Maximizing Core Strength and Recovery after Cesarean Section

April is C-section Awareness Month. A C-section, short for cesarean section, involves delivering a baby through an incision in the mother's abdomen and uterus. According to the Obstetric Care Consensus from the American College of Obstetrics and Gynecology (ACOG), approximately 1 in 3 women give birth via C-section. For many, this procedure is not a choice but the only safe method to deliver the baby, though it often requires a longer recovery period and carries more potential risks. During a C-section, the lower abdominal wall fascia is separated and stretched at the midline to access the uterus. After the baby is delivered, the endopelvic fascia is repaired. Unfortunately, most postpartum women receive limited information about healing their core and incision beyond basic wound care.

Whenever an incision occurs, a scar develops as part of the body's natural healing process, involving the deposition of collagen, a fibrous protein. The wound closure healing period lasts 6-8 weeks. Scar tissue is not limited to the surface; it can penetrate deeper layers beneath the skin and fascia, reaching muscles, organs, and even joints. When the scar reaches these deeper layers, adhesions might form, leading to:

• Pain and sensitivity at and around the scar or remote areas caused by nerve irritation and decreased blood flow

• Reduced mobility and difficulty standing up straight due to fascial restrictions

• Constipation or irritable bowel due to decrease organ mobility, causing a swollen or bloated abdomen

• Myofascial pain/muscle guarding in the abdominals, diaphragm, pelvic floor, hips and even the jaw

• Nausea, sometimes persisting for years

• Disruption of the pelvic core piston function, causing core weakness and hip weakness and/or stiffness

• Urinary urgency, increased frequency (including nighttime voiding) and/or urinary incontinence

• Pain with sexual intercourse or altered sensation with intimacy

At Healthy Core, postpartum pelvic floor rehabilitation is a significant focus, and recovery from a c-section is often neglected. Pain and dysfunction can stem from a past pregnancy or surgery, no matter how much time has passed. Our standard postpartum evaluation involves assessing and treating muscle and fascial restrictions, diastasis recti (abdominal separation), rib and pelvic alignment, posture, strength, and overall body mobility. We evaluate scar mobility, particularly in relation to underlying organs like the bladder, bowel, and ovaries. Our treatment method includes addressing restrictions through manual therapy such as visceral mobilization (myofascial release of deep abdominal fascia), vacuum cupping therapy, dry needling, and mobilization of joints and muscles, along with teaching you how to perform your own scar mobilization at home. Personalized exercise prescriptions focus on addressing mobility and strength/coordination deficits to meet your specific functional goals, whether it's standing without pain, caring for your family and home, or returning to high-intensity exercise.

We provide a complimentary virtual consultation to address any inquiries you may have. For further details on postpartum exercise and core restoration after childbirth, click here.

initially published April 2018; revised April 2024