Exercise after C-section delivery to reduce tummy

 

What is the C -section?

Caesarean delivery (also called a caesarean section or C-section) is the surgical delivery of a baby by an incision through the mother's abdomen (belly) and uterus(womb). This procedure is done when it is determined to be a safer method than vaginal delivery for the mother, baby, or both.

In a caesarean delivery, an incision (cut) is made in the skin and into the uterus at the lower part of the mother’s abdomen. The incision in the skin may be vertical (longitudinal) or transverse (horizontal), and the incision in the uterus may be vertical or transverse.

A transverse incision extends across the pubic hairline, whereas, a vertical incision extends from the navel to the pubic hairline. A transverse uterine incision is used most often because it heals well and there is less bleeding. Transverse uterine incisions also increase the chance for vaginal birth in a future pregnancy. However, the type of incision depends on the conditions of the mother and the fetus.

A new study based on the data from the National Family and Health Survey has shown that there is a significant increase in the rate of caesarean births in India.

While the WHO recommends the rate of caesarean delivery to be 10-15%, the number was 17.2% for India during the period from Jan 2015 to Dec 2016. This is higher than the rate seen in rich countries such as the Netherlands and Finland. The report says that if this trend continues, India could soon have the largest number of C-section births in the world(source-the Hindu)

Recovery From a C-Section

Recovery from a C-section depends on factors including:

• Birth circumstances (elective C-sections are often easier to recover from)
• Her previous level of fitness
• Care taken during recovery
• Support at home (and the presence of other children to look after)
• Timeliness of pain medication

Benefits of Exercise in the Postpartum Period

There is far more research available on exercise in pregnancy than in the postnatal period, and most of the research related to exercise in the postnatal period is on its effects on mental health. There really isn’t much dedicated to the other aspects of physical health.

However, here are some evidence-backed benefits of the postnatal exercise that you can mention :

Physical

• Enhances cardiovascular health through improved glucose tolerance, lipid profiles, and vascular function.
• Improves aerobic function (VO2max)
• May reduce body fat and improve basal metabolic rate, especially for women who aren’t lactating.
• May improve bone mineral density or prevent lactation-related bone loss in women who are breastfeeding.
• May help children form more regular physical activity habits.
• 
  

Mental and Emotional

• Has a positive effect on well-being and symptoms of depression.
• Improves mood and body image.
• Reduces rates of postnatal anxiety and depression.
• May improve the rate and severity of postpartum depression.

And of course, let’s not forget the positive benefits of exercise in general, as it:

• Protects against the development of the chronic disease.
• Improves respiratory function.
• Reduces the risk of coronary artery disease.
• Decreases blood triglycerides.
• Increases HDL.
• Improves insulin sensitivity.
• Reduces visceral fat.
• Decreases death rates from coronary artery disease.
• Decreases rates of cardiovascular disease, stroke, type 2 diabetes, bone fractures (due to osteoporosis), and some forms of cancer (breast/colon).

How soon can I start exercise after a C-section?

A caesarean section involves major surgery, where the abdomen is cut and the baby is removed. After that, the cut abdominal muscles are sutured and an antiseptic dressing is put over the wound. The stitches are removed in about a week.  Postoperatively, care is needed to ensure that the wound does not get infected, no complication develops and healing occurs smoothly. The entire healing takes about a minimum period of six to eight weeks. Any strain on the abdominal muscles during this period can cause incisional hernia or may delay healing.

A woman puts on weight during pregnancy and subsequent breastfeeding. Care of a newborn is also an exhausting task which does not leave a lot of free time for the mother. Therefore, many women tend to gain weight after delivery and become vulnerable to the health hazards of obesity. Therefore, it is important to lose excess weight added during pregnancy and breastfeeding.

A low calorie diet and regular exercise are key in helping a woman to lose weight. Usually, exercise should be avoided during the first six to eight weeks, to avoid any strain and facilitate the healing of the post-C-section wound. If one is keen on it, a very light exercise should be initiated and that too after four to six weeks of a C-section. Start slowly and gradually increase how hard you work and how long you exercise. Always listen to your body.  The scar and sutured stomach muscles react best to consistent, regular exercise. Walking, aerobics, and yoga are the type of exercises which are more suitable and can be done after a C-section. Any activity or exercise which puts a strain on the abdominal muscles should be avoided. This includes exercises involving leg raising or bending in front. Similarly, lifting or pushing heavy weights should be avoided.

The amount of exercise should be increased gradually. If you feel tired or experience some discomfort after doing exercise, it should be stopped immediately.   Those who have had any post-operative complication or suffer from some chronic health issue like hypertension, diabetes, and etcetera, should consult their doctor before doing any exercise.

Abdomen and pelvic floor exercises are beneficial following caesarean delivery. To increase strength and stability in the core muscles, try breathing exercises, isometric contractions, and exercises that target the transverse abdominis. Regaining strength gradually will help you return to doing the activities you love with ease.

Try these gentle exercises after caesarean delivery. They require no equipment and can be performed from anywhere.

1.Pelvic floor exercises

During your pregnancy, your pelvic floor muscles will loosen due to hormonal changes in your body. This loosening, along with your growing baby pressing on your bladder, may cause you to leak urine when you cough, laugh, sneeze or exercise. Your pelvic floor muscles surround and support all the organs in your pelvis - your womb, bowels and bladder

Doing pelvic floor exercises will strengthen these muscles and help you control any accidents. It will also help you ease your baby out during labour and recover faster after the birth

 After your c-section, you can start to exercise your pelvic floor once your catheter has been removed and as soon as you feel ready. These exercises will help strengthen the muscles that support your womb, bowels and bladder. This may help you manage any problems with leaking urine.

2. Belly breathing

This exercise is a great relaxation technique. It also helps retrain the core muscles to work together during daily activities. This exercise will target your transverse abdominis muscles.

 Lie on your back on a comfortable bed or couch.

1. Place your hands on your belly and relax your body.
2. Take a deep breath in through your nose, feeling your abdomen expand into your hands.
3. Breathe out through your mouth. As you exhale, pull your belly button in toward your spine, contracting your abdominal muscles. Hold for 3 seconds.
4. Repeat 5 to 10 times, 3 times a day.

3.Abdominal exercises

These exercises will help to strengthen the muscles in your abdomen (tummy area). This will help you to protect your spine and have good posture.

• Lie on your side and slightly bend your knees.
• Relax your abdominal muscles and breath in gently.
• As you breathe out, gently pull in your abdominal muscles.
• At the same time, squeeze your pelvic floor muscles.
• Hold in your abdominal muscles and squeeze your pelvic floor for 10 seconds, then gently release.
• Repeat this exercise 10 times.
• Try to do this exercise three times a day.

4. Wall sit

This full-body isometric exercise is an excellent way to get all the muscle groups to work together in unison. Muscles worked: quadriceps, hamstrings, pelvic floor muscles, core, and lower back

1. Stand with your feet 1 to 2 feet away from the wall.
2. Slowly lean back toward the wall, lowering yourself into a sitting position. Your hips and knees should be at 90-degrees to one another.
3. Engage your core. Take a deep breath in and while you exhale, feel as if you’re pulling your belly button into the wall.
4. For an added bonus, contract your pelvic floor by doing a Kegel while holding this position.
5. Hold for as long as possible. Rest 1 minute, then repeat 5 times.

5.Leg slides

This exercise helps engage the core muscles in a gentle but effective way. The transverse abdominis muscle is an important area to strengthen as it supports the body core. Also, it supports the linea alba, a fibrous structure that extends from the xiphoid process down to the pubic bone and also supports core stability.

1. Lie on your back on the floor with your knees bent and feet flat on the ground. Wear socks or put a towel under your feet to allow your feet to slide easily on the floor.
2. Take a deep breath. As you exhale, contract your abdominal muscles by pulling your belly button to your spine without changing the curve of your lower back.
3. While maintaining this contraction, slowly extend your foot away from your body until the leg is fully extended.
4. Slowly bring it back to the starting position.
5. Repeat 10 times on each side. Perform once per day

6.Scar massage

Scar massage is beneficial for any surgical incision.  After cesarean section delivery, the scar can be painful, cause poor muscle recruitment in the abdominal wall and cause adhesions that prevent healthy movement of the organs in the pelvic region.  A simple technique of scar massage can prevent this, and help the scar heal nicely with good mobility and improve the function of the abdominal muscles.  Scar massage can even prevent excessive scarring and make the scar appear less noticeable. These exercises will work on fascia, connective tissue.

1. Lie on your back with your fingers positioned above your scar. Pull the skin with your fingertips around the scar and observe its movement. Try sliding it up and down and side to side. Notice if it moves more easily in 1 direction than another.
2. Working in 1 direction, slowly move the scar back and forth. You will want to start off gently and gradually move up to a more aggressive massage.
3. Move the scar up and down, side to side, and even around in circles. Small movements are better, but tissue mobilization can be done in all areas of the abdomen.
4. If the scar is painful, stop and try again at a later date. Once you feel comfortable, you can perform this massage once a day.

7.Pelvic tilt exercises or Kegels

These are exercises that can be done in lying, seated or standing positions and require very little effort. They do, however, make a huge difference in your rate of recovery and also firm up the abdominal area.  These exercises are important not only in regaining the strength of the abdominal wall, but they also help prevent urine leakage after a c-section.Repeat this simple exercise 10 times, twice a day:

·         Lie on your back and bend your knees.

·         Squeeze in your pelvic floor muscles as you breathe out.

·         Pull your belly button in and up at the same time.

·         Try to hold the squeeze for 10 seconds without holding your breath.

8.Physical exercise

Before returning to your pre-pregnancy levels of exercise, wait until you’ve had your 6-8  week postnatal check with your doctor. Try to build up your exercise levels gradually. Once you have recovered from your c-section and no longer have any pain, it is usually safe to start low-impact exercises, such as swimming, pilates, yoga, gentle jogging and low resistance gym work.

Your doctor may recommend you wait for at least 12-15 weeks or maybe more its  depend on your health condition before starting any high-impact exercises, such as aerobics, running and resistance or weight training.

Note: Be sure to consult your doctor before engaging in exercise postpartum. Always start small, working up to more challenging movements. Avoid activities that place a lot of stress on the abdominal muscles and hip joints. If possible, consult a physical therapist or postpartum exercise specialist. If you notice an increase in bleeding, fatigue, or inflammation of the scar area, stop and seek medical help.

Point to be remembered:

·         Consult your doctor before starting your workout

·         . Protect your scar and abdominal area as much as possible and use caution whenever moving around. 

·         Trying to stay mobile and performing pelvic floor exercises will help increase your rate of recovery. You will be more intensely active a lot sooner.

·         Great care should be taken when doing daily tasks, such as getting out of bed, lifting heavy objects or walking up and downstairs. Work and move at a pace that you can manage.

·         . Always break movements, such as getting out of bed, up into parts. Never attempt to do the movement in one go. Remember to use your arms for support – especially when using your weakened back and abdominal muscles.

·         Remember, you’re rebuilding from major surgery, so don’t rush your recovery! Be sure that you’re recovering emotionally as well as physically.

  When you start to exercise after Caesarean, you need to Avoid some abs exercises like crunches, sit-up, bicycle crunches, leg raise and many more which put more strain on your abs muscles. Don't do jumping exercise like squat thrust, burpees, jumping jacks, plyometric exercise, running, sprinting, Zumba, kickboxing. So don't do any exercises that cause pain, pull at or puts pressure on your C-section. After a few months, you can do this exercise but you need to avoid in the beginning. Start with light exercises as I mentioned earlier, after that change level of your exercise.

References:

https://www.stanfordchildrens.org/en/topic/default?id=cesarean-delivery-92-P07768

https://www.healthline.com/health/pregnancy/c-section-recovery-exercises

https://www.tommys.org/pregnancy-information/labour-birth/caesarean-section/when-and-how-exercise-after-c-section

https://flo.health/being-a-mom/recovering-from-birth/postpartum-problems/exercises-after-cesarean-delivery