Returning to Exercise after Cesarean Section

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By Contributing Author

Heather Baker, Phd, PT

In 2010 and 2011, the nationalcesarean section rate in the United States was 32.8% (Hamilton et al. 2012), orapproximately one mama in three. Given that the procedure is so common, manywomen falsely assume that it’s a fairly easy surgery with an easy recovery.While some women do bounce back, the vast majority experience a long, slowrecovery. During the recovery period, there is often confusion about when it’ssafe to exercise, what to look for in the healing process, whatexercises/activities are safe to do, and when to expect to feel “normal” again.While it’s important not to begin exercising without the clearance of yourOB-GYN (surgeon), I will attempt to shed some light on this confusing time.
When is it safe toexercise?A good general guideline forpost-partum exercise (vaginal or cesarean delivery) is to wait to start anyformal program until after your 6 week post-partum visit. In the case of a cesareansection or a difficult/complicated vaginal delivery, you may (but not always)be asked to wait another 4-6 weeks. The uterus takes at least 6-8 weeks to healafter cesarean section so exercising prior to this time increases the risk ofcomplications.
What physical signsshould mom be aware of during the healing process?Avoid moderately strenuousactivities if excessive vaginal bleeding is present and stop exercisingcompletely and notify your health care provider if there’s bright red blood orif exercising worsens bleeding

• Genitals may be dehydrated or irritated especially inbreast feeding moms. Wear undergarments that allow the genitals to breath andif the discomfort continues, talk to your CNM/OB-GYN
• Cesarean section scars are often hypersensitive-chooseexercise garments that don’t repeatedly rub the area. If you notice skin breakdown around your scar, adjust your garments to avoid rubbing/friction
• Anemia and thyroid complications are not unheard uppost-partum. If you’re feeling excessively fatigued, bruising easily orotherwise just feeling “off” talk to your OB-GYN/CNM

Whatexercises/activities are safe to do?Walking is a great way to startgetting back into exercise. Start gently and slowly then gradually increase thespeed and duration as able. Walking is also nice because it gets you out of thehouse and you don’t need a sitter-simply put baby in the stroller and off yougo! As you start to feel stronger andwalking is no longer painful/difficult, you can start to incorporate more varietyinto your exercise routine. Group fitness classes geared at the postpartumwoman are often helpful because you’ll be around other women going through asimilar life situation. A good support system at this time in life ispriceless!If group classes aren’t yourthing, you have other options-many of which can be performed at home withoutthe need for a sitter. The key is to incorporate a mix of cardiovascularexercises and strengthening exercises.

• Good cardiovascular options apartfrom walking include the elliptical trainer, biking (look for an upright bikeand wide seat for comfort), and swimming. Dance videos can also be fun and addvariety. If you want to run, start slow with a walk-run progression- 1 minuteof walking followed by 1 minute of running works well.
• Gentle strength training is alsoimportant. If you haven’t exercised or done resistance training since beforepregnancy, start light! Body weight activities are safe, inexpensive, andconvenient. Good options include squats, plie squats, lunges (forward, side,backward), push-ups, and planks.

Most new moms are more concernedabout their abdominals. If you have a diastasis rectus (see my previouspost)-DO NOT DO CRUNCHES!!! If you’re positive that you don’t have a DR, starttoning the abdominals by gently pulling your navel toward your spine andholding for 10-seconds. Planks are good once you’ve mastered the basics as aregentle/level 1 pilates classes and DVDs. Jumping into an aggressive core classtoo soon will cause more harm than good. If you’re concerned about what to do,talk to your OB-GYN/CNM and get a referral for PT. You may only need 1 sessionbut it’s better to be safe than risk injury.
What equipment doesmom need?Typically after a cesareansection, women are issued some type of abdominal binder to assist withhealing and add support. It is often recommended that a woman wear theabdominal support for the first 6 weeks until the post-partum check up. Somewomen find it helpful/more comfortable to wear if when they start exercising.This is up to the mom, if it makes exercise more comfortable initially, goahead and wear it but remember that it is not a long term substitute for goodabdominal strength.

• Sportsbra/supportive nursing bra. Breast size changes dramatically duringpregnancy and postpartum so it’s essential to get fit for a good and supportivebra. This not only protects the breasts and chest muscles but can alsoprevent/improve back pain and promote good posture
• Correctfitting gym shoes. It’s not uncommon for women to experience changes in thelength, width or arch of the foot during pregnancy and postpartum. Get measuredfor gym shoes when you’re ready to resume exercise (walking included!). Also besure to choose an appropriate shoe for your desired sport.
• Water bottle.Stay hydrated during exercise to promote general health, prevent dehydrationand avoid interfering with breast-mild production.

When can mom can getback to her old routine?Listen to your body. If you’reexhausted and sore, try a walk. If this makes you feel worse stop there. Your bodyis working hard to heal so you must give it the rest it needs. The key is tostart slow with walking and move forward from there as tolerated. If you wereactive throughout pregnancy, you may come back faster, but remember you didhave major surgery. Typically, it’s recommended to avoid strenuous competitiveevents for about 6 months post partum. In my experience, it takes a solid yearto feel like yourself again after having a baby.
Closing Thought:Exercise is good but it’simportant to start slow. It will help your body return to its pre-partum state,will improve your sense of well being/fight off post-partum depression, andwill give you more energy. However, it is of UTMOST importance to be mindfuland respectful of your body. It’s been through a lot over the past 40-weeks!Good luck!!
References:      HamiltonBE, Martin JA, Ventura SJ. Births: preliminary data for 2010. Natl VitalStat Rep 2011;60(2):1-25.(http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_02.pdf)