Bouncing back from a C-section can be a daunting thought. Most women are told that all C-sections require a cut through the muscle in the belly. This is not actually true. In fact, in most C-sections, the abdominal muscles are moved to the side by the surgeon in order to gain access to the uterus and baby. Hopefully if you have had a C-section, I am not forcing you to re-live the experience. But here is a general summary of what is actually cut.
- The derma or the outer layer of the skin.
- The fat.
- The fascia is also cut which is the thin layer that supports the muscle fibers.
- Then the peritoneum is cut which is the cavity around the abdomen.
Since all this tissue is cut, there are layers of scar tissue that form during the healing process. Therefore, when the muscle returns to its original location, which occurs through the healing process and even weight loss, it does not glide as smoothly as it once did before the C-section. The scar tissue can be a rough surface, which may impact the muscle’s ability to contract. This is in part the cause of the weakness and instability in the abdominal section of the core. Despite this, a well-designed exercise program can help in managing this limitation. But most doctors do not suggest activity until 4-8 week post-partum. Before giving you the exercise routine I suggest I would like to mention that the healing process might take much longer if you have had children close together (both by C-section). You may experience more challenges regaining strength and it might take 8-24 months before you reach the core strength and mobility required to begin activity.
PHASE I: 3-5 weeks After Delivery
The most important effort that can be made while in the pain-free stages after delivery is posture training. Maintaining posture is challenging if you are still experiencing abdominal pain which often causes the body to hunch forward. If you are also nursing, then posture training is also critical. Nursing can cause extreme rounding (or slouching ) of the upper body and even cause your head to protrude forward which strains the neck.
Although exercise is not recommended by most OBGYNs after a C-section until 6 weeks from delivery, I suggest simple and consistent posture exercises.
These are great to perform after nursing or even bottle feeding (any posture that places your upper body in a rounded position).
- Sit with a foam roller in a chair and squeeze your shoulder blades together. You can also do this laying down. I prefer sitting up in a chair doing paperwork or watching tv.
- Stand against a wall as straight as you can while pulling your shoulder blades down and back. Then, move your arms through a comfortable range of motion.
- Practice standing while holding your baby, with your best posture and perform standing Kegel exercises. This way you are also applying this functionally to your life.
- Using a resistance tube, row the handles towards the crease of your underarm. Squeeze the shoulders blades together. Make sure you are standing with good posture and that your head is comfortable. The resistance should not be too challenging at this stage. Perform about 10-20 reps, for 3 sets.
Since alignment and poor posture exasperates the forced rounding of the upper body, it is critical to work on this as soon as you are mobile and pain-free. Sitting and standing posture exercises should be done as often as possible. However, it should not be mixed with your cuddling, napping and bonding time.
PHASE II: 5-6 Weeks Post Delivery
Your next assignment is to reconnect the pelvic floor with your brain. Getting the muscles, connective tissue and ligaments deep in the pelvic floor to ‘fire’ in harmony with improve all areas of your life moving forward. And I really mean all movement – sex, laughing, coughing, bending over, running, etc…
Perform Kegels as often as you can. The minimum amount of sets should be 2 minutes at least 4 times during the day.
PHASE III: 6-7weeks + Post Delivery
As soon as you are able to perform walking, jogging, recumbent biking or elliptical movement begin at a low intensity. But while moving you should be concentrating on engaging and squeezing the pelvic floor muscles and pulling your abdominals up and in to help lift your posture. Normally low intensity cardio is not my recommendation for weight loss or metabolic training. But in this case, I am a fan of the treadmill and elliptical because the movement is weight bearing, and repetitive allowing you to simultaneously focus on the pelvic floor integration.
PHASE IV: About 8 weeks Post Delivery
If you think about it, having a baby means you are committing to being a life-long multi-tasker. But it has to extend beyond, folding clothes with one hand and holding the baby. You must apply multi-tasking to exercising, sitting and standing. So you will always need to apply a little brainpower to the pelvic floor and correct alignment of your posture otherwise you will just be burning calories and not building strength. Strength training the body is the key to getting your body back and improving your metabolism.
Here are the exercises I suggest around 6-8 week post-delivery.
- Bridges on the floor with a small ball squeezed between your legs. Bridge, hold, squeeze the ball 10 times, lower down and repeat 10 -20 times.
- Bicycle Crunches. I suggest starting with sets of 20. Work up to 5 sets.
- Step ups with dumbbells. Keep the step between 6-8 inches. Although I want you to build strength in your legs, focus on perfect posture as you take each step. 10-15 reps per leg for up to 3 sets.
- Xering abduction lifts require a rubber ring that goes around your ankles. Once it is around your ankles, shift your weight to one leg (balancing with good posture) and lift your leg between 9-18 inches form the ground. Control each rep as it returns to the starting position. As you lift your leg each time, squeeze your glute. You can also hold onto something to help you with your balance so you can concentrate on your posture and alignment. Perform 10-15 reps per leg for up to 3 sets total.
- Planks on your forearms or hands are fantastic. You can add so many different variations. Try to avoid being on your knees. Even if you can only hold the plank on your forearms (no knees) for 5 seconds start there. Make sure your mid section is not sagging. You can always lift your hips up higher. I recommend 10-30 second sets and repeat 3-5 times. Add variations like touching your knee to your elbow.
Most of the advice I have provided above is suitable for a healthy woman. Your doctor will always be your final advisor. The key is whether your incisions are healing well enough to begin the more challenging exercise routine and if you are experiencing pain when doing any of the movements. Always listen to your body and try to reach out to women who have been successful exercising after the birth of their kids. Despite the fact that exercise was a big part of my daily routine throughout my pregnancy, it was hard after giving birth to get back to it. I was tired too. One thing got me through it – I NEVER BROKE PROMISES I MADE TO MYSELF. If I promised to train, I did. I knew that I would feel amazing afterwards – both my body and mind. Good luck with your healing and Congrats on the having your baby!