How to Safely Start Exercising After a C-Section

Returning to exercise after having a baby is no small feat, whatever kind of birth you had. But working out post Caesarean section is its own challenge. "You've had major abdominal surgery, and you have to care for a newborn at the same time", says Ann Nwabuebo, DPT, a pelvic health physiotherapist in Philadelphia and the founder of Body Connect Physical Therapy.

If you're ready to just move already, there's good news: some early research shows that exercise after a C-section can help you feel less pain as you recover. (And if you're not ready? No pressure. Rest, recovery and figuring out new-parent life are your priorities right now.)

Of course, before doing any full-on exercise, like taking a class or going for a run, you should be cleared to work out by your health care provider, usually around six to eight weeks post-partum. But that isn't permission to do all the fitness, and it doesn't mean you can't do anything beforehand. The following tips cover how to comfortably rebuild your movement routine before and after you get the green light.

The early days after a C-section aren't the time for planks or Pallof presses, they're the time for deep breath work to "re-educate" the core muscles, as Nwabuebo puts it.

Jessie Mundell, a certified personal trainer and kinesiologist who specialises in pre- and postnatal fitness in Kingston, Ontario, has had two C-sections herself. She advises breathing into the front of the chest, into the back of the ribs, and all the way down into the lower belly, "right around that C-section scar", she says. On an inhale, try to feel the connection in all those spots. On the exhale, try to feel a "gentle tensing" of the abdominals and a teeny bit of lift through the pelvic floor. This kind of breathing can be done any time, even while lying in bed (you're welcome). But it's especially helpful when you have to exert effort, since the breath is a great cue to your body to engage your core. One good time to use it: when picking up your baby out of the bassinet, pram or car seat. Start your exhale breath, grab your baby, then lift them as you finish exhaling, says Mundell.

Just because you didn't have a vaginal delivery doesn't mean your pelvic floor muscles don't need some attention post-partum, notes Nwabuebo. After all, you've been carrying the extra weight of the foetus, placenta and amniotic fluid for months. Mundell notes that her postnatal C-section clients often experience tension or tightness in the pelvic floor, so she works with them to regain flexibility and range of motion. Both strength-building and flexibility work are important because those muscles need to handle the additional stress of weight bearing and impact when you're ready for exercise, explains Mundell.

Your health care provider should check your pelvic floor during your postnatal visit, and an evaluation by a pelvic health physiotherapist is always a good idea if you can get one. But you can work on your pelvic muscles on your own for a couple of minutes every day by contracting the pelvic floor and relaxing and lengthening it. Exhale to lift the pelvic floor, and inhale to relax it all the way down to the level of openness you use when peeing. (For more tips on how to do this, see here).

OK, depending on how much support you have and how good you are at making yourself rest, you may have been up and about, living life, soon after your surgery. But if you've been able to take it easy, about four weeks post-partum is a reasonable time to start mindfully incorporating everyday movements into your routine, says Amanda Williams, MD, a board-certified obstetrician-gynaecologist in Oakland, California, and a member of the Nike (M)ove Like a Mother advisory board. Start carrying groceries, climbing stairs and picking up that car seat with careful recruitment of your recovering core and pelvic floor (remember to "zip up" your deep core on an exhale to prepare for exertion, suggests Mundell). This intentional approach to day-to-day life keeps your back and pelvic floor more comfortable and helps prep you for more structured exercise later.

As you start to spend more time living vertically, consider an abdominal support belt, which pros love for C-section recovery. "They can be really helpful for people who are having a hard time feeling connected to their core; the feedback of having something in contact with the abdomen can help them find it", says Nwabuebo. Dr Williams agrees: "They're like a second core, doing the work to stabilise you while your core is rebuilding".

Just don't go too tight (we're a no on waist trainers and corsets), since excess pressure can worsen pelvic floor issues. "It should feel like a gentle, supportive hug and not a squishing or tightening", says Mundell. Wear the belt when it feels good, especially during exercise or challenging activities, but take breaks and don't wear it while sleeping, says Nwabuebo. Most people ditch the belt by around 12 weeks post-partum, she notes.

As you progress, there are a few cues that you might want to take a break or find a gentler form of exercise until you gain more strength: abdominal pain or pain around the scar, lower back pain, incontinence or constipation, abdominal coning (your tummy makes a cone shape during an exercise), and postnatal bleeding that gets heavier after activity, the experts note. If in doubt about a symptom, ask your doctor for advice.

Throughout your recovery, it's worth reminding yourself you can always scale back and continue to build fitness after a C-section. Trust in your body and you'll get there.