Okay so you read the books, took the classes, and followed the Instagrammers to get ready for labor and delivery.

But did any of them talk about healing after c-section?

If you are lucky, the answer is yes! But for the majority of pregnant folx, the classes and books they read are all about what happens with a vaginal delivery. And this makes sense, as almost 70% of births each year occur via vaginal delivery. But that leaves 30% of those who delivered a baby without somewhere to turn.

Welcome to our take on healing after c-section. 

First things first, c-sections are a major surgery! Your delivery surgeon had to pass through seven - yes, SEVEN - layers of tissue to deliver your little one into the world! Let’s pause a moment and just appreciate each layer of your body that is healing from this:

1. Skin
2. Subcutaneous tissue (aka the adipose/fat layer under the skin)
3. Fascia
4. Muscle (luckily these are just parted and not cut into on the regular anymore)
5. Peritoneum (the tissue inside of the abdominal cavity)
6. Uterus
7. Amniotic sac

And because this is a major abdominal surgery, your body (not just the incision site) deserves rest, support, and proper care. That proper care includes seeing the experts in rehabilitation (aka pelvic floor therapists!) to help you navigate the healing process for your abdominals as well as your pelvic floor and the rest of your body! 

I mean think about it - during pregnancy the abdominal muscles & fascia are stretched and the connective tissues are stressed to support the baby growing in the womb.

Add on top of that the scar tissue that is now affecting the abdominal fascia, the bladder, and even the bowels. Without proper mobilization and attention, this scar tissue can continue to impact how we move our body and how our bowel & bladder functions for years to come. 

Finally, we cannot forget the pelvic floor! This is an often overlooked component, however these muscles have been firing daily for nine months supporting an ever increasing load. You may be thinking, “but wait, isn’t pelvic floor therapy just for vaginal deliveries?” Not at all!

During pregnancy, as your baby grows, your pelvic floor is constantly adapting to the changes in posture, stability, and strength. Common postural changes may include excessive anterior pelvic tilt (hips forward, butt out) and lumbar curve (an increase in your low back arch), and reduced thoracic (mid to upper back) and ribcage mobility (hello difficulty with breathing!).

Changes like these impact core pressure management, which will impact how the core and pelvic floor reacts to increases or changes in pressure - which can commonly present as urinary leakage during activity or a cough/laugh/sneeze, but this is just one scenario. 

Even if you never pushed or attempted a vaginal delivery, this is still 9 months of intense work and constant recalibration. Traditional healthcare is mainly concerned with the quality of healing of your scar at your 6 week check-up, however, as you can see, recovery and healing go beyond skin-deep. So if you aren’t already seeing a pelvic floor therapist (You should be!), then after you see the OB and get the ‘all clear’ give us a call to get started on your full body recovery!

When Can You Start Therapy?

As early as you’d like! Some patients see us as early as 2 weeks post-delivery. Afterall, you were just sent home with a brand new baby that you are expected to care for, along with caring for yourself. So while most people think six weeks is the magic number, you could still use some support and guidance with things like getting on/off a chair, in/out of bed, picking up and carrying little one, navigating urination and bowel movements after abdominal surgery, and any other tasks you life demands from you, earlier than six weeks.

However, once we reach the coveted six-week mark we are now able to begin mobilizing your c-section scar - if you are up for it! At this point your body is through the majority of the skin healing, your collagen fibers are laid down, and they are ready for some remodeling. I know this sounds silly but it’s true! Our role here is to help make sure you can bend and reach and twist and lift without pain or pulling in your c-section scar. 

Are you further along than six weeks post-delivery? Don’t worry! There is no such thing as “too late” when it comes to your healing. Even if you are months - or years - out from your c-section, it is never too late to start! Everyone’s journey is different and no matter if your goal is to hold your little one without pain or to train to run a marathon, we are here to support you and your progress. 

Why Would I Need Pelvic Therapy?

Unfortunately, we have been convinced that several postpartum symptoms are just a “normal” part of life, but they’re actually signs your body could use support. Some of these symptoms include: 

• Pelvic heaviness or pressure (including feeling like something is “falling out”)
• Urinary leakage or strong urgency
• Core weakness or the persistent “mom pooch”
• Diastasis recti, or separation of the abdominals 
• Scar sensitivity, tightness, or numbness
• Low back or hip pain
• Pelvic pain
• Pain with movement 
• Pain with intimacy 
• Constipation or hemorrhoids 
• Fearfulness around return to exercise or movement

What Happens in a Pelvic Floor Session?

While each session is individualized based on patient concerns, for a postpartum assessment you can typically expect:

• Emotional support and space to share your story
• Assessment of posture, breathing, and core function
• Assessment of the pelvic floor (internal and external options available) 
• Gentle work on scar tissue and surrounding muscles
• Strategies for safe movement, lifting, and daily life
• Progressive strength-building and coordination

We will work together one on one in a private treatment room to provide you the safety and comfort to discuss any concerns you may have.

How You Can Support Healing at Home

Your recovery starts with simple, intentional steps:

• Rest early, and skip the pressure to “bounce back”
• Practice diaphragmatic breathing to engage your core, focusing on full 360 degree expansion of the ribcage
• Take gentle walks when you feel ready (and be sure to listen to your body when it says you’ve gone far enough)
• Stay hydrated and well-nourished, adjusting intake if you are breast/chestfeeding 
• Once cleared, try gentle massage over your scar to restore mobility (we review this with you in pelvic floor therapy!)
• Avoid straining when using the bathroom (bring on those breathing techniques and pooping postures!)
  
  

An important thing to remember is that recovery is a journey and not a race. As difficult as it can be, comparing yourself to others can be more emotionally draining than helpful. Your timeline is your own, but know that you do not need to live with symptoms or pain. It is okay if you don't know where to start- that is quite literally our job to help provide that type of guidance. 

If you're healing after a c-section and want expert, compassionate, and inclusive support, reach out to learn more about how our team of occupational and physical therapists can help you get started!