WHAT GOT CUT? WHAT DOES IT MEAN FOR THE STRENGTH AND THE LOOK OF YOUR TUMMY? WHAT EXERCISES WILL HELP AND HOW SOON CAN YOU START?
What Happened In There?
Just because lots (that’s millions) of women have a c-section, that doesn’t mean it’s not major surgery. Don’t underestimate the physiological trauma your body has undergone, and don’t let anyone make you feel like it’s no big deal, or an easy ride. Giving birth, however you do it, IS a big deal!
When you have a c-section, a horizontal incision is made with a scalpel, just above the pubic bone where the pubic hair begins, through five layers of skin, tissue, and muscle:
1) the derma, or outer layer of skin and 2) fat; 3) the fascia, the tough, thin layer that supports the muscle; 4) the rectus muscle, which is manually separated by the surgeon’s fingers down to the pubic bone; and 5) the peritoneum, a shiny layer that encases the entire abdominal cavity. The rectus muscles are parted to gain access to the uterus and your baby.
A ‘bikini line’ transverse (side to side) cut is the more common type of cut, as this results in less scarring and chance of infection or complications. A vertical cut is usually now used only in emergency situations and can be slower to heal, with more scarring.
In neither incision are the abdominal muscles cut. The two strips of rectus muscle are manually further separated at the midline to gain access. This is important – your muscles have not been cut!
WHAT DOES THAT MEAN FOR YOUR TUMMY?
Layers of tissue are cut, and then sewn back together, which creates scarring through multiple levels of tissue of your abdominal wall. This scarring affects the muscles’ ability to glide over the top of each other during muscle contraction. The result is weakness and a lack of stabilization.
If you have had more than one c-section, with a gap of less than two years in between, then your abdomen may not have repaired completely before your body went through the whole process of pregnancy and surgery again. Your recovery and ability to regain physiological balance is related to hormones, body weight, posture and alignment, and muscle tone.
Starting with stronger abdominal muscles will help with recovery, and strengthening the deep muscles of your core and pelvic floor during pregnancy will give you the “muscle memory” to make it easier to do the exercises after the birth.
But if you’re reading this and your stomach muscles can’t remember last Tuesday, let alone how to synchronise with your pelvic floor, don’t worry!
EXERCISE AFTER C-SECTION | 0-6 WEEKS POST C-SECTION: JUST FIND THE MUSCLES
Start as soon as you can. You’re not ‘exercising’, you’re breathing and re-connecting your brain to your tummy and your pelvic floor. And the sooner you do this after any type of birth, the better.
For full instructions on how to restore your core (IE get a flatter tummy again) after birth, you can follow the week by week, step by step MuTu System program.
Your ‘Core’ is explained in this post. You need your core if you want to stand up, sit, move, twist, pull, push, bend or turn. Kinda important. It’s connected (literally) to the muscles of your pelvic floor, which you need to prevent you from wetting yourself or having a prolapse. Kinda important too. You need strong core muscles to help close a diastasis recti, or separation of your abdominal muscles. And if you want a flatter tummy after having babies, you need all of the above in spades.
After a Cesarean section, you will experience numbness around your scar site, and so the the visualisation of ‘gently drawing belly button to spine’ may be unhelpful as you may not be able to feel this movement.
Instead imagine your abdomen as a clock, with your belly button at 12 o’clock, your pubic bone at 6 o’clock, and your hip bones as 3 and 6. Imagine you are slowly and gently drawing the hip bones, or 3 and 6 o’clock, together. It will also work if you imagine you are drawing them apart! Don’t worry that you can’t feel much happening for now. Go gently and do the movement on a long, slow exhale.
At the same time, engage your pelvic floor muscles. Not a little squeeze at the front, a deep, high lift in the middle. More on how to do pelvic floor exercises properly here (no, squeezing like you’re trying not to wee doesn’t cut it).
Get as used to this movement as you can. Practice as you sit in bed recovering, and as you feed your baby – just take long slow breaths in time with the muscle contractions. When you move around – roll out of bed (always from your side!) when you start to try lifting things, when you do anything that is going to place forward forceful pressure on your scar site… engage the muscles.
Don’t try to get up from lying on your back – always roll to your side first. And don’t – under any circumstances, not now or in the future – do sit ups or crunches.
If you have had one or more Cesarean births, or other abdominal surgery, then there may also be scar tissue or adhesions exacerbating your mummy tummy. Massage (just rub the skin gently between your fingers around the scar) will help to break down scar tissue, encourage oxygen flow in, and toxin flow out of, the area which will aid healing.
Whilst muscles have not been cut, ligaments and fascia have been, and this all takes time to heal. The more you can ‘connect with’ and use your deep core muscles, the quicker recovery will be. Scar tissue and adhesions can cause a tummy overhang, and body fat may appear to be unevenly distributed around your middle. Stress, lack of sleep and a lack of sensation or confidence with your stomach (factors all common to most new mums!) will make this worse.
So, in the early days, massage, mobilize, find and strengthen your deep muscles, eat clean fresh food to recover and nourish your body, try to get plenty of sleep and love your body a little. The will help you heal, restore and strengthen your abdominal muscles.