How Can I Best Recover After A Caesarean Section Birth?
Here’s a question for you: why is there so little guidance given to women after they have a Caesarean Section about how to recover?
I mean – it’s major abdominal surgery. You would think that after major surgery you’d be given an extensive list of what to do, and what not to do, to ensure that the scar heals well and you don’t end up with complications.
But with new mums, not only are we often given very little advice on leaving hospital beyond what pain medication to take and what to look out for with signs of infection, we are also often expected to imminently get back to housework and looking after toddlers.
If a scar does not heal well, there can be long term and far reaching issues to do with the adhesions that form. Adhesions are a normal part of healing, but when this internal scar tissue is excessive, and ends up wrapping around nearby structures like the bladder, the bowel or the urethra, it can cause issues such as painful sex, pain during bladder and bowel emptying, or pain and tightness when lifting your arms above your head.
I’ve put together my top 6 tips regarding what you can proactively do in the early weeks and months after a Caesarean Section, to encourage the strands of collagen in your healing scar to be long, and flexible, and mobile.
Tip #1 – Posture and Stretching
In the early days/weeks after having a C Section, it’s often painful and difficult to move and stand up as straight as usual.
And the most important thing for scar healing in those first 6 weeks (in particular the first 2 weeks) is REST.
However, one of the best tips for good recovery for the scar is to focus your attention on returning to normal movement as able, including upright posture & gentle stretching.
Accept the pain meds that are offered to you, and while working on resting and reducing strain (more on that soon) mindfully work on achieving upright posture and moving through different ranges of trunk movement with regular gentle stretching.
So what does this look like in real life?
- Set up an area to feed your baby where you’re not going to be flexed/slouched over all the time – sit in an upright supported position for some or all of your feeds.
- Set your pram handle at a height so that you don’t have to bend forward
- Consciously stand tall where possible when carrying your baby, and if you’re baby wearing, ensure the carrier is well fitted so that you aren’t constantly being pulled into a forward slouched position.
- Make daily habits for gentle stretching sequences into side flexion, rotation, and most importantly extension (or in the early days just aim to achieve ‘neutral’). This might be down on the mat when the baby is having a play, or against the edge of the cot.
Want to see video examples of early post c section posture and stretching sequences you can try? Join the FitRight Members group!
How amazing it would be if every pregnant woman or new mum who is in the first couple of months after a c-section had access to the resources there!
Tip #2 – Deep Breathing
Okay so this one probably sounds obvious, but have you ever considered how you tend to breathe when you’re in pain or you’re apprehensive?
Many of us tend to revert to upper chest, shallow breathing patterns – and this is not helpful for caesarean scar healing.
From a scar healing point of view, all the layers of tissues need to learn how to move and slide over each other again. Adhesions (scar tissue in the inner layers of your scar) are going to form as part of normal healing, and it’s important that these strands of healing tissue are being created in a flexible, moveable way – not being rigidly splinted in one position due to lack of movement in the lower abdomen.
We have spoken about gently stretching and moving through the trunk, but by consciously taking your breath to the lower part of your chest, and encouraging your diaphragm to move down and your belly to gently move outwards on a breath in, you are adding another positive step to scar healing.
What does this look like in real life?
- Take a moment to learn how to do a ‘diaphragm breath’. Place your hands on your belly, relax your shoulders, and as you breathe in direct the movement and gentle expansion to where your hands are.
- Once you have the hang of this, think about how to make it a habit to do 5 or so diaphragm breaths regularly in your day. What about each time you feed your baby? Once you have the attachment to bottle or breast sorted, take a moment to do five diaphragm breaths and consciously move your belly. This could do wonders for mindfulness and creating a calm feeding environment too.
Just keep remembering the golden rule for those early weeks – keep the pain medication cover going to enable normal movement, upright posture and NORMAL BREATHING as much as possible!
Tip #3 – Minimising Abdominal Pressure
For the first 6 weeks, and in particular in the first 2 weeks, your scar is going through a healing phase where, although gentle movement and touch are essential, high amounts of pressure could be detrimental.
If you’d had the same scar but for something else, like bowel surgery for example, you would probably be given strict instructions about not lifting anything heavier than a full kettle in those early weeks.
But with a C section? Your priority and the information you’re given is to do more with caring for your precious newborn and less to do with your scar recovery.
Here’s the guidance that I would recommend: over the first 6 weeks (and ESPECIALLY the first 2 weeks), wherever possible, try not to put strain through your tummy.
Why? Well, worst case scenario your internal or external stitches could come apart (called scar dehiscence). But also this is the time that collagen fibres are being laid down to create a scar and excessive load could lead to an excessive response and lots of adhesions forming.
So what does this look like in real life?
- Try to roll to your side to get in and out of bed. You were probably already doing this out of necessity in late pregnancy due to your abs muscles being stretched and at a mechanical disadvantage! But now, the reason is that jack-knifing up from lying on your back to sitting creates a lot of pressure in the tummy. If you roll all the way onto your side and push up with your arms in front of you, you’ll put a lot less load through the C section. And then to get back down you reverse that movement and face sideways while you lower yourself down before rolling onto your back.
- Try not to lift anything heavier than your baby. Look, if you have a toddler, and/or a fifo partner, this probably isn’t possible. But if you have any other option – don’t lift the car capsule or the pram, don’t lift your toddler into their high chair or the bath… oh, and this probably isn’t the best time to move house.
- Try to get help with settling your baby in the night time. Getting up and down multiple times a night from the bed, and walking the hallway settling the baby for hours is going to be a big load on your scar.
- Prioritise rest. Gentle walks and stretches are great, but if you can, avoid hours of walking around the shops & housework!
If you want heaps more resources visit www.fitright.physio/members.
Tip #4 – Gradual Return to Exercise
So just to be clear, although my recommendations are about decreasing load and optimising rest in the early weeks after a C Section, that doesn’t mean we need to be bed bound.
It’s really great to keep your muscles strong and your cardiovascular fitness up so that when the scar is healed adequately that you CAN increase load, you’re not starting with as little deconditioning as possible!
My main recommendations are as follows:
- Start very gradually so that you can monitor how you feel during and after and decrease or increase accordingly (don’t start all guns blazing and then regret it!)
- The way to know you’ve done too much is by monitoring how your scar feels – if it’s burny or achey or sore, what you’ve done in the last day was probably too much.
What could gentle exercise look like in the early weeks after a caesarean?
- Walking – don’t start with a 15 minute walk to the cafe, with the baby in the carrier, with hills, and then need to walk back. Rather, in the first week or two, start with walking 2 minutes to the end of the street and back. How do you feel? Build up gradually (either speed, load – like pushing the pram, or distance, but not all three concurrently) and a realistic aim is 30-45 mins brisk walk by 6 weeks postnatal.
- Strength work – I’m talking squats, split squats, calf raises – things you can absolutely do a few minutes of while multitasking and settling your baby post feed.
Want to be led through workouts like this for 0-2 weeks, 3-6 weeks and >6-8 weeks post C Section? The FitRight Mums Members group has these videos that I’ve created for you to follow!
Tip #5 – Gentle Scar Massage
Just a caveat with this one… this is not my area of expertise, the knowledge I’ve gained with regards to scar massage is from my Occupational Therapist colleagues who specialise in scar healing.
But from a personal and a professional point of view – I’m a scar massage convert!
Here are some important points to know:
- You can start a gentle form of scar massage as soon as your wound is ‘healed’, which is usually the point when you no longer require a dressing (approximately 2-3 weeks, ask your obstetrician). At this point it would be about gentle touch and movement only, normalising touch and preventing hypersensitivity.
- After approximately 6 weeks, the aim of scar massage changes from simply being about exploring to being about stretching the healing layers away from each other and preventing excessive adhesion formation.
- The ideal amount of time for scar massage would be 20 minutes per day, but as Occupational Therapist Jess Chandler points out in our interview, that’s rarely if ever possible in new motherhood!
“There’s an ideal, and there’s nothing – if you find something between those two with regards to scar massage, you’ll be miles ahead of most people!”
If you want to learn more, there are videos instructing how to do this on the FitRight Mums Members group, both early post C Section and further down the track when you can go firmer.
Plus there is an awesome interview with Jess Chandler – she is a wealth of knowledge with all things scar massage and supportwear!
Tip #6 – Cream and Support wear
Another caveat with this one… this is not my area of expertise, the info below is also from my Occupational Therapist friends.
Let’s talk about creams and dressings first.
Here are some important points to know:
- There is no scientific evidence for creams/oils such as bio med, vitamin e, frankincense, etc. when it comes to scar healing. The only product with good quality research behind it is silicone, such as Stratamed (for early healing) and Strataderm.
- Stratamed is used for early healing and has been shown to prevent infection – this is usually only used for those deemed high risk for poor scarring
- Strataderm is started over the scar from approx 2 weeks and is recommended to be used regularly until there is no redness (should be 6-12 weeks) – this calms down excess collagen production.
Now compression garments…
Compression is excellent for scar healing, and you can benefit from wearing compression garments for as long as your scar is red. It works by holding the layers of healing tissues together, and supporting the healing scar during movement.
So can you just wear Spanx?
Occupational Therapist Jess Chandler explains why Supportwear such as SRC Recovery shorts are worth the extra money:
- They are medically graded compression, much firmer than normal Supportwear, and graded compression is what has been shown to be optimal for scar healing
- Rather than compressing the mid/upper tummy, they have specific targeted compression on the lower tummy where the c section scar is.
Want to know more? Jess’s interview on the Mums Members group is GOLD! www.fitright.physio/members