Shakira Akabusi, mum to Rio, Ezra and twins Asher and Aryana, fitness expert, Mumlister and founder of StrongLikeMum is passionate about empowering women to build confidence and positivity during pregnancy and postpartum.
One area lots of mums are concerned about postpartum is exercising after a c-section. Having had a cesarean herself, here are Shakira's tips and advice as well as some exercises to get you started...
I’d been working with cesarean mothers long before I was scheduled in for my own, with the birth of my twins in 2020. As a pre and postnatal exercise specialist, I knew what to expect but soon learnt that what you pick up in textbooks is only half of the story and there is so much that we can learn from lived experience.
As my birth date drew nearer, reality set in and I began to feel nervous about the procedure. This was unknown territory and just as I’d heard from many clients, I began to worry about what this might mean for my body going forwards. Even knowing the ‘facts’ as an expert, thoughts crossed my mind about what my scar might look like or feel like. Would I be able to run again properly postpartum and how long would it be before I could lift my babies without the worry of negative repercussions on my recovery?
I’m happy to say that I was able to get back into my natural running routine by around 6 months postpartum. As for lifting my children, it's advised not to lift too heavy for at least a week or two postpartum, and I certainly avoided lifting my toddler at this time. From an exercise point of view my cesarean recovery was different to my previous births as well. Now, almost 2 years after my surgery, I look back and realise how much more can be done to support women who are preparing for, or have undergone a cesarean section. Not just physically but emotionally.
Interestingly our emotional state can also impact our cesarean recovery. Research shows that emotional distress and high stress levels could trigger scar tissue regrowth, meaning that with long-term chronic stress, any internal scar tissue from abdominal surgery could spread and wrap itself around other internal body tissues or organs. For this reason and more, finding time to rest, recuperate and sleep when we can is imperative.
Here’s what you need to know about returning to exercise after a cesarean and the best exercises to help us reconnect with our core postpartum.
What happens during a cesarean
During a cesarean birth, seven layers of skin, fat and body tissue are cut through to open up the uterus and deliver baby.
Contrary to what many believe, the Rectus Abdominis muscle itself is not cut during the procedure, the two halves of this muscle are separated via the midline, known as the Linea Alba, a fibrous sheath of tissue, running down the midline of the muscle.
After surgery each layer is stitched together and closed with the last being the skin, which is where we can see the visible evidence of a scar.
Immediate post-birth recovery
The incision from a cesarean heals from the outside in, meaning that whilst it may look healed on the outside there is still a lot of recovery to be done underneath. Skin is a fast healer, knitting together a new framework within just a few days or a week but the further we move through the body’s layers, the longer the wound takes to come completely together.
Scar tissue itself is formed slightly differently to our natural skin. Although it might feel tough or rubbery to touch, it actually only ever reaches about 70% of the strength of the muscle it has replaced.
Immediately after birth, you will be encouraged to walk within the first 24 hours. This is to ease gas pains, stimulate bowel movement and prevent blood clots from forming. However, this isn’t as easy as it sounds. I found my first walk very intimidating and it did nothing to boost my confidence in my recovery.
However, it’s amazing how quickly the body can recover, especially if we can help it along with the correct exercises. Within a few days I felt more settled and after just a few weeks was able to walk and move with much more confidence.
So what exercises can we be doing during the immediate postnatal period to help with cesarean recovery?
The deep impact of Optimal Breathing
I never believed that breathing alone could have a direct impact on my postnatal recovery but it absolutely can. When we take a proper deep breath, we encourage our diaphragm to move downwards. This descent of our diaphragm means all our internal organs are moved slightly downwards as well.
This motion acts as a massage for our intestines and other internal organs which means any abdominal scar tissue is kept mobile.
This is important to make sure the scar tissue doesn’t become too rigid or bind and stiffen around other internal body tissue. So, as soon as you feel comfortable and have been cleared by a medical professional, working on a few deep breaths throughout the day, keeping your shoulders relaxed and your pelvic floor relaxed can really help start our recovery process.
Pelvic Floor and Cesareans
I’ve lost count of the amount of times I’ve been asked whether women still need to work on pelvic floor exercises if they've had a cesarean birth. The myth that since the cervix and vagina haven’t been stretched during delivery, means that we don't need to worry about pelvic floor weakness is one of the most common misconceptions around cesarean mothers.
Although we may not have needed to contend with crowning, our pelvic floor has still carried the weight of baby, placenta and amniotic fluid throughout the 9 months of pregnancy, and as such it will absolutely still need our support during recovery. The current guidelines from the RCOG (Royal College of Obstetricians and Gynocologists) state that women can begin pelvic floor exercises immediately after labour, as soon as they feel ready provided labour has been uncomplicated.
This is also applied to cesarean deliveries, however we must wait until the catheter has been removed. Saying that, just because you can begin these exercises in the immediate postnatal period, that by no means means you’ll feel ready to. You may prefer to wait until your 6-8 week check to begin these exercises. What’s most important is that you feel comfortable to get going and always raise any questions or concerns with your medical team.
Pelvic Floor reconnect exercise
• Lie back on the floor or sit comfortably in a chair.
• Place your hands over your abdomen or relax them at your side.
• Inhale and as you do so relax your body, keeping shoulders down and pelvic floor relaxed.
• It may help to visualise a flower opening as you relax your pelvic floor muscles.
• As you exhale use a gentle ‘fffff’ sound and draw up your pelvic floor.
To do this, as you exhale visualise your coccyx bone (at the back of your pelvis/bottom of your spine) and your public bone (at the front/middle of your pelvis) moving inwards towards one another and then drawing up.
This visualisation will help to encourage complete pelvic floor activation.
Once we feel ready to begin gentle deep core exercises there’s plenty we can do. I would advise waiting until your 6-8 week check with the GP before upping the intensity of your exercises. However, once you’re ready here’s four of my favourites movements to support a cesarean recovery.
Pelvic Tilt
• Lie on your back, with your knees bent up and the soles of your feet flat to the floor, placed hip width apart. Relax your arms by your side.
• Inhale and relax your pelvic floor.
• As you exhale draw up your pelvic floor and simultaneously allow your pelvis to tilt backwards, connecting your lower back more to the floor.
• Hold this tilt for 8 counts if possible.
• Inhale and release your pelvic floor and return to the neutral start position.
Four point kneeling w/ arm raise
• Begin on all fours in the table top position, with arms under shoulders and knees under hips, placed hip width apart. Inhale and relax your pelvic floor. As you exhale draw up your pelvic floor and simultaneously raise your right arm off the floor. As you do this focus on maintaining good alignment along your spine keeping your torso and hips level throughout.
• Inhale and release your arm back to the floor. Repeat on the other side.
Progression: Bird-Dog
• We can progress the above exercise by simultaneously lifting our arm and opposite leg, creating more instability for our core.
• As above, begin on all fours in the table top position, with arms under shoulders and knees under hips, placed hip width apart. Inhale and relax your pelvic floor.
• As you exhale lift one arm out in-front of you with the opposite leg lifting straight out behind you at the same time.
• Hold for a count of 8. Making sure to keep the torso and pelvis levels, without tilting throughout the movement. Make sure not to lift the raised leg too high in order to keep good alignment along the spine.
• Exhale and return to the box position. Repeat on the other side.
Leg Raises
• Lie back on the floor with your calves supported on a platform such as a chair or bench. Both your hips and knees should be bent to a 90 degree angle.
• Inhale and as you exhale engage your pelvic floor and lift your right leg off the bench, followed immediately by your left.
• Hold both legs off the chair, in line with each other, for a count of 8 if possible.
• Inhale and release your legs to rest back on the platform, first with the right, followed immediately by the left.
• If you feel any back pain or feel you’re arching as you lift your legs off, modify this exercise to a single leg lift only.
Scar tissue massage
Along with the above exercises, something that really helped my cesarean recovery was scar tissue massage. It’s generally advised that we wait until our 6-8 week check to begin, however some women feel ready to begin massaging the rest of the abdomen a little before this time. What is imperative is that the scar has completely healed, before you massage close to or on the scar itself.
Abdominal massage techniques can include circular motions around the middle of your abdomen using two fingers from each hand (fore finger and middle finger) moving closer to the scar over the coming weeks and eventually beginning to move sideways and outwards just above the scar and eventually small circular motions on the scar itself. Once you feel ready you can also pick up and pinch the scar or roll the scar between your fingers.
For more information on scar tissue massage contact a women's health physio for a one on one assessment.
StrongLikeMum
Number one on the list for postnatal recovery in my mind is knowledge. Learning what our body is experiencing and understanding why we need certain movements or techniques to recover is imperative to healing properly. For more information on cesarean recovery and postnatal rehabilitation in general check out my book StrongLikeMum, available June 9th and open to pre-order now.