellow fluid)
New swelling in the area
Skin hot to the touch around the incision
Hardening of the tissues in the area
Mobilizing the scar
If you touch your scar and it feels stiff or different than the skin around it, or you just have a general feeling of tightness in the lower abdomen, you may benefit from scar tissue mobilization. Before your scar is healed, we start by working around the scar. Do not work directly on the scar until the incision is completely healed! The average incision heals around 6-8 weeks postpartum.
Around week 3, you can begin to perform gentle small circles (clockwise and counterclockwise) at least 3 inches above and below the scar. Even moving the skin near the scar starts to help with healing!
Around week 6, work 1-3 inches from the incision to gently pull the skin away from the scar (from above and below).
Around week 12, you can begin to gently pinch and pull the scar up and away and work to be able to roll the scar between your fingers.
Research has also shown silicone strips and gels can help with scar healing(2) and pliability. General recommendations are to start using after the scar is fully closed. It can take 2-3 months (sometimes longer) for full effect. If you are using silicone strips instead of silicone gel, make sure to carefully wash the strip daily to prevent infection.
Desensitizing the scar
After a c-section surgery, the scar can be numb in some spots and overly sensitive in others. Desensitizing helps to normalize the sensation in this area. Before the incision is fully healed, you can do this to the skin nearby the scar. You can also try icing the scar which will help with swelling and also creates some new sensory input to the area. Placing the ice over your bandage or clothing is a good place to start.
Once the scar is fully healed, you can start working on the scar itself.
To desensitize a scar: gather some materials with different textures. For example, a cotton ball, a washcloth, a t-shirt etc. Start with the material that feels the most comfortable and gently rub that material around the scar and on the scar (once it is healed). You can rub side to side, up and down, in small circles – whatever you prefer. Do this for a few minutes a day until that material no longer feels uncomfortable on the skin. Then, move on to the next material. It may take a few months before the nerves in this area are fully healed and desensitized.
Re-connecting with your body
First, REST. Allow your body to recover and heal as long as it needs.
Next – connect with your breath! During pregnancy, baby takes up a lot of space and changes the way we breathe. Think about breathing down into your body and letting things relax as you take a breath in. Try not to shrug your shoulders into your ears as you take a deep breath. You can start connecting with your breath as soon as day 1 postpartum. Just allow yourself to breathe and relax.
Areas you can direct your breath to rather than your shoulders:
Down into your belly
Down into your pelvic floor
Out into your rib cage
Out into your lower back
Looking for more breathing exercises? Check out our blog on 3 exercises to improve your breath.
Re-connect with your pelvic floor
Starting around 1 week postpartum, you can begin to work on re-connecting with your pelvic floor. Even with a c-section, your pelvic floor has been through 9-10 months of changes. This can affect muscle coordination, muscle strength, and muscle efficiency.
For your pelvic floor to be fully functional, it needs to be able to fully contract AND fully relax. Squeeze your hand into a tight fist – now try to pick something up without relaxing your grip. Not possible! The same idea is true for the pelvic floor. If it is always tense and can’t relax, it won’t be able to help support your body as well.
Remember the breath we talked about already? This is key for helping your pelvic floor. As you breathe in, feel your pelvic floor relax. As you breathe out, you can think about gently lifting your pelvic floor (Kegel). This “lift” should be gentle and should center on your pelvic floor – no clenching your butt muscles!
Start some gentle movement
Once you are cleared to get up and move around, this is essential for healing! This can look like:
Doing ankle pumps
Shoulder rolls
Shoulder blade squeezes
Gentle pelvic tilts
Gentle cat/cow motions while sitting on the edge of your bed
Taking little walks around the house and yard (and further when you are ready!)
When we are feeling out of place in our body, it is common to compensate by tensing and clenching muscles. Find gentle movements that help you to be aware of where you are holding tension in your body and help to slowly bring awareness and movement there. Just be mindful of avoiding excessive movements that strain the incision while it is still healing.
Re-connecting with your core
Starting around weeks 5-6, we want to work on starting to reconnect with the core. Even prior to the c-section, your abdominal muscles have gone through 9-10 months of changes to accommodate a growing baby. And remember the 7 layers we talked about earlier? The core muscles are part of that. After a c-section, it can feel very difficult to connect to the lower abdominal muscles.
We have 4 layers of core muscles - a lot of the time when people hear “core exercises”, sit ups are the immediate thought. In this case, we want to connect with a deeper layer of core muscles called the transverse abdominis (TA) before we start thinking about sit ups. That deep layer acts more like a “hug” to the core. If you wore a belly band during pregnancy, the deep core works very similarly – gentle compression, gentle hug to the abdomen.
Try this:
As you breathe in, relax (there’s that breathing thing again!).
As you exhale, think about breathing like you are breathing through a straw, and think about gently pulling the points of your hips toward each other to find some gentle tension.
The core should pull in toward your spine slightly, it should not bulge out (and no “crunching”!).
If you are having trouble with any of this, or are unsure what steps to take in order to move forward with your healing process - restoring strength and function - schedule an appointment with a pelvic floor physical therapist. We are happy to help you!
Photo by Brass Tacks Branding
Physical Therapy post C-section
At Anchor Physical Therapy, we look forward to helping you return to doing what you love without limitations or pain. We provide the education and guidance to understand your body more completely. You can absolutely feel empowered, strong and capable through your post c-section healing journey!
Chelsea Tulimiero, PT, DPT
Chelsea@anchorptnh.com
Next on your reading list:
Resources
Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women’s Health. 2017;Volume 9(9):81-88. doi:https://doi.org/10.2147/ijwh.s98876
Wang F, Li X, Wang X, Jiang X. Efficacy of topical silicone gel in scar management: A systematic review and meta‐analysis of randomised controlled trials. International Wound Journal. 2020;17(3):765-773. doi:https://doi.org/10.1111/iwj.13337
