For some moms cesarean birth is the safest way to bring baby into the world, whether it was planned or unexpected.

A cesarean is a surgical procedure to deliver baby through an incision in the abdomen and uterus.

A cesarean incision goes through 7 layers of tissue: skin, fat, rectus sheath, rectus abdominals (split more than cut), parietal peritoneum, loose peritoneum and the uterus. Cutting through all these layers also transects through tiny nerves, causing the scar (and surrounding area) to feel numb or have altered sensation. The most important part of healing is rest in the first weeks. But there are ways to support the healing process in safe ways.

Post-Cesarean Care Guidelines:

1. Incision Care: get products ahead of time that can help with scar healing, like cesarean specific high-waisted underwear or bloomers, silicone strips, and scar cream. (no affiliation, just love these products)

2. Mitigating Intraabdominal Pressure: Learn safe ways to reduce pressure on the incision. One such way is to hug a pillow if you need to cough, sneeze, clear your throat or laugh. Hugging a pillow supports your abdominals by shortening them and not allowing them to bulge out or have to contract as strongly. 


3. Immediate Movements: Gentle exercises to promote blood flow and ease muscle tension like neck stretches, shoulder circles, overhead arm reaches, seated or low kneeling side bends, heel slides, ankle pumps and pelvic tilts. Go slow and match with your breathing, exhale through the movement and stay within pain free ranges.

4. Scar Tissue Management: Gentle touch and scar massage for sensation and healing.

   Some women may never regain sensation. Others may feel itchy or sparks of sensation as the nerves regrow. While others may have hypersensitivity to touch. There are ways to promote return of normal sensation while healing. The simplest way to do this is with touch. Your body responds to touch through special cells in the skin that are connected to different nerves. By touching the skin in various ways you'll target these different nerves.

   Since this area is still fragile and healing starting with a gentle touch with something soft, like a cotton ball or wash cloth around the incision rather than on it is ideal. This can help you begin the process of reconnecting to the area, which is helpful for emotional healing around the cesarean as well.

   Take it one step at a time, moving on to more pressure with your hands as you feel comfortable both physically and emotionally, again staying on the skin again the incision. You can do strokes, circles, and light pulling in different directions.

   After the incision is closed and formed into a scar or after 6 weeks there is more healing that needs to occur. As a scar forms the fibers are not organized and your body needs to "clean up" the fibers to create order. Scars are not as strong as the surrounding tissue. One way the body ensures tensile strength in scar tissue is organizing the fibers in the direction of force.

   Performing scar massage can improve how your body organizes the scar tissue. Massaging the scar may sound intimidating but doesn't have to be. You can begin by gently rubbing in circles along the scar with lotion. The circles should go in both clockwise and counterclockwise directions. The lotion doesn't need to be special, but there are some ingredients like onion extract, silicone, aloe vera, and green tea that have been shown to be more effective with scar healing.

   Then move on to mobilizing the scar by pulling it up and down, side to side, and roll the scar between your fingers. Divide the scar into 3 or 4 sections, do the three different styles working a total of 10-20 times at each section. This does not require lotion and should be done in a way that doesn’t cause pain, but may produce strong sensations or pulling. Taking your time and being consistent will give you the best results.

5. Scar Tension Reduction: Gradually introduce gentle stretches to reduce scar tension.

   Having a cesarean also means a line of scar tissue running across your low abdomen. This scar tissue can act as a wall between your upper body and lower body restricting blood flow, lymph flow and communication. For some this barrier is not only a physical one but an emotional one that presents a challenge to connect with.

   A powerful way to break into this wall is with belly breathing. Belly breathing does two very important things for you.

   • Calms your autonomic nervous system (fight or flight)

   • Stretches your scar and surrounding tissue from the inside out

   To begin, find a comfortable place to relax, either sitting or lying down [you can do this where ever you need to calm down too]. Place your hands on the lowest part of your belly, over clothes if you're not ready to touch your scar or directly on skin. Breath in through your nose like you're smelling a sweet flower and want to savor the scent. As your lungs fill direct the expansion motion to where your hands are resting on your belly. Pause. Exhale slowly out your mouth as if to make a feather quiver. Repeat 5 times.

   If while doing this pain is elicited in your scar, expand less, only stretching up to the point of pain then breath the pain out with your exhale. With every breath you are rewiring your nervous system and creating physical change in your tissue. Keep at it for genuine long lasting results!

   You can also progress to lengthening exercises, like I show you in this video.

6. Everyday Movements: Mindfully practice daily activities like sit to stand, rolling in bed, getting up and walking around a short distance, emphasizing correct movement patterns. You will be doing these activities any way so might as well use them as exercise. Just like previous match them to your breathing, exhale through the movement.

   For example with rolling in bed: inhale to prep, exhale to bend your knees & maybe even put a pillow between your knees, inhale pause, exhale to reach across your body to grab the side of the bed or sheet, inhale to pause, exhale to push through your heels like you are squishing and smearing a bug and pull through your arm to roll to your side.

   For walking go slow with short steps while trying to stand up as straight as possible and slowly breathing to support the movement.

7. Core Breathing: Reconnect with pelvic floor and transverse abdominus through controlled diaphragm breathing in various positions. Start on your side or back with your knees bent. Inhale through your nose filling your ribs keeping your belly and pelvic floor relaxed and soft to provide lengthening. Exhale as you energize the pelvic floor and belly picturing these areas assisting the air out of your mouth in a gentle way by drawing or scooping in. Right now your focus is all about the breathing, not the intensity of the contractions. Repeat this process 5-10 times.

   Since you will be up and moving you also want to practice this breathing in different positions, like on hands and knees, sitting and standing. Then gradually incorporate this breathing with simple moves like cat/cow, pelvic tilts, angel wings, heel slides, marches, and side plank on your pelvis, glute bridges.

8. Smart Strengthening: Progress to more complex strengthening exercises as healing allows, like bird dog, dead bug, side planks, bridges, kick stand squats and RDLs, pallofs press and more. None of these should be started until after 6 weeks and even then you may not be ready for the full version. Modify based on ability and strength level. If you have difficulty connecting to your core during the move and notice pulling, pressure, doming or pooching, or pain it’s likely too much for your body at the moment. It’s okay to go slow and take your time, then you’re less likely to create compensations and more likely to build proper strength and mobility.

The most important thing to remember is when to stop. If you have any increase in pain, bleeding, or signs of infection stop all exercise and check in with your provider. So you may not resume exercise “as you know it” until you have reconnected, rebooted and restored your healing pelvic floor and abdominal muscles with no other imbalances in your muscular and scar tissue.

Be mindful and seek guidance from healthcare providers and modify exercises based on your healing state.