Body anatomy

Caesarean section: returning to physical trainings

Caesarean section is the birth of a baby through a surgical incision in the abdomen and uterus.

Everything you need to know about how to train safely after a caesarean operation!

About 85% of women will become pregnant at least once in their lives. Most of them will give birth naturally, but somewhere around 30% will give birth by caesarean section. And the number of those who have a caesarean section is growing every day.

As caesarean operations are on the rise and it is already known that exercise plays a vital role in the postpartum period, it is very important that you (or your coach) know how to return to training after such a birth.

What is a caesarean section?

Caesarean section is the birth of a baby through a surgical incision in the abdomen and uterus. It involves the use of epidural anesthesia or spinal anesthesia, and in some critical situations, total anesthesia.

Planned and unplanned caesarean sections

A caesarean section can be planned or unplanned, such as in cases where vaginal births become complicated and emergencies occur. But not all unplanned caesarean sections are urgent.

Some women go through trauma and suffering after an unplanned caesarean section. Therefore, as a coach, it is good to know if your client’s caesarean section was planned or unplanned, in order to better understand her needs. Some women, although happy for the born baby, may have feelings of failure or disappointment due to a change of plan during birth.

Recovery after caesarean section

After the caesarean, the patient can remain hospitalized between 3 and 5 days. Recovery after caesarean section depends on several factors:

  • circumstances of birth (elective caesarean section is easier);

  • physical condition;

  • the care taken during recovery;

  • support from home (and the presence of other children to take care of);

  • how soon taking pain medication begins.

Also, the intensity of the pain can vary. Some women go through great pain and struggle with any simple thing they do, and others go through only a slight discomfort. The pain may be intermittent or constant. Usually, sudden movements cause pain. The pain is reduced in the first 5 days and usually after 10 days they pass and there is no need for pills.

The benefits of exercise after birth

There are more researches made on the benefits of exercise during pregnancy than after birth, and many of them made after birth are related to mental health. But here are some proven benefits of postpartum exercise.

Physical benefits:

  • they improve cardiovascular health through better tolerance to glucose, lipid profile and vascular function;

  • improve vascular functions (VO2max);

  • they can reduce body fat and improve basal metabolism, especially for those of you who are not lactating;

  • they can improve bone mineral density or prevent bone problems caused by lactation;

  • they can help children to develop regular physical habits.

Mental and emotional benefits:

  • they have beneficial effects on well-being and relieve the symptoms of depression;

  • they improve mood and self-image;

  • they reduce anxiety and postnatal depression.

And, of course, let’s not forget the general benefits of exercise:

  • protect from disease;

  • improve respiratory function and reduce the risk of coronary heart disease;

  • they decrease blood triglycerides;

  • they increase HDL (good cholesterol);

  • they increase insulin sensitivity;

  • reduce visceral fat.

It is clear that doing sports after giving birth is something beneficial. But how fast can you start exercising after a caesarean section? And what activities are safe?

It is usually said that you can return to normal physical activity after 6 weeks. Let’s see what it’s really about!

The myth of returning to training after 6 weeks

For generations, women have been told that the postpartum period lasts 6 weeks – from the day of birth to the sixth week of the doctor’s check-up.

Six weeks. Let’s talk about this a little bit. Yes, many women notice a decrease in pain after a few weeks and can do normal physical tasks after 6 weeks. And after 6 weeks, many doctors recommend to patients to gradually increase their physical activity according to their abilities.

But a caesarean section is an abdominal surgery that requires healing of a few layers of tissue, so it is not at all okay to return to your usual workouts after only six weeks!

The 6-week tip is a myth for two reasons:

  1. Advising a woman who has had a caesarean section to do NOTHING for 6 weeks can make recovery difficult. As they heal, many women can move around doing normal daily activities, these movements supporting healing.

  2. It is dangerous to say that all women can do any physical activity they want after only 6 weeks. Healing of muscle wounds can take between 6 months and a year – and a caesarean section is a very deep muscle wound.

Caesarean section is a routine operation, but it is not minor! Healing does not end in week 6. In fact, the caesarean scar has only 51-59% of its resistance to normal tension, 6 weeks after the operation. On the surface, the caesarean scar may appear healed, but the deep layers under the skin take time.

But research on recovery after caesarean section provides limited information. Suggestions are based more on assumptions than concrete evidence.

For example, women who have given birth are told not to lift heavy objects because this will create intra-abdominal pressure, which will strain the abdominal muscles and the pelvic floor muscle. But research has found that a woman who lifts 16 kg from a counter or 18 kg from a table or floor creates less intra-abdominal pressure than moving from a sitting to an upright position or when climbing stairs.

It has also been found that for many women, lifting from a chair creates more abdominal pressure than many other activities that women are advised to avoid, such as abs or lifting weights from the floor.

This suggests that some activities you can do in the gym are less stressful than activities you already do in your daily life.

How to get back to exercise after caesarean section

  1. Every person is different

Recovery after caesarean section is very varied. Here’s what you should consider:

  • How you heal and how you feel physically

Most of the problems you experience after a caesarean are pain, reduced mobility, problems with the abdominal wound, vaginal bleeding and urinary inconsistency. Some women can heal very quickly, and others last longer, especially if they had a problematic birth.

A consultation with your doctor is mandatory before starting any exercise regimen!

  • History of exercise

How physically active you were before pregnancy can have an impact on your ability to return to exercise. The more active you were, the faster your recovery will be.

  • Pregnancy and birth experience

Possible pain during pregnancy, duration of labor, number of births and possible trauma, all influence the recovery time.

What must be kept in mind is the fact that there are no generally valid rules and everyone must make an evaluation according to their condition before starting exercising. We will talk about this in more detail.

  1. Mental health

It is normal for a mother to go through sadness and irritability in the first days or weeks after birth. It is estimated that 40-80% of new mothers go through this due to massive hormonal fluctuations – especially a drastic decrease in estrogen and progesterone.

For some, these poor mood symptoms can last a month or more. Then you can say that it’s a case postpartum depression. Those who suffer from this also go through poor sleep, low energy, decreased pleasure, feelings of helplessness, constant negative feelings and inability to adapt.

All this must be treated by a doctor who specializes in such cases! If you are a coach with such a client, and you notice these symptoms, immediately recommend her to seek professional help!

  1. Worries and obstacles in postpartum recovery

  • Stress and lack of sleep

You may not be able to sleep well every night, but anytime you can rest a little better will have an impact on how you feel mentally, on energy, on metabolism and on hormones. The better you manage to rest, the faster you recover!

Stress and lack of sleep can:

  • affect blood circulation;

  • it forces the body to produce more cortisol, which can lead to weight gain;

  • decrease blood flow to the digestive system, causing sensitivity in the stomach;

  • alter testosterone and estrogen, lowering libido;

  • it negatively affects the mind.

  • Abdominal pain and scar hardening

Take care of your body in the first weeks after the caesarean. Abdominal pain and sensitive abdominal scarring are common after such surgery.

  1. Physical evaluation

You must first have your doctor’s approval to return to exercise! It is the first and most important step! The doctor is the only one able to advise you in this situation. After he approves it, you can slowly start doing exercise.

Training after caesarean

In the first 6 weeks after the cesarean section you should:

  • practice contraction and relaxation of the pelvic floor muscles;

  • treat pain and spinal tension;

  • do optimal breathing exercises;

  • start an easy walking routine;

  • work on posture and proprioception.

By skipping this stage you will not speed up recovery and it may create problems later.

From week 7 you can return to sports, but keep in mind that this can be done only with the consent of the doctor. During this period you must always pay attention to:

  • monitoring the scar to make sure it heals properly;

  • creating a basic level of strength through simple and functional movements;

  • improving aerobic capacity.

It is recommended to combine aerobic activities with light weight training, along with stretching and recovery.

At first you will have mobility problems and you will get tired quickly, so keep that in mind and don’t despair. You will not be able to be in top shape at first. It’s perfectly normal! Reduce the number of sets if you do not feel able to do them, shorten your workouts or divide them into several mini-sessions per day!

  • Cardio

Cardio intensity should remain low during this period. Start with low-impact exercises so you do not stress the pelvic floor muscle. You can walk 45 minutes a day at a leisurely pace. From week 13, if you do not have pain or urinary inconsistency, you can increase your walking time to 60 minutes a day.

  • Strength training

You can do strength training 2-3 days a week. Stay at 2-3 sets of 8-12 repetitions. From week 13 you can add and walk for 15 minutes after the training session.

You can progress slowly towards more intense exercises. Try to choose exercises that do not put pressure on the pelvic floor muscle. A (good) coach can be helpful here.

Avoid exercises that:

  • cause pain (especially in the lumbar or abdominal area);

  • cause symptoms of urinary inconsistency;

  • cause sensations of heaviness in the perineum area;

  • cause a visible swelling in the white line (the line that divides the abdominal muscles into two vertical parts)

For the rest of the day, rest as much as possible.

Week 19

From week 19, if there are no complications, you can move to a slightly higher intensity:

  • continue to increase the strength of your abdominal wall;

  • keep working on breathing;

  • increase your aerobic capacity;

  • increase the weights used in strength training;

  • start training specific to certain sports (if applicable).

  • Cardio

From week 19 you can return to slightly more intense cardio training, with greater impact:

  • 1-2 HIIT sessions per week;

  • 1-2 moderate cardio sessions;

  • daily walks.

  • Strength training

Just do exercises that you feel comfortable of doing and progress easily to heavier weights. You must not have pain of any kind!

Do 2-4 workouts a week and stay at 2-4 sets per exercise, 8-12 reps each. You can do 15 minutes of HIIT at the end of the sessions.

After 42 weeks, if everything went well, you can do any activity you liked before pregnancy.

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