It’s a good bet that you or someone you know had a C-section. Because cesarean births now account for about a third of all births in the US.
Although millions of mothers in the US have delivered babies that way (and have the scars to prove it), there’s still a lack of focus on what happens to the body after such an invasive procedure. Exhibit A: There’s no medical term for the loose skin you can get after a C-section in the lower abdominal area. That’s according to perinatal athletic therapist Janette Yee, who — like a lot of moms — refers to it as a “C-section shelf.”
“I find it interesting that it affects most women after this surgery, and there's no word for it in our language,” Yee said. “What does that mean about our culture if we can’t even talk about it?”
At the very least, it means it’s time to break down the basics of what recovery looks like after a C-section. So we called up Yee to discuss the procedure, misconceptions, and how to help yourself heal. Because prioritizing your health remains crucially important as you care for a baby.
It’s a kind of delivery that requires major abdominal surgery. The entire front of your body is cut open, right through the uterus.” It requires at least two incisions: through the abdomen and the uterus.
Note: We’ll use the terms “C-section,” “cesarean” and “C-birth” interchangeably in this guide. But Yee, and others in the perinatal space, often prefer terms like “C-birth” and “belly birth” because those better convey that a mother played an active role. As opposed to being a “passive onlooker [while] a surgeon birthed your child,” Yee said.
When people use the term ‘natural birth’ to refer to a vaginal birth — or joke that they’re ‘too posh to push’ — that can reinforce the attitude that a C-birth is ‘the easy way out.’ Or that a mother didn’t have the ‘real’ childbirth experience. That’s a myth, Yee said.
In reality, a cesarean is an option when certain circumstances make vaginal birth unsafe or there’s a problem with labor (think: the baby is breech, the placenta is blocking the cervix). But a C-section also carries its own risk of complications and infection. And it requires physical and mental recovery. For ideal neonatal and maternal health care outcomes, C-sections should account for between 10% and 15% of births, according to the World Health Organization. That’s much lower than the current rate in the US.
Another thing to know: Having a C-section doesn’t necessarily preclude you from having a vaginal birth in the future.
Serious initial pain. Everyone feels different levels of pain after surgery. But let’s be real: this post-surgery pain could be some of the worst you’ve ever experienced. Which is why you’ll likely be prescribed pain meds. And might be in the hospital for two to four days to recover. (Mothers who deliver vaginally typically stay one to two nights in the hospital). Yee said it could take around two weeks for the pain to even start to fade. So you’ll likely need to rely on support, in the form of relatives and friends. And compression garments like ab wraps and belly binders, Yee said.
Limited movement. Remember, a surgeon just sliced your abdominals. So all movements that require your core — from taking the stairs to changing a diaper and driving — might not be doable in the first two weeks as you begin to heal. Which could mean being strategic about things like making sure your bed, baby, and bathroom are on the same floor, if your home has more than one level. Even if you don’t feel pain in your abdomen, chances are your muscles still aren’t strong enough for you to carry out everyday tasks yet, Yee said. In the first few weeks postpartum, some moms can go for a short and gentle walk. But others might not be ready for that because of pain or vaginal bleeding from the movement, Yee said. Speaking of…
Vaginal bleeding. It doesn’t just happen with vaginal births. Because, as Yee explained, that bleeding is from inside your uterus. Where there’s a wound that’s trying to heal — all as the uterus is going back to its normal size. Note: Yee recommends avoiding sex or using tampons for a few weeks after birth because it could cause infection.
Swelling. After getting pumped with medication, your body could look and feel swollen, Yee said. That could mean you still look pregnant after giving birth. And that you have trouble fitting your puffy feet into your shoes.
Breastfeeding hurdles. You may be able to breastfeed normally, but studies suggest that a C-section could delay the start of milk production. And when it comes to positioning your baby, you might want to try a ‘football hold’ to minimize the pressure on your incision.
Start to feel more like ‘yourself.’ According to surveys, that six-week mark is when a postpartum mom tends to feel more like herself, Yee said. Though that’s a subjective measurement, it likely means she isn’t bleeding anymore and is able to do her daily activities with much less pain and more function. It could also be when your uterus returns to pre-pregnancy size, your cervix closes back up, and the swelling at the incision site goes down.
Consider resuming some activities. “If you have no pain and good core function, there’s no need to wait for six weeks” to start gently exercising or driving again, said Yee. (Putting your foot on the pedals requires more core strength than you probably realized.) Most women aren’t ready to safely have sex before six weeks.
Get checked for infection. For an uncomplicated pregnancy, your first postpartum checkup is typically around six weeks. And that’s an important time to check for an infection from the cesarean. Don’t want to scare you, but bacterial infections are a serious concern. And just putting it out there that the scar tissue forming on your midsection could start sticking to parts of your body that it shouldn’t, like your intestines, Yee said. Which could impact your digestive and reproductive systems. All that to say: Make an appointment earlier than six weeks if things feel off.
Practice belly breathing. It’s not just for yoga. Yee recommends inhaling into a full belly to help stretch the skin around your scar and rebuild core muscle control.
Consider massaging your scar regularly. After about six weeks post-C-birth, putting your hands on your scar and gently pushing skin around could help relieve some pain, said Yee. The idea behind it: moving the skin can help make the incision area more elastic. “Even if it's just a little bit, five minutes a day can make a massive change to lifelong pain and dysfunction,” Yee said. “In my opinion, it’s mandatory.” But only start scar massages after your scar is healed and your doc gives the OK.
Move your abdominals. If you’re still not feeling connected to your lower abs, you’re not alone. But if you’re up for it, it might be time to try out movements that target those muscles. One exercise (of many) that Yee recommends: Find something heavy, like a dresser. Lie down on your back in front of it, put your hands under it, and lift one leg. Then repeat with the other leg. Five times per leg.
Remember that physical recovery takes months. Know that many women experience numbness months after surgery. And also that getting a late start on rehabbing your scar and ab muscles isn’t something to worry about. But if you can, it’s best to begin incorporating light massage and abdominal movements into your routine within the first six months after birth, Yee said.
Here’s the thing: Birth trauma is real. And if you had a particularly scary birth, maybe where your expectations weren’t met, you experienced complications, and/or your belly was cut open, you could have a tough time recovering mentally. Yee said that some people who have C-sections are amazed by how badass their bodies are to give birth in such a way. While others are sickened by what they went through, which can make it hard for them to look at and touch their C-birth scar. Yee’s suggestion: Share your birth story with someone you feel won’t judge you. She said that as a therapist — even one who focuses on physical movement — that’s often where her sessions with clients start. Because clearing that mental block is important for continuing more physical work.
If your cesarean incision pain increases, you get a fever, or you experience heavy bleeding within a few weeks after giving birth, then you should talk to your doc ASAP. But if all goes well, that six-week post-op visit with your physician will do. After that, consider following up with:
A mental health therapist. And you can search for one who specializes in perinatal support. That person can help you navigate postpartum hormones so you can manage concerns like perinatal depression.
A pelvic floor therapist. This specialist can help you deal with issues related to bladder leakage or painful sex — real postpartum possibilities — and help with healing the internal part of your C-section scar.
An athletic therapist. Particularly one who specializes in perinatal care (like Yee). This type of therapist can help you with abdominal rehab. And is especially helpful for serious athletes recovering from C-sections.
Leaving the hospital after a C-section doesn’t necessarily mean you’ve recovered from it. That can actually take weeks (or months) of prioritizing your physical and mental health. Because a cesarean birth is a major surgery and by no means an ‘easy’ way to deliver.
Skimm'd by Carly Mallenbaum, Eleanor Goldberg, Anthony Rivas, Alicia Valenski, and Jane Ackermann
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