What Really Happens to Your Body When You Have a C-Section

You might be sore and unable to lift heavy things while recovering from a C-section.
Image Credit: Westend61/Westend61/GettyImages

What Really Happens to Your Body When examines the head-to-toe effects of common behaviors, actions and habits in your everyday life.

If you've ever given birth or know a person who has (that makes all of us), you likely know someone who has had a cesarean section — also called a C-section.

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C-sections — which involve abdominal surgery to deliver a baby through an incision in your uterus — are very common. In fact, about 30 percent of all births in the U.S. happen via C-section, according to Cleveland Clinic.

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Though common, C-sections are a major surgery (they are performed in most cases when giving birth vaginally isn't possible or safe for you or your baby). And like any serious surgery, the recovery process can be taxing on your body.

Here, experts share what symptoms you might expect to have after a C-section, whether your surgery was planned or due to an unforeseen complication.

What Happens During a C-Section?

A C-section begins with either general anesthesia or an epidural to numb you from the waist down. Then, a sterile drape is placed over your body to prep for the procedure.

Here’s what happens step-by-step during a C-section, per Penn Medicine:

  1. A cut is made through your skin and the wall of your abdomen. This will be either horizontal (along the bikini line) or vertical.
  2. Your abdominal muscles are separated to allow access to your uterus.
  3. Another cut — either horizontal or vertical — is made in the wall of your uterus.
  4. Your baby is delivered through these incisions.
  5. You'll likely feel some pressure (often described as a pushing sensation) twice — when the layers of tissue are stretched to access the uterus and then during the delivery of the baby.
  6. The umbilical cord is cut, and the placenta is removed.

The procedure itself takes about 20 minutes (if it's your first C-section; subsequent surgeries may take a little longer) and parents often stay in the hospital that night to make sure they recover well.

Possible Side Effects of a C-Section

Though every person's post-surgery experience varies, here are some of the most common symptoms you may encounter after a C-section.

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1. You May Be Constipated

A C-section can slow your bowels. "There are three main reasons for this," says Stephanie Hack, MD, FACOG, a board-certified obstetrician and gynecologist and founder of Lady Parts Doctor.

"First, the bowels are slightly ‌stunned‌ after a C-section," Dr. Hack says. During the surgery, your intestines go through a lot — they are manually manipulated and moved out of the way to get to your uterus, she adds.

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"Second, some of the medicines you take have a bowel-slowing effect," she says.

This includes the anesthesia used during a C-section as well as the pain medications (sometimes narcotics) that you may take after surgery, says Marcy Crouch, PT, DPT, a pelvic floor physical therapist and co-host of the No Mama Left Behind podcast.

"Lastly, you're often asked not to eat for a certain period before and after your C-section," Dr. Hack says. "This decreases the amount of food in your intestines, and thus may increase the time before you have another bowel movement."

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A lack of food — and fluids — can also dehydrate you, which contributes to constipation. Breast or chestfeeding can amplify constipation, too, Crouch says. That's because a lot of the water you drink goes to making milk (instead of to your bowel).

What You Can Do

To get things flowing again, sip on H2O and “resume eating and walking as soon as possible,” Dr. Hack says.

Crouch agrees: “fiber-rich foods [specifically prunes], plenty of water and gentle walks can be your best friends here.”

And if possible, limit narcotics in favor of other non-constipating meds or pain management strategies, Dr. Hack adds.

2. You’ll Be Unable to Lift Anything Heavy

After a C-section, the general recommendation is to avoid lifting "anything heavier than your baby for the first six to eight weeks," according to Mount Sinai. Lifting heavy objects can hinder the healing process.

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During a C-section, your doctor has to cut through many tissue layers in your abdomen to get to your uterus. "Putting too much pressure on these layers before they are fully healed can lead them to reopen, causing you pain and injury," Dr. Hack says.

What You Can Do

Patience is key. “Take your time and allow your body to heal,” Dr. Hack says.

In most cases, you’ll get the green light to resume your normal activities after the eight-week mark. Always “confirm with your doctor or midwife before increasing your physical activity,” Dr. Hack says.

3. You’ll Feel Sore at the Incision Site

Most people have pain at their incision site after a C-section, Crouch says. You may feel it any time you activate your abdominal area, or even when you least expect it (like when you laugh, cough or sneeze).

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Remember, you've just undergone a major surgery that involved cutting through many layers of tissue. Feeling sore is normal.

Your incision site will likely feel tender for three weeks or longer, but thankfully, any intense pain should go away after about three days post-surgery, per Mount Sinai.

For some, "scar sensitivity and [scar] pain can hang around for years," Crouch says.

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What You Can Do

“Keeping the incision area clean and dry, and following the doctor's advice on pain management, can help,” Crouch says.

For the first two weeks, most people take pain medicine to decrease any discomfort, per Mount Sinai. While many over-the-counter pain relievers are generally safe, always talk with your ob-gyn or midwife before taking any medicine, especially if you’re nursing.

Another great tip to reduce pain: “Hug a pillow when you have to laugh, cough or sneeze,” Crouch says. “That gives your tummy and the scar something to brace against, and it makes that motion more comfortable,” she says.

Wearing loose-fitting clothing, which won’t rub up against your incision site, is another great way to prevent pain, too, Crouch adds.

And if your scar sensitivity and pain linger longer, let your ob-gyn or midwife know. They can possibly refer you to physical or pelvic floor therapy.

4. You Might Be at a Greater Risk for Blood Clots

In general, pregnancy puts you at a greater risk for blood clots. "This is due to changes that happen with your clotting factors in the prenatal and postpartum states," Dr. Hack says.

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Your increased risk could also be due to the pressure put on the veins in your pelvis and legs from your growing uterus, according to UT Southwestern Medical Center. This pressure slows the return of blood, leading to a greater likelihood of clots.

Specifically, a C-section itself doubles your risk for a blood clot in your legs, pelvic organs or lungs, per Centers for Disease Control and Prevention (CDC).

This is partly "because you are typically not as active while you rest and recover," Dr. Hack says. When you don't move a lot, your blood flow gets sluggish, making blood pool in certain places and possibly form clots.

Signs of a blood clot in your arm or leg may include the following, per the CDC:

  • Swelling
  • Pain or tenderness not caused by injury
  • Skin that is warm to the touch
  • Redness or discoloration of the skin

Signs of a blood clot in your lung may include the following, per the CDC:

  • Difficulty breathing
  • Chest pain that worsens with a deep breath or cough
  • Coughing up blood
  • Faster than normal or irregular heartbeat

If you feel any of these symptoms, get immediate medical attention as blood clots can become dangerous and potentially life-threatening.

What You Can Do

After a C-section, your doctor may put compression devices on your legs to keep your blood from pooling, according to UT Southwestern Medical Center. Gentle compression helps improve circulation and reduces your risk of clots.

Likewise, “being active as soon as possible after a C-section helps,” Dr. Hack says. A little goes a long way: Walking around your hospital room, or even moving your arms and legs while sitting up, can be helpful.

Also, “be sure to discuss your medical history with your doctor or midwife,” Dr. Hack says. Certain medical conditions may predispose you to developing blood clots and require anti-clotting medications, she says.

5. Your Core May Be Weak

"C-sections can temporarily weaken your core for two reasons," Crouch says. "One is the pregnancy itself, which has stretched your abdominal muscles for nine months," she says.

"Another is this is a major [abdominal] surgery," Crouch says. The nature of the procedure further weakens your core. "In order to reach your uterus, your abdominal muscles are separated at the midline, and in some cases, cut," Dr. Hack says.

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Plus the incision goes through many layers of tissue, Crouch adds. No wonder your core feels unstable while in the recovery process.

What You Can Do

While you might be in a rush to rebuild your core strength, you must allow adequate time for healing to prevent possible injury, Dr. Hack says.

Sit-ups and other ab-focused exercises are too strenuous (and potentially harmful) during the early days and weeks of healing, but there are still things you can do to support your core strength. Here are Crouch’s tips for safely rehabbing your core muscles:

  • Engage in gentle movements like light walking
  • Focus on breathing exercises
  • Gently activate your abs when you get out of bed, lift the baby or move around the house
  • When getting out of bed, roll to your side and use your hands to push up to a seated position

Once your doctor or midwife gives you the green light for exercise (usually around the six- to eight-week mark), start with a slow and focused postpartum program, Crouch says.

Her online course, Postpartum Power, provides a roadmap for C-section recovery with guidance on functional exercises, stretching and breath training.

6. You’ll Have Vaginal Bleeding or Discharge for Weeks

If you didn't deliver vaginally, you might be surprised to learn that you'll still get vaginal bleeding after birth. Called lochia, this bloody discharge also has cervical mucus and some uterine lining, according to the Cleveland Clinic.

This is a normal part of your body's postpartum healing process. "After any birth, the uterus must heal," Dr. Hack says. And it does this by shedding any uterine tissue and materials related to pregnancy.

At first, lochia will look dark or bright red, then fade to a pinkish brown color until gradually turning to a yellowish-white, per the Cleveland Clinic.

What You Can Do

Again, like most things postpartum, this is a waiting game. “Bleeding after vaginal and cesarean birth can last up to eight weeks postpartum,” Dr. Hack says.

In the meantime, stick to sanitary pads until you're done bleeding. Tampons can bring bacteria into your uterus, according to the Cleveland Clinic.

If your postpartum vaginal discharge has a fishy or foul odor, tell your ob-gyn or midwife right away as this could indicate an infection.

7. You Might Have Pelvic Floor Problems

"It can be surprising to a lot of C-section parents that they get pelvic floor issues like pain with sex, leaking pee, constipation, pelvic pain or prolapse [i.e., when a pelvic organ slips down from its normal position and bulges into the vagina]," Crouch says.

"But C-sections aren't protective of pelvic floor problems," she adds.

In fact, pelvic floor issues often happen way before surgery does. Indeed, your pelvic floor — the muscles that sit at the bottom of the pelvis — endure a lot of strain while carrying the weight of your baby during pregnancy.

"Postpartum pelvic floor issues are usually a result of the collective load and changes your body accumulates through nine months of pregnancy," says Molly Scheumann, PT, DPT, a pelvic floor physical therapist at The Down There Doc.

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Also, as we've learned, C-sections can affect your core strength and stability. Thing is, "your abdominal muscles work very closely with your pelvic floor muscles to regulate the pressure in your abdomen," Scheumann adds.

When one or both of these muscle groups are weakened or "don't work well together, abdominal pressure can be thrown off," she says. And this can cause multiple pelvic floor-related symptoms, like leaking urine, pain or prolapse.

Scarring from your C-section can also affect your pelvic floor function. That's because scar tissue isn't as strong or flexible as the original tissue it replaced, Dr. Hack says.

What You Can Do

If you have any pelvic floor issues after your C-section, reach out to a pelvic floor specialist. These specialists, often called pelvic floor physical therapists, are trained to diagnose and treat pelvic floor dysfunction.

Resources like PelvicRehab.com and the Academy of Pelvic Health Physical Therapy can help you find a qualified pelvic health therapist in your area.

8. You May Have Difficulty Breast or Chestfeeding

After a C-section (especially if it was unplanned or due to an emergency), you might need to focus on rest and recovery and not begin breast or chestfeeding right away.

"These delays can affect the development of an adequate milk supply," Dr. Hack says.

Abdominal pain from your incision can also make it feel challenging to breast or chestfeed comfortably.

What's more, the epidural you received before surgery could also affect nursing. Anecdotally, some parents say that epidurals affect their baby's latch after birth, while others say it doesn't. Clinical data is also conflicting about whether or not epidurals have an effect on your infant's latch after birth, per a February 2021 review in the ‌Journal of Clinical Anesthesia‌.

Fortunately, these side effects seem to be temporary. Epidurals don't impair babies' development or ability to breastfeed in the long term, per the American Academy of Pediatrics (AAP).

What You Can Do

If possible, try and feed within the first hour of birth, and then around 8 to 12 times per day for the first two weeks to help establish a healthy milk supply, per the National Health Service. Sometimes, C-section parents are separated from their babies for longer periods of time, and may feel like they need to "catch up" on making milk. If this is the case for you, milk production can be jumpstarted by stimulation with a breast pump or hand expression (i.e., pushing it out by hand).

As long as there are no additional complications, and you nurse frequently, you’ll likely be able to build an adequate milk supply to feed your baby, according to the AAP.

You can also adjust your feeding position to make it more comfortable for you and your baby as you recover post-surgery. Here are a few tips, per the AAP:

  • Sit up in bed
  • Use one or two extra pillows to support your baby on your lap and protect your incision
  • Lie down on your side with your baby facing you
  • Use a football hold with enough pillows to raise your baby's head to the level of your breast or chest

If you’re still having difficulty nursing after a C-section, don’t hesitate to ask for help. Talk to your ob-gyn, midwife or an international board-certified lactation consultant (IBCLC).

IBCLCs are health care professionals with expertise in lactation. They can provide great guidance and support throughout your breast or chestfeeding journey.

Where to Find Licensed Lactation Consultants

9. You May Have Back Pain

As if pregnancy-related back pain wasn't hard enough, back discomfort might stick around after delivery, too.

Changes in posture are partly to blame for back pain, Crouch says. Dr. Hack agrees: "Your center of balance has changed, and your muscles must readjust as your body returns to its pre-pregnant state."

The bones and ligaments in your pelvis must also shift back, which may lead to back pain and discomfort as well, according to the Cleveland Clinic.

Plus, lifting or feeding your baby present more posture and pain challenges, Crouch says. For example, you may slouch, slump or crane your neck while breast or chestfeeding, to achieve a position that's most comfortable for your baby. Combined, these can all add up to sore back muscles.

"The low back also works closely with your abdominal wall and pelvic floor," Scheumann says. After a C-section, both of these muscle groups can be weakened, putting strain on your low back.

And "your back might feel a little cranky from the anesthesia" you had during surgery, Crouch says. Indeed, epidurals can cause temporary tenderness or back pain, per the Cleveland Clinic.

What You Can Do

While postpartum back pain is common, it’s “not normal and should be addressed by a physical therapist,” Scheumann says.

Besides working with a physical therapist during recovery, you can also do the following things to support your back, per Crouch:

  • Get in some movement.‌ Gentle walking and stretching (think: cat-cow, child's pose and seated figure four) can do wonders for your back (and hip) pain.
  • Practice good body mechanics‌. Always lift with your legs instead of hinging at your back.
  • Invest in supportive garments‌. Compression leggings can be great for back support.
  • Activate your abs‌. During any physical activity, gently draw in your abdomen (along with your pelvic floor at the same time) to help support your low back.
  • Apply heat and cold therapy‌. Use heat and ice intermittently for 15 to 20 minutes at a time.

10. You May Be More Likely to Have a C-Section in Future Pregnancies

Depending on the reason for your C-section, you may be at a higher risk for needing another in future pregnancies.

For example, if you needed a C-section because you stopped dilating, you're more likely to go through the same thing in another pregnancy over some who has not, Dr. Hack says.

Plus, if you've already had C-sections (usually two), your doctor will typically recommend you go that route again for safety reasons, she adds. That's because a vaginal birth after caesarean (or, VBAC) has some serious risks such as a uterine rupture.

What You Can Do

If you plan to get pregnant again, start reviewing your birthing options with your doctor as soon as possible, Dr. Hack says. “While C-sections can’t always be prevented, you can discuss your risk factors and concerns,” she adds.

Depending on your situation and risk level, you may still have the chance to deliver vaginally after a previous C-section if that’s your preference.

“The literature supports a trial of vaginal birth for most moms with a second baby, and most VBACs are successful,” Crouch says.

11. You May Have Nerve Damage

"Numbness, tingling or altered sensation around your incision site are common symptoms of nerve damage following a C-section," Scheumann says.

There are several reasons why C-sections can damage nerves:

  • Direct trauma to nerves‌: "Direct trauma to nerves during the incision or handling of tissues can lead to nerve injury," Scheumann says.
  • Indirect trauma to nerves‌: "The surgical procedure involves an incision through layers of tissue, including skin, fat and muscle, which may inadvertently affect nerves in your abdominal area," Scheumann says.
  • Compression or traction on nerves‌: If there's excessive scar formation, compression or traction on the nerves (like a nerve getting pulled into the suture line, for example), it can result in damage, Scheumann says.

What You Can Do

While certain kinds of nerve damage may be permanent, other nerve injuries can heal and improve with the right recovery strategies. “In most cases, these issues can be addressed with the guidance of a pelvic floor physical therapist,” Scheumann says.

How Long Is C-Section Recovery?

The recovery from a C-section is a marathon, not a sprint, Crouch says. While everyone is different, here's a general timeline for the recovery process:

Two to three weeks post-surgery‌: "Your superficial incision, usually low and where your pubic hair is, usually seals up within a few weeks," Crouch says.

Six to eight weeks post-surgery‌: "While you may look down at your incision after two to three weeks and see that it has healed, that's only a superficial view," Dr. Hack says. "The tissue underneath is going through a complex process of healing that will take several more weeks to heal," she says. On average, tissue healing takes between six to eight weeks.

Eight weeks to a year post-surgery‌: "Just because the wound is healed doesn't mean it's recovered or that you'll feel "normal" after six or eight weeks," Crouch says. "The internal healing, where your body has to knit together muscles, tissues and basically reconstruct its inner landscape, takes much longer," she says.

Every body works on its own timeline, but it's estimated full recovery after a C-section can take nine months up to a year, Crouch says.

And keep in mind, healing may be even slower if you've had a previous C-section. "While not the case for everyone, recovery can be more difficult after each subsequent C-section," Dr. Hack says.

When Can You Start Exercising After a C-Section?

Though most people get permission to start regular physical activity after six to eight weeks, it doesn’t mean your body is ready, Crouch says. It’s wiser to gradually ease back into more intense forms of movement (like weightlifting).

“Let your body guide the process,” she says. If you feel pain during an activity, heed your body’s message, and stop doing it.

Dr. Hack agrees: “Trying to be active too soon can slow your healing and lead to injury.” Again, working with a physical therapist, who can create an individualized program of rehab exercises, can be a great resource during C-section recovery.

When to See a Doctor

Ultimately, giving birth by C-section is extremely common and sometimes necessary for parents.

While many of the above symptoms are a normal part of the C-section recovery process, others could mean something more serious is going on.

If you're unsure whether a symptom is normal or not, call your ob-gyn or midwife. And call them immediately if you have any of the following symptoms, per the Cleveland Clinic:

  • Red or swollen incision
  • Pus or leaking discharge from the incision
  • Fever or worsening pain
  • Heavy bleeding
  • Severe pelvic pain and cramping

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references

Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.

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