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April 18, 2023

199 | C-section Post-Op & Postpartum Return To Fitness

199 | C-section Post-Op & Postpartum Return To Fitness with Annie Miller

First off, the lack of education you’re sent home with after this massive abdominal surgery should be malpractice. It’s truly incredible. 

I did not plan for a C-section at all. I mean, I planned for the possibility of a C-section as far as my birth plan went, but I was not at all prepared for C-section recovery on the backend of delivery. I had a 72 hour stay in the hospital. So we were there from November 22 to November 25. We went home the day after Thanksgiving.

In the hospital, I purchased MammaSteFit 16 week C-section lifting program, as well as their C-section scar mobilization program. I know that scar tissue can wreak havoc on your insides and tissue mobility. So it was important to me to learn how to mobilize that area and not be afraid of it essentially. 

I know that some people don’t experience a lot of pain after having a C-section. But that was not my personal experience. I was on oxy for I think 7 to 10 days from the C-section. My pain was very high for seven days and then on the eighth day, it just dropped significantly. It was like I turned the corner. 

The pain for me was in standing up, and I think I also had pain just from also pushing at a 10 vaginally. Because the pain I was experiencing was around the incision, but also just extreme heaviness in my pelvic floor. And near my rectum. 

At times, I felt like I had to walk bent over. So the nurses let me know that standing up really tall and straight was actually beneficial for me, so I tried to do that as much as possible, but that was also very uncomfortable. 

The lack of mobility was a big mental hurdle for me in postpartum. You already lose so much autonomy. Feeling unable and just not being able to move with intention was one of my least favorite parts of early postpartum.

I found that as far as returning to exercise. I really wanted to move my body a lot sooner than my body was going to allow for. At around three weeks I really really really wanted to move with intention. More than walking. But at that point, I was still finding that, even in moving around my house more , I would get more bleeding, or have more pain the next day.

For instance, at the three week mark, I just did some very gentle mobility, unweighted, lunging, thoracic, spine mobility, and breath work, and I literally had more bleeding the next day, because that was too much. This is just my experience, so take it with a grain of salt . It’s not meant to scare anyone. It’s just literally meant to pull back the curtain on a fit person recovering from a C-section.

Around week four I was feeling a lot better and able to generally walk more and move more without an increase in bleeding. My bleeding was actually almost completely gone at week four. And so I had Mamma stay fit schedule my program start on January 2 which was my six week mark. 

I had a five week postpartum appointment, and I was completely cleared for everything, meaning sex, movement, exercise. All the things. She did an internal exam, and my uterus was healing really well, and I only had a two finger separation in my core. So that gave me the external affirmation I needed to move forward. Because let me tell you, I felt like I was in a brand new body postpartum. I could not tell where anything was in my midsection from muscles to organs. It felt very strange. And sometimes even four months postpartum. It still feels weird.

Right at six weeks I began moving and following the program. It was four days a week. And when I say working out or lifting, I mean unweighted kneeling hip hinges. It’s far stretch to call these workouts. And it’s in my opinion exactly what was needed for me. From a mental standpoint, as well as a physical standpoint. It allowed me to get in intentional movement and feel successful. And it also just reacquainted me to my body. I would honestly call the first four weeks a reacquainting phase.

My outlook on returning to fitness was like it always is, a long-haul mentality. I see the first three months as really, just being consistent and taking note of how I am doing and adjusting as needed. It is not to reach a certain goal weight it is not to hit any loads in the gym or any skills even. The goal was literally just to be consistent and follow the program. That was the goal.

I could then reassess where I’m at and what is realistic moving forward as far as performance goals or body weight, goals, or body composition goals. But my perspective was always a 9 to 15 month process. 

I’ll also note that my biggest focus or concern was getting to where I felt like my pelvic floor was not an issue, it was strong, maybe even stronger than before and also mobile. And that my incision felt normal. I didn’t feel stretched, or in any kind of compromised position. 

That was the biggest hold up for me, or maybe what was most shocking when I started working out. Was just that intense awareness and sensation on and around my incision. Especially on my left side. I just constantly felt like I was at risk of busting open and tearing the incision, so I was extremely conservative with the range of motions that I was using in my movements as well as any load that I was adding to my body.

I would highly suggest following some kind of C-section specific lifting program if you are returning to weight training after having a C-section just because mobilization of that area is so important. And so this program for instance, if I was following included far more rotational work, then I would’ve ever put into any program for any reason. 

I would say by nine weeks of following the program, being about 70% consistent, I was able to hit accessory work loads that I was using pre-conception. So doing dumbbell RDL‘s or dumbbell lunges with weights that I was using in the past. It’s kind of a progress marker. The barbell was a whole different story. For whatever reason large compound, axial loaded movements just did not feel right. And I still need far more time to build confidence with the way my body feels in the season. Squats in particular. As well as deadlifts. For both of those I would say that it’s actually more my pelvic floor, than anything to do with the C-section that causes any apprehension.

I just keep reminding myself that there’s no rush, and that I would rather go slow and feel way better then push it and have to have a setback or lose confidence in my progress or my body’s ability. So I am constantly reminding myself to be conservative and it’s also nice that I know I can push in the accessory work. Which has kind of been a saving grace for me. Pushing in the accessory work has allowed me to feel like I am actually building strength and muscle in this season. Without having to push any large barbell compound movements really hard. But it still feels familiar and fun to do those large compound movements.

Movements that I would say made me feel the most unstable postpartum, were any planking or bird-dog variations. I could not do a plank until about eight weeks of following the program, which was what almost 3 months postpartum. And I had to do bird dogs with my feet, pushing against a wall for much longer than the program had them scheduled for. So the program was progressing. Bird-dog variations a lot faster than I felt like my core and my C-section incision could handle. So I just held off on that and now can do a full bird, dog or bird, dog variations, weighted, banded, variations. They’re difficult, but they’re all doable. That’s been a huge area of growth and performance success in the last three months.

Step ups and hip thrusts were the other two exercises that really threw me for a loop. I have never felt so unstable and a step up in my entire life. I felt more stable doing step ups after meniscus surgery then I did being postpartum. My assumption is that has mostly to do with the pelvic floor, and maybe some instability that I have in my pelvis. They are feeling much better. But I had to modify by using a balance stick or holding onto the rack and doing my step ups . It’s just a matter of building strength and stability which I’m fully aware of and willing to do. As far as the hip thrusts go. I don’t know when I will be comfortable doing hip thrusts post C-section. At four months I am still uncomfortable it does not feel good on my incision and I am distracted by how it feels on my incision to where I can’t perform the exercise and get the muscle contraction that I want in my posterior chain. So I have the ability to modify, and that’s what I’ve been doing. For hip thrusts, I have been doing the same single leg, hip thrust variation the entire time in my ass has never been so sore, and I have never felt my glutes so much than using this variation. Single leg exercises are a great way to increase load that you are moving without actually adding external weight. and it is obviously beneficial, especially in postpartum to do unilateral work. So I did not mind doing this variation at all, and it seem to be working for me very well. The variation is with my foot on a wedge. The thinner end of the wedge is towards me, so my heel is on that end. And my back is on a decline bench. For whatever reason, that particular set up is demolishing my glutes. It really is a similar set up to an actual hip thrust machine. So that makes sense. I started with a bilateral version with a band around my hips. So both feet on the wedges. Then did a B stance, variation, and transitioned to a single leg variation. And soon enough I am sure I will add a dumbbell to my hips if I have not already done so. This is until doing barbell hip thrusts. Feels comfortable enough on my incision.

All upper body stuff felt great for the most part. The only exercise that really took some time to rebuild and get used to was pull ups, and push ups. 

Pull ups were due to the stretch in the lats that I just have not experienced in a while, as well as coning in my midsection. And push-ups were all about my core. So I’m actually lifting close to what I was mentioned before getting pregnant, but push-ups were difficult because of being in that plank position, which I mentioned towards the beginning of the episode, is being really challenging for me. 

And lastly, I want to address bleeding that I experienced. Because this can happen, or is an indicator with C-sections, that you have done too much in your body is letting you know.

After week one of workouts, I had heavy bleeding for 3 days after not bleeding at all for nearly 3 weeks.

I presume this was actually my period returning early because about 3.5 weeks later the same thing happened. And at 3 months postpartum I began tracking with my Oura ring, and 100% menstruated. So, though bleeding can be an internal warning sign, I do not think it was tied to exercise. Simply a coincidence in timing.

Navigating post c section is strange because of the additional internal healing taking place. There was and is just a level of uncertainty that comes with the process. But it can be done and movement can feel amazing and empowering again.

Whether you’ve had a C-section, given birth, are recovering from injury or just in a body you are less familiar with, I hope this episode brings some level of solidarity.

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I'm an adventurous introvert from Vancouver, Washington who lives on sleep + "me time." I'm a lover of lifting weights, dinosaurs, real talk and traveling with my husband. I am here to help you move better, lift more, bust the myths of the fitness industry, and inspire you to love the process.

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