Managing Your C-section scar in the Early postpartum weeks
Approximately 30% of pregnant people in the United States will give birth via c-section.
That’s 1 in 3 people giving birth via cesarean, the majority of which are unplanned cesarean births with a small percentage being planned c-sections for various reasons. While they are common, most people giving birth via cesarean have not planned for this potential outcome. The surprise of an unexpected cesarean birth can leave people feeling lost as to how to navigate recovery and support themselves.
There is so much that can be done to help support your body in the first few months following a c-section. In this blog post, we’re going to talk through some techniques and exercises you can use during the first 12 weeks postpartum to help support yourself following a cesarean birth. We’ll break these exercises down into sections based on timelines. If you’re reading this and you’re beyond the first 12 weeks after childbirth, this information is still appropriate for you and you can begin wherever feels appropriate for your stage of recovery.
As a disclaimer, if you’re having pain, please contact your medical provider first. Redness, heat or swelling in the area can be a sign of infection and may require immediately medical attention. This blog post is not meant to take the place of medical advice. Additionally, recovering from an unexpected c-section can be a difficult experience. Please reach out to your OBgyn or midwife if you are in need of mental health support. Postpartum anxiety and depression are common in the postpartum period, particularly when birth does not go as expected. If you’re in central Texas, our favorite mental health resources are Reproductive Psychiatry Clinic and the Postpartum Health Alliance of Texas.
It’s important to note that while I’ll be breaking down scar management and care week by week, everyone recovers at different speeds. The rate of progression described is appropriate for people having an uncomplicated, straightforward recovery. If you are experiencing or begin to experience heaviness in the pelvis, urinary incontinence, struggles with wound healing, significant, worsening pelvic or abdominal pain, please contact your team for personalized support or reach out to us here for one on one guidance.
Postpartum recovery is not a one-size-fits-all timeline.
Now! On to the good stuff. If you’re feeling good and eager to get started, follow along with me below.
Weeks 1-3 following c-section
It’s important to start gentle and rest these early weeks. During the first few weeks postpartum we recommend limiting activity outside of childcare and self care tasks. Give your body a chance to rest and reduce activity if you begin to notice any increased pain. To contribute to scar healing and recovery in the first few weeks postpartum, consider these three activities:
Take big deep belly breaths. Practice diaphragmatic breathing, or belly breathing, in all positions including laying on your back, sitting, while standing, even while you’re feeding your baby. Diaphragmatic breathing is all about filling your belly with air and relaxing as you inhale. This full expansion of the abdomen will help keep your muscles moving as your incision heals.
When standing, focus on standing up straight. Don’t let yourself bend forward at the hips. While this might feel uncomfortable at first, it will help prevent the muscles and skin surrounding the incision from tightening.
Look at the scar. While you don’t yet want to begin scar massage or desensitization, you want to make sure the scar is healing well and there are no signs of infection. If you start to experience increased pain or notice redness, heat or swelling around the scar, contact your medical provider. Looking at the scar can also help you avoid developing an aversion to the area in the future. It’s not uncommon for people to want to avoid looking at or even thinking about their scar. Be gentle with yourself.
Weeks 4-6 following c-section
Continue with the previous recommendations if you’re not ready to progress. If you are feeling ready for next steps, read on!
Continue with all techniques from the previous week.
If the wound has closed, begin with scar desensitization. This is typically around weeks 5 or 6. If your incision has not yet fully closed, delay this until then. Learn about scar desensitization here.
Slowly increase walking endurance by 5 minutes or so per week. Reduce walking time if noticing and leakage, pain or heaviness in the pelvis.
Weeks 7-9 following c-section
Around week 6 or when the incision has fully closed, begin scar massage. Learn about scar massage here.
Begin stretching your hip flexors, quadriceps and front body. See the images below for some of my favorite stretches for c-section recovery! When holding any of these stretches, aim to hold the position for 30-45 seconds and repeat a few times in a row. The stretch should feel moderate but never painful.
Begin working on core strength, preferably with guidance from physical therapy. Because a c-section is abdominal surgery, the surrounding muscles are impacted by tissue trauma. Regaining core strength is important for anyone recovering following childbirth, including following cesarean birth.
See a pelvic floor PT if you’re still experiencing pain surround your scar. A 2020 prospective cohort study found that up to 25% of people experienced scar pain at 3 months postpartum. There is so much that can be done to help manage pain at this stage if you’re still uncomfortable. Pain past the first 4-6 weeks postpartum can be treated with physical therapy.
Continue increasing walking endurance by 5 minutes or so per week.
Weeks 10-12 following c-section
Continue stretching, performing scar massage and desensitization as needed.
Continue strengthening your core, glutes and postural muscles.
Continue or begin working with a pelvic floor physical therapist for any remaining pain or related symptoms.
And remember - everyone recovers at a different pace. A realistic expectation for postpartum recovery is 6-18 months, not 6 weeks. Wherever you are in your journey, pelvic floor physical therapy can support and guide you. If you’re interested in working with one of our pelvic floor PTs in our Austin, TX clinic or virtually, contact us here.
Recovery doesn’t need to be a guessing game. We’re here to help.
Want to learn more about c-section scar pain and recovery?
Click here to learn about our self-paced, c-section recovery program to help you reduce pain and sensitivity around your scar while regaining strength and confidence after your cesarean. It’s never too late or too early to start supporting your body through your recovery.
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.