By Abby Avelino, MD
Hey fit momma, congrats on your new baby! You’re likely busy with unpacking and adjusting to the post cesarean life and moving about can be a bit of a struggle at first, but in recent studies gradual early ambulation is key to a good recovery. But before we start, check with your obstetrician to make sure you don’t have any conditions that may need special precautions during more intense activities.
Immediate post-operative phase. By now you’re probably in your room, just waking from a restful sleep, excited to see your baby and hopefully happy with your anesthesia or some pain relievers. Some pain or discomfort is likely normal during the first few days after a section. Recent recommendations have encouraged Enhanced Recovery After Surgery or ERAS, which includes early mobilization. In my personal practice, I usually start my patients on turning side to side and slowly sitting up once fully awake and once anesthesia has given the go signal. Once you’re ok with that, after about 15-20 minutes, on sitting position, you can start dangling your legs on the side of your bed. Yes, you may still have a catheter in there, but worry not, it will be removed soon, as this is also part of ERAS. Once freed from the catheter, you can try slowly walking around in your room with some assistance if necessary. It will be hard to stand up straight but eventually you will get used to it. Once more comfortable, walking about 10 minutes at a time can help you slowly regain cardiorespiratory fitness.
Weeks 1-2. Welcome home! Standing from sitting and walking should be more comfortable by now. You will probably be a bit busy and sleep deprived with a new baby, but let’s take the adjustment period easy. Walking can now be done for longer periods as tolerated. You may also go up and down the stairs slowly and with assistance if needed. If you’ve been able to keep up the exercise up from conception to right before delivery, gradual endurance training can start now, beginning with low impact activities so as not to put too much strain on the abdomen and the pelvic floor. You may consult your obstetrician as some patients may benefit from an abdominal binder during this time.
Weeks 3-6. You’re now stronger and a bit more used to the new mom life but not yet back to “normal.” The incision from the section is typically dry by now, but bear in mind that the layers of the abdominal fascia are still less than 50% of its original tensile strength until you reach 6-8 weeks postpartum. So even at this time, some exercises may still need to be modified like those on our app. You will have likely seen your obstetrician for a follow up by now. If cleared from any complications, light exercises to strengthen abdominopelvic muscles can be done.
Week 6 onwards. Though classically defined as the end of the postpartum period, it is not always the same for everyone. Not all the changes during pregnancy are reversed at this time. Though the app provides routines for specific phases of pregnancy, you still have to listen and connect with your own body. Some joints and ligaments may require even 3 months to return to their previous configuration. Know your strengths and weaknesses and consult your obstetrician if there is something unexpected.
Artal, R. 2019. Exercise during pregnancy and the postpartum period. Uptodate. https://www.uptodate.com/contents/exercise-during-pregnancy-and-the-postpartum-period?search=exercise-during-pregnancy-and-the-postpartum-&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
Macones, G. et al. Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations. American College of Obstetrics and Gynecology. https://www.ajog.org/article/S0002-9378(19)30572-1/fulltext#sec2.7