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 enough to drink (aim for 1 1/2 – 2 1/2 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.
Wound support and breathing
- Support your wound with your hands or a pillow if you need to cough, sneeze, laugh or go to the toilet to open your bowels.
- Relaxed abdominal breathing - feeling the tummy gently rise and fall with deep breaths in through the nose and out through the mouth, up to 5 breaths at a time - can help to relieve the discomfort of wind pain and after birth pains.
It is important to start deep breathing and huffing/coughing exercises as soon as possible to keep your chest clear.
- Sit in an upright position and take a deep breath into your lower chest and out again.
- Take 3-4 deep breaths followed by a huff (forced breath out) 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.
Do this pelvic tilting exercise regularly during the day when lying, standing or sitting. Nappy changes are a good time to remember this exercise.
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.
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
- some slight leaking of urine, especially when you laugh, cough or run
- A change in sexual function
- Problems with bowel control - leakage of wind
- 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 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.
Let your tummy muscles soften and relax and them gently draw your lower tummy (belly button and below) in towards your spine - keep breathing normally. Do this often during the day and gradually increase the length of hold, up to 5 - 10 seconds. Rest and then repeat this exercise 5 - 10 times. You can practice this exercise when lying down on your side, on hands and knees, sitting or standing.
If you can't feel much try this: as you breathe in expand your ribs as much as possible. Hold that expansion while 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.
Every time you lift your baby, push/pull or change your position (eg rolling over in bed or going from sitting to standing), remember to first tighten your pelvic floor muscles and then brace your tummy muscles.
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.
Take care of your back by:
- Stand "tall". Imagine you have a piece of string pulling the centre of your head towards the ceiling.
- Change nappies, dress and bath baby at waist height. If you need to get lower, bend your knees and hips and keep your back straight.
- If sitting to feed your baby or expressing, sit in a comfortable chair with good back support. Consider using a footstool and/or pillow(s) to find the best position for you. Relax the muscles in your neck and shoulders when holding and feeding your baby.
- Avoid lifting anything heavier than your baby for the first 6 weeks.
- If you have a toddler, squat, kneel down or let your toddler climb onto your lap if they need comforting, rather than lifting.
- Whenever you are lifting, remember to bend your knees, keeping your back straight, brace your pelvic floor muscles and low tummy muscles, and hold the object you are lifting close to your body. Avoid lifting and twisting - move your feet to turn instead.
- When carrying your baby, avoid carrying on one hip as this increases strain on your back.
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.
Gradually regain your general fitness after the birth of your baby. You may like to start a walking program or join a Postnatal Exercise class, run by a physiotherapist, close to home.
Once you are more than 6 weeks postnatal, you may like to start gentle bike riding or swimming but please wait until your stitches (tummy or perineum) have healed. Yoga or Pilates may also be useful but please speak with your instructor before starting your first session.
We recommend avoiding high impact exercise (eg running, aerobics), contact sports (eg netball) or heavy weights for at least 3 - 4 months after the birth of your baby. A gradual return to these activities is also suggested. You must be confident that your tummy and pelvic floor muscles have returned to normal strength, and you are not experiencing any back pain, before resuming these high impact activities.
Women's Health Physiotherapy,
Women's and Children's Hospital Adelaide (South Australia)
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