What happens during a C-Section?
C-section is short for caesarean section. This type of birthing delivery can be planned or unplanned.
During the C-section, your doctor makes an incision into the skin, through the fat cells and connective tissue, and then into the abdominal cavity.
Your doctor then spreads the abdominal muscles apart and moves the bladder out of the way so that he or she can reach the uterus.
Your doctor then makes an incision into the uterus, and your baby is guided out. Shortly after your baby is delivered, your birthing team removes the placenta.
The uterus is then stitched up, the bladder is put back into place, and the connective tissue, abdominals, and skin are stitched up, to varying degrees.
C-sections require a lot of layers of sutures, which can lead to the formation of scar tissue.
Week One After Having A C-Section
The first week after your C-section you can expect to feel some numbness and soreness at the incision site.
It’s normal for your scar to be slightly raised, puffy, and even darker than your normal skin tone, so don’t be alarmed.
Generally, your doctor will watch your healing process and give you at-home-care instructions to ensure your wound heals properly.
Make sure to support the incision site and abdomen when you cough, sneeze, or laugh by bracing your abs (imagine pulling your belly button to your spine) or by applying gentle pressure to the incision site with your hand.
For the first few weeks after giving birth, you'll have vaginal discharge called lochia, which consists of blood, bacteria, and sloughed-off tissue from the lining of your uterus, along with normal bleeding. This is true for women who deliver by C-section or vaginally. The discharge will be bright red for the first couple of days.
You might have some gas pain and bloating during the first two days. Gas tends to build up because the intestines are sluggish after surgery. Getting up and moving around will help your digestive system get going again.
Moving or Exercising Just After a C-Section
You will be encouraged to get out of bed at least a couple of times the day after surgery – or even the day of surgery – to walk around and get your blood pumping. Wiggling your feet, rotating your ankles, and moving and stretching your legs are all great ways to this.
Just walking to the bathroom may seem impossible at first, but moving around is important for your c-section recovery.
You want to make sure you continue to keep your blood circulating so that your chances of developing blood clots are minimized.
Also, walking will make your bowels less sluggish, which will help you feel more comfortable a lot sooner.
For these reasons, you'll be encouraged to walk every day. Consider going for your walks shortly after you've taken pain medication, so that you feel less discomfort during your outing.
Signs of An Infection After Having a C-Section
It's also important that you urinate regularly. A full bladder makes it harder for your uterus to stay contracted and increases pressure on your c-section wound.
Call your caregiver if you have any signs of an infection, including:
Your discharge and bleeding will diminish, but both can last up to six weeks. Discharge and bleeding should gradually turn from bright red to pink and then yellow-white.
If menstrual-type bleeding continues past the first four days after delivery or comes back after slowing, call your healthcare provider.
Immediately call your doctor if you have any signs of a blood clot, including severe or persistent pain or tenderness and warmth in one area of your leg, or one leg that is more swollen than the other.
Weeks Two-Six After Having a C-Section
Many women forget that a caesarean is a major operation. The first six weeks after the operation, you should focus on healing and recovery; this is not a time to push your body too far, too fast.
Generally, most doctors don't recommend any strenuous exercise or heavy lifting for at least six weeks post surgery, but you can begin pelvic floor exercises and core breathing (see below) right away.
Pelvic Floor Exercise
Every time you lift your baby, tighten your pelvic floor muscles and lower tummy muscles at the same time. This will help you protect your back, and will prevent you from leaking urine.
In the early days, you can reprogram your core to function from the diaphragm down through the trunk to the pelvic floor muscles by practicing your core breathing from a supine position, and when comfortable, in a seated position.
Core breathing is simple. When you inhale, feel your ribcage, belly, and pelvic floor expand and gently relax. Then on your exhale breath, purse your lips (like you are blowing through a straw) and gently exhale to encourage activation through the pelvic floor and deep abdominal muscles.
Before doing any activity (even before picking up your baby), pull in your abdomen, exhale your core breath, get deep tension and support in the pelvic floor, and then begin the movement or lift.
Once you feel comfortable with pelvic floor exercises, you can also start to work on your lower tummy muscles, which will help to strengthen your back.
Try this simple and safe exercise 10 times, twice a day, gradually building up to three times a day. If you find it difficult, start with five times, twice a day.
How to do a pelvic floor exercise:
This gentle toning exercise is completely safe and won’t hurt your stitches or scar, so there's no need to wait, unless it feels painful.
Actually, the tissues around your scar will benefit from being gently flexed, so standing up straight and doing gentle abdominal squeezes will help your scar knit together.
During the first six weeks after having your baby, you can gradually increase activity at a pace that feels good to you.
But cut yourself some slack; this is not the time to jump back into the workouts you did before or during pregnancy. Your body needs to heal and recover.
Start with a five-minute walk. Once you feel comfortable with that time and distance, extend your walk to 10 or 15 minutes. If you are unsure about any specific exercise or activity and how it will affect your healing, ask your doctor.
Six Weeks and Beyond Your C-Section
Your healing process is not done just because you hit the six-week mark. Getting “cleared” for exercise by your doctor, does not mean that your body is completely healed from pregnancy and delivery.
Start with exercises that help you build a strong foundation and slowly tone and flatten your tummy. And then when you’re ready and able, ease yourself back into weight training exercises (www.beyond-baby.com) and sprints.
Sprints, as well as metabolic conditioning and proper weight training are great ways to shed some of the baby weight. In the beginning, you may only be able to do 10 minutes, but you will get stronger--trust me.
Just remember, the effects of pregnancy hormones can affect your joints for up to six months after birth, so stay away from high-impact activities--this is a process.
Ab Work & Diastasis Recti
Many new moms want to get back in the gym and start crunching away and working their abs, but this is a BIG mistake. Rigorous ab routines can actually do more harm than good causing pelvic floor and intra-abdominal pressure.
Some women develop a gap in their abdominal muscles as their bellies expand during pregnancy and labor, a condition called diastasis recti.
Intra-abdominal pressure from ab work can actually cause the diastasis, or gap, worsen and cause injuring those muscles. Before starting any ab routine, use caution and check the condition of your stomach muscles.
How to Check for a Diastasis Recti:
If you feel a gap between your ab muscles, ask your doctor to do a physical exam. If your doctor says it's safe to start ab work, start slowly and strengthen your abdominal muscles with pelvic floor strengthening and core training that avoids intra-abdominal pressure.
Frequently Asked Questions (FAQs)
What’s the best way to improve the healing of my c-section incision?
A c-section incision takes several weeks to heal, and it may be some time after that before you feel like working out. However, walking at an easy pace is encouraged because it promotes healing and helps prevent blood clots and other complications. Massaging your incision can also improve circulation and speed up healing time.
Only begin to massage your c-section scar after the wound has fully closed and your have no scabs.
How do I massage my C-section scar?
Before you massage your C-section scar, make sure your wound is fully closed. Spend more time on thick areas and place gentle tension on places where you feel resistance. You should not feel any pain or discomfort.
How to massage your C-Section scar:
How long will it take for my belly to flatten?
Whether you had a c-section or a vaginal birth, it still takes a minimum of six weeks for your uterus to return to pre-pregnancy size.
Remember to be patient and to follow the steps listed above to begin easing back into exercise when the time is right.
What is a “c-shelf” and how can I avoid it?
A few months postpartum you may notice a “c-shelf “ that appears. This is the little (or not so little) bulge some women experience around their c-section incision.
A scar, the unavoidable result of surgery, and its more dense and adherent tissue properties can cause some pocketing which can show fat deposit more. Loose skin, genetics, recurrent surgeries and body type all contribute as well.
It can be frustrating, but your wound is healing, so be patient. Also, remember that you may have some weight changes from pregnancy, as well as, some loose skin hanging over the scar.
These factors will get over time and your incision and tissue will mature over the first year postpartum.
What should my scar to look like post-surgery?
There are generally three stages of healing when it comes to c-section recovery and scars.
Stage one (Week 1) Inflammatory Stage:
This is the active phase where cellular "workers" rush into the area to begin recovery. This is where you really feel like you just had surgery.
Stage two (Months 1-3): Proliferative Stage:
This is the initial rebuilding period. New collagen and capillaries form and swelling may be fairly active. These are the days that you feel recovery progressing, but still need to take it easy.
Stage three (up to Year 1): Remodeling Stage:
"Finish carpenters" are tidying up. Collagen has reformed, and the c-section scar is maturing. You will have days on end when you feel really good, and then all of a sudden, have a day where you feel like you just underwent surgery. Common complaints at this time in the c-section recovery phase are itching or occasional soreness around the scar after active days. Those with keloids or symptomatic scars can have a longer remodeling period.
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