The Barbell Mamas Podcast | Pregnancy, Postpartum, Pelvic Health
The times are changing and moms have athletic goals, want to exercise at high-intensity or lift heavy weights, and want to be able to continue with their exercise routines during pregnancy, after baby and with healthcare providers that support them along the way.
In this podcast, we are going to bring you up-to-date health and fitness information about all topics in women's health with a special lens of exercise. With standalone episodes and special guests, we hope to help you feel prepared and supported in your motherhood or pelvic health journey.
The Barbell Mamas Podcast | Pregnancy, Postpartum, Pelvic Health
The Cesarean Recovery Roadmap: Movement, Healing, and Beyond
Cesarean birth requires thoughtful rehabilitation, but the old advice of extended bed rest is outdated. As a pelvic floor physical therapist who's competed in CrossFit and weightlifting through pregnancy and postpartum, I'm sharing evidence-based guidance for early C-section recovery and return to movement.
Surprisingly, research shows that appropriate movement soon after surgery actually reduces complications. Just as patients who undergo heart surgery are encouraged to walk the same day, C-section recovery benefits from gentle, early mobilization. Using a pillow to splint your incision can make those first movements more comfortable, though some discomfort is normal and expected.
Between 2-6 weeks postpartum, you can progress to bodyweight exercises in neutral positions - think glute bridges, gentle squats with baby, and seated upper body movements. These often feel better than extended walking during early recovery. Throughout this phase, we watch for clinical signs to guide progression: sharp pain, increased redness, or signs of infection indicate a need to scale back.
The emotional component of cesarean recovery deserves equal attention. Many women experience complex feelings when looking at their scar, especially if the surgery wasn't planned. While everyone emphasizes that "a healthy baby is what matters," it's completely valid to process your feelings about your birth experience and changing body.
Around 4-6 weeks post-surgery, gentle scar mobilization becomes important, though surprisingly, there's zero research on this despite it being standard clinical practice with excellent results. After six weeks, we can explore movements beyond neutral positions - gentle extensions, rotations, and side bends - to prepare for the full range of movements required in daily life and physical activity.
Ready to reclaim your strength after cesarean birth? This episode provides the framework to guide your individual journey back to the movements you love.
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Hello everyone and welcome to the Barbell Mamas podcast. My name is Christina Previtt. I'm a pelvic floor physical therapist, researcher in exercise and pregnancy, and a mom of two who has competed in CrossFit, powerlifting or weightlifting, pregnant, postpartum or both. In this podcast, we want to talk about the realities of being a mom who loves to exercise, whether you're a recreational exerciser or an athlete. We want to talk about all of the things that we go through as females, going into this motherhood journey. We're going to talk about fertility, pregnancy and postpartum topics that are relevant to the active individual. While I am a pelvic floor physical therapist, I am not your pelvic floor physical therapist and know that this podcast does not substitute medical advice. All right, come along for this journey with us while we navigate motherhood together, and I can't wait to get started. Hello everybody and welcome back to the Barbell Mamas podcast, christina Previtt. Here Today I want to talk about early C-section, rehabilitation and return to movement.
Speaker 1:Before we get into today's topic, I just wanted to say a massive thank you. I received so many messages last week after I disclosed a little bit about what's been going on in our personal life, right With my miscarriage and then my mom's diagnosis. Just know that I am so thankful to everybody who reached out to see if I was okay and, you know, just say that they were thinking about my family and I just so appreciate that. My mom is in this holding pattern right now where she has a lot of scans and a lot of information to still gather so that they can make the right game plan for her. And this is like the worst time. It's like the hurry up and wait where we are just waiting for these follow-up scans until we have a game plan and the fear of the unknown is very heightened, and so I'm just trying to function as best as I can. I was talking to my mentor today and I said, you know, it's not even the amount of time, because right now my mom doesn't need me physically. It's more that I feel like my brain is just in this foggy pattern right now where I just don't have the same bandwidth that I usually do to get stuff done and I'm a little bit foggy and a little bit spaced out at times just trying to cope with everything going on in the back of my mind. So I am just so thankful to everybody who sent messages to me and I responded to many of them and I just I appreciate you all so much. So thank you so much.
Speaker 1:Okay, let's talk about early cesarean section rehab. When we are thinking about early, I'm talking like less than 12 weeks from when C-section happened to trying to get back to bigger movements and talking about when the timelines are to do that. When we are thinking about rehab with a C-section, oftentimes we're thinking about surgical considerations and early wound healing, our ab core considerations that we would think about coming into the postpartum period from a pregnancy, irrespective of a C-section or not, in addition to an incision. Right, because we have that stretching of our rectus muscles and subsequently a lot of women feel weaker in their core wall postpartum because of that stretching, and then on top of that we also have a C-section incision In addition to that. It really does depend what was the reason for the C-section and how far you went into laboring and pushing, because then we might also be thinking not only about C-section scar considerations and core considerations but also pelvic floor considerations, because if you were pushing for two and a half or three hours and then exhaustion, fetal distress, fatigue all of those reasons why they may flip to a cesarean occurred, then there would definitely be some pelvic floor considerations for return, in addition to kind of our C-section scars.
Speaker 1:When we are thinking about early, early, early right, some people will go by the philosophy of five in the bed, five around the bed, five in the home in the very early days after a C-section, and these are based on some cultural considerations where there was a lot of family support. Family would come in for those two weeks and they would handle everything else around the home and it was kind of this bonding space and time for mom and baby where mom doesn't have to think about anything else, right, if she's got other kiddos, people are with her with their other kiddos spouse are off or other family members what have you and mom can just focus on her connection time with her newborn infant, as well as, of course, early healing. However, when we take that context and pull it into early post-op healing, I don't agree with that. Staying in the bed or doing nothing for five days anyway, whether it's vaginal delivery or a cesarean, but after a surgery, right, we actually want to be encouraging movement. So the first thing that is going to be my point is that I am going to encourage my mamas who have had C-sections to start moving around fairly early on, and we have data now from moms who are in hospital from a C-section that those who move around more, even in hospitals so this is the early days have less post-operative complications than those that move less. Why that happens is that when we are having a surgery we want blood to flow to prevent things like blood clots or other issues from happening in any surgery and a C-section is a surgery, right, if you had a heart surgery, if you had your knee replaced, if you had a kidney surgery, they would try and get you up and moving around that day. Right, we crack your chest open and we do heart surgery. You're trying to walk to the bed. Once your catheter is discharged, you are trying to transfer into your chair and sit up in your chair and it's because what we realize is this early movement in the research they'll call it early ambulation or early mobilization helps to prevent deconditioning, so muscle loss from complete bed rest, and it tends to prevent post-operative complications. So the first thing that I will say from an early C-section rehabilitation perspective is that starting to move around, do some gentle walking Now I'm not talking going out and doing a 5K or 10K walk, going out for a hike a day after your cesarean. I'm talking about moving around your house, moving around the hospital bed, not being afraid of movement very early on. Is it going to be uncomfortable and pulling and painful around the incision? Yes, what we can do for that is to help with splinting, where we take a pillow, put the pillow across your belly and kind of give it a little bit of pressure and then use that pressure, keep that pressure while you're trying to wiggle around in bed or go from a sideline to sitting position or sitting to standing. That splinting can help a little bit with the pain, but it is going to be painful to move.
Speaker 1:Many of my mamas and it's funny this is true with vaginal deliveries as well You're going to have some people who are going to say, oh my gosh, my C-section was easier than my vaginal delivery. It felt very. You know, after the first couple of days that were uncomfortable, it felt pretty easy to move around. And then other people are going to say, oh my gosh, like that was so much worse than I ever would have expected. My pain was so much higher when you lie on that continuum. I don't know the reason for one versus the other. We don't really have anything that gives us some clarity on that. There's just a lot of variability in how people respond to the surgery. However, using splinting to do some moving around and trying to do a little bit of movement in those early days after a C-section can be super helpful and I would encourage you to try and do a little bit.
Speaker 1:Now, where a lot of people feel stages of gray, of like I'm not really sure how fast I can progress this or not is when we get out of those initial couple of days, right, when you just had a C-section, like you're not wanting to go into the gym, you're coming off of the epidural and you're probably tired from labor and delivery and you have this new baby whether it's your first baby or your fifth baby the first couple of days you're trying to figure all of that out. But when you start getting discharged home and the pain is still there but it's starting to lose some of its sharpness, then a lot of people are wondering you know, what do I do when we are in those first few weeks? We are trying to protect your incision and protect in a couple of ways. We want to prevent infection, right. So we want to make sure that the wound is clean. And then we don't want to have popped stitches or a separation of the glue or you know, whatever you are using, whatever your surgeon is using, to close up that wound. We don't want that to pop open because it just creates delayed healing. It has a chance for increased risk of infection and all these other things. However, that doesn't mean that you can't move around at all or that any movement of the incision is necessarily a bad thing.
Speaker 1:We just want to respect that early healing and so things that I will encourage my mamas to do in the early, like thinking, you know, less than two weeks is one to really try and take big belly breaths, like I want your stomach to move up and down. That will feel like a gentle pull or tug on the scar, but it is not doing a really extreme range. So a expanding of the belly out and then coming in and not doing a sit-up or anything, but just kind of squeezing some of your ab muscles and again you're going to feel that little tiny bit of a wiggle or pull of the scar. Pain should be very minimal, but you're starting to stretch the scar and contract the scar, get the scar to be moving around and you can start that pretty early on, including doing some pelvic floor contractions as well. You know those are things that you can, I can encourage you to do, in that, you know, starting, you know, one week to two weeks after surgery and what that's just trying to do is just getting a little bit of very gentle wiggling to the scar that isn't going to put too much stress or strain on it but is going to encourage some of that movement Now, after that two week mark.
Speaker 1:Then we can start thinking about doing some body weight movements in neutral, right In those early protective phases with your C-section right, thinking less than six weeks. We don't want to do anything that's going to put a lot of stress or strain on that healing scar. We want to respect that time. Doing too much too early is going to cause you to have to hold back later on, and so what we can think about is that when you stay in neutral so rib cage over pelvis in low intensity exercises, so not putting your body under a ton of strain that scar isn't really moving that much. What do I mean by that? I mean, like glute bridges, body weight squats or squats with the baby lunges, things like that, like bicep curls, overhead presses. If you want to start putting in some of those movements, especially if you're doing seated upper body movements, a lot of that is going to be a-okay for a scar a scar. I will also see how individuals are doing two weeks post-surgery in clinic if individuals are looking for some help with how far to go.
Speaker 1:But those exercises, those easy core and body weight movement exercises, in that two to four week mark, if you're just starting to go a bit stir crazy, can sometimes feel even better than walking for longer distances. Right, if I can get you in side lying and doing some hip strengthening exercises, get a mini band around your ankles or knees and get you doing some clamshells, side lying raises, like whatever those gentle movements can be like. Whatever those gentle movements can be can be super, super helpful. You can start thinking about walking longer and longer distances and gradually building up your tolerance, even in that early, early post-operative phase. Remember, last week I talked about this Delphi where we are going to start encouraging some gentle movements, right, and we're looking for clinical buoys versus creating these blanket restrictions.
Speaker 1:Now, if you're in those early phases, what are things that we are looking for A sharp amount of pain in the scar, any increase in redness oozing from the wound or anything that might make you think that there's an infection. Right, having a lot of redness, puffiness, swelling around your scar, especially if that had gone away and now is returning, those are all signs of definitely pushing it too far. But definitely also to talk to your midwife, talk to your medical provider, that there may be an infection there. We just want to make sure everything is all good. Additionally, in those early couple of weeks I try to encourage my mamas to look at their scar when a C-section happens, especially if it was an emergency and it was not intended and it was not desired and a lot was done to prepare to avoid a C-section.
Speaker 1:There can be an emotional response and I have a couple of people in my caseload right now who we've kind of gone through and talked about this, where they never considered having a C-section or they didn't think they were going to need one or everyone said, oh, you're so active, there's no way, everything's going to go fine, it's going to be easy peasy. And when they look at that score on their body, an emotional response comes up. Their eyes start to prick with tears, they get a stress response, their heart rate starts to increase, they get anxious. So part of this early rehab, yes, is starting to encourage some gentle movement, starting to get that scar to wiggle around a little bit.
Speaker 1:We're not thinking scar mobilization just yet, but we're also allowing your body to reflect, come to terms with, feel the feelings from an emotional, stress, anxiety perspective of looking at that scar that is now on your body and it is okay to feel all of those emotions. It is okay to feel all of those emotions and every time you feel it pull or you feel that pain, to be reminded that this was not something that you wanted and it is not selfish to grieve that or be upset by that, because so many people are telling you that the only thing that is important is that your baby is healthy. Of course you are a mother. That is important to you and it definitely took priority in that moment. However, it is also okay to be sad about this scar or be sad about the postpartum journey that you did not want to have, which was recovering from a surgery versus recovering from a vaginal delivery.
Speaker 1:So in that early, less than six weeks phase, walking, doing some light body weight movements, especially staying in neutral lunges, working on some hip movements maybe getting a a booty band around your knees and working on doing some lateral movements to get hips strengthening. All those things are great To get the scar moving very early on. Focusing on those big belly breaths and those ab contractions, all are going to be wonderful. Pushing in to a little bit of tension, having some pain and pulling on that scar is going to be normal as you move your body, sharp significant, severe increases in pain, redness, swelling, anything that might be a thought of infection. Not only is that a reason for you to pull back but also is a reason for you to potentially go see your provider Now, when we get into that four to six week range now, we may start to work on the scar itself.
Speaker 1:Once kind of stitches are away or there's a good kind of the scab has started to heal off of your C-section scar and that timeline is going to be different for everybody. But once we're there we can start and it's closed, we can start putting some pressure on the scar and start doing some massage further away from the scar. What do I mean by that? So early on, the scar itself may have a hyper or hypoalgesic sensation. What I mean by that is that it can feel very, very tender or hypersensitive or it can feel numb hypo. That is because there's these little tiny nerves that kind of come across our skin. It is impossible to avoid all of them. There's a lot of differences person to person about where they are and depending on where your scar is, your surgeon may have hit one of them in the cutting. Again, very normal for you to have either one of those sensations, but you may notice that. So putting some light, gentle pressure whether that is your hand, that is a clean cloth and doing some gentle touches across your scar and noticing your own kind of body's response to that scar, whether it's a little bit more sensitive or numb you can start working on that.
Speaker 1:Okay, a lot of our rehabilitation principles are around getting the C-section scar to move and move well on the body using a C-section scar mobilization, massage, etc. It is fascinating to me this is totally an aside in a soapbox as a person who is in research that we have absolutely no research on C-section scar mobilization, despite the fact that it is our gold standard in pelvic PT and clinically I've seen such a huge benefit for doing C-section scar mobilization. So much so that I tell my mamas after vaginal birth that we should treat our perennial scars like we do our C-section scars. We probably have a lot less individuals that have pain with penetration and return to sexual activity. But I digress. We need the research there too, which I think is super important, but again, something for another day.
Speaker 1:In that four to six week mark, we can start putting our hands and touches, doing some gentle. We can start putting our hands and touches, doing some gentle, pressing down on the scar. What you're going to notice is that some parts of the scar are going to be more raised than others. It is going to depend. For some people, we just tend to see this tendency that the side that the surgeon is it feels a little bit tighter just because of their positioning, if they did internal stitches, so you may feel that the left or the right side feels more tender than the other. I also see this where the center, because we have the horizontal and vertical incisions, are a little bit more raised. Again, you're going to have some differences in how the skin is coming together. Totally fine, totally fine With the glue that is now far more common, at least in my area to be used on the skin, similar to what a lot of people will use on their faces to try and have less of a scar.
Speaker 1:I'm seeing that obstetricians in my area are more commonly using glue to close up the skin after a C-section. I'm seeing really great recovery from that and so after again that's scabbed over, we can start doing some of that gentle pressure. How I often will start my mamas after a C-section is that I will get them to start moving their skin not directly on the scar but away from it. What do I mean by that? So you can put some gentle pressure on the scar itself. In that early four to six weeks ish mark, once we are feeling okay with the the there's a low infection risk etc. But then at the rib cage I may get them to wiggle their skin up and down and what that's going to do is it's going to very gently move the scar, similar to breathing, a little bit more intense than that. Think of it like a level up, but we're not directly massaging, other than up and down against the scar, that pressure. If that is okay, then we can start doing some cross frictions or wiggles across the scar itself. So we'll push down on the scar and then move up and down along the scar, then I'll get individuals to go in diagonal directions and do some of that scar massage every single day.
Speaker 1:In terms of how much we have to do in order to feel better or in order for it to reduce that pulling sensation, it really does depend on the person. I know you probably hate this. You're like Christina. I want you to tell me that we're going to do five minutes of this every day and it's going to reduce risk of this outcome by this much. And, as I said, we have zero research on C-section scar mobilization. I will oftentimes get my clients to habit stack this, and so you know, if it's the shower in the morning that you have 30 seconds to do some scar mobilization. If it's when you are nursing in the early postpartum period, if it's before you go to sleep, like whatever it may be, that you can, you know, just create a 30, 90, two minute, three minute stretch of time. Some individuals will just do, you know, 10, 15 seconds a couple of times throughout the day. We have no rules, but for my clients, just this is again clinical that stick with a little bit every single day and do it consistently over months. I have seen really nice looking scars and I have some individuals and again, a little bit of this is your own genetics and your skin makeup and all those types of things, how many C-sections you've had. However, they can heal really nicely and the scar can be quite minimal, depending on you know your body and your recovery.
Speaker 1:When we're in that four to six week mark, right, and then, especially after six weeks, then we're going to try and encourage you to go into positions that are not just neutral. I like doing some, either a yoga, getting in to Sphinx pose and then Cobra pose. So, starting to start with just tummy time, right, I think that everybody needs tummy time, including mom, not just baby and see how you feel, just putting pressure on a hard surface like the floor on your belly, and then I'd gradually get you to push up through your forearms and see how that stretch feels, or I will flip you, if you have, like a exercise ball or a wall ball, and I'll get you to extend and then from there see how you feel and do either deep breaths or some massage on your scar in a more extended position. Where I feel like we have missed the mark in pelvic PT is that we do everything in neutral and everything sticks to neutral and we never explore ranges of motion away from that in rehab. However, my moms, if they're running, they're extended. If they're doing, you know, hanging from a bar, they're extended. If they're putting baby in a crib, don't tell me, you're staying in neutral, you're in a flexed position. Your body you turn, you twist, like that's life. And so after that six week mark, five, six week mark, then I try and bias you into different directions whether that's rotation or side bending or extending, and see at what point you start to feel a gentle polar stretch on your scar. Then we can do some scar massage there. Then we do our strengthening in neutral and then we take our strengthening through range.
Speaker 1:How fast I progress that from four to six to eight to 12 weeks really does depend on the person, how consistent they are with their exercise, what their level of fitness was before pregnancy, during pregnancy and what their goals are right. If I have somebody who's trying to return to a rec soccer league and they really enjoyed it, they've been playing with the same group of girls for 10 years and they want to get back to kicking a soccer ball, then I'm really going to be focusing on that kickback so that it doesn't feel painful or sore, so that they can hit that soccer ball as hard as they want and not worry about their belly hurting them when they're doing that. And I also want to make sure that their core wall is strong enough, that they got some power to kick that ball. And therefore I might be focusing a little bit more, a little bit more aggressively, on lower load, bigger range of motion and more power-based or speed-based movements, because that's what they're wanting to do. But outside of that six to eight weeks now, we're just doing a linear progression, whether that is gradually increasing your range of motion into more of a backbend or more of a sidebend, increasing your pressure that you're using with your scar mobilization, increasing the load on your core-based movements. Right, bodyweight exercises are really great for core, but we can also load the core with weight, whether that's a Russian twist or back extensions or hanging from the bar and doing toes-to-bar if we got CrossFitters or just so many different options side bends, weighted sit-ups all of those things we can just gradually apply progressive overload. When we are thinking about that dosage, we're always just trying to stay within navigational buoys right. If there's a very sharp increase in pain, if, after you do the exercise, the pain is increased and it's lasting for more than 20 to 30 minutes, if you're having some incisional pain that is kicking around for longer and longer, those are your body signs that you're pushing a little bit too hard. We need to let our body adapt and wait or maybe slow down our rate of progression.
Speaker 1:But I feel like so much of our conversation around early rehab has focused on early recovery after vaginal delivery and we haven't done a great job yet of saying that all of these early recovery principles about getting you doing a little bit more, a little bit sooner. It applies to our individuals who've had a C-section too, where previously we would say, you know, don't do any moving around in the hospital after a C-section. We're starting to encourage some moving around where we would say don't do any loading of the core wall after a C-section for six weeks, like don't drive and a lot of that don't drive is some of the you know risks for fast reactions. But a lot of moms are saying well, that's not realistic. How am I going to get to my appointments at two weeks if you're telling me not to drive for six weeks and I don't have a partner who can take me, you know. So we're seeing a lot of these restrictions become a little bit more what would be absolute. Don't do this to relative, like let's have some caution, because you are still in that early healing phase and I think that's great.
Speaker 1:It's a big surgery, like we don't want to forget that a C-section is a big surgery and we also want to consider that motherhood fitness starts as soon as that baby's out. Right, you're picking up that baby already, as soon as baby is born. If you have a partner or spouse or a family member that is around you that can help with those tasks, that's amazing. But I also want to be cognizant of the fact that there are people that don't have that support. Or they have a spouse that has to go away, or you know my military people who have spouses that are deployed, or you know, like there's so many different situations and circumstances that can make trying to restrict movement a reason why they feel a lot of shame, like they're ruining their postpartum recovery because there are circumstances that they have to move that are completely beyond their control. All right, I hope you all found that helpful.
Speaker 1:I know I'm not giving like specifics do this and do this but I want to kind of talk in like buckets of things that we can do in the early postoperative window because, as I've been going on and on about, I do not believe in blanket guidelines, I believe in frameworks over protocols, because everybody is a little bit different.
Speaker 1:Yes, wounds are going to heal at a specific timeline, but the health of your tissues also matters in terms of healing timelines and so it's funny.
Speaker 1:Last thing I'll say before I close off is I just gave an obstetrical grand rounds last week and this was the question that I got from one of the residents which is so great about, like you know what, about some of the early wound healing and what we're thinking about and this is my response, this is what prompted this video is me saying you know, early on, it's gentle movements that we're doing. We're not really putting a ton of stress or strain, but we want to encourage that early movement because it allows that stress or strain to happen later on healthier, more stronger, tensile strength, a scar tissue that our mamas can leverage to make sure that they're feeling good after their cesarean. If you have any thoughts, questions, concerns about this, if you want to talk about this more, make sure you reach out to me. Otherwise, I hope you have a wonderful week everyone. Thank you again for all your messages and we will talk to you all.
