The C-Section Experience: What You Need to Know About the Surgery and Recovery

If you’re having a cesarean section (c-section), you might be wondering what to expect during the procedure and recovery. This post will provide a comprehensive overview of the c-section process, including:

• The layers of tissue and muscle cut during a c-section,
• What happens before, during, and after the procedure,
• Common experiences and sensations during and after a c-section,
• Recovery timeline and tips for healing, and
• Answers to frequently asked questions about c-sections and abdominal muscles.

By the end of this post, you’ll have a better understanding of what a c-section entails and how to navigate the recovery process.

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Are C-Sections Common?

Yes. The national rate of c-sections is about 30%. This means that anywhere from 1/3 to 1/4 of pregnant women will undergo this surgical procedure.

There are many different reasons to get a c-section. The most common reason is what we call labor dystocia.

This means that your labor doesn’t progress as it should. Either your cervix stops dilating, or your baby doesn’t descend into your pelvis normally.

Other common reasons include:

• Non-reassuring fetal status (aka a bad fetal heart rate tracing)
• Breech presentation
• Repeat c-section
• Failed VBAC attempt (vaginal birth after cesarean section)
• Placenta previa

Layers and muscles cut during a C-section

During a cesarean section, six layers of tissue are cut to reach the uterus:

1. Skin
2. Subcutaneous Tissue
3. Fascia
4. Rectus Abdominal Muscles
5. Peritoneum
6. Uterus

While all of these layers are cut, it’s important to note that the rectus abdominal muscles are typically separated along the midline rather than cut.

The only muscle that is always cut during a c-section is the uterus, which is necessary to deliver the baby.

In rare cases, the rectus abdominal muscles may need to be cut if the patient’s anatomy does not allow for easy access to the uterus. If this occurs, the muscles will be stitched back together after the delivery.

what can you expect before, during, & After the C-section

Before the C Section:

There are two types of c-sections: scheduled and unplanned.

Your experience leading up to the surgery will differ depending on the type.

Common preparations for both types of c-sections could include:

• Spinal/Epidural Anesthesia: An anesthesiologist will inject a numbing medication into your spinal canal once you enter the operating room. This will numb you from your breast bone down, and you won’t be able to walk for a few hours after the procedure.
• Shaving: Your healthcare team may shave any pubic hair in your lower abdomen to prevent hair from getting into the surgical field, which can increase the risk of infection.

During the C-Section:

• Pfannenstiel Incision (The First Layer): A 10 cm abdominal incision is made above your pubic bone near the bikini line to access all six layers of tissue.
• The Second Layer and Beyond: After the skin, the subcutaneous fat, fascia, and rectus sheath are cut. The abdominal muscles are typically split down the midline, not cut.
• Uterine Incision: A small, low transverse incision is made in the uterus to reveal the amniotic sac, which is then gently opened to release the amniotic fluid.
• Pressure and Delivery: You will feel a lot of pressure as the primary surgeon reaches in to grab the baby, while the assistant surgeon provides pressure on your upper abdomen to guide the baby out.
• Uterus Exteriorization: After the baby is delivered, the uterus may be taken out of the body to make repairing the uterine incision easier. This can sometimes cause an increase in nausea and vomiting. It is then replaced, and all cut layers are repaired with stitches.

After the C-Section:

• Vaginal Bleeding: Even though you had a c-section, it is common to bleed from your vagina for about 2 weeks post-delivery.
• Nausea/Shaking: You may experience nausea and shivering in the operating room as well as the recovery room due to the anesthesia and changes in hormone levels.
• Pain and Weakness: As the anesthesia wears off, you will start to experience pain around the incision site and difficulty moving. Take pain medication as needed and try to walk around a day after your c-section, if possible.
• Recovery Timeline: On average, it takes about 6 weeks to start feeling like your normal self again. Avoid strenuous activity, heavy lifting, or serious abdominal training during this time. After 8-12 weeks, your c-section scar will be fully healed, and most women begin to feel comfortable doing more activities.

How Long Does It Take To Heal After A C-Section?

On average, it can take 6 weeks to start feeling like your normal self again. This means no strenuous activity, heavy lifting, or serious abdominal training.

After 8-12 weeks, your c-section scar will be fully healed and most women begin to feel comfortable doing more activities.

However, every woman is different. You may or may not heal as quickly as other women.

C- Section Recovery Tips

Okay, so what can you do following your c-section to help make sure you recover as quickly as possible?

The very first thing you need to do is move!

Get walking.

Walking is one of the most important things you can do in the postpartum period. Especially if you had a c-section.

I further discuss the benefits of walking in the postpartum period in my post- Getting Fit After Pregnancy.

Here are a couple of other things you might consider.

Abdominal Binder

All postpartum women will be offered an abdominal binder shortly after delivery.

This is an elastic band that wraps around your waist. You can adjust it using the velcro to make it as tight as you need it to be. Here is a great abdominal binder you can get from Amazon.

There isn’t great data to show that it has any major impact on recovery, but many women feel better wearing one. You might get some pain relief, or it might help you feel better psychologically.

Get one and see how it makes you feel. If you don’t like it, don’t wear it.

You should only need to wear it for 2-4 weeks.

For more information check out, abdominal binding after c-section, how long should you do it for?

Support Girdle

Another similar device is the postpartum girdle. This is a type of corset that compresses your abdomen and hips.

Again, there is no evidence that this will actually help you with recovery, but you might feel better support while wearing it. Many women prefer this girdle that could be bought on Amazon.

If you do, great. If you don’t, don’t worry about it!

Exercise

Here are two great exercises you can do shortly after delivery to help you regain strength in the core:

1. Posterior Pelvic Tilts

This is a very simple exercise that you can do while lying down. All you have to do is bend your knees up and concentrate on bringing your belly button down towards the floor.

This will naturally shift your pelvis posteriorly and activate your deep core muscles. Hold this position for a 3-count and release.

If this exercise causes pain or discomfort – do not do it!

2. Diaphragmatic Breathing

Diaphragmatic breathing is another simple exercise you can do immediately after your delivery. This exercise will help activate your deep core muscles- the transverse abdominis.

You can do it lying down or sitting up. To start, take a deep breath by expanding your belly as much as you can. Try your best to not breathe into your chest (i.e, don’t shrug your shoulders). After you inhale, hold your breath for a 3 count, and then exhale slowly and completely.

By exhaling as much as you can, your core muscles will be activated.

If this exercise causes pain or discomfort – do not do it!

As time goes on, you’ll be able to do more and more core exercises. Your health care provider will give you more guidance as to what you can and cannot do.

For your convenience, I have created an entire post on exercises to perform post c-section.

In this last section, I will answer a few other frequently asked questions regarding c-sections and abdominal muscles.

Other FAQs

Can I Get Muscle Damage From A C-Section?

It is unlikely that you will get muscle damage from a c-section. Your body is amazing and will do a remarkable job at healing itself as long as you allow it to heal.

Stay well hydrated, take exercise very slowly, and listen to your doctor.

I Have A Weak Core After A C-Section. Now What?

Almost every woman will have a weak core after a c-section. It’s normal! Even women who had a vaginal birth will have a weak core.

The reasons are because:

1) Your rectus muscles are stretched apart as your uterus grows.

2) You don’t use your core muscles as much throughout the pregnancy. The less you use a muscle, the weaker it will become.

3) We cut through many layers of tissue before we can get to the baby. The majority of these layers are stitched back together and will need time to heal.

But don’t worry, you will regain your strength.

Start by doing the exercises I recommended above as well as pelvic floor exercises. After you see your doctor and get clearance for more exercises, you can start doing direct core work.

Here is an entire post on how to strengthen your core in the postpartum period.

How Many Layers Are Stitched During A C-Section?

After the baby is delivered, the only layer that isn’t routinely stitched is the peritoneum. Otherwise, your obstetrician will stitch the uterus, the rectus muscles, the fascia, the subcutaneous tissue, and then your skin using dissolvable suture.

How Many Stitches Do You Get After A C-Section Delivery?

In general, each cut layer is closed with one long continuous stitch that is dissolvable. You won’t even see the stitch used to close your skin because it will be located underneath the skin.

What Part of The Uterus is Cut During A Cesarean Section?

During a c-section, a transverse or horizontal incision is made in the lower part of the uterus, known as the lower uterine segment.

If your baby is very premature, you may need a vertical incision as the lower uterine segment isn’t quite developed until 32 weeks of gestation.

If you get a vertical incision on the uterus, you will always need a repeat c-section as these types of incisions carry a higher risk of uterine rupture in subsequent pregnancies.

Final Thoughts On Cesarean Deliveries

A cesarean section is a major surgical procedure that involves cutting through several layers of tissue and muscle to deliver your baby.

While the abdominal muscles are typically not cut during a c-section, the procedure can still lead to a weakened core and a lengthy recovery process.

Key points to remember:

1. During a c-section, six layers are cut: skin, subcutaneous tissue, fascia, rectus abdominal muscles (usually separated, not cut), peritoneum, and the uterus.
2. The recovery process can take up to 6-8 weeks, during which time you should avoid strenuous activities and heavy lifting.
3. Walking and gentle exercises, such as posterior pelvic tilts and diaphragmatic breathing, can help with the recovery process.
4. Abdominal binders and support girdles may provide comfort and support, but their effectiveness in aiding recovery is not well-established.
5. It’s essential to listen to your body and follow your healthcare provider’s advice during the recovery process.

Remember, every woman’s experience with a c-section is unique.

If you have any concerns or questions about your recovery or the procedure itself, don’t hesitate to discuss them with your healthcare provider.

With proper care and patience, you can successfully navigate the recovery process and regain your core strength.

Posts Related to Postpartum Exercise

• Amazing Post C-Section Workout For New Moms
• 17 Surprising C Section Facts You Probably Didn’t Know
• Dangers of Exercising Too Soon After Childbirth

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Brittany Robles, MD, MPH, CPT

Brittany Robles is a full-time OBGYN physician, a NASM certified trainer, and a prenatal and postnatal fitness specialist. She holds a Master of Public Health degree in maternal health with a special interest in exercise and nutrition. She is also the co-author of The White Coat Trainer. Learn more about her here.

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References:

1. Clapp MA, Barth WH. The Future of Cesarean Delivery Rates in the United States. Clin Obstet Gynecol. 2017 Dec;60(4):829-839. doi: 10.1097/GRF.0000000000000325. PMID: 29045299.
2. Myers, Jennifer R. DO; Gillier, Christin M. MD; Kriner, Ronald M. DO; Constant, Ann D.; Wetzel, Laura A.; Anasti, James N. MD The Use of Abdominal Binders in Patients Undergoing Cesarean Delivery, Obstetrics & Gynecology: May 2014 – Volume 123 – Issue – p 160S
3. Ring L, Landau R, Delgado C. The Current Role of General Anesthesia for Cesarean Delivery [published online ahead of print, 2021 Feb 24]. Curr Anesthesiol Rep. 2021;1-10. doi:10.1007/s40140-021-00437-6