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Early Postpartum Recovery: C-Section Edition

One of our very own pevlic floor physical therapists, Dr. Amber Calhoun, shares her story with recovery following a cesarean delivery of her first baby and how, like many new moms, she found herself googling recommendations on what to do. She has since gone on to become a physical therapist who specializes in pelvic floor rehab as well as strength and conditioning. She has a love for exercise, movement, improving the pregnancy/postpartum experience and helping moms return to sport after baby.

Read on to learn Dr. Calhoun's top 5 tips for recovery

I had my first baby at 20 years old. My first birth experience was not as expected and in many

ways a result of being a young, first-time mom. I was ill-informed of my birth choices and

consented to a slew of interventions that lead to 36+ hours of labor, a failed induction, and

eventually a delivery via Cesarean. This was not what I had envisioned for my first birth. I

planned to go to the hospital to be induced, expecting to come home in a couple days with a

newborn and a sore perineum. It hadn’t occurred to me that I could possibly be caring for a

newborn following major abdominal surgery (and believe me, it is a major surgery). The most

surprising thing is that I was given little instructions on how to care for myself following a

surgical procedure. As a result, I had to figure it all out on my own, googling for

recommendations, maybe like you are now (and we all know google can be your worst enemy

sometimes, filled with heaps of conflicting information).

I have since become a Physical Therapist and have pursued additional training specializing in

pelvic floor therapy and women’s health. I have learned so much that I wish I had known when

I was recovering from my first birth experience.

In many cases, our concerns or aches and pains are treated as just a normal product of pregnancy and birth, but it doesn’t have to be that way.

In my practice, I have found ways to provide education to women either during pregnancy or in

the early postpartum period to help ease discomforts and be proactive about caring for

themselves while also caring for a tiny human. In those early postpartum hours, you are fully consumed with the care of your new bundle, changing diapers, learning the feeding rhythm, counting the hours between feeds and dirty diapers, the list could go on and on.

It can be easy get lost in the excitement and not truly get the care you need as a mother, regardless of your birth experience. During the early postpartum period, it is so essential to care for yourself just as you are caring for your baby.

Additionally, Cesarean recovery requires a little special attention and considerations while

healing (again MAJOR SURGERY). I’m hoping to provide you all with some recommendations that can easily be implemented with action steps as early as a couple hours after birth and spanning to the first few weeks at home while incisions are healing and you’re recovering.

1. Walk as much as you can. It will feel impossible to want to get up shortly after the

operation, but it is quite important to jump start your recovery. Walking can have such a

positive impact on many different body systems after this type of surgery, and prevent

discomforts from popping up due to inactivity.

a. Firstly, following any operation, you are more at risk for developing a blood clot,

or a condition called a Deep Vein Thrombosis (also known as a DVT). Blood

clotting and DVT risk is significantly reduced when blood is pumped back up to

your heart. Walking uses your leg muscles to pump that blood back to the heart

pretty efficiently.

b. It will help with your first bowel movement. This may not be on your mind prior

to baby, but it can really be a scary milestone postpartum. The medications used

for pain relief, spinal block, and/or sedation can have some significant effects on

your GI system, making things move a little slower than normal. While this is a

good thing during the operation, it can make the first bowel movement pretty

uncomfortable or cause some pretty severe constipation.

c. Walking helps reduce post-op swelling. Fluids and medications administered

while laboring and/or during the operation can contribute to significant swelling

in the early postpartum period (and if you’re anything like me, it can last for a

couple weeks). Similar to preventing blood clots, using your leg muscles helps to

pump the waste products and fluid out of your body, easing discomforts from

postoperative swelling.

2. Support your abdomen. Brace your abdomen when doing any activity that either puts

pressure from the outside or increases pressure inside. You may be wondering what

that means. Here are some examples.

a. When you get up and down from a chair, hold a pillow into your stomach to

support your sore muscles, and use your arms to help propel you out of the chair

and/or lower yourself into the chair.

b. Brace with a pillow into your stomach for coughing, sneezing, and initiating early

bowel movements.

c. Use support pillows for holding baby. This is especially helpful if initiating

breastfeeding to help bring baby to breast level and reduce bending at the


3. Find good toileting posture. As I have alluded to, the first bowel movement post-partum

can be scary. Having a good toileting strategy can make this a smoother process and

reduce discomfort. Also, drink lots of water and take the stool softener!! The

medications used as anesthetic during labor and surgery can slow GI function and cause


a. Elevate the feet to mimic a squatting position (hello, squatty potty!). In the

hospital, this may be more difficult, but finding something to elevate both feet

help the muscles of the pelvic floor relax for a good bowel movement. Often

times, a makeshift stool can be two rolls of toilet paper (one to support each

foot) to elevate the feet.

b. Lean slightly forward and use a pillow or rolled up towel to provide external

support for your abdomen.

c. Make a fist with your hand and try to blow through the center of your hand to

increase abdominal pressure WITHOUT straining. This helps propel the bowel

movement without having to bear down.

4. Use the log roll. Getting into and out of bed can be a challenge following pregnancy and

abdominal surgery. Often times, this task can cause some significant core and back pain

in the postpartum period.

a. Getting into bed: Sit on the edge of the bed with feet hanging off. Lower yourself

down onto your elbow and then shoulder and bring your feet up as you lower

down. From here, you can roll onto your back or whatever other comfortable

position you like to rest in.

b. When it’s time to get out of bed, do the reverse. Roll to your side on the edge of

the bed. Use your arms to push your self to a seated position, swinging the legs

off as you sit up. Use your arms to help propel yourself forward when returning

to standing.

c. Utilize the log roll strategy when getting up and down from the floor or couch as


d. Avoid using a “sit up” motion as much as possible until your incision is healed

and your core strength has returned to a more normal level.

5. Prioritize rest and gentle movement. It is essential to rest after any birth experience, but

like many things, its easier said than done.

a. Spend your first days home with baby primarily in bed, with the exception of

taking short laps around your home multiple times a day. Allowing your body to

rest following birth is important for the healing process.

b. Practice breathing for relaxation.

c. Initiate gentle bed focused exercise.

Dr. Amber Calhoun, PT, DPT, CSCS

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