C-Section Recovery Week by Week - The Must-Have Recovery Tips

C-Section Recovery Week by Week

Congratulations! Birth can be one of the most incredible and transformative experiences of your life and C-Section birth is no different. The Empowered Motherhood Program  C-Section Recovery Week by Week Program has supported thousands of women to heal from their C-section birth and return to the type of exercise they love.

In this post, we take all of our knowledge and experience from this program and share it with you. We hope you find a few nuggets of wisdom.

It's important to remember that every woman's experience with birth and postpartum recovery is unique, and all of your emotions surrounding birth are valid. You may have planned your C-Section birth, knowing that it was the best option for you and your baby. On the other hand, a caesarean birth may have been completely unexpected and a deep departure from the birth you had planned. We hope that in this post, you will find the resources and tools you need to support your Caesarean section recovery alongside your mental and emotional healing.

C-Section Recovery - The First Two Weeks  

If you have had a caesarean birth, you will know it is definitely not the easy way out. In fact, it is the opposite. We believe that as a C-Section mother, you are truly unique. It is the only time in your life when you will undergo major surgery and will also be given a new baby to take care of.

Most people don't realise that after a C-Section Birth, six layers of tissue require healing simultaneously.  There is a huge load on you at this time as a mother, and we want to help lighten it a little.

C-section recovery takes time and patience. It also requires the vulnerability to ask for help. The first few weeks can be extremely painful. Especially if you are unable, or choose not to, take the recommended pain medications. 

Let’s look at what to expect in the first week after a C-Section birth and some C-Section recovery tips for the first two weeks.

Pain Management

Everyone’s measure of pain is different. However, we know that for most women, pain after their C-section birth generally peaks around 18-24 hours after delivery. Trust us, the pain will come as a shock. It is very real, and it’s a lot. It’s just another reason why they say strong as a mother. But this isn’t something you need to battle through. Our goal in the first week is to optimise healing, and severe pain can interfere with your body’s healing ability. 

If you can, we recommend taking pain medication in the first 24-48 hours after delivery to assist with managing your pain. Managing your pain well will also support your ability to start moving earlier. Don’t be afraid to ask for stronger pain relief if your pain starts to become too much for you. Continue to take simple analgesia such as paracetamol and ibuprofen for the first week following your C-section.

Walking and Movement 

The Empowered Motherhood Program C-Section Recovery Program is designed to be done from birth (once your catheter has been removed). This is because we know that gentle movement and mobilistation will help to improve circulation, improve bowel function and reduce your risk of blood clots, deep vein thrombosis, constipation and infection. The first two weeks of the EMP C-Section Recovery Program focus on gentle core and pelvic floor activation, postural support and upper spine mobility. This will help alleviate any neck or shoulder pain. 

The first two weeks of the C-Section Recovery program also include some incredible expert education to help you feel informed about your birth and how to heal your body in the best way possible.

Pelvic Floor 

Generally, your catheter will be removed the day after your C-section. Once your catheter is removed, you can start gentle pelvic floor contractions. The process of pregnancy itself places a significant load on the pelvic floor. During pregnancy, the levator hiatus (the pelvic floor outlet through which the urethra, vagina, and rectum pass through) increases in width as the muscles of the pelvic floor start to thin and stretch. In addition, there is an increased mechanical load on the pelvic floor from the weight of your baby, the weight of the uterus and placenta and the increased blood volume and body weight.

This happens prior to birth, which is why even if you had a cesarean birth, your pelvic floor will be in a weakened state and your levator hiatus will be wider than what it was pre-pregnancy. 

The EMP C-Section recovery program includes gentle early postnatal pelvic floor and core workouts to help you to re-gain strength and control through your pelvic floor.

Breastfeeding

Depending on whether you had a planned or emergency C-Section, your milk may take some time to ‘come in’. We know that this can feel distressing, but please be assured that your baby only needs small amounts of colostrum in the first few days. This can be pre-expressed in pregnancy or hand expressed in the postnatal period. 

Most hospitals will now allow for immediate skin to skin contact as a general rule (with exceptions where the health of your baby requires immediate care).  Skin to skin contact not only helps for bonding with your baby but also supports early breastfeeding.

Physically, breastfeeding after a c-section birth is challenging. Seeking the advice of your midwife can help you to find the best position for you and your baby. You may want to try side-lying or football hold positions in the first few weeks after birth. 

Watch this short video on breastfeeding essentials here with Lactation Consultant and Midwife Cathy Shortt.

Wound Management and Compression

Our goal. Avoid infection. Think 'clean and dry', 'clean and dry'. 

You can shower within a day of your surgery, but please note that baths are not recommended until your incision has healed. Avoid scrubbing or rubbing your wound. Dry the area by gently patting it with a clean towel or cloth. Some women have recommended using a hair dryer set to cool to dry their incisions.

In the first few weeks post-c-section, there is a lot of pain and inflammation surrounding your wound. Research has shown that applying compression to an abdominal wound following surgery reduces pain and increases mobility through your wound and abdominal wall. Using a pillow or rolled-up towel to gently compress your wound when you move, get in and out of bed, open your bowels or sneeze, cough or laugh in the early days of your postnatal recovery can greatly assist with your wound management and reducing inflammation. 

Please see the video above where Titled Women's Health Physiotherapist and EMP Founder Lyz Evans shares tips on early C-Section recovery and why a pillow or towel is a must for those first few days at home.

Low-level research shows that wearing Tubigrip in conjunction with gentle core activation can help reduce inflammation and optimise healing in the postnatal period. Tubigrip is very soft, so it is quite comfortable to use in the first week after birth. 

Tubigrip can also provide biofeedback to remind you to maintain your posture and engage your core. You should only need to wear it for a few hours each day when you are going to be more mobile or need more support. 

Mental Health 

Having supported thousands of women, including women's health physios, GPs, midwives and obstetricians through their own C-Section recovery, we know that the decision to have a caesarean birth is never made lightly. 

Birth is more than simply a way to get the baby out. It is an incredible and often life-changing event. One that we often spend years thinking about and dreaming of. So when your birth doesn’t go the way you had planned, you may be feeling traumatised, disappointed that you were robbed of the birth experience you were after and perhaps even disconnected from your baby. All these feelings are valid and normal. 

Your mental and emotional well-being as a mother is just as important as your physical well-being. We know that your birthing experience can affect your confidence and sense of self, including your:

• ability to connect with your baby and/or partner,
• ability to have sex without pain or fear;
• ability to exercise; and
• productivity at work.  

A key goal of the Empowered Motherhood Program is to end the taboo when it comes to birth trauma. There are incredible organisations like the Australasian Birth Trauma Association, the Centre of Perinatal Excellence (founder Dr Nicole Highet is our expert psychologist in the EMP), the Gidget Foundation and PANDA, which all have tools, support networks and resources designed to support parents who have experienced a traumatic birth.

If you are feeling let down or scarred from your birth, you are not alone and there is support available to you. So please reach out because your mental health matters. 

For more on healing from a traumatic birth, please watch this video https://www.empoweredmother.com.au/blog/healing-from-a-traumatic-birth

Lochia 

Thought postnatal bleeding was just for vaginal births? Sorry. Lochia (a combination of blood, mucus, and uterine tissue) is part of the healing process and occurs whether you have had a vaginal or c-section birth. So be prepared to bleed for up to six-ten weeks post-birth.

If you are at all concerned about the amount of lochia you are experiencing, are passing clots larger than the size of a golf ball or are filling more than one maternity pad per hour,  please reach out to your midwife or health care professional.

Constipation and Gas

The double whammy. As if you needed this.

Firstly, that first postpartum poo can be scary. Using a pillow when you open your bowels can help to support your wound.  The combination of drugs used in abdominal surgery can cause your bowels to become sluggish or completely  "shut down", so use stool softeners to help you to make that first postpartum poo soft and easy to pass.

If you have had a C-section before, you may have experienced pain in your right shoulder or a headache that just wouldn’t go away. Strangely, both of these things can be caused by gas. Post-surgery, trapped gas can press on the diaphragm and this can trigger a nerve and extend the pain to the shoulders. 

For this reason, your midwife may offer you anti-gas medication. Releasing trapped gas is another reason that movement is encouraged early after your C-section surgery.

Other issues to be mindful of in the first two weeks

• Blood Clots: A C-section birth increases your risk of postnatal blood clots. Wearing your hospital compression stockings and regular movement can help reduce your risk of blood clots. If you have any warning signs, such as redness, pain, or swelling around the wound, or are passing blood clots larger than the size of a golf ball or filling more than one maternity pad per hour, please check in with your GP or Obstetrician. 
• A post-dural puncture headache is an unusual and specific kind of severe headache which can only happen after an epidural or spinal injection. It can be felt at the front or the back of the head. If you are experiencing a strong or severe headache after your birth, seek immediate assistance from your GP or obstetrician. 

 C-Section Recovery Weeks Three to Six  

Congratulations on making it past the hardest two weeks of your C-section recovery. Your pain may have reduced, but we know that lack of sleep, constant pain management, hormonal changes and the whirlwind that is postpartum life can take their toll.

Be kind to yourself, Mumma. You are still deep in your recovery and deep in the process of learning about your new baby (and perhaps learning about yourself as a mother).

In Weeks 3 to 6 of the Empowered Motherhood Program C-Section recovery program, our focus is on helping you start to re-build strength and control through your pelvic floor and core while creating mobility throughout your entire body.

Starting immediately from birth, your body will go through 4 main stages of healing. One of these stages involves the laying down of new collagen fibres and the contraction of the scar tissue. These new collagen fibres are laid down in a very haphazard and disorganisedly. 

In weeks three to six, our classes are designed to help you mobilise your scar so that it doesn’t heal tight and thick and stick to the organs around it. Because our founder, Lyz Evans, filmed these workouts while she was recovering from a C-section birth herself, we know that they will really resonate with you and help you feel stronger and more mobile.

Let’s look at what to expect in the first week after a C-Section birth and some C-Section recovery tips for weeks three to six. 

Wound Management 

By the third week after the surgery, the inflammation phase of wound healing is starting to subside, and the wound edges are beginning to come together. The incision site may still be swollen, tender, and red, but these symptoms should gradually improve over time. You may still be experiencing some discomfort and may need to continue taking pain medication as prescribed by your doctor.

It's essential to keep the incision site clean and dry during this stage of healing to prevent infection. 

Your pain should slowly start to reduce week by week until week six when the incision site should be almost fully healed. To continue to protect your wound, we recommend avoiding any heavy lifting or straining. Please note that this includes avoiding straining on the toilet. Make sure you are drinking enough water (which can be really hard as a mum!) and are eating fibre-rich foods.

Try to stick with lifting objects that are around the same weight as or less than your baby's weight. Use your breath to support any lifting you are doing. Exhale and engage your pelvic floor and deep core before lifting.

Certain clothes may irritate your wound. Tubigrip can be a great tool to use in the first few weeks of C-section recovery. It is not only soft and gentle on your scar, but it can also serve as a reminder to engage your core and protect your back. 

As your wound heals, it may become itchy, or you may notice a pulling sensation at one end of your stitches. These are quite normal parts of your recovery, and hopefully, you will reduce that pulling sensation once you start wound massage (see below for tips).  However, if you experience abnormal symptoms, such as fever, increased pain, or discharge from the incision site, immediately contact your GP or OB.

Returning to Exercise 

The EMP C-Section Week by Week Program guides you through every stage of your postnatal recovery. The first two weeks are all about working with your body’s natural healing processes to help optimise your postnatal recovery. 

Weeks three to six are when we really focus on mobility and starting to build strength and connection through your pelvic floor and core. Returning to exercise after a C-section birth can feel quite intimidating, so our early postnatal workouts are led by a women’s health physiotherapist to help you feel safe and confident as you start to rebuild strength and tone. 

There isn't a one-size-fits-all answer when it comes to postnatal recovery, and this is why we offer a personalized where-to-start quiz to help you find the best programs and workouts for you. How quickly you progress through the program will depend on your exercise history, any complications you may be experiencing, the amount of rest you are getting, and how consistent you can be with your exercise.

Our motto is to help you feel energised, not exhausted, and our workouts are designed accordingly. We know how demanding life as a new mum is, and we want you to have enough energy to go through your day while doing everything you can to heal your body in the best way possible.

Because our C-Section week-by-week program has been designed specifically for C-section mums, it should never feel painful. If you are experiencing any pain through your wound or anywhere else in your body, we recommend stopping exercise and checking in with your health care professional. 

Pelvic Floor

When women who have given birth by Caesarean section are examined postnatally, there is a clinically significant reduction in pelvic floor strength and also a descent of approximately 4.9mm. This shows that pregnancy itself, rather than the mode of delivery, impacts the pelvic floor, which can be seen in the postnatal period.

Your pelvic floor is a combination of muscles, ligaments, and fascia that sit in your pelvic bowl. It connects to your tailbone and the back, your pubic bone at the front, and your sit bones on either side. It acts like a hammock or sling to support your bowel, bladder, and uterus.

From this, we know that pregnancy itself will place an increased demand on your pelvic floor, and it is important to rehabilitate and strengthen your pelvic floor.

The pelvic floor is responsible for:

• Supporting the organs of the pelvis during rest and whilst moving. A job which is much harder during pregnancy.
• Maintaining continence.
• Increasing pleasure and sensation during sex.
• Supporting your organs during high-pressure activities such as coughing, jumping or sneezing. 

No matter how you give birth, your postpartum recovery starts with your pelvic floor! 

Watch this short video on how to strengthen your pelvic floor after birth here.

Back Pain 

Back pain can be incredibly common after a C-section birth. On top of everything you are already dealing with, back pain is probably the last thing you feel like and can be a source of a lot of frustration (not to mention pain!). Here are four reasons why you may experience back pain after your c-section birth and some tips for managing your pain. 

1. Postural changes: As a new mum, you're going to spend hours and hours hunched adoringly over your baby. Feeding, changing, and rocking to sleep involves a forward fold position and can put a lot of load on your lower back. If you have not done a lot of exercise during your pregnancy, this can lead to weakening in your postural muscles and can make you more susceptible to this type of pain. This is why a lot of our focus in our Pregnancy Program and our early C-section week-by-week program is on postural support and strengthening. 
2. Healing process: A caesarean section involves a surgical incision in the abdominal wall, and the healing process can be painful and slow. The pain from the incision can radiate to the back, especially if you have stopped or significantly reduced the amount of pain medication you are on. Naturally, we tend to hunch forward to protect our wound, and this can exacerbate the amount of back pain we are experiencing. If you are still experiencing pain in your wound and this is causing you to be restrictive in your movements, taking simple analgesia or ibuprofen can help with long-term recovery. 
3. Weakened Abdominal Wall: When your abdominal wall is in a weakened state, it is not able to support your spine as well as it could pre-pregnancy. This places more load on the muscles of your back and pelvis. This is why it is important to start re-building your core connection as early as you can in your postnatal recovery in a safe way. Our early core workouts focus on strengthening the deepest layer of abdominal muscles - your transversus abdominis and include exercises such as pelvic tilts, gentle core activation in supine and all fours and diaphragmatic breathing. This can help restore the strength and function of the abdominal muscles, reduce stress on the lower back, and relieve back pain.
4. Hormonal changes: Hormonal changes designed to lengthen and stretch the muscles of the pelvis affect the whole body. It takes time to rebuild strength and control through your entire body. Whilst your body is in this changed hormonal state (which can continue for up to 18 months postpartum), you may be more susceptible to strain and injury.  

Mental Health 

"As long as the baby is healthy, that's all that matters". We don't agree with this often-quoted statement.

Birth is more than simply a way to get the baby out. It is an incredible and often life-changing event. One that we often spend years thinking about and dreaming of.

So when your birth doesn't go the way you may have hoped, it can leave you feeling let down, ripped off and, in many cases - traumatised. Added to that, women who don't have the 'perfect birth' often mention feelings of failure and guilt. 

In one Australian study involving 500 birthing women, one in three women (33%) identified their birth as traumatic.

In addition to this, many new mothers can experience feelings of overwhelm and anxiety in the early years of motherhood. 

If you are struggling at all with your mental health, then please reach out for support. And if you need support in processing your birth or talking to a healthcare professional, we recommend getting in touch with the Australasian Birth Trauma Association.

For more on healing from a traumatic birth, please watch this video https://www.empoweredmother.com.au/blog/healing-from-a-traumatic-birth

Core Rehab

It often surprises a lot of mums that they still look seven months pregnant after giving birth. Your abdominal wall has had to stretch significantly to create space to grow your baby, and despite what we see on social media, it doesn’t just bounce back.

 During pregnancy, the abdominal muscles lengthen and thin in order to create space for your baby. This creates an appearance of a distended belly in the postnatal period when these muscle fibres remain in a lengthened and thinned state.  

In addition, the linea alba, a band of connective tissue that runs from the breastbone to the pubic bone, will also have thinned and may have several tiny micro-tears, which can contribute to abdominal muscle separation beyond the normal ranges.

In addition, at 3 weeks postnatal, your uterus will still be enlarged, and the peritoneum (lining of abdominal contents and the fascia in the abdominal area) will still be distended. All this is to say that it is COMPLETELY normal to still look pregnant in the postnatal period. Healing your abdominal wall takes time and a lot of self-acceptance and love.

 You may also have some degrees of abdominal separation (which is a normal part of pregnancy and not something to be afraid of!). Abdominal separation can usually be healed with the right exercise, breathing and movement patterns. Support garments such as recovery shorts and tights can help in this stage of your recovery to reduce the enlargement of your abdominal wall and assist in helping the muscles and fascia to 'stiffen' and tighten.
  

In the Empowered Motherhood Program, our Core Connect series will help you to:

• Breathe Well: Learn to breathe in a way that supports the natural movement of the abdominal wall;
• Improve Posture: Our early postnatal classes are designed to help improve mobility and posture so that your abdominal wall can function optimally. This is incredibly important for our C-Section Mums, who often feel pulled forward by their wound.
• Engage your Deep Core: Our physio-led classes are designed to help you properly engage your deepest layer of abdominal muscles, your transversus abdominis (TvA).
• Heal Separation: A mistake that we see women make is that they stick to safe “TvA” exercises such as toe taps, heel slides and pelvic floor exercises. Building strength and muscle bulk in your rectus abdominis and obliques will also help to

C-Section Recovery Weeks Six to Twelve

You made it! The first six weeks of your c-section recovery are done! Well done!

Six to Twelve weeks of your postnatal recovery is Level 2 of the EMP. This is where we really focus on building strength and control through your core, starting to incorporate functional strength training and really helping you to start to feel more like your normal self.

It is also where we start to introduce C-Section wound massage into the program.

Six weeks is also the time you might have an appointment with your GP. Read this article to see why we also recommend making an appointment with your women’s health physiotherapist at this time.

Wound Massage 

As we mentioned above, when your C-section scar heals, new collagen fibres are laid down in a very haphazard and disorganised way. The goal of wound massage is to mobilise the scar so that the scar doesn’t heal tight and thick and sticks to the organs around it.

When you massage your C-section scar, you help the new collagen fibres align and lay more uniformly. Massage can also help increase blood flow, reduce scar thickness and tension (the pulling sensation we referred to earlier), reduce scar appearance, and improve posture and core activation.

If you don't massage your wound, scar tissue may build up, and you may experience: 

• 
Lower Back Pain
• Poor Posture 
• Irritation of your Bladder (and feeling like you constantly need to go)
• Lack of core strength and healing 
• Pelvic Pain 
• Pain with intercourse 

We recommend starting your wound massage at around 6-7 weeks postpartum. The wound must be closed and have healed well. Your stitches should be removed and no further dressing placed on your scar. The first few times you massage your wound, you may only feel comfortable touching it very gentle and releasing the tissue above and below your scar.

You can start a very gentle massage when your scar has healed well. The first stage of wound massage is the superficial layer (the skin layer). Start by gently rubbing along the wound and feeling for any restrictions. If you feel a tight spot, stay on that spot and work on releasing those tight collagen bands that have healed haphazardly. 

The second and third layers of scar massage include muscular and visceral release.  These both involve a deeper massage into the muscles and organs surrounding your wound.

You may want to add some gentle mobilising movements to your massage to help release tight muscles and fascia.

The EMP C-Section program includes C-Section wound massage, wound de-sensitization and wound mobility.

Return to Running 

Running after birth.  It can feel heavy, strange and even scary. So why do so many women want to rush back to running after birth? Well, there’s the feeling of freedom of being outdoors and out of the house. The mental and physical release. The endorphin rush. And of course, the weight loss that often accompanies running.

But before you lace up your trainers and get the jogging pram out - STOP!

We want to make sure that your body is RUN READY! Why? So that you don’t suffer the consequences of a premature return to running, including prolapse (or making your prolapse symptoms worse), incontinence, pelvic pain, and musculoskeletal injury.

Considering all of the above physiological changes (mental and emotional changes, lack of sleep and nutritional factors), most women won’t be ’RUN READY’ until six months, and some might not be ready until 12 months postnatal. 

However, as a general rule, we recommend that all women wait until three months postpartum for the reasons above (and below!).

If you are interested in returning to running after birth, we recommend reading this article here.

C-Section Recovery with Prolapse 

If you are living with prolapse and have chosen to have a c-section birth for your second or subsequent births, the approach we take in the Empowered Motherhood Program is to focus on your c-section recovery for the first six weeks with a specialized emphasis on your pelvic floor.  From twelve weeks postnatal, we recommend that our members switch to the EMP Pelvic Floor Safe program which is a specialised week by week program designed for women living with prolapse, OASI, avulsion or other pelvic floor complications.

Sexual Intercourse and Intimacy 

Sex may be the absolute last thing on your mind. Culturally, there is an expectation that we place on mothers to return to sex after birth at or around the six-week mark. This arbitrary date is often prescribed because a woman has been ‘cleared’ for sex, meaning her risk of infection is minimal.

This does not mean that she is physically, mentally or emotionally ready. Your journey back towards sexual intercourse depends on a myriad of factors and should be done at a time and in a way that makes you feel safe, supported and loved. For some women, this can begin with self-pleasure as they become re-acquainted with their own bodies after birth.

In the EMP, we are lucky to have a range of expert interviews which help you to understand a little more about the way your body has changed after birth and how you can best support yourself to return to intimacy and sex after birth.

Summary

We know just how physically and emotionally taxing a caesarean birth can be. We have supported hundreds of women through their C-section recovery, and we understand how difficult it can be to recover from major abdominal surgery whilst caring for a newborn.
We are here to support you in healing your body in the best way possible.

Through the Empowered Motherhood Program C-Section Program, we will work with you to help heal your C-Section wound and create a strong and functional core.

But more importantly, we will support you as you find a place of acceptance and appreciation for your body and the entry point your baby made into the world.

We believe that as a C-Section mother, you are truly unique. It is also the only time in your life when you will undergo major surgery and will also be given a new baby to take care of.

Whilst you might not feel like you have time for your own recovery at this stage, there are some simple yet incredibly effective steps you can take. We will show you how you can heal your wound, strengthen your core, and recover from your C-section birth in a way that is empowering and nurturing.

Kimmy and Lyz x