According to the CDC there was a reported total of 3.79 million births in the United States in 2018. The cesarean (c-section) delivery rate in 2018 was 31.9%, similar to the 32.0% rate in 2017. With a nearly 1 in 3 chance of having a c-section, it is important that women understand what proper c-section recovery looks like. While most women (especially if their c-section is planned) expect some pain, a longer recovery, and certain restrictions that come with a c-section, many are undereducated when it comes to long-term c-section recovery. Mamas are given limited information about the need for scar management once everything is declared “healed” at the postpartum visit. I frequently hear from moms in our clinic saying that they wish they knew the importance of long-term c-section recovery.
The Cesarean Delivery Process
To understand more about the importance of proper c-section recovery, it can be helpful to understand what happens during a c-section. There are different approaches for the initial superficial incision, but most commonly an OB will use a low horizontal incision just above the pubic bone.
It’s key to understand that there are many layers of tissue and muscle that are disrupted during a c-section. The different layers that are affected with the delivery include:
- A few layers of fascia (aka connective tissue)
- Rectus abdominis muscle (6-pack muscle), which is stretched to the side
- Abdominal peritoneum (the lining of the abdomen)
- Visceral peritoneum (the covering of the abdominal organs)
- And finally, the uterus
The Healing Process
Now think about the fact that each of those layers has to heal. Healing occurs through the formation of scar tissue, and the scar tissue can extend deep into each of those layers mentioned above. The problem with scar tissue is that it doesn’t have the same properties as healthy, normal skin and it can spread beyond the line of the incision, causing a host of problems that we’ll talk about later.
Another important factor to point out is that the uterus sits behind the bladder so as the uterus incision is healing it tucks behind the bladder, which sometimes leads to scar tissue that forms around the bladder, leading to possible incontinence issues!
Common Issues After C-Section
There are a number of issues that women experience after having a c-section. And many of them are related to the presence of scar tissue. Some of them might even surprise you! These are the most common issues we see here at our clinic:
- Core weakness
- Burning, numbness, sensitivity, or pain along the incision
- Puckering or puffiness at the incision
- A “shelf” appearance at the incision
- Incontinence (You read that right! Just because you had a c-section doesn’t mean you’re exempt from pelvic floor issues!)
- Digestive issues (Sometimes this can stem from scar tissue spreading throughout your abdomen and limiting normal digestion)
- Long-term low back pain. (YES, sometimes low back pain 10+ years down the road can be related to your scar tissue)
Short-Term C-section Recovery
By following some basic recommendations, you can set yourself up for success when it comes to your c-section recovery. Implementing some of these tips right away can make a huge impact on your long-term recovery.
Gentle Exercise and Stretching
Immediately following your c-section it is key to get moving to promote healing. I’m not talking about running or getting back to your exercise class. Keep it simple: Trying to move around the house even once an hour during the day can help with blood flow and tissue healing. As you start with gentle activity, it is key to remember that these activities should not cause increased pain or increased vaginal bleeding. Pay attention to your body.
To keep scar tissue from limiting how your back moves, it can be helpful to try to lie flat on your back for a few minutes each day. Ideally you will lie flat on the floor with no pillow and with your legs straight. You may have to work up to this as you tolerate more stretching. Maybe while your baby is taking care of tummy time, you can lie right next to him or her to help your body recover, too! Simply lying flat on the floor like this can help very gently stretch the tissues to keep them from getting too tight. This exercise is especially effective since we spend so much time in a position where we are bent at our trunk and hips while caring for a baby.
Becoming more aware of your posture can also help to gently stretch out the incision as it heals. Trying to incorporate some shoulder blade squeezes (pictured below) can help strengthen your shoulder blade muscles to promote better posture. As you practice better posture, you might feel a gentle stretch at your incision. If you notice a more intense stretch, scale back a little to allow your incision to heal at a normal rate.
Scar Stretching and Scar Massage
Did you know that scar massage is an important piece of c-section recovery? Most women I talk to have never heard of scar massage after having a c-section. But incorporating scar massage into your c-section recovery can greatly improve the recovery process if performed correctly and can even help prevent long-term issues like low back pain.
Scar Massage During Healing
If any scabbing is still present (even if it’s just a little), you can gently start to stretch the skin above your scar. To do this: place your palm directly on the skin over your belly button and add some gentle pressure in toward your core and slowly pull the skin upwards towards your ribs. You may feel some gentle stretching at your incision, but this should not be painful. You can move your hand to the right or left side of your belly button and repeat the stretch. Stretch for 1-2 minutes per day.
Scar Massage After Healing
Eventually, once your scabs and skin have completely healed, you can begin doing the same skin stretching closer to and right on the incision (this may be anywhere from 6-12 weeks postpartum). As you get more comfortable touching this area you can start by doing gentle scar massage. To do this: take two to four fingers and place them directly on or just to the side of the scar line. Add some gentle pressure inward as you massage in circles, diagonals, zig zags, side to side, etc. Massage for 2-3 minutes, 3-4 times per week, using your own tolerance as a guide. There should be no bleeding that occurs with this, as your skin should be completely healed before starting this step.
Physical Therapy Treatment for C-section Recovery
A physical therapist can help you when it comes to scar and c-section recovery as well. Certain physical therapists are specially trained to help break up those deeper levels of scar tissue and teach you how to properly perform scar massage as well. It can be helpful to see a pelvic floor therapist, especially those that specialize in prenatal and postnatal care, as the therapist can also help you recover fully from your pregnancy while incorporating c-section care. They will assess your full body including posture and breathing to identify other factors that can lead to pain (such as back pain or pelvic pain) or pelvic floor dysfunction (such as prolapse, diastasis recti or incontinence).
Perhaps one of the most important factors in c-section recovery is working on how to properly re-train the transverse abdominis muscle for improved core, pelvic, and low back support. This can be difficult to accomplish on your own with exercises, so a physical therapist can make a big difference when it comes to strengthening the core. It is likely that your treatment would involve hands-on manual therapy, strengthening exercises, stretching, posture training, and breath retraining to help all aspects of your body to come together and get you back to the activities you enjoy without fear of overdoing it before your body is ready.
If you need guidance when it comes to your c-section recovery contact us to set up a FREE consultation with a pelvic floor physical therapist.