The C-section Tragedy

The joy around childbirth is palpable. It’s a beautiful drama that ends in a tiny miracle. But I am finding a recurrent problem with one part of the process: C-sections. It’s not that C-sections shouldn’t ever be performed. Sometimes they’re necessary. No, instead the problem is the lack of post-op care for mom.

For the life of me I can’t understand the neglect surrounding mothers that undergo a cesarean section. I’ve yet to encounter even one woman who has been given a suggestion for rehab after the procedure. On the contrary, most relay that they’re told to just start moving again when they’re pain free. It’s a recipe for disaster. Here’s why.
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To rehab or not to rehab?

Rehab after surgically cutting through an entire muscle group is a given, except for this particular surgery. Why? Everyone pounds the pavement for the importance of core strength, so why are mothers not advised to rehab after a C-section? If a high school athlete has a partial tear in his abdominal muscle, he would rehab for weeks. If mom has the entirety of her abdominal muscles cut and separated, she just waits for the pain to go away. It’s a health care disconnect. It’s not safe. And it sets mom up for failure.
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We know with certainty that surgical procedures produce scar tissue around the fascia and muscles. And we also know that this scar tissue infiltration is protective in the short-term, but hinders function in the long-term.  When the scar-tissue-ridden fascial tissue can’t slide, glide, and contract properly, the entire muscle group malfunctions. Strength decreases and motor control suffers. The nervous system sets the resting tone of the muscle too high or too low, resulting in trigger points and/or a flabby muscle. This leaves you with an inactive muscle.

The way you move

If you lose your ability to activate your abdominal wall, you’ve lost your chance at flexing your trunk. There are no alternative options. When you lose those muscles, your natural movement pattern is forced to adapt and you start to rely up on other muscle groups too heavily. Over time, you’ll feel your low back and hip flexors start to scream at you. It may take 6 months or 5 years, but it’s inevitable. You can’t get around it.

Time reveals all wounds

The tragedy here is that this is often a slower process. The pain starts improving and the incision itself is healed within weeks. The movement dysfunction, however, teases out over time. The more activity mom takes on, the faster the weakness shows up. Because this doesn’t happen overnight, and because they’re told that being pain free means that they’re good to go, moms usually express confusion about why they’re having any pain all. Unfortunately, this course was set the moment they skipped out on rehab.

A mother’s sacrifice

I believe there’s a natural tendency towards avoiding rehab in the scenario anyway. Rehab means taking care of yourself; but our experience is that a new mom typically has a built-in desire to focus on caring for her new baby. This sacrifice is a beautiful thing, but this particular decision to avoid rehab is cloaked in misconceptions. To believe that rehab isn’t necessary is going to cost you something in the long run. If the decision is made to skip rehab, it at least needs to be made with all of the information. Right now, moms are not fully informed.

What to look for

You may fall into this category if:

  • Abdominal strengthening exercises hurt your back
  • You have a stereotypical “swayback” posture with a big arch in your low back
  • You can feel pain and/or nodular tissue around the incision site
  • Hugging your knees to your chest (fetal position) feels oh-so-good at day’s end
  • Your back is tight/painful directly behind where your c-section incision sits


For help with problem-solving this issue, and to get back to moving well, contact us at


Update (October, 26, 2017):

Our friend Dr. Susan Murrey of West Suburban Women’s Health in Western Springs, IL was kind enough to clarify the nuances of the C-section procedure that is most commonly used today. In fact, the rectus abdominus (6-pack muscles) is very seldomly cut all the way through. Instead the abdominal cavity is accessed by separating the middle of the abdominal fascia (along the linea alba). Although this doesn’t change the fact that these moms need rehab, this is an important clarification. Thanks, Sue!