As trainers that pride themselves on a holistic approach to training – including proper rehabilitation from injury, we ask quite invasive questions regarding a woman’s pregnancy and birthing experience. More often than not, if a woman has has a c-section, their tone when they inform us of this is flippant, like it isn’t that bad, like it doesn’t matter, like it doesn’t affect her. We have always treated a c-section as a major abdominal surgery, and trained the client accordingly, however it wasn’t until my own abdominal surgery that i realised exactly how bad it can be, how much it matters, and how much it does affect every aspect of my life.
Now, i include this video, not to freak you out, but to show you exactly how big the surgery is… (warning, this is a real C-Section)
You also need to imagine the uterus, which is the last cut before the baby as it contracts and shrinks down to it’s normal size. Where does the cut and the scarring from the c section end up? (the answer is: right in the middle of your pelvis!).
In the next 6 weeks, the mother is instructed not to lift anything heavier than her baby. This seems fine, except when you consider that caring for a child can be very physical! Before having a baby, when did we ever lift 3-5kg all day, everyday? A mum will put her baby on the floor, pick it up again, carry to another room to change, breastfeed it, pick it up and carry it again, put it down to sleep, and do it all over again in about an hour. Regardless of your fitness and awareness, if you have had a c section, you will adopt a certain posture to avoid pain. It looks a little like this:
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This posture is a very stiff torso – as twisting can “pull” and cause pain and tearing. It also is a slight forward bend, which takes the stretch off the cut, thereby relieving pain. Imagine performing all those new mummy movements, all the lifting and carrying of weight, with this new posture as well….
Which brings me to my first point: It IS that bad! It is not a procedure to be taken lightly! It is NOT the easy way out (in fact, for many women a 6 week recovery is much longer than those with uncomplicated natural births). I’m pointing this out not to pass judgement, but to implore all the personal trainers out there to take it seriously when you’re training a client who has experienced this!
Which brings me to my second point: It DOES matter! It matters because there can be neurological damage, which affects the mum’s ability to coordinate her core muscles. A dysfunctional core causes all the usual problems like back pain and stress incontinence. It matters because the posture you adopt to avoid pain is also the posture that can cause neck pain, shoulder injury (think rotator cuff) and adds downward pressure to the pelvic floor! It is your trainer’s job to “unload” that pressure, to take the weight of the deep core and allow your pelvic floor, thoracic, and diaphragm to move as they’re supposed to! Ignoring a c-section is like ignoring ACL surgery, and prescribing a box jump on their first session back; no-one would do that to a client!!
My third point: it DOES affect the mum. In lots of ways. If we just look at her posture and leave it there, we have already talked about how it increases load on the pelvic floor and can contribute to neck and back pain. Did you realise that posture can affect your decision making, hormones, and mood*? While it’s not clear if depression comes before the depressed posture or as a result of it, the facts are that the posture of pain is a lot like the depressed posture, and can affect the mum’s decisions, well-being, and mental health accordingly.
For us as personal trainers to mum’s, reversing those postural changes is a top priority, followed closely by good lifting techniques and the pelvic floor “knack”. Our mum’s have to realise that they have had a major surgery, and nurture their body back to health. Great nutrition strategies such as these will arm you and your clients with enhanced recovery, when they take their surgery seriously and take proactive steps to rehabilitate it! We hope that soon this will be the prevailing attitude, instead of “it’s nothing” when they inform us of their birth experience!