I am sure my father in law would not mind me using him as a reference but a few years ago now, he had a hip operation to help repair his hip joint after falling from his road bike on a closed circuit cycling event. Since his operation he has had multiple follow up appointments with his surgeon, physiotherapist and hydrotherapy to help his recovery with plenty of ‘homework’ to be done at home in between appointments. He has worked very hard to recover and rehab his hip and he has had to retrain his body to return to his ‘normal’ pre-injured activity level and he is still not quite there yet.

Since the arrival of my baby boy via a C-section it got me thinking about all the women who return to exercise post a C-section and how little information women are given about the process. After my boy was born, I was told the following

• 1. Dont lift anything (heavier than your newborn baby)
• 2. Dont drive for 6 weeks
• 3. Dont go up and down stairs if you can help it

WAIT A MINUTE! WHAT?! How am I supposed to cope? I have just had MAJOR ABDOMINAL SURGERY!!!

Luckily for me I had 2 of the most amazing women in my life come and save the day, my mom and mother in law! Phew! Without them I am not sure how I would have gotten through it! They came and did the washing, cooking, cleaning, school pick up and drop off and walking the dog. I could not have done it without them! Oh! and not to forget my fabulous childminder who came to collect and drop off my daughter so she had some fun and other kiddies to play with whilst I could rest and recuperate. Plus, my brilliant husband who took the bull by the horns, and did so much more than I could have asked him to do so that I could just rest and recover.  So, it took a team to help me within the first 6 weeks, but thats not even mentioning my active steps to recovery!

WHAT!!! A women who has had MAJOR (and I say MAJOR) abdominal surgery should wait 6 weeks before they are signed off by their GP to get going and start exercising again! STOP! NO! PLEASE WAIT!!

Where is your physiotherapy referral?

What about how to move during those first 6 weeks?

What exercises are safe for me to do and what should I avoid?

How do I care for other siblings whilst I have a newborn?

I am here to tell you how you can start to do things within the first 6 weeks to help with your healing process; so take a deep breathe and lets begin…..

• 1. Rest and relax as much as you possibly can

• 2. Rolling over every time you aim to sit up or lie down, aim to lie on your side first. This will avoid any crunching or sit up type position which will put a lot of pressure on the scar and abdominals.

• 3. Restore your breathing. Start re-connecting with your breathe. Super easy and simple to do when lying in bed resting. Breathe in to feel ribcage and belly gently expand and relax and breathe out to feel ribcage soften in and down, naval draw gently towards spine and engage your pelvic floor gently. Before you do any lifting, rolling or sit to stand movements try practicing your breathe and breathe out to perform the movement or lift.

• 4. Walking  – increase your walking slowly depending on your energy levels. Some days you will feel great and other days you might feel like you have taken a step backwards. That’s quite normal. Go with your body, and if you feel great do some more walking and if not, rest more. Eventually you will feel up for doing more even if at the time you don’t feel like that will ever happen!

• 5. See a women’s wellness physiotherapist in your area. Even if you don’t have pain or discomfort it would be a good idea just to have an overall clearance with a professional who understands what you have gone through and can really tell you how your body is healing.

• 6. Start some gentle exercises. (guided my a fitness professional who specializes in women’s health and fitness)  This very much depends on each person, some feel ready to go within 2 weeks of a C-section and others take much longer.

• 7. Don’t be hard on yourself and this is not a time to push yourself to test your limits, go with your body and if it says yes I am ready to try and do more, then do, and if you feel exhausted the next day it’s a sign your body is still recovering and building its strength so do less. Eventually your body will just do what you are asking.

Happy Healing! 

Go slow and build a strong foundation!

I am sure there are many methods that can be applied to performing the C- section massage, but here is how I do it and has worked for me and my past clients.

Start by using any oil/cream you may have. I personally liked using Rosehip oil, it is said to be great for nourishing the skin, improving texture and tone, plus its supposed to help stretch marks! Tropic, Tamanu Healing Balm is also great on any scars.

WHOLE TUMMY MASSAGE

Start by massaging your entire stomach in a clockwise direction. This will get you feeling comfortable with touching your skin and bringing connection to your brain. Moving in a clockwise direction can help improve digestion and often this is quite slow post surgery due to not moving as much. Once you feel comfortable with this try and move closer and closer to the scar until you feel comfortable touching the scar. Sometimes I have ladies just hold their whole palm of hand over their scar and breathe. The massage is meant to be healing, restful and relaxing. If at any point you become stressed or emotional, please stop and visit it another day to give it another try.

SIDE TO SIDE - LEFT TO RIGHT AND RIGHT TO LEFT

you may or may not be ready to touch your scar but you can do this as close to your scar as possible and for those who are comfortable, you can perform this on the scar. Starting from the left side of your scar, press lightly down into your skin and drag your finger all the way to the right side of the scar. Repeat this movement 5-10 times. Then reverse this movement and do it from right to left 5-10 times.

**notice how the scar feels, all of it lumpy, parts of it lumpy, the ends feel restricted etc. As you progress your massage and touch do you feel this improving**

PRESS AND PULL

Starting just above the scar moving from left to right again, press lightly down and drag your fingers towards your belly button. Lift off and move a little to the right along the scar, press down and pull upwards towards your belly button. Keep repeating this until you reach the end of your scar on one side and then do it all the way back to the starting side.

DIAGONAL PRESS AND PULL

Similar to the above but starting on the scar press lightly down and on a diagonal pull upwards, using your other hand to anchor below the scar and pull slightly downwards. Repeat along the scar from left to right and then back from right to left.

CIRCLES

Performing mini circles with your index and middle finger, moving from left to right and right to left again. Press firmly without causing pain. If you don't feel comfortable doing this on the scar do it above and below the scar until you find it easier to do it on the scar.

COMPRESS AND TWIST

In order to do this you do need a smooth lacrosse type massage ball. Like a spikey massage ball but smooth. Press it down onto the scar and gently twist, move along the scar (or as close to it as possible) from left to right and right to left. I also like doing this in a clockwise direction around my whole stomach as can aid digestion and reduce stiffness and tightness in other areas that may be affected by the surgery indirectly.

EXTRA TIPS

1. Don't force a movement
2. Work where you feel tighter
3. If there is pain, stop immediately
4. Work as close to the scar as you can until you feel ready to massage on the scar
5. There is no rush, go at your own pace
6. If you don't like using your fingers, look to invest in the smooth lacrosse massage ball its great for doing all of the above without touching the tummy and scar.
7. Hydrate and move gently within your comfort level
8. Try and do your massage at the same time daily until you achieve a sense of suppleness in the skin and tissues. Once you have achieved this then you can do it once a week and move to once a month
9. Scar tissue remains active for up to 2 years so keeping this going will be really helpful as it slowly heals over time with a good foundation.

I CANT TOUCH MY SCAR OR TUMMY!

Often a C section can be a very traumatic experience if it was not planned. This causes us to disconnect from this area due to the event being too overwhelming. This is out body's way of coping with a stressful and traumatic time. It's a very natural part of coping with trauma. Being unable to touch or look at your scar may mean your body is dealing with some trauma from the event and you may need to seek professional support and help to unlock and let go of the trauma so that you can focus on self healing and self care.

I found this amazing visual video on you tube by Naturally Nurtured Birth Services and found this to be so great in understanding the depth of the incision. It really shows that it's not just the outside layer (skin) that has been cut. Watching this, I hope will give you a deeper understanding of why taking your time to recovery properly is important and how the holistic approach to c section recovery is vital to greater healing in the long term.

Here is an outline of the layers that a Cesarean Section cuts through.

Initial cuts (and the visible scar) are horizontal through:

• Skin
• Fat
• Fascia

Then the incisions are made vertically through:

• Abdominal muscle
• Peritonium (the fascial membrane which wraps around the internal organs)
• Uterus (Bladder is moved down)
• Amniotic Sac

Until you reach the baby.

You see, it’s really important to remember that whilst all we see as a lasting reminder of the Cesarean Section might be the most superficial incision at the skin level, it is really an elaborate corset of suturing, enabling all these layers to knit back together and heal. So it is not just the most superficial scar that needs to be included in the massage.

Why Should you Massage your Scar?

Often as a result of the C section, we can experience pain and tenderness in areas other than the scar itself. It is important to note that whilst massage can help in the manner in which scars develop and heal it will NOT prevent them from being visible. What is more important to understand are the lasting benefits that massage can help with beneath the scar.

If you experience any of the following then you need to start massaging your scar and surrounding areas;

pain during sex

clitoral and/or labial pain

feeling like you need to go to wee A LOT

numbness or tenderness around the scar

lumpy or hard spots over/around the scar

feeling of tightness or rigidity around the scar

pelvic pain, lower back pain, pain in the groin

you can’t feel your abdominals doing work!

struggling with infertility after a previous C-section

digestive troubles, IBS

When is it safe to touch/massage your scar?

It is important to remember that each mother is different therefore the healing process is very individual. The progress also depends on the degree of trauma she has suffered and the skill of the person carrying out the suturing. As a general guideline, it will take approximately 6-8 weeks for an incision to heal.

Once you have been given the all clear from your GP or midwife you can start gently massaging your stomach starting as far away from your scar as possible and working closer and closer as you begin to feel more comfortable. There is not pressure to start touching your scar immediately, go slow, take your time. Please also note, if you have had a c section a long time ago, it is never too late to start massaging your scar, breaking down those adhesion and helping your body restore its strength.

After my C section, I lost all strength in my body and I found it particularly difficult to get up from lying down and had to perform the 'log roll' technique to get up out of bed for quite a few months. This makes it particularly challenging when baby wakes crying and you need to feed, it just adds to your body aches and pains.

One of my main aims is to empower women to know more about their post natal recovering bodies so that you know how to heal from the inside out. The scar may look fine on the outside but there are many layers they have had to cut through to get the baby out. So, why not know what its all about and you might find it helps you understand how and why you need to heal properly before starting to run again or doing whatever other form of exercise you love.

So..How do Scars Form?

When we have a wound that needs to heal, our body does something amazing … it lays down new protein fibres to knit the wound together. This protein is called collagen. While these new fibers are regenerating, the uneven distribution of collagen cells is often chaotic and forms itself in a messy fashion. If left untreated, a thicker, more dense and fibrous tissue can form a scar tissue or so called adhesions. Unfortunately these can sometimes bind to nearby tissues and it can result in a pulling sensation or sometimes even a ‘trapped', restrictive feeling. Adhesions can also be a source of digestive / bowel problems, incontinence, lower back pain and sometimes even infertility. It is estimated that 93% of people develop adhesions in response to the trauma of abdominal surgery.

Once we are ‘healed’ there is a visual reminder in the form of a scar. There are four stages of wound healing: hemostasis, inflammation, proliferation and maturation. In brief:

• Hemostatis phase
  This is when the wound begins to close by clotting (think scab forming).

• Inflammatory phase
  This is when the blood vessels leak something called transudate which is made of water, salt and protein) and causes localised swelling, which both controls bleeding and prevents further infection. I’m pretty sure this is what we refer to as the wound ‘weeping’ or pus.
• Proliferative phase
  This is when the wound is rebuilt with new tissue made up of collagen and extracellular matrix, it’s also when things start to feel a bit tight and pucker up a little because the wound contracts as the new tissues are built and pulls things together. Perhaps the most important aspect of this phase is the laying down of new blood vessels so that the new tissue can be healthy and receive the oxygen and nutrients required.
• Maturation phase (aka remodeling stage)
  This is when the wound fully closes, and the ‘repair’ cells are no longer needed.

The primary aim of scar massage is to promote the alignment of collagen fibres (‘break’ the adhesions and help them to form in a ‘less messy’ way) which are laid down as part of the healing process and also the development of more supple scar tissue which will allow for movement. This benefit will not be as visibly obvious as the texture and the appearance of the actual scar, but will certainly be a ‘felt’ benefit as these adhesions are ‘tidied up’.

A C-Section results in major abdominal surgery. Whether it was an elective or emergency C-Section, the recovery is much tougher than of a vaginal delivery. Its really important you do start moving as soon as you feel comfortable and starting with a gentle walk for 10mins around your room or corridor.

In those first few weeks its important to rest and focus on your little one and your recovery.

1. Move as much as you can to help improve blood flow which can help speed up your recovery
2. Avoid lifting or carrying anything heavy
3. Drink plenty of fluid
4. Once the scar and stitches have healed you can start gentle abdominal massage
5. If you need to cough or laugh, place a pillow on your tummy and press firmly whilst coughing or laughing to ease any discomfort

During your 0-10 weeks recovery, some of you may want to start your healing journey and here are a few things you can start to focus on until you are given the all clear from your GP or midwife to start exercising.

1. Breathing
2. C-section and DR Abdominal Massage
3. Integration on breathe, PF and TVA activation during functional day to day demanding exercises
4. Nutrition - hydration, increased protein intake and anti-inflammatory foods will be a must for supporting your recovery.

Please join me for my Post Natal Self Care Class on Saturdays 10.15-10.45am. (please email me Angela.jameson@physically-fit.co.uk, as dates change) Its free and the focus is to improve your knowledge about your post natal recovery and a chance to ask any questions you might have about getting started into an exercise programme. It will also be a chance to meet other mums who are recovering so you don't feel alone in the process.