C-section recovery guide
What happens in a c-section?
A caesarean section is major open abdominal surgery that accounts for approximately 1 in 4 births in the UK. Despite this common occurrence there isn ’t much published guidance to help you feel prepared for your recovery from a c-section birth. During a c-section your consultant will cut through several layers to access your baby and bring them out gently, along with the placenta. The incisions will be stitched together using dissolvable stitches, or stitches/staples that will need to be removed a few days later.
Types of scar
When a scar heals, a good visual outcome is a flat, white scar that leaves a very fine line. This is known as a normotrophic scar. It is important to remember that it will take two years for your scar to reach full maturity and will go through many changes in this time. It is important to be aware of other types of scaring and understand how it is best to treat them.
A keloid scar is darker than the normal skin tone, raised and they extend beyond the original wound border. Keloid scars can be painful, itchy, sensitive to clothing and may continue to grow if not treated correctly. Early intervention is key!
A hypertrophic scar is also darker than the skin tone and raised, however a hypertrophic scar will remain within the original border of the wound. They will usually improve overtime but are slower to heal. Symptoms may be similar to that of a keloid scar. Compression can help to reduce the development of a hypertrophic scar.
A widespread scar occurs because of tension on the wound in early healing, They are flat scars that are wider than usual and may have striations across the surgical cut.
The first 6 weeks
You have just had major abdominal surgery! In the early stages allow people around you to help. You should avoid getting up too many times and allow yourself time to rest and recover. When getting up from lying down, roll onto your side and push yourself up with your hands. Avoid bracing heavily through your abdomen as this will place too much strain on your scar, and may place you at risk of re-opening the wound.
When you feel ready, return to very gentle walking with a slow build up. Be mindful of your posture and ensure you are not bracing through your abdomen. If your scar becomes more sore than it is at rest, or you are feeling pain in other areas, then reduce how much you are walking until you can do so without feeling these symptoms.
Your tummy will be swollen and inflamed following surgery, it is very common for c-section tummy ’ s to take a little bit longer to reduce compared to vaginal births. Applying compression will not only help with reducing swelling but it will also help you to feel more supported when moving around. There are numerous compression garments available to buy in the style of pants, shorts and belly binders. I would also recommend a tubigrip, size K or L is usually suitable. Remove compression when you are resting and allow air to your scar to aid healing.
During pregnancy your rib cage shifts to make room for your baby and taking a deep breath can become difficult. Introducing breathing exercises in the early stages of postpartum recovery encourages efficient breathing with the diaphragm, and allows your deep core stabilising muscles to contract which contributes to improved posture. Diaphragm breathing will also calm your nervous system, this reduces stress and promotes relaxation.
Diaphragm breathing; Place one hand on your stomach, and your other hand on your chest. Take a deep breath in, and push your belly outwards. Try and keep the movement of your chest to a minimum, so you concentrate on taking a deep breath. When you breathe out, allow your rib cage to relax, do not force your breath out.
Your pelvic floor is an important group of muscles that support your pelvic organs and play an important role in bladder and bowel control, as well as sexual function. During pregnancy hormones cause your pelvic floor muscles to relax and they are under increased strain due to the weight of your baby. This can make it harder for you to control your bladder in later stages of pregnancy and can often be a problem after birth. Although this is common, it is not normal! When you feel ready, identifying your pelvic floor in the early stages of postpartum can help to prevent issues developing as you become more active.
Identifying your pelvic floor; Lie on your back with your knees bent, using diaphragm breathing, take a deep breath in. As you breathe out, squeeze around your back passage as though you are trying not to pass wind, and then imagine you are trying to squeeze the front and back of your pelvis together. Relax as you breathe in. Try to avoid pulling in your tummy, squeezing your legs together or tightening your buttocks. A pelvic floor squeeze should be gentle!
Reaching 6 weeks postpartum can feel like the first big milestone. Around this point you should see your GP for a check up and will likely be signed off. This should be viewed as a sign off to begin rehabilitation. You should book in to see a women ’ s health specialist and undergo a comprehensive postnatal check to assess your recovery and create agreed goals of rehabilitation. By this point you may be considering returning to your usual exercise routine, or you may want to lose weight. Before rushing in to exercises it is imperative to gain a detailed understanding of which types of exercise are suitable for you at this stage in your recovery. Everyone will recover differently and it is important to do things when you feel ready. A postnatal check can still be done many years postpartum!
A postpartum check at Femme Health Clinic will include: A detailed consultation of your pregnancy and birth history Breathing and ribcage assessment Posture and functional movement screening External pelvic floor assessment Abdominal assessment C-section scar assessment A tailored treatment and rehabilitation plan.
After 6 weeks
During pregnancy your pelvic floor muscles stretch and your pelvic organs will move, altering your posture. All of this can contribute to an increased risk of pelvic floor dysfunction due to muscular imbalances within the core and pelvis.
Your rehabilitation should include;
Pelvic floor and core
Abdominal wall rehabilitation
Reintroduction of functional strength exercises
Cardiovascular fitness
Impact exercise should not be introduced until at least 12 weeks postpartum and you should follow a personalised rehabilitation programme to rebuild strength first.
C-section scar massage
As your body heals from a c-section, scar tissue will form to close the wound. Scar tissue is fibrotic, “sticky” and less mobile than normal tissue, this can lead to the formation of adhesions causing layers underneath the skin to stick together. Fascial restrictions created by adhesions can lead to multiple issues such as: digestive problems, neck and shoulder pain, bladder issues, menstrual pain, pelvic floor dysfunction and joint pain including the lower back, knees and hips.
By using scar massage and mobilisation you can help the scar tissue to blend with the tissue surrounding it and ease issues caused by adhesions. Connective tissue in the body is constantly changing by reshaping and regenerating itself. It is for this reason we are still able to affect older scars. Scar massage should be started once your scar has healed and is free of stitches and scabs.
Download my free c-section scar product guide to discover which products are most suitable to use on your scar to aid healing. (Link in instagram bio).
Disclaimer
The information in this guide is intended for your general knowledge and should not replace any personalised professional medical advice. Consult your healthcare provider with any questions or concerns you may have regarding your health.