As every mama who’s ever given birth knows: your perfect birth plan probably won’t go… well, perfectly. And this is true for both vaginal and cesarean deliveries! Some women really hope for a natural birth at home, but the baby’s position or other labor circumstances prohibit that from happening. And even if you’re at the hospital, you still may end up with a very different childbirth story than you imagined! 

Here’s the deal: c-sections, whether by choice or by medical intervention, are much more common than you might imagine. In Tennessee, where I practice pelvic floor physical therapy, the c-section rate is 32.4%! That’s nearly 1 in 3 women. And yet, so many childbirth and postpartum resources don’t address  cesarean delivery comprehensively. 

If you’ve been here for even a little while, you know that I want better postpartum care for all women, whether you delivered vaginally or with a c-section. Birth is incredible, and bringing my daughter into the world was a powerful experience. However, it also inflicts trauma on the body, and it should be rehabbed just like any other significant physical injury — or in the case of c-sections, major surgery! 

Anatomy of a cesarean delivery

Most women are simply not aware of the details of a c-section — and I think we all should be. Even if you’re not planning on having one, you never know what might happen during your labor process, and in my opinion, it’s always better to be knowledgeable and prepared in the event of an alternate plan. I actually wrote a post about the five things you should know before a c-section, but the first one is this: it’s a major abdominal surgery. 

During your c-section, your OB-GYN will cut through several layers to get to your baby safely. First, they’ll cut the skin, fat, and fascia (tissue that directly encases the abdominal musculature), before splitting the abdominal muscles along the grain. Then, they’ll cut the peritoneum and uterus, move your bladder out of the way, and cut the amniotic sac to deliver your baby.

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Because a c-section is a substantial abdominal surgery, recovery looks different than a vaginal delivery would. Unfortunately, these differences are not often discussed like they should be — so I’m doing my best to give you the details.

What to expect immediately after your c-section

Of course, as you’d expect, you’ll be left with a postpartum cesarean scar. Your scar might itch, and it will appear pink, puffy, and raised for the first few days. But there are lots of other recovery symptoms you might not expect. 

For starters, your abdomen was opened during surgery, so experiencing pain from trapped gas after delivery is really common. This trapped gas pain can actually be felt under your shoulder blades a lot of the time, because the added pressure on your diaphragm can refer pain up to the shoulder blade and rib region. You will probably also experience general abdominal pain or discomfort and sore muscles. 

In addition, the medications you received will likely affect you in the days following your c-section. Many women experience swelling from IV fluids along with constipation, which is typical during postpartum no matter the delivery method. Leg swelling is the most common, so it’s helpful to bring compression socks in your delivery bag and get moving as early as you can! The anesthesia needed for a c-section might exacerbate that swelling further. 

Lastly, even if you didn’t deliver vaginally, don’t be surprised when you experience normal lochia, vaginal discharge after giving birth. Your body still needs to expel anything your uterus doesn’t need anymore now that your baby is out in the world, so don’t be alarmed when you see this post c-section. 

Signs of infection

While all of the symptoms I outlined above are normal, it’s important to keep an eye on atypical symptoms that can indicate a postoperative infection. If you experience any of the following, get in touch with your provider right away. 

• severe abdominal pain
• redness at the incision site (especially worsening instead of resolving over time)
• swelling of the incision site (especially worsening instead of resolving over time)
• pus discharge from the incision site
• pain at the incision site that doesn’t go away or gets worse
• fever 
• painful urination
• foul-smelling vaginal discharge
• Bleeding that soaks a pad within an hour
• bleeding that contains large clots (think golf ball size)
• leg pain or swelling

Supporting yourself 

Don’t be afraid to ask your provider (and/or a pelvic floor physical therapist) for detailed care instructions after a c-section. Personally, I am a huge fan of supportive pelvic floor and core support garments after any delivery, but especially c-sections. These support garments can offer amazing assistance to your muscles as they heal, rest, recover, and finally, get strong again. I rounded up all of my favorites here!

What is scar desensitization 

It’s important to heal your entire core and pelvic floor after pregnancy and childbirth, but if you’ve had a cesarean, you’ll need to focus on c-section scar care, too. Scar desensitization is an important early step in this process! It’s important because it reduces numbness around the scar and limits the development of hypersensitivity. To perform desensitization, gently rub different materials on and around your scar to desensitize your it (and the surrounding skin) to touch and pressure. Of course, only do this as your body heals and you’re able to do so. 

How to perform c-section scar desensitization 

Step 1: indirect desensitization

This is a great place to start if you want to begin this practice before your scar has healed. It’s also a great way to “work up to” touching your scar. If you’re not ready to directly touch your scar yet due to difficult feelings, I just want to remind you there’s no shame in that.

C-sections can come with emotional trauma, and other women experience “the heebie jeebies” around post operative scars in general. This is all normal. Go at the pace that works best for you, and know that you’re doing a great job caring for your body. You can start gently touching above and below your scar as early as week 1 postpartum, but many may wait a few weeks longer due to associated feelings — either option is totally fine. 

When you begin, the goal is to gently touch above and below your scar with different textures of materials to reduce hypersensitivity of your nerves. Start with the softest, least irritating material and move on to the “harsher” materials as you become accustomed to the soft material. I’ll outline the specific steps below — but for the indirect method, just follow those steps above and below your scar instead of on your scar directly.  

Step 2: direct desensitization

Direct c-section scar desensitization should be performed after 6 weeks, or when your scar has healed. 

1. Gather a variety of textured materials, like a silk robe, a cotton ball, a terry towel and an old t-shirt.
2. Lie down on the bed and make yourself comfortable. 
3. Gently rub on and around your scar with the softest material (or material that causes the least discomfort for you). You can go back and forth, make small circles, or gently tap — whatever works for you. 
4. Perform this exercise with your first material for 5 minutes daily until your scar is not sensitive to that material. 
5. Move on to the next material and perform the same exercises for 5 minutes daily until your skin is not bothered. 
6. Keep changing materials as your scar and nerves become desensitized.

Simple enough, right? Remember, your nerves can take up to 6 months to heal and regenerate, so don’t feel bad if this takes longer than a few weeks! Just stick with your daily routine and you’ll help your body recalibrate to touch over time. 

Need more guidance?

If you’re wondering about what is safe to do during the first six weeks postpartum, I created a course just for you. This 12-week program is designed to help mamas recovering from both vaginal and cesarean deliveries — with specific modules depending on which childbirth method you’re recovering from. The first six weeks focus on safe movements and functional mobility, and the second six weeks focus on helping you rebuild your core, pelvic floor, and full body strength over time!

Inside, you’ll find safe movements to help you get in and out of bed, hold your baby, and gain functionality as you heal. There are also lots of educational videos on scar massage, scar desensitization, and c-section specific movement modules. Movement Through Early Postpartum was created to support you holistically as you navigate those first few postpartum months. I hope it’s a huge help, mama!

Purchase Movement Through Early Postpartum here!