After giving birth, many women wonder when they can get back to their exercise routine, but it can be particularly confusing for women who delivered via cesarean, or C-section.
“[A C-section] is a major abdominal surgery, and just like any other surgery, it takes time to heal,” says Blair Green, DPT, pelvic-health specialist and coauthor of Go Ahead, Stop and Pee: Running During Pregnancy and Postpartum. Typically, experts recommend waiting six weeks after surgery before restarting your exercise routine, but women who are recovering from a C-section may need to wait longer.
Not only does the incision itself need to heal before you can start exercising, but the core muscles — which are active in every movement we make — have to be retrained.
“If we cut through [our core muscles], they’re essentially ‘injured,’ and even though the injury was a surgery, they still need time to heal and retrain themselves,” Green says.
Here are some tips on when — and how — to exercise after a C-section.
IMMEDIATELY AFTER SURGERY
- Protect your incision
“Initially, you want to protect your incision,” says Jennifer Joslyn, DPT, a physical therapist at Motion Minnesota who specializes in pelvic health. This means avoiding movements that could irritate the incision, like excessive twisting, bending, and lifting heavy objects. Ideally, you’ll avoid these types of movements for the first few weeks following surgery.
“Most women don’t feel well enough to even do much more than just household walking distances and taking care of the baby until about three weeks out,” says Elizabeth Chumanov, DPT, PhD, co-coordinator of the Active Moms Clinic at the University of Wisconsin–Madison Sports Rehabilitation Clinic.
- Practice diaphragmatic breathing
While you may not be able — or necessarily want — to exercise while you recover, there are small things you can do during those six weeks to help you begin restoring core strength and function. “One thing I always recommend is deep diaphragmatic breathing,” Green says.
Your diaphragm is a dome-shaped sheet of muscle that separates your chest and abdominal cavities, and acts as the primary muscle of respiration. It actually works with your abdominal and pelvic-floor muscles — a group of muscles on the bottom of your pelvis that support your pelvic organs and help with posture. This means that simply activating the diaphragm can help restore the function of your entire core.
But also that deep breathing helps you heal, because it transports blood and oxygen to your tissues,” Green says.
To do it, lie on your back, place both hands on your rib cage, and take 10 to 20 deep breaths. As you inhale, you should feel air coming into your ribs and abdomen. “And then, when you breathe out, you should feel your ribs funneling down and in, and your abdomen should drop,” Green says.
In an ideal world, you would practice deep breathing three or four times a day. That said, many new moms are simply trying to adjust to their new routine, and may struggle with adding anything else to their plate. So, Green recommends focusing on deep breathing for five minutes at the start and/or end of your day.
- Don’t overdo it
Light walking is OK, too, as long as there’s no pain, Green says. But if you were on bedrest for any length of your pregnancy, you’ll want to take greater care with starting any kind of activity — light walking included. “I know a couple of women who were on bedrest for six months of their pregnancy, and in those situations, I would not recommend waking up two weeks after you had a baby and going for a walk,” Green says.
AFTER YOUR SIX-WEEK CHECKUP
- Start with basic strength exercises
Once your OB/GYN has cleared you for exercise, typically six weeks after giving birth, you can start incorporating basic strength exercises like squats, lunges, bird-dogs, and planks. In the early stages of rebuilding your fitness, avoid high-intensity and high-impact activities like heavy strength training, running, bootcamp-style and metabolic-conditioning circuits, and plyometrics. You want to make sure your core and pelvic floor are healed and strong enough to handle those types of dynamic movements.
- Ease into running, plyometrics, and heavy weightlifting
If you’re a runner, Green recommends giving yourself eight to 12 weeks to recover and retrain your abdominal muscles, and starting with a run-walk program. You can also do low-impact cardio exercise like biking, rowing, or the elliptical to rebuild your fitness before you jump into running again. And if you do plyometrics or heavy weightlifting, wait three to six months, Green says.
- Pay attention to how you feel
When you do exercise, listen to what your body is telling you. If you experience pain, heaviness, or pressure in the pelvic floor, doming or coning in your abdomen, urine or stool leakage, or any pain or irritation in your C-section scar, this could be a sign that the exercise should be modified, Joslyn says.
If your abdomen pushes out during an exercise (referred to as “coning” or “doming”), for example, chances are your abdominal muscles aren’t strong enough yet to handle that exercise. Or, it may mean that you need to breathe or activate your core in a different way.
- Reactivate your core muscles
“When you’re pregnant, your body has to make room for your baby, and your tissues and muscles are stretching and expanding,” Joslyn says, “and so once you have your baby, initially it may be hard to find those core muscles again and activate them.”
To help women relearn how to activate their core, Joslyn recommends an exercise that targets your deep core muscle — the transverse abdominis. Here’s how to do the move:
- Lie on your back with your knees bent 90 degrees and feet flat on the ground.
- With your fingers, find your hips on both sides of the front of your pelvis. Then, move your fingers in 1 inch.
- Inhale, keeping your pelvic floor and abdominal muscles relaxed.
- Imagine there is a string in-between your hip bones. As you exhale, imagine that string pulling your hip bones together to engage your transverse abdominis.
Once you know how to reactivate your core muscles, you can better activate them during any other exercise.
- Try to be patient
Remember: Just because your doctor has cleared you for exercise doesn’t mean you’re mentally or physically ready, or that you can pick up where you left off before your pregnancy, experts say.
It’s important to adjust your exercises and timeline according to how you feel and steer clear of self-judgments that tell you that you “should” be healing or progressing differently. Some women feel great at their six-week OB/GYN appointment, whereas others feel weak and fatigued and may even be in pain.
“Everybody’s just a little bit different in terms of that [exercise] timeline,” Joslyn says.
Try not to rush into exercise, or chase the unrealistic goal of reaching your pre-baby shape as quickly as possible. Remember that your body went through a lot of changes during your pregnancy — and continues changing even after the baby is born. Rather than get hung up on ideas of reclaiming your pre-baby body or achieving an unrealistic post-baby body for you, practice the mindset of meeting your body exactly as it is each and every day.
“We need to respect the recovery time,” Green says, “and that often gets lost in the shuffle.”