Returning to exercise after a Caesarean section

Statistics show that 1 in 4 births in the UK is by Caesarean section (“C-section”). Women deliver this way for many reasons. Some women elect to have a C-section, and others go through the stages of labour and then deliver their baby via C-section often as a result of an emergency occurring. Given the number of women it affects, I’ve put together some Q&A based on discussions I commonly have with clients on this subject – particularly around returning to exercise safely, addressing some common post c-section issues and addressing myths concerning pelvic floor health and "poochy" tummies.

What is a C-section?

It’s an incision made horizontally, just above your pubic hair line. Contrary to common belief, your abdominal muscles are not cut with this incision – it’s actually the outer coating of the muscle and the cling film type structure in between the 6-pack muscles (rectus abdominus) which is.

The incision is made on the outside of your body horizontally, and then your surgeon gently peels your linea alba apart (vertically) to gain access. The linea alba runs vertically down your stomach, and separates your rectus abdominus in half, above and below your belly button. The outside incision is then sutured back together, but the inside “cling film”/linea alba is not.

I know I’m having a C-section, so I don’t need to do pelvic floor exercise / I had a C-section so my pelvic floor is ok.

If you elect to have a C-section, there’s a misconception that your pelvic floor will be fine. You might think that because your body won’t be going through the stages of labour, your pelvic floor won’t be affected. This is wrong. Pregnancy itself puts tremendous pressure on your pelvic floor, as the weight of your developing baby gets bigger and bigger, and therefore weakens these muscles. It’s still very important that you strengthen your pelvic floor during and after pregnancy, even if you elected to have a C-section.

If you’ve gone through the stages of labour and, after several unsuccessful attempts of trying to deliver naturally, you then have a C-section, think about what muscles have been stressed throughout this ordeal – the abdominals and the pelvic floor. You may have been labouring for hours and this pushing puts an immense amount of pressure on these areas. Put simply, it’s your pelvic floor and abdominal muscles which helped you deliver your baby.

When can you return to exercise following a C-section?

You will need to have had your doctor’s check-up before your return to exercise after a C-section. Most importantly, I encourage post-natal women who’ve had a C-section to return to exercise when they feel ready. It’s major surgery and your body will need time to heal.

What is recovery like after a C-section?

After a C-section, your recovery time is longer than a natural birth. You may have a loss of sensation, a numbness in your abdominals especially around the scar area, and the scar tissue itself may reduce your ability to do certain movements completely pain-free. Your pelvic floor may take a little while to activate consciously too, but keep sending the signal from your brain to these muscles, and eventually, it will switch back on.

You will also need to be eating right. Good nutrition is a fundamental part of any post-natal recovery. My focus with clients is on ‘healing’ nutrition.

What exercise is safe after a C-section?

I believe that building up the foundations is the most appropriate place to start with post-natal clients, whichever type of delivery they’ve had. We focus on connecting again with the transversus abdominus ("TvA") and pelvic floor with safe, appropriate exercises.

Like most exercise, there is no quick fix cure for strengthening the abdominals following a C-section. It can take months of training, careful instruction and lots of homework.

Before starting any programme with a post-natal client I undertake a thorough pre-screen to ensure that I am the best person to help her. If your core and pelvic floor strength isn’t assessed and addressed early with correct procedure (exercise for most and sadly surgery for some) and using the correct techniques, then they may stay in a weakened state for the rest of your life. This can lead to poor posture, pelvic floor dysfunction and lower back pain. The good news though is that with the right assessment, instruction and homework, it is possible for most to improve.