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Date issued: June 2021

Review date: June 2023

Ref: C-454

PDF:  C Section Advice final June 2021.pdf [pdf] 571KB

Returning to Activity after having a Caesarean

Recovery from your operation varies from person-to-person. Your return to normal activity should be gradual.

Up To 6 weeks

This is when the initial healing takes place. The wound needs time to heal on the inside, even if it appears healed on the outside quite quickly.

• Avoid standing still for long periods (30 mins or more), particularly in the early days post-op.

• Support the incision with your hand or a towel when you cough, sneeze or laugh.

• When getting out of bed roll onto your side first then push up with your arms. You should then do this in reverse when getting back into bed.

• Avoid heavy lifting, you are allowed to carry your baby but anything heavier is advised against e.g. a pram, car seat or bag of groceries.

• Daily walking is advised as this improves blood flow and promotes healing. Starting with short distances and    building up gradually

• Remember to listen to your body, and stop if anything is uncomfortable

Start your pelvic floor muscle exercises and the early abdominal exercises in this booklet (Pelvic tilt / Knee rolls / one legstretch)

  6 to 12 weeks

• Try low impact exercises such as swimming, cycling, low level Pilates, a cross- trainer, more vigorous walking or gentle aerobics. Make sure that any vaginal discharge or bleeding has stopped before you do so.

• If you are exercising with an instructor make sure that you tell them that you have had a recent caesarean section.

12 weeks +

• You will need to wait at least three months before you start more physically active exercise including high impact activities and competitive sports.

Pelvic Floor Muscle (PFM) exercises

It is important to train these muscles to help you to recover from your caesarean section. The pelvic floor muscle is like a sling/hammock that runs from inside the front of your pelvis to the coccyx.

What position should I do them in?

Try in lying or sitting first then work towards standing as you feel able.

How do I activate the pelvic floor muscles?

Tighten the back passage, close around the vaginal exit and lift the muscles at the front, as if you are stopping the flow of urine or squeezing tight inside your vagina

Try to hold for up to 10 seconds then relax.

Aiming for 10 repetitions of 10 second holds

Now try squeezing quickly then relax.

Aiming for 10 fast repetitions

Early Abdominal Exercises (0-6 weeks post op)

1. Basic abdominal contraction:

• Lie on your back with your knees bent, feet on the floor/bed and relax into the floor/bed.

• Find neutral spine, neither too tucked nor too arched. Lay your hands on your lower abdominal muscles (as shown).

• Breathe in gently allowing your tummy to rise. As you let the breath out, keep your back and ribs relaxed while drawing in your lower tummy (at the navel/ belly button level) towards the spine.

You will probably feel the muscles under your fingers tense up. Keep the spine in the neutral position and the pelvis still.

Hold for 2 or 3 breaths and then relax fully. This is the muscle to use for support when you are being physically active with bending, lifting or standing for a period of time.

2.Pelvic tilt

Do a basic abdominal contraction, drawing up your pelvic floor muscles at the same time, and flatten your lower back into the floor/bed allowing your pelvis to tilt. Breathe normally throughout the exercise. Hold for 5 seconds Repeat 3 times.

 3. Knee Rolls

Do a basic abdominal contraction, keeping your back still on the bed, and your knees and feet together, slowly let both knees go to one side. Bring them back to the middle and relax. Repeat the basic abdominal contraction and do the same exercise to the left side.

Complete 5 knee rolls each side.

4. One leg stretch

Do a basic abdominal contraction, drawing up your pelvic floor muscles at the same time then gently slide one heel away from you, keeping the heel in contact with the floor/bed. Do not hold your breath.

Repeat 5 times on each leg.

Scar Management Post Caesarean Section

Scar Healing

It takes approximately six weeks for your scar to heal fully. It may feel tender, itchy and numb in the first few weeks and can heal to be pink or red and slightly raised. Once healed, it should not be excessively painful or sensitive or prevent you from doing any of your everyday activities. It can take two years for your scar to fade to a smooth white line. As your scar heals, the scar tissue can attach to the skin and muscles around it which can make the scar sensitive, painful or raised. Scar massage can help reduce these adhesions.

Only start scar massage once your scar is fully healed, there must be no open areas or scabs. It takes approximately six weeks for your scar to heal fully. Check with your GP before you begin if you have concerns.

How

1. It helps to use a warm compress before starting to help in order to relax the muscles and increase blood flow to the area.

2. Make yourself comfortable: lying or semi sitting, use pillows.

3. You can use oil for comfort e.g. almond, coconut or olive oil.

4. Aim to do this for ten minutes per day.

Technique: Caesarean section massage

1. Start by gently massaging around the scar, focusing on tissues immediately above and below it. As it becomes less sensitive, place the pads of your fingertips just above the scar line. Move the skin gently up and down, side to side and in circles along the length of the scar. Work more into  areas of resistance where the skin feels tighter. You should feel stretching in the tissue but it should not be painful

2.As this becomes easier, push your fingers firmly down into the tummy muscles and repeat the up and down, side to side and circular movements. Feel free to massage the entire lower tummy area. You must be firm but not aggressive as you massage: let pain be your guide. A slight tingling sensation as you stretch tissues is normal. Keep massaging into deeper areas as pain allows.

3. When you are comfortable with the first two, roll the scar between your thumb and finger. It may take some days or weeks before you can do this one.

Contact your midwife or a GP straight away if you have any of the following symptoms after a caesarean:

• Severe pain

• Leaking urine

• Pain when peeing

• Heavy vaginal bleeding

• Your wound becomes more red, painful and swollen

• A discharge of pus or foul-smelling fluid from your wound

• A cough or shortness of breath

• Swelling or pain in your lower leg

Other Sources of information:

• POGP Fit following Surgery booklet found at https://pogp.csp.org.uk/information-patients

• POGP Exercise and advise after pregnancy booklet found at https://pogp.csp.org.uk/publications/exercise-advice-after-pregnancy