A caesarean section can be a planned delivery or an emergency procedure if a vaginal birth becomes too risky for baby or mum. A caesarean is classified as a major surgical operation that takes time to recover from. The surgeon will cut through skin, subcutaneous fat, fascia, muscle, uterus, and amniotic sac if still intact. After delivery each of the structures needs to be sutured together to heal. These structures don’t heal in a few days and takes up to 6 months to regain their functional strength they had prior to delivery.
Your abdominal muscles are a major structure that’s damaged during a caesarean to get to the uterus. Your abdominals are your “sit up” muscles and help compress your abdominal wall. When these muscles are cut during a caesarean these actions are compromised. For these muscles to fully recover they will need rehab to be able to function appropriately moving forward. Hence why, working with a women’s health physiotherapist is recommended in the recovery after birth.
Research shows us that the abdominal fascia has only regained 51-59% of its strength 6 week postnatally. It takes up to 6-7 months for them to regain 73-93% of its original strength (Goom, T et al 2019). This is exactly why low impact exercise is recommended within the first 3 months after birth. RANZCOG outlines how to recover after your caesarean which can be found in the references. In terms of physical recovery, women who participated in physiotherapy at 8 weeks postpartum were showed to have less pain and better exercise participation at 14 weeks postpartum (stone et al 2021)
In the early postpartum period (first 6-8 weeks) it’s recommended to complete gentle ab exercises as well as belly binding to aid in the recovery of your abdominal muscles. These exercises are mainly around bracing your ‘core’ and improving the abdominal separation you may have. This should be completed under the guidance of a women’s health physiotherapist.
At your 6-week physiotherapist appointment a component of your assessment is to reassess your abdominal strength and separation following the gentle ab exercises you have done in the early postpartum period. To return to exercise you must first get your clearance from your GP, if your scar has healed and the GP has cleared you for exercise, your physio will begin your rehabilitation exercises. Each program is very individualised and can change from person to person. If you have any questions or concerns regarding your rehabilitation after a caesarean please contact our physiotherapists at Bump Fitness! They are happy to help you with any questions and start you on your postpartum journey to recovery today.
Until next time,
Courtney
RANZCOG C-section Guidelines Link
https://ranzcog.edu.au/wp-content/uploads/2022/06/Caesarean-section.pdf
References
- Stone J, Skibiski K, Hwang S, Barnes C. Physical therapy in addition to standard of care improves patient satisfaction and recovery post-caesarean section. J Womens Health Physical Therapy, 2021. vol 45(1); 10 – 19
- Keshwani N, Mathur S, McLean L. The impact of exercise therapy and abdominal binding in the management of diastasis recti abdominis in the early post-partum period: a pilot randomized controlled trial. Physiotherapy Theory and Practice. 2019 Oct 25:1-6.
- Tom Goom, Gráinne Donnelly and Emma Brockwell. 2019. Return to Running Postnatl-Guidelines for medical, health and fitness professionals managing this population. https://absolute.physio/wp-content/uploads/2019/09/returning-to-running-postnatal-guidelines.pdf