Recovering after a Caesarean section - your body
caesarean; section; wound; muscles; pain; exercises;
After a caesarean section pain from your wound can make moving difficult. The following exercises can help you recover from both the operation and the pregnancy. It is important to have adequate fluids (aim for 2 – 3 litres per day then drink to your thirst) and regular pain relief, as this will help your bladder and bowel function and help you to move around more easily.
The first 24 hours
It is important to start deep breathing and huffing/coughing exercises as soon as possible to keep your chest clear.
- Sit up and take deep breaths into your lower chest.
- Take 3-4 deep breaths followed by a huff (forced breath out) and a cough while supporting your wound with a pillow or your hands.
- Tighten your pelvic floor muscles at the same time (check the topic on Pelvic floor exercises).
Do deep breathing, huffing and coughing exercises every hour that you are awake until you can comfortably get in/out of bed and walk around.
Simple leg exercises should be done until you are up and about to increase the circulation in your legs and reduce the risk of clotting. Bend and stretch your ankle and legs 10 times every hour that you are awake until you can comfortably get in/out of bed and walk around.
The next few days
Wind pain, pain when moving and back ache are common in the first few days.
Deep breathing for wind pain
- Lie on your back with your knees bent up.
- Take a deep breath in and let your tummy rise up at the same time.
- Hold this for a few seconds and then relax and slowly breathe out.
Repeat 4-5 times.
Getting in and out of bed
- When rolling or getting in and out of bed it is important to support your wound using your tummy muscles.
- Don't try sitting straight up from lying on your back.
- You need to roll onto your side with knees bent while bracing with your tummy muscles.
- Then push yourself up into a sitting position using your lower elbow.
While you are in hospital this is made easier by having the head of the bed raised up.
Pelvic tilting (for backache and for strengthening tummy muscles)
- Lie on your back with your knees bent.
- Place one hand on your pubic bone (the bone at the lower end of your tummy) and the other under your ribs.
- Breathe in and then as you breathe out slowly tighten your tummy muscles (so that your tummy is drawn in), and flatten your back against the bed.
- Your hands should move closer together.
- By doing this you are shortening your tummy wall muscles (rectus abdominis muscles).
- Try to hold the muscles tight for a count of 5 to 10 while breathing normally.
- Relax and repeat this 5 to 10 times.
This position – knees bent with 2 pillows under them and one for your head is a lovely position to rest in while in hospital. If you have lower back pain try lying in this position.
Pelvic floor muscles
These muscles support your pelvic organs (bladder, uterus (womb) and bowel). They become weakened during the pregnancy due to hormonal changes and by the increasing weight of your baby.
If the pelvic floor muscles remain weakened it is possible that you may experience
- Loss of bladder control (incontinence)
- A change in sexual function
- Problems with bowel control
- Prolapse – the gradual 'falling down' of your pelvic organs.
For all women after childbirth – including after a caesarean – it is very important that these muscles are exercised so that they return to normal. For more information have a look at the topic Pelvic floor exercises.
Pelvic floor exercises should be continued daily for the rest of your life.
More about abdominal (tummy) muscles
The most important functions of these muscles are to stabilise and protect your spine and to support your internal organs. During pregnancy these muscles are stretched a lot, so to get them to work well after the birth of your baby you need to get them back to their normal length and strength.
During pregnancy the muscles running between your ribs and pubic bone (rectus abdominis muscles) can separate – which can increase the risk of back pain.
This shortens the rectus abdominis muscles and is important in reducing any separation.
- Do the tilting when you are lying down (as described earlier) and also do it while standing against a wall.
- Stand against a wall with your knees bent and feet a little away from the wall. Breathe in and as you breathe out tighten your abdominal muscles and flatten your back against the wall.
- Hold this position for 10 to 15 seconds or longer while breathing normally.
This activates a deep muscle that wraps right around the abdomen rather like a corset. The muscle is called the transversus abdominis. It helps the back muscles protect your spine against injury and pain.
- Lie on your side with your knees bent comfortably and relax completely.
- Breathe in and as you breathe out try to draw your belly button in towards your spine.
- If you are doing it correctly you should feel this in the lower part of your abdomen between your belly button and your pubic bone.
It is also important to do this bracing while you are standing.
- Begin gently in the first few days, gradually increasing the strength and length of the hold.
- Aim to draw in your belly button for a count of 5 – 10 while breathing normally. Release slowly and relax. Repeat this 4 or more times.
This can be done often during the day.
If you can't feel much try this: As you breathe in expand your ribs as much as possible. Hold that expansion which you breathe out and draw in your belly button towards your spine. It may help if you imagine you are trying to do up a pair of tight jeans.
Pelvic tilting and abdominal bracing with alternate leg movements
This exercise is important if you have had a separation of your rectus abdominis muscles. This exercise is encouraged as a progression of the previous tummy exercises – it is important to check with a physiotherapist to make sure that you are doing this correctly.
- Lie on your back with your knees bent.
- Place one hand under your back and do a pelvic tilt. Remember to breathe normally.
- Hold the pelvic tilt (your hand should feel a constant pressure from your back).
- Slowly slide one leg down the bed keeping your foot in contact with the bed. Then slide the leg up again.
- Relax, then do this with the other leg.
- Repeat 5 times for each leg.
If you are unable to maintain your pelvic tilt as you move your leg, stop and try again when you feel stronger.
- Gentle walking is encouraged from day one after your operation.
- It is best to avoid high impact activity and contact sport for the first 3-6 months because your ligaments are softer than normal.
- Low impact activity such as brisker walking and swimming can be started when you feel comfortable and your wound is healed, usually 6 weeks postnatal.
- There are classes in the community run by physiotherapists for women who have recently had a baby. Ask your physiotherapist for more information.
Posture and back care
Pelvic tilting and abdominal bracing are essential exercises for maintaining good posture, and to prevent back ache that is due to bad posture and injury due to poor lifting and bending techniques.
When these abdominal muscles support the spine and increase how well the back muscles work this takes strain off the ligaments and discs of the lower back.
These exercises will benefit you all of your life.
Stand tall maintaining the normal curves in your spine with your chin in and shoulders back. Pull your belly button in slightly and tuck your bottom under (tighten your tummy).
Feeding your baby
- When feeding it is best to sit in a chair rather than sitting in bed.
- Sit well back in the chair and support your lower back by placing a rolled up towel in the hollow of your back.
- If possible put your feet on a low stool.
- Remember to keep your back straight and relax your shoulders.
- Bring your baby's mouth up to your nipple.
- You may need a pillow to support the weight of your baby.
Poor posture can lead to neck and back soreness. If this happens, try circling your shoulders several times.
Bending and lifting
Brace your lower abdominal muscles by drawing in your belly button whenever bending and lifting. Bend from your hips and knees keeping your back flat.
Hold the object close to your body and lift by straightening your legs.
Make it a habit to brace your lower abdominal muscles before and during bending and lifting. Contract your pelvic floor muscles at the same time.
It is recommended that you do not lift anything heavier than your baby in the first 4-6 weeks, but since you will have to do this sometimes remember to be careful and do these bracing exercises when you do need to lift something heavy.
'Mothers matter too – a guide to postnatal recovery following Caesarean Section', Women's Health Physiotherapy, Women's and Children's Hospital Adelaide (South Australia)
The information on this site should not be used as an alternative to professional care. If you have a particular problem, see your doctor or midwife.