Tips From a Pelvic Floor Physical Therapist to Help Your Postpartum C-Section Recovery
Congratulations! If you’ve made it to this blog post, it’s likely that you recently birthed a baby (or are expecting to very soon). I want to provide you with some information that will hopefully help you in your postpartum C-section recovery. Know that there can be a lot of emotions around having a C-section, whether it was planned or unexpected, this is very normal. It seems many women leave the hospital after this major surgery only to feel like they have no idea how to care for their newborn, themselves and their scar…and this can lead to a lot of fear surrounding movement, recovery and general well-being after surgery. I don’t want that for you. My hope is to be able to arm you with some tools to utilize post-surgery that will empower you during an extremely vulnerable time.
What is a C-section?
So, let’s start with the basics…what is a C-section? A Cesarean section is a surgical procedure utilized to birth a baby. A lower uterine segment Cesarean section (LUCS) is the most common type of procedure performed today. This involves a horizontal incision just above the pubic bone that will cut through 6-7 different tissue layerings. I want to emphasize that this is a MAJOR SURGERY and should be treated as such.
C-Section Incisions and What to Expect
After a C-section is performed, your incision will either be stitched or stapled back together along with potential use of glue on the outside skin layer. You may expect some bleeding vaginally due to the incision made on the uterus, and you will likely be instructed not to lift or carry anything heavier than your baby.
C-Section Scarring
Let’s talk a little bit more about that scar. Scarring is a normal process of healing and there are many different techniques and self-care treatments that you can perform at home to assist your scar and surrounding tissues for optimal healing.
Protecting Your C-Section Scar
Initially, it is very important to adhere to your hospital's wound care guidelines. That first week of healing, your main priority is to keep it clean, protected and to stay on top of your pain management. A few ways to protect your scar would be increased awareness surrounding the way that you move your body around.
For instance:
Log rolling to get in and out of bed versus just sitting straight up → this will reduce the amount of intra abdominal pressure as well as reduce the amount you are “curling” up into your scar.
Using your arms to push out of a chair.
Hugging a pillow if you feel a cough or sneeze coming on.
Breathing through each activity you do versus holding your breath (again, we want to decrease the amount of intra abdominal pressure).
Avoiding overly flexed positions for extended amounts of time → we don’t want to encourage the scar to be in a shortened position. Being in an overly hip flexed, bent at the waist position for the majority of the day will encourage the scar to heal that way.
Try to position yourself throughout the day in a more upright position when standing, or fully extended while laying on your back.
If sidelying is a preference, try to keep your knees from coming too far up towards your chest.
Try to include small bursts of upright mobility. This will be very dependent on how you are feeling and recovering, but including short walks around your house is very important for circulation, muscle pumping and overall healing! Just remember, ALWAYS listen to your body and keep mobility to very short bursts of movement.
Lastly, and this is often a hard one, ASK FOR HELP! Now is not the time to be the hero. You literally had major abdominal surgery. If there was ever a time to accept or ask for help, it would be now!
This means letting someone else carry the car seat with the baby in it, asking someone to help get the baby out of the bassinet for you, asking for help getting positioned while nursing or bottle feeding, asking for help with diaper changes, baths, self-care, making meals…the list goes on!
Give yourself some grace and patience during the healing process while adapting to caring for a newborn and yourself at the same time. Don’t beat yourself up if you aren’t able to do all the things you think you “should” be doing according to all the advice and lists out there (including this one!).
Ask for help if you are struggling with an increased sense of anxiety and/or depression after having your baby, there are many postpartum mental health resources available.
Techniques for Reducing C-Section Scar Sensitivity
After that first week, you can start to perform some techniques, known as nerve desensitization, around the incision to help it from becoming too sensitive.
Why might you need to do nerve desensitization techniques?
When you have had an incision that cuts through so many different layers, your nerves are also likely affected. This can cause some increased sensitivity to the scar and surrounding area. Avoiding the scar and surrounding areas can often cause even further sensitivity. This may feel like burning, itching, stabbing or shooting pain, or sensitivity to pressure - even light pressure like your sheets laying on top of you.
Nerve desensitization techniques can look like starting with the surrounding area (not directly on the scar) and lightly touching and gliding over just above, below and to either side of the scar. I would recommend starting with your hand and/or other soft materials at first…things like a Q-tip/cotton ball, silk pillowcase or a soft blanket. As the nerve sensitivity starts to improve you can try some rougher materials like a loofah or a washcloth. You can start with just lightly touching these surrounding tissues and progress to gently rubbing back and forth.
Gentle C-Section Mobility Techniques
Aside from nerve desensitization techniques, you can also start to work on very gentle mobility through your center by focusing on deep, diaphragmatic (or 360 degree) breathing. As you breathe in through your nose, you allow your pelvic floor to relax and your belly, rib cage and sides to expand. You don’t want to push yourself into pain, so listen to your body with this and start slowly! As the weeks progress, you may find yourself tolerating deeper breathing and more belly expansion. You can even put one hand on top of your belly button, above the scar, to give yourself a cue to breathe into your hand. As you exhale, just allow that air to passively leave the body with your belly, ribcage and sides returning back to their resting position.
Another form of passive mobility (like the breathing technique just described) for the scar and surrounding tissues, is to practice laying fully flat on your back with your legs extended. If this is too intense for you at first, consider a small pillow under your knees and then progress to fully flat from there.
Reconnecting With Your Postpartum Body & C-Section Scar
You may have found yourself having a very unexpected C-section. If this was the case, you may struggle coping and may develop some negative feelings in regards to your scar…this may even be the case if your C-section was a planned event. If you are feeling this way, know that this is common and I want to encourage you to spend a little more time with your scar.
Try to place a hand over it while you breathe.
Try to get more familiar with your scar by looking at it in the mirror and gently touching it.
Try to think positive thoughts when you look at your scar → remind yourself of what that scar just gave you, how strong you are to get through something like that, and the story you will get to tell your child once they are older about how they came into this world!
These may seem a little silly, but our brain is a powerful tool! We want to try to train it to think positively and remind ourselves of what it just did…your body is a powerhouse that just got through one of the hardest things a human being can go through! It may not have been the plan, it may not have been the way you wanted it to happen, but you got through it and you are AMAZING and STRONGER because of it. If you are continuing to have a very hard time coping with the way you birthed your baby, I also want to encourage you to seek help from a medical professional, such as a perinatal or postpartum mental health professional.
C-Section Deep Core and Pelvic Floor Physical Therapy Techniques
And lastly, during this 2 to 6 week time period, depending on your symptoms and how you are feeling, you may start to work on very gentle deep core and pelvic floor activation. Now, this does not look like squeezing your pelvic floor and deep abdominal muscles as hard as you can. Instead, it looks like just going through a gentle range of motion with those muscles and coordinating it with your breathing. As you inhale and your belly, ribcage and sides expand, remember that your pelvic floor and core muscles are relaxed. As you exhale, instead of just allowing those muscles to return to their resting position, gently engage them by slowly drawing the pelvic floor up, and lightly and gradually drawing your lower abdominal muscles in towards your center, like they are zipping, wrapping and/or “hugging” you. If this is painful, back off. You want to start slowly with this and always remember to listen to your body!
C-Section Red Flags
During this 2 to 6 week time period where you are allowing your scar to fully heal, you also want to be aware of any major red flags - things like increased redness to the scar, increased discharge from the scar, if you start to run a fever, or suddenly have more pain than you did before, definitely call your doctor!
C-Section Scar Tissue Mobilization Techniques
Now, let’s cover the time period when your scar is fully healed. This is usually around 6 weeks and beyond. This is the time to start working on scar tissue mobilization and a little bit more reconnection to your pelvic floor and deep core muscles. There are many techniques you can utilize to mobilize the scar tissue once it is fully healed. As always, start very gently and to your tolerance. You don’t want to push, pull or move it so hard that it causes you pain. I would start with a technique called “cross-friction”. You can cross your third finger over the top of your index finger, then use the pad of your index finger, apply gentle pressure, moving up/down over the horizontal incision and along the length of the entire scar, or choosing sections. If you find an area in particular that feels “stuck” or is a little more tender, work a little more on that section to tolerance. You can also utilize a circular motion directly over the scar with your index finger and third finger as well as a rolling technique, taking the scar with both hands and rolling it forward and backward. Other methods include having one finger above the scar, the other below the scar and gently pulling in opposite directions - this can be somewhat intense and might be a good technique to use after trying some of the other ones! Same technique as above, but now with one finger on one side of the horizontal incision and the other on the opposite end pulling in and out. If you’re interested in more C-section scar massage techniques, click here for further information!
Functional Mobility After Your C-Section
Now that your scar is fully healed, you may also be doing a little bit more movement and activity around the house. I want you to be focusing on gently engaging your core to brace yourself when you do various tasks! This might look like on the exhale, gently lifting your pelvic floor, zipping/wrapping/hugging your lower abdominal section as you prepare to bend over to pick up your baby from the bassinet. Continue to breathe through the activity, but keep your deep core lightly engaged. Use that technique anytime you may be in an awkward position, carrying any amount of weight, lifting, bending, or moving yourself in and out of positions in the bedroom, bathroom, main room etc. I do want to note that you can be using this technique prior to the 6 week mark, but you do need to be cautiously listening to your body for any signs of pain or discomfort with that.
When to Seek Pelvic Floor Physical Therapy Following a C-Section
After you are several months into recovery, there are many ways to progress towards your long-term goals for your new life as a mom (or maybe mom of multiple children). If you are finding yourself struggling with any part of your healing process or postpartum recovery, please seek out a pelvic floor physical therapist near you! They can guide you through each phase of recovery, be a support person FOR YOU, and give you an individualized treatment plan to help you achieve your goals.
Reach out For Pelvic Floor Physical Therapy in Reno
If you are in the Reno or surrounding area, Advanced Pelvic and Spine Physical Therapy is here for you! We do also offer Telehealth/virtual visits if you are unable to come for an in-person session or are a further distance away from the clinic. Feel free to reach out by sending me an email or call the clinic directly for any questions you may have in regards to your postpartum experience…we are here to help!