Postpartum Recovery Primer: When Can I Start Bending after my C-section?

Let’s face it: postpartum recovery is tough. You’re exhausted, overwhelmed, and full of hormones. If you’re recovering from a cesarean delivery (aka caesarean or C-section), the postpartum healing process is complicated by additional concerns: post-surgical pain, limited mobility, and reduced abdominal strength, to name a few.

Many new moms receive advice about protecting their C-section incision and managing post-operative pain. Unfortunately, few receive education about returning to physical activity after surgery. Many moms wonder when they can resume bending, lifting, and carrying – activities that are integral to daily life as a new parent.

C-section recovery is complex and unique to each person. That said, it’s still possible for new moms to return to their activities safely and comfortably after a C-section. Consider this your guide to everything you need to know about bending and moving after a cesarean delivery.

Understanding the basics of C-section surgery can help you appreciate the importance of a patient approach to recovery. During your cesarean, your OB-GYN made incisions through the following tissue layers: 

• The abdominal skin and its underlying connective tissue (fascia)
• Four layers of abdominal muscles
• The peritoneum, a protective membrane that surrounds your uterus
• The muscular wall of the uterus. 

After delivering your baby through these incisions, your healthcare provider closed the incision sites at your uterus, abdominal muscles, and skin.

The sutures your OB-GYN used to close your incision sites aren’t designed to hold your tissues together under heavy loads. In fact, these stitches will begin to stretch within a few days of surgery. 

However, this doesn’t mean that your C-section scar is going to pop open at the slightest movement - your tissues simply need some time to heal around the sutures.

After your OB-GYN closes the incision, your body gets to work, sending specialized cells to the area to fight infection and stop the bleeding. Cells called fibroblasts start building “bridges” of new cells between the tissues that were cut. Eventually, these bridges will connect to form the external C-section scar you can see, as well as the internal scars in your abdominal muscles and uterine wall.

Scar appearance can vary widely: the thickness, color, and flexibility of your C-section scar depends on several factors, including your genetics, ethnicity, and the closure technique your OB-GYN used.

Importantly, the appearance of your external scar does not reflect the healing status of the internal uterine scar. The presence of a well-healed skin scar does not guarantee that your uterine incision site has healed fully. Conversely, a funky-looking skin scar doesn’t necessarily mean that you’re healing poorly internally.

This uncertainty about what’s happening internally means that new moms need to give their bodies adequate C-section recovery time. Check out this article for some helpful tips for facilitating healing from day one!

If you’re struggling to stay patient in the postpartum period, it helps to understand the potential complications of incomplete healing.

If the internal (uterine) portion of a C-section scar is too thin, this may increase the risk of uterine rupture during subsequent pregnancies. This adverse pregnancy outcome can endanger both the pregnant person and their baby.

An isthmocele is a defect that can develop at the uterine incision site after a C-section. This defect can affect fertility and cause problems with future pregnancies. Some people with isthmocele will require another surgery to correct it.

Even if you don’t intend to become pregnant again, poor healing of a C-section scar can still create problems. Some people experience chronic pelvic pain and/or pain with sex due to their scars. While these symptoms can often be treated successfully, it’s worth preventing a problem before it starts!

Incomplete scar healing can also impair muscle function by changing the way that the abdominal muscles and connective tissue glide over one another. Altered abdominal muscle activity can lead to pain in multiple regions, from the abdomen itself to the pelvis and lower back.

While these complications can sound scary, don’t panic: with the appropriate approach, you can increase your odds of a smooth, healthy recovery after a cesarean birth.

Forward bending is surprisingly demanding for the trunk and abs: bending forward, even partially, increases the pressure inside the abdomen. This increased internal pressure strains the abdominal muscles that are healing after a C-section.

Regardless of your delivery method, pregnancy weakens the abdominal and other core muscles. Compared to vaginal delivery, cesarean delivery weakens the abs more substantially. Six weeks after a C-section––the time at which many new moms receive the “green light” to return to all activities—your abs are only about 50-60% as strong as they were before pregnancy.

At 6-7 months postpartum, your abdominals still haven’t regained their full pre-pregnancy strength. This reduction in strength and endurance can predispose you to pain and injuries in your back, pelvic floor muscles, and beyond.

Fortunately, none of this means you can’t move, bend, or lift for months after delivery. Next, we’ll discuss techniques to help you move with less fear and discomfort after a cesarean birth.

The First Three Weeks

For the first 2-3 weeks after your C-section, pain at the incision site will be your guide: even the thought of bending over will likely be unappealing during this time. 

1. This is where your support network comes in: ask your partner, friends, or another family member for help whenever you can. If you have older children, this is a perfect opportunity to get them involved in their new sibling’s life.
2. You’ll need to get creative with your daily activities. If you have to reach down for something, use your legs to squat rather than bending forward at the waist. You can also use a grabber tool to pick up small objects without bending.
3. As you become more active, keep an eye on your healing C-section incision. If you notice any signs of infection, including pus, smelly discharge, increasing redness, or excessive warmth around the incision site, call your healthcare provider.

Weeks 3-6

Because each birthing person is unique, there’s no hard-and-fast rule for how long you should wait to start bending. Most recommendations are based on expert opinion, and nearly all of them stress that you “should consult with your healthcare provider before resuming physical activity”.

After the first couple of weeks postpartum, you may feel ready to start bending forward. Your healthcare provider will likely ask to see you for a check-up around this time to assess the healing of your C-section scar. If they tell you that you are “healing normally”, you may find the following tips helpful:

• Remember to breathe! By exhaling as you bend, you’ll reduce internal pressure against your incision site, and this can make bending safer and more comfortable.
• Focus on bending without lifting before you add weight. For example, ensure that you can bend forward and return to standing with minimal discomfort before you try to lift your baby out of a bassinet.
• Give yourself a boost. Use your arms to help lower and lift yourself into and out of bent positions.
• Add some cushion. Grab a pillow and gently press it against your incision site. This external pressure counters the internal pressure created by bending. 

• • Pro tip: the pillow trick also works well for reducing pain when you sneeze, have bowel movements, and transition in and out of bed!
• Modify your feeding position. You may experience pain at your incision site while breastfeeding. Check out this article for details on the best breastfeeding positions for C-section recovery.

These tips can help make bending more comfortable in the early weeks after a cesarean delivery. Remember that C-section recovery time is different for everyone: rather than worrying about where you “should be”, focus on how you feel right now, and adjust your activity accordingly. 

Beyond Week 6

As you continue to recover from your cesarean birth, you’ll gradually feel stronger and more confident about bending and other physical activity. 

It’s common to experience ongoing discomfort at the C-section scar, even 8+ weeks after cesarean delivery. However, this discomfort should gradually decrease over time: if it’s sticking around or increasing, call your healthcare provider. 

• Support your core with compression. A postpartum compression garment can provide external support for healing abdominal muscles, reduce discomfort around the C-section scar, and make basic movements more comfortable. Check out this great compression option!
• Avoid constipation to reduce abdominal pressure. It’s no secret that postpartum pooping can be a challenge. If you’re constipated and straining to pass bowel movements, it becomes even harder: straining puts additional pressure on your healing incision site. If you’re struggling to poop, talk to your OB-GYN about adjusting your pain medication, your stool softener, or both, since these medications affect bowel movements.
• Start scar massage with permission from your healthcare provider. When performed properly, gentle scar massage can aid in scar healing and reduce pain at the incision site. Check out this article for a guide to C-section scar massage.
• Use gentle exercises to promote muscle recovery. Remember that statistic showing that the abdominals take months to regain their pre-pregnancy strength? By starting to gently re-engage your deep core muscles shortly after cesarean delivery, you can kickstart the recovery process.

Regardless of how you approach your C-section recovery, be patient with yourself and the process. It took many months of pregnancy to reach your delivery date: recovering from pregnancy and your cesarean will take time, too. Wherever you are right now, you’re doing great!

References 

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