1 Preparation

Now, if you’ve had an emergency C-section, then obviously it’s a bit late to prepare. However, all of these things will still be helpful to start doing now.

Preparing and practicing the following points can make the first few days and weeks after a caesarian so much easier:

  1. Practice getting in and out of bed safely. It will be tempting to try to sit straight up out of bed when there is no baby in your tummy anymore, but that can be painful and damaging to the wound at the base of your tummy. So, practice rolling onto your side first, bringing your legs over the edge of the bed, then using your arm to push yourself into sitting. Avoid using your abdominals. To get into bed, try crawling in on all fours, facing the head of the bed, drop down onto one hip, then slide your lower hand out to lie onto your side, again, avoiding any use of your abdominals.
  2. The medications you’ll receive in hospital may have a constipating effect. So, to keep things flowing freely, you might like to increase the fibre in your diet for the week before delivery, and keep it up for the weeks after. Similarly, keep well hydrated to keep your poo soft.
  3. Pack hospital clothes that won’t press on the wound line. Usually, the wound is about 10-15cm long, just about your pubic bone. So underwear that sits below or preferably above (think big granny panties) that line are best. Similarly, pants without a tight waistband are best.
  4. if you have toddlers, remember that you are not to lift anything heavier than your newborn for the first six weeks. Therefore, your toddler will have to get used to not getting picked up by mum. Encourage their independence by getting them to use stools to climb up to chairs/bath. Let them come to you and have cuddles at their level rather than lifting them. Teach them to climb into the carseat, stage by stage, by themselves.
  5. You’ll probably be advised not to drive for 6 weeks after birth. Make sure you have someone to drive you, or access to public transport that you can take a pram onto. Occasionally, doctors may give you the all clear to drive prior to the six-week mark, however, many insurance companies won’t cover you in that time. So check with your insurance before jumping in the car.
  6. Rest and ask for help. Abdominal surgery can really take it out of you, and sleepless nights with a newborn can add to fatigue. You need to heal, so plan strategically and don’t try to be superwoman. You may need help around the house – it can be hard to accept help sometimes, but say YES!

2 Abdominal support

Remember, your abdominal muscles have been stretched for the past 9 months, and after a caesarean, they are still stretched. However, the baby is no longer there to hold the muscles taut anymore. Therefore, it can feel like you have minimal control or support around your abdominals or back. An abdominal support can help give support, and aid recovery. Tubigrip is great and you can get it from your women’s health physio.

I usually recommend tubigrip for the first week or so, as it’s easy to go to the toilet in. However, post natal recovery shorts can be really helpful and a little more user friendly too. They all pretty much do the same thing, and are safe for caesarian. It’s just a matter of personal preference on style/cost/color. Avoid the really restrictive, tie-up corset type garments.

3 Avoid increasing abdominal pressure

Activities that increase the pressure inside your abdomen may cause the wound to dehisce (open) so avoid the following:

  • sit-ups or crunches for at least 12 weeks
  • sitting up straight out of bed, roll out instead (see above)
  • constipation
  • excessive coughing – if you have to cough, roll up a towel into a sausage shape, press it firmly against the wound and cover it with both hands and forearms. Press firmly whilst you cough. It’s important to clear chest secretions after surgery to prevent lung complications, but avoid doing it excessively. In fact, carry your cough cushion around and use it when you need to laugh or move quickly
  • lifting anything heavier than your baby for 6 weeks. That means no shopping bags, washing baskets, toddlers or the suitcase you bought into hospital with you.

4 Pelvic floor and deep abdominal exercises

In the first days after a c-section, it is important to start to gently activate your pelvic floor and deep abdominal muscles.

Pelvic floor

Your pelvic floor has been spared the stretch of a vaginal birth BUT, it has still had 9 months of extra weight and hormones making it weaker. Start your pelvic floor exercises the day after your c-section. Refer to my ‘pelvic floor’ videos for technique.

Start in lying, and co-ordinating your pelvic floor contraction with breath: Breath in and relax your pelvic floor, breath out and squeeze your pelvic floor. Difficult huh? Once you’ve mastered this, you can start to hold a little longer, whilst you breathe normally:

*This number is however many weeks old your baby is. i.e. if your baby is 1 week old, hold for 1 second. When your baby is 2 weeks old, hold for 2 seconds. And so on. You’re aiming for 10 x 10 second holds.

For the first few weeks, perform these exercises in lying i.e. when chilling out with your baby, when you go back to bed after a feed etc. Then progress to sitting, and eventually standing.

Also, remember to squeeze your pelvic floor before you cough/sneeze, lift your baby or weights, or change positions.

Deep abdominals muscles

You have 4 layers of abdominals:

  • the top layer (2 strips down the front of your belly, otherwise known as your six pack) may be a bit separated (see my video on ‘diastasis of rectus abdominus’)
  • 2 layers of obliques (side abdominals) underneath that
  • Your deepest layer, transversus abdominus (TA), attaches all the way around your ribcage, down your lower back vertebrae on either side, and all the way around the rim of your pelvis. It acts like a corset, stabalises your spine, and works with your pelvic floor muscles for bladder and bowel control, low back and pelvic stability, and it gives you your waist shape.
  • All of these abdominal muscles will be stretched from pregnancy, but the baby is not holding them on stretch anymore, so they need a little reminding on how to function.

Avoid using your upper tummy muscles too much, but start to activate your lower tummy muscles:

  1. Get onto your hands and knees, with your wrists under your shoulders and knees under your hips. Aim to do this in front of a mirror to find a long, flat spine, with a gentle arc in your lower back.
  2. Without moving your spine from this position, let your belly relax by gently bulging it towards the floor
  3. Then, squeeze your pelvic floor and gently draw in your lower tummy up towards your spine, without moving your back position.
  4. Keep breathing, and hold this muscle contraction for approx. 5 seconds
  5. Relax this muscle gently towards the ground and rest for 5 seconds
  6. Repeat 10 times, holding your back, chest and shoulder position
  7. Progress this by aiming to hold 1 second longer each week, and try doing this in different positions, ie sitting up tall when you are feeding your baby, or standing

Most importantly, activate your pelvic floor and lower tummy muscles just before you change positions, and lift your baby throughout the day. Practice this by standing up from your chair now:

  • Sit up tall and bring your knees just wider than your hips.
  • Lean forward from your hips, keeping your spine tall
  • Squeeze and lift your pelvic floor muscles, and gently draw your tummy in towards your spine.
  • Hold these muscles contracted whilst you stand up from your chair, using your legs to drive up and your spine long
  • Gently let go of these muscles when you are standing, then contract them as you sit back down in your chair.

5 Wound massage

Once given the all clear of infection at your six-week doctor check up, it’s a good idea to start some gentle self massage. There are many layers of skin, fascia, muscle and nerves involved in the wound, and they can tether together. In the shower, use two fingers to massage lightly over the wound (you can start just above and below the wound if it feels really sensitive). It may feel strange, a bit numb, or tingly – that’s normal. And you may find that one side is a little more tender/puffed up than the other – that’s usually the side that surgical instruments have been used a little more. Again, that’s normal. It will take some time, but daily gentle massage in the shower, or with some moisturising cream can help to desensitise and limber up the area.