So you’ve had a surgical birth. You’re feeling better, getting the hang of this newborn baby thing, and climbing the walls to get moving again and socialize. You want to feel normal. You want to minimize your fitness loss and start shedding some baby weight. When is it ok to start exercising, and specifically, hiking?
Let’s start off with some biology review. Cesarean Section Birth is major abdominal surgery. Your uterus needs to heal from pregnancy and the incision, and your connective tissue, skin, and abdominal muscles need to heal from the incision. There are 3 phases of tissue healing:
- Acute/Inflammation: the area is hot and swollen. This phase lasts about 3 days.
- Proliferative/Wound Contraction: the tissue is mended with collagen. Good blood flow and proper nutrition improve healing, as well as silicone next to the wound (check out the c-panty for improved scar appearance). This phase occurs from about 3 days to 3 weeks.
- Maturation/Remodeling: the healing tissue changes, becoming stronger scar tissue. This phase takes a year or longer.
OK, so I’m good after 3 weeks? Not so fast. A few qualifiers:
Do you still have bleeding, also known as lochia? If you start doing too much activity too soon, the bleeding may increase or start again after it has stopped. Bright red blood is a sign of too much activity.
Are you still taking pain medication? Even Tylenol or Ibuprofin can mask your pain so that you end up doing too much too soon.
Do you have OB approval? Ask your OB at your 2 week incision check up about exercise. S/he will encourage you to walk, but ask about specifics. When is it ok to walk 1 mile, 2 miles, 3 miles? What about hills, trails with uneven ground? What about wearing your baby vs. pushing a stroller? Note that your provider may not have thought about these specifics. Also note that getting a stroller in/out of the car may not be ok until 8 weeks or so, but pushing a stroller on flat ground may be ok as soon as you can walk a ½ mile comfortably without pain meds.
As a physical therapist, I am highly biased to specific rehab. Most Moms complain of a core that feels weak, “disconnected,” poochy. Perhaps you have low back pain. Perhaps you have pelvic pain. There are a lot of options out there for core rehab. You may want to see a physical therapist that you have worked with before. Some other options I know of are:
- The Tummy Team (thetummyteam.com). Kelly Dean, PT is located in Camas, WA and has both a physical office for seeing patients, an economical on-line program (that is on sale from Black Friday through Cyber Monday!), and Skype sessions. She specializes in healing diastasis recti (a split abdominal muscle that is very common post pregnancy) and associated low back pain, pelvic pain, constipation. Another PT in her practice specializes in pelvic problems, such as organ prolapse.
- fit2b.us is a “Tummy Safe” online workout program run by a Portland Mom. I love Bethany’s compassionate, informative, and very doable workouts. She has prenatal, post partum, and regular fitness routines. Fit2b.us has worked with the Tummy Team to create exercise safe for those recovering from diastasis recti.
- Mamalates at Mamalates.com. Wendy Foster in Portland has a great pilates studio for Moms! Prenatal and post natal classes, as well as cesarean recovery workshops, and a post partum exercise CD. (Also on sale right now and we have some copies to give away to people leading hikes for Hike it Baby!)
Numerous other therapists who specialize in women’s needs. I’m sure there are other exercise programs out there that I don’t know of.
“Sweet!” you’re saying, “I’m ready to go! I’m not bleeding anymore, not taking pain medication, my OB has given me permission to do exercise as it feels ok. My core and pelvic floor feel fine.”
Great! Let’s consider loading. In other words, starting easier and progressing in difficulty. The points below will give you an idea of what is easier loading, and progressing in difficulty. This is not meant to be an exact progression. Your own progression varies upon your individual birth recovery and your pre-birth fitness level – we all have our own journey. Remember the story of the tortoise and the hare? You want the slow and steady, gentle and consistent progress of the tortoise. The hare did too much too soon and got side-lined.
- walking on flat ground
- walking without baby
- walking slowly, say 1.5 mph which is walking a mile in 40 minutes
- walking for shorter times, say starting at 5 minutes and increasing in 5 minute increments until you are walking a mile
- You may graduate out of this level as early as 3 weeks or perhaps at 8 weeks.
- walking with some moderate hills without baby
- walking on flat ground with baby in a stroller for longer periods or in a carrier for shorter periods
- walking a little faster, say 2 mph which is walking a mile in 30 minutes
- increasing your time or distance so that now you are walking 2 miles or an hour
- You may graduate out of here between 6 weeks and 12 weeks.
- Able to do more hills or steeper hills without baby
- Doing some hills with baby in the stroller or carrier
- Walking at 3 mph, which is a mile in 20 minutes
- You are now walking 2-4 miles
- Maybe you are here as soon as 10 weeks or have worked up to it over the last 4 months.
- You can walk with baby in the stroller or a carrier on whatever terrain you choose. Perhaps you are doing “black diamond hikes.” Your friends are amazed you can do these hikes at all, much less with a baby strapped to you!
- You are beginning to run again, if you were running previously.
- You have no pain, discomfort, urinary leakage, or prolapse signs during or after your walks/hike/run.
- As early as 12 weeks, as long as 6 months or more.
One last thing to consider: pressure to be a “Super Mom.” In our competitive society, it’s become fashionable to “recover” from pregnancy and birth so quickly, it’s as if it never happened. In reality, by not giving ourselves the rest we need, we can allow recovery never to happen. I’m not saying you need to partake in the “don’t leave your house for a month and don’t do any chores for 40 days post birth” advice (though kudos to you if you follow this!), but be considerate of yourself. You spent the last 9 months creating and growing a new person, then birthing that person into the world. You’ve got a newborn and you’re not sleeping well. You’re recovering from major abdominal surgery. Maybe you labored for a whole day or more before that surgery. You’re dealing with the new role of motherhood and role changes with your partner. Perhaps there is financial stress. Maybe breastfeeding has gotten off to a rocky start.
Yes, you need to get out of your house, socialize, meet other new Moms, get some fresh air, get some exercise. But be careful of doing too much too soon. Be true to yourself and be clear with yourself and others what is appropriate for you today, right now. Be slow and steady. Be kind to yourself. You’ll be ready to rock it soon enough!
Jenn Haunold, DPT is a physical therapist living in Corvallis, OR and is the branch leader of Hike it Baby Corvallis. She had a cesarean birth with her son Aiden in February 2013 and has successfully healed a diastasis recti with the help of The Tummy Team.
Her Cesarean Journey: Jenn had a planned cesarean at 37 weeks due to a complete placenta previa, where the placenta implants over the cervix, making a vaginal birth impossible. After returning home, Jenn took minimal pain meds because she knows from past injuries that without some discomfort, she will push herself too much and take longer to heal. She found that ice packs over the incision were very helpful the first week. At 2 weeks post cesarean, she couldn’t even walk around the block yet due to soreness! At 5 weeks, she walked 3 miles without baby on Leif Erikson (a fire road) slowly and it took 1.5 hours. At 6 weeks she started Mom & Baby yoga, but was modifying postures until 8 weeks due to her core feeling weak. By 12 weeks, she was walking 3+ miles with baby and lifting weights at the gym again.