I recently had one of my pregnant patients request that she schedule an appointment with me to get a “game plan” for what she should do after her baby is born via c-section. I thought how awesome to be so proactive wanting to learn how to make things easier from the get go once baby is home.
Unfortunately she was unable to come in time before the birth, but I thought that would be a great blog to help all Mammas learn a little about how to make that transition after c-section a little easier!
First off it seems that most view recovery after a c-section as “no big deal” including some doctors that may not see the benefit of referring their patients to Physical Therapy to help with the recovery process. It is a major surgery that involves an incision through muscles, tissues and then again through the uterus. So yes…it’s a big deal!!
So what happens next…at the 8 week checkup women are giving the “green light” by their doctor to resume their activities and exercise routine, with no guidance what to do from there, or advice how to transition back to their pre-baby routines… nothing!
You are not healed or recovered by a long shot at that 8 week checkup. It can actually take up to a year to recover. Collagen fibers are laid down where the c-section incision is, and their job is to close the open skin and strengthen it.
Thus….a scar is born…
Scars can heal without any significant complications as long as there are no infections and Mom is relatively healthy.
However adhesions can develop along with the scar under the skin, resulting in scar tissue. These adhesions or scar tissue can connect tissues together, and not in a good way. Scar tissue is like “spider webs” or “saran wrap” under the skin, and can adhere to nerves, muscles and organs.
Fascia can also be affected by scar tissue. Fascia can be described like the stretchy chicken skin/tissue we think of with prepping a chicken or turkey. Fascia in interwoven in our body and along our organs. Once these adhesions are laid down, it may feel like something is “pulling” inside our body with certain motions.
HELP A COLLAGEN OUT….MOVE YOUR BODY
Those first weeks and months with baby can involve a lot of sitting, whether we are breastfeeding or just resting with baby in our arms. We must move our bodies in order for the abdominal area to be stretched and place a little tension in that area, so the collagen fibers are laid down in a more optimal position.
Sitting a lot or even guarding that area, as I see some Moms do after c-sections by maintaining poor posture with a “slumped” body position, can make the collagen along the scar want to “bunch up.” Movement is so important to prevent the collagen from shortening so we can move without any restrictions.
After your first doctor appointment post baby and everything looks OK, and the scar has healed without any complications, start to do some basic range of motion exercises such as pelvic clocks:
Example is shown below on the right…
You can place a small support under your back like pictured, or if there is no pain or discomfort, can leave it out.
Imagine clock on pelvis with 12 at your head and 6 at feet and 3 at left hip and 9 at right hip.
Start by pushing your lower back into the mat to find 12 and then tailbone into mat to find 6.
Now go from 3 to 9 by only rotating at your hips. Keep knees in line with feet and upper body stable.
Clock: rotate pelvis around outside of clock finding each hour evenly trying to move solely through hips.
Do 10-20 times each direction, 2x a day
It should not be painful, could be a little uncomfortable, if too painful you can decrease the amount of motion each way
Once you are able to tolerate lying on your stomach, try stretching your abdomen area where the scar is.
Place your hands under your shoulders, or can even prop your elbows onto the table. As you do this lift your chest up a bit higher until you feel the stretch along the scar. You may have to stretch your elbows out straighter to feel the stretch. It may be a little uncomfortable but should not be painful.
Try and hold that position 5 seconds to start, working up to 10 seconds. 5-10 reps 2x a day. If there is increased pain along that area, stop the exercise for now, and try again in another week.
PERFORM SCAR TISSUE MASSAGE
Another way to prevent adhesions from forming along the scar is to perform scar tissue massage. Scars can be the culprit or part of the picture with pelvic pain diagnoses including painful intercourse, abdominal pain, low back pain and even with bladder issues such as urge incontinence and frequency. No matter how long ago you had your c-section, it’s important to check your scar for any restrictions. Below is a link to an excellent video from another women’s health physical therapist on how to massage your scar. You want to make sure the scar is healed, no signs of infection (which include redness, warmth, fever) and no open areas before you start to touch the scar itself. Also it’s best not to use any lotion, keeping your fingers dry so you can manipulate the scar without “slipping” off the scar. Check out the video:
BLOW BEFORE YOU GO
It’s never too soon to engage that pelvic floor! You knew that was coming sooner or later… right? However it’s not so much about the “kegel” by itself, but how we use it along with our breathing pattern while moving our bodies. Certain activities that we do such as lifting a car seat, pushing a vacuum or picking up our kids will require more support from our “core” muscles and pelvic floor than others.
Practice this now….take a big inhale, imagine your lower rib cage like an umbrella opening up in all directions while you relax your pelvic floor, (also known as the muscles you use to hold back gas or urine.) Then as you exhale, imagine lifting the pelvic floor muscles, aka your “kegel.” You may feel a little tightening along the front of your lower abdomen as well as you do this. This muscle is known as your transverse abdominus. This is a deep abdominal muscle that runs horizontally around your abdomen and actually attaches to your back. This muscle and your pelvic floor muscles work together.
So basically you want to exhale while you are lifting something, (on the exertion part) while engaging the pelvic floor at the same time. So an example…when you lift your child…Inhale as you squat down, then exhale right before you lift your child and stand back up. You will exhale the entire time you are standing back up. You can practice just doing a regular squat first, inhale on the way down, exhale while engaging the pelvic floor on the way up, without any added weight.
That being said in the early days after a c-section, the smallest of motions, like just getting out of bed can be a challenge. Use this same technique when getting up from a chair or turning in bed. Exhale with the pelvic floor lift as you turn in bed, or reaching up to get something off a tall shelf, or picking something off the floor. This will help provide more support to the abdomen.
TO BRACE OR NOT TO BRACE
I usually recommend that new Moms stay away from the belly wraps or braces after having a baby. One reason is that the brace can interfere with the breathing component that we discussed above. Second reason is that if worn for a long period the muscles tend to get used to the brace doing the work. Third reason is there is a prolapse, the brace could promote pressure downward to some degree. That being said… if someone really feels they need the added support to function with a newborn in those early weeks home with baby go right ahead! However I would ditch it around the 6-8 week mark, so you can start to use and train the muscles you should be using.
Another option that I have heard good things about are compression shorts or leggings that have a compressive abdominal area designed to help give support with c-section recovery. Here is the site https://www.srchealth.com/src-recovery-shorts/ You can wear these right after surgery. They are snug along the abdomen, which is helpful in providing support, but not so much so that would interfere and cause the above mentioned issues.
After any surgery it is common to become constipated. It could be related to pain medication, or just the shock of abdominal surgery throws off our system. Having constipation for a long time could lead to abdominal pain, general discomfort or even pelvic floor dysfunction. Having enough fiber and water in our diet helps to ensure that we get our system back on track again.
If you are breastfeeding, the water part will be easy. Getting enough fiber daily can be a little more challenging. The recommended amount of fiber grams to consume daily is between 25 and 35. Examples of foods high in fiber include nuts, beans, quinoa, avocado, berries, squash, and peas. There is a free app for the iphone that will track your fiber grams. It’s called All-Bran Fibre Tracker by Kellogg. This would be a good way to check and see how much you are actually taking in every day.
Regular exercise also helps prevent constipation. Walking daily would be a good form of light exercise to add in during those early days postpartum.
Our bodies need the right amount of nutrients after having a baby to recover. So many times Moms think of exercise as the only way to “fix our body,” after baby, but the healing process can take longer if we are not eating right. So in order to promote healing we need to have a nutrient rich diet full of REAL food. Since collagen is what makes up our muscles, ligaments and fascia, we want to promote collagen production to help heal the c-section scar by including plenty of protein in our diet.
Examples of quality protein include meat, chicken, fish, nuts, eggs, leftover chicken soup, bacon, etc
Another collagen rich food is bone broth. You could either make your own or buy at the store. There are also collagen protein powders you could add to a smoothie. Bulletproof Executive is a reputable brand that sells collagen protein powder, as well an upgraded whey. Other reputable protein powder brands include Vega Sport, Thorne Vegalite and Designs for Health Pea.
Anything that could cause inflammation to the body you want to avoid as well. This will just slow down the healing process. These include caffeine, foods high in sugar, smoking, alcohol, and streroids.
So there you have it! The top 6 things I recommend to all Moms who have undergone a c-section.
Now for those who had a c-section many years ago, do you have any issues going on, maybe back pain, abdominal pain, pelvic floor dysfunctions, painful sex, etc? If so there’s a chance the scar might be contributing somehow.
The earlier you can treat a painful scar the better! Versus waiting years down the line and having other symptoms creep up along with the scar tissue. Get checked out sooner than later!
As always if I can answer any questions I am here for you! Just give me a call at 317-689-0073 or email me at Camille@indywomenpt.com
Owner of Indy Women Physical Therapy