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C-section recovery

After Cesarean section delivery of a baby, most women are told that they can return to exercise and most activities after 6 weeks.  Is there something magical about the 6-week mark after baby?  Why is this the arbitrary time?  And how accurate is that timeframe in safely returning to exercise?   

A c-section delivery involves an incision through the uterus and the fascial layers of the abdomen and the movement of the abdominal muscles to deliver a baby.  This is a major abdominal surgery that requires not only recovery from pregnancy but also recovery through several layers of the abdominal wall.  It is important to consider healing times for this tissue as you return to activities around the house and return to exercise. 

Scar tissue takes time to form and for the fascial tissue to regain the tensile strength from prior to the surgery.  At the 6-week mark, scar tissue has about 50% of the original fascial strength.  Even if the scar appears healed, the fascial tissue continues to need more time.  

A general timeline for returning to activity can be in general phases: 

Rest and Recover: Weeks 0-6 to 8 depending on scar healing.  The scar should not be red, irritated, or leaking fluid.  This is a good time to practice pelvic floor activations, diaphragmatic breathing, and slow walks.  It is important to take this time to bond with your baby, learn how your body is moving through space after pregnancy and delivery, and take the time to nourish your body with good food and sleep.   

Rehabilitation: Weeks 8 to 20: This time starts when the c-section scar is well healed and after your follow up visit with your gynecologist for clearance to return to exercise.  When the skin is well healed, we can start working on scar tissue massage and helping break up any stiffness in the tissue that is developing.  This is also a great time to see your pelvic floor PT to make sure that the pelvic floor muscles are firing and working in the best way possible.  Even if you didn’t have a vaginal delivery, pregnancy itself puts a lot of strain on the pelvis and surrounding tissues.  Your pelvic floor PT can also help to check your scar, assess for diastasis rectus abdominus, and help to return to exercise safely.  As you add exercises into your routine, it is important to keep a few things in mind.  Exercises should not cause pain, incontinence (leaking urine or stool), sensations of heaviness in your pelvis, or bulging in your abdomen.   

Return to exercise: Weeks 20 onward:  This is the time to build strength of the abdominal wall and pelvic floor, return to aerobic and strength training.  This is all case by case as everyone’s body heals at a different pace.  This can be another good time to check in with your pelvic floor PT if you are struggling to return to a specific exercise or activity.   

Recovering from a c-section requires time for tissue healing and returning strength.  Setting up appointments with a pelvic floor PT can help in your journey to recovery. 

Sarah is the proud co-owner of Foundational Concepts, Specialty Physical Therapy which opened in March 2013. Sarah lectures at the University of Missouri Department of PT, University of Kansas Departments of PT and Nurse Midwifery, and at Rockhurst University Department of PT. She is board certified in Women’s Health PT and holds certifications in medical therapeutic yoga, lymphedema therapy and dry needling.

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