C-Section Recovery: Tips and Pelvic Floor Exercises for Healing

Thrilled and overwhelmed. Excited, yet exhausted — and let’s not forget sore. When you’re healing from a cesarean birth, or C-section, while caring for a newborn, those feelings can be, well — amplified. While you’re recovering from a C-section delivery, you’re feeding the baby every few hours and sleeping much less. You’re experiencing all the typical postpartum body changes, like engorged breasts and mood swings. And you’re doing it all with a painful new incision across your belly. A cesarean section is major surgery and C-section recovery often takes longer than with a vaginal delivery. Here, Hinge Health physical therapists share what to expect after your C-section birth, postpartum care strategies for yourself and your baby, plus how pelvic floor exercises can help speed your recovery.

C-Section Healing: What to Expect

A hospital or birthing center stay after a cesarean section is usually two to four days, according to The American College of Obstetricians and Gynecologists. But it can take six to 12 weeks or longer to fully recover and feel better, depending on the details of your birth experience, says Kandis Daroski, PT, DPT, Hinge Health pelvic health specialist and doctor of physical therapy. Knowing what to expect, especially in those first few days and weeks, can help. Some common expectations for recovery include:

• Mild cramping (sometimes called afterpains), especially if you are breastfeeding

• Vaginal bleeding or vaginal discharge for about four to six weeks

• Vaginal bleeding with blood clots and cramps (usually tapering after the first weeks)

• Incision pain and numbness

• Breast swelling and soreness

• Constipation

• Emotional ups and downs*

*If you are experiencing extreme mood changes, thoughts of harming yourself or your baby, or feelings that interfere with your ability to care for yourself or your baby, see your provider right away. Don’t wait for your postpartum checkup. There are effective ways to treat postpartum depression with medication, therapy, support groups, and more.

C-Section Incision Care

Your healthcare provider will give you detailed instructions for incision care before you leave the hospital or birthing facility. Ways to help your incision heal include:

• Wash with mild soap and water. Showering is usually fine; but don’t soak in a bathtub until your doctor gives you the okay. Gently pat the incision dry.

• Ease discomfort with ice packs. Icing your incision site three to five times a day for about 10 minutes can help reduce pain and swelling.  

• Take pain medicine, if needed. Your healthcare provider can recommend over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others), that are safe to take while breastfeeding.

• Support your stomach. As you move around more, C-section compression garments such as belly braces, compression underwear, or high-waisted leggings can help you feel more comfortable, while protecting the incision. Pressing a pillow gently against your incision when you need to laugh, cough, or sneeze can provide pain relief as well.

• Look for any signs of infection. Let your doctor know if:

  • Your incision separates, or is red, swollen, or warm to the touch

  • There is oozing or discharge at the incision site

  • You develop a fever

  • You have sudden abdominal pain

  • Your pain gets worse, not better

The Best Way to Breastfeed After a C-Section

In their first few weeks and months, most exclusively breastfed babies will nurse every two to four hours, on average. That means you’ll be holding your baby up to your breast eight to twelve times per day. How you sit and position your baby can help prevent incision pain and back pain during breastfeeding. Experiment to find the position that is most comfortable for you and your baby. Two C-section-friendly breastfeeding holds to try:

Football Hold

Just as the name suggests, it involves holding your baby by the side of your body — like you’d clutch a football. This position helps keep the baby's weight off your incision.

• Sit up straight (in a chair or on a couch).

• Hold your baby beside you, with their head near your breast. Support their upper back with your forearm and their head and neck with your hand. Face the baby toward your breast.

• If needed, place a pillow under your elbow so that you can position your baby high enough to reach your nipple. You can also support your breast in a C-shaped hold with your other hand.

Side-Lying Hold

This position allows you to relax while nursing, may be more comfortable if you had a C-section, and helps avoid back pain.

• Lie on your side, with pillows behind your back and under your head for support. (A pillow placed between your knees may make you more comfortable.)

• Place your baby closely beside you facing your breast, holding them in position with one hand.

• With your other hand, grasp your breast and touch your nipple to your baby's lips. Once your baby latches on, you can use one arm to support your own head and the other to support your baby. You can place a pillow or rolled-up blanket behind your baby’s back for extra support.

• Don’t fall asleep while you’re nursing. When your baby has finished nursing, return your baby to their own bed to sleep

Consult with a lactation consultant for additional help with breastfeeding positions, if needed.

C-Section Tips for Healing: Dos and Don’ts

Rest, time, and patience are the best strategies for postpartum healing. You may be able to resume most regular activities in four to eight weeks. As you recover and heal, keep these tips in mind and ask your doctor if you have specific questions about your situation.

Do: Take walks  

Physical activity and fresh air are good for both your body and mind and can help promote healing. Keep your strolls short, slow, and on flat ground at first. Walking hills and climbing stairs engages your core, which can cause pain or pull on your incision.

Don’t: Drive for two weeks 

The location of your incision and muscles affected during your C-section may affect your ability to take the wheel safely.

Do: Modify everyday activities

Making small adjustments to common movements can help reduce discomfort as you recover. Some techniques to try:

Getting in bed: 

• Sit at the side of your bed. Using your arms for support, lean to the side so your head moves toward your pillow.

• As you do this, bring your legs up onto your bed. Then you can roll from your side onto your back.

Getting out of bed:

• Start on your back and bend your knees so they point toward the ceiling and your feet are flat on the bed.

• Roll onto your side, keeping your shoulders, hips, and knees in a straight line.

• Using the arm that’s on top, push yourself up to a seated position while swinging your legs off the side of your bed.

Getting in and out of a car:

• Adjust the seat so your hips are higher than your knees, if possible, to reduce stress on your abdominal muscles.

• Swing both feet out of the car.

• Scoot to the edge of the seat.

• Use handrails on the car ceiling for support as you press through your legs and stand.

Standing from a chair:

• Scoot to the edge of the seat.

• Hinge forward (nose over toes) and press through your feet to stand.

Don’t: Overdo it

That means no intense exercise or heavy house cleaning as you heal. Also: Avoid lifting anything heavier than the weight of your newborn for the first six to eight weeks after surgery. If a family member or friend can help you with daily tasks, let them. And whenever possible, rest while your baby sleeps.  

Do: Try C-section scar massage and desensitization 

Once your incision has completely closed, C-section scar massage and desensitization techniques can help your scar look and feel better. Wait at least six weeks after delivery, unless your doctor says otherwise.

Don’t: Have sex (until cleared by your doctor) 

Most people are cleared to resume sex at their six-week check-up. Once you get the go-ahead, use a personal lubricant, try spooning or side-lying positions, and focus on open communication with your partner. 

Do: Stick to sanitary napkins 

Use sanitary napkins instead of tampons until your doctor says it’s okay.

Do: Practice proper pooping posture 

Sit up straight and rest your feet on a small box or toilet stool to bring your knees higher than your hips. This will help relax your pelvic floor and make it easier to pass stool. You can also brace your incision with a pillow when you push during a bowel movement for extra support. 

When to Call the Doctor

While C-section complications are uncommon, be aware of signs of infection, as well as other postpartum or post-surgery issues. Call your doctor if you have:

• Fever (greater than 100.4° F) and/or chills

• Warmth, redness, swelling, or oozing at the incision

• Sudden or worsening abdominal pain

• Foul-smelling vaginal discharge

• Pain or burning when urinating

• Heavy bleeding, passage of large clots, or bleeding that comes back after slowing

• Swelling, pain, or redness in your leg

• Symptoms of postpartum preeclampsia, such as swelling in your hands or face, sudden weight gain, headache, or vision changes

• Thoughts of harming yourself or your baby or feelings that interfere with your ability to care for yourself or your baby

Pelvic Floor Physical Therapy for C-Section Recovery

Your pelvic floor is a group of muscles and tissues that forms a hammock from your pubic bone in the front to your tailbone in the back. Like the foundation of a house, it helps support the structures above, like your uterus, bowel, and bladder. When you’re pregnant, these muscles work double-duty to help support your growing baby. Nearly everyone’s abdominal muscles separate by the end of pregnancy (known as diastasis recti), which puts additional strain on your pelvic floor. And when you deliver via C-section, your pelvic floor muscles help compensate for your abdominal muscles as your incision heals. “It’s a common misconception that pelvic floor issues mostly affect people who’ve had vaginal deliveries rather than C-sections,” says Dr. Daroski. Your pelvic floor was challenged by nine months of pregnancy no matter how you deliver, she explains. And because the muscles of your core and pelvic floor are connected, an abdominal incision can impact your pelvic floor. “Pelvic floor exercises can make a big difference in your C-section recovery” says Dr. Daroski. 

Pelvic floor exercises are not just Kegels. Rather, they include a variety of moves that help strengthen or relax the muscles of your core and pelvic floor, rejoin separated abdominal muscles, and much more.

Many people can safely start doing pelvic floor exercises within a few weeks of having a baby, but get clearance from your doctor before you begin any exercise. Once you get the okay, a pelvic floor physical therapist (PT) can help. A PT can tailor a postpartum workout program to your personal circumstances and what is safe and appropriate for you. 

You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

Pelvic floor exercises can help you reconnect to your core, strengthen and coordinate the muscles of your pelvic floor, and rejoin separated abdominal muscles after cesarean birth. The following exercises recommended by Hinge Health pelvic floor physical therapists are a great way to help you recover after a C-section:

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Take Time for Rest and Healing

“Cesareans are major surgeries that can have an impact on your pelvic health,” says Samantha Charlotin, PT, DPT, a Hinge Health pelvic floor physical therapist. No matter how you deliver, you need time and rest for healing, she explains. “For C-sections, that includes scar massage and desensitization. And pay attention to any bladder, bowel, or sexual symptoms so you can address them early with pelvic floor physical therapy.”

How Hinge Health Can Help You

If you have pelvic pain or symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Patient education: C-section (cesarean delivery) (Beyond the Basics). Berghella, MD, V. (2022, December 6). UpToDate. Www.uptodate.com. https://www.uptodate.com/contents/c-section-cesarean-delivery-beyond-the-basics

2. Centers for Disease Control and Prevention. (2018, December 3). How Much and How Often to Breastfeed. Centers for Disease Control and Prevention. https://www.cdc.gov/nutrition/InfantandToddlerNutrition/breastfeeding/how-much-and-how-often.html

3. Cesarean Birth. (2022, May). Www.acog.org. https://www.acog.org/womens-health/faqs/cesarean-birth

4. Cesarean Section: What to Expect at Home | Kaiser Permanente. (2023, July 10). Healthy.kaiserpermanente.org. https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.cesarean-section-what-to-expect-at-home.ud1242#:~:text=Your%20Recovery

5. Going home after a C-section Information | Mount Sinai - New York. (n.d.). Mount Sinai Health System. https://www.mountsinai.org/health-library/discharge-instructions/going-home-after-a-c-section

6. Mayo Clinic. (2018). C-section recovery: What to expect. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/c-section-recovery/art-20047310