HAVING A BABY IS ONE OF THOSE MEDICAL EXPERIENCES WHERE, IN MY OPINION, THE REALITY OF WHAT HAPPENS IS OFTEN TOTALLY UNDERSTATED AND WOEFULLY MISUNDERSTOOD. The standard medical approach to rehabilitating a woman who has had a baby, especially when through C-section, is to give her a handful of exercises to improve her ‘core’. The problem with this approach is that it’s based on the belief that when you do a certain exercise, you are using – and therefore strengthening – a certain muscle. This isn’t necessarily true.

Laparoscopies, episiotomies, tearing of the pelvic floor – many women experience one or more of these issues in the course of their lifetime, and they can all create problems. Even a minimal tear with one or two stitches can present a challenge to the nervous system.

If a mother has a C-section, there are even more issues to contend with. When you have any surgery, sensations that the body normally experiences – such as touch, pressure, stretch and pain – are interrupted, not only by the incision but also by the resultant scar tissue. And until you decrease the problems caused by the scar, it may be difficult to strengthen the muscles in that area, no matter how many core-strengthening workouts you try to do.

What actually happens

The role of scar tissue is to heal and lay down new tissue, which attaches to other tissues around the injury, to make the vulnerable area more stable. At the same time, nerve cells work to regenerate so they can provide the necessary feedback to the brain, so the area can function properly.

There are so many muscles in that area that are required for keeping you upright, and stabilising the spine. The abdominals, oblique muscles… the pelvic floor alone comprises a dozen or so muscles. And any incisions through the skin, fascia and connective tissue in this area may affect your ability to use these muscles.

Symptoms that may be associated with these scars:

Lower back instability and pain

Neck pain

Pelvic floor overworking, or underworking, resulting in inability to go to the toilet, or inability to control flow

Inability to control leg function appropriately – feelings of weakness.

Sensations related to touching the scar

Fatigue or energy-based issues

Postural changes during pregnancy can also have an impact on your health and body functioning. During pregnancy, your spine typically becomes more curved than it should be, putting pressure on different parts of the spine and having an impact on the pelvic floor muscles. During labour, C-section incisions and natural tears in the pelvic floor can cause these issues to get worse and persist.

A general approach for most females is to use pelvic floor exercises called Kegels. The problem with a Kegel exercise is that it often just tries to strengthen the pelvic floor but doesn’t take into consideration how you breathe, previous injuries and existing issues in the pelvic floor. So they might not be as effective as you think.

Why is breathing so important?

Breathing shouldn’t be an issue, but for many who have been exposed to desk-bound jobs or excessive exercise, postural stress or injuries can change the way that we breathe. Even decreased exposure to crawling patterns through the use of baby walkers, or encouraging children to walk too quickly, can help a person to develop poor breathing strategies that can continue through to adulthood.

The optimal way we breathe should see the stomach move away from the spine. Many people draw their belly in all the time and this creates overuse of the muscles in the chest, neck and shoulders. When we breathe in, the belly should move outwards. This causes the abdominals and pelvic floor muscles to stretch and then recoil when you exhale, contributing to stability. As breathing changes, so does the reaction of the trunk, pelvic floor and other muscles.

When a C-section has been performed, you might feel pain with each breath you take. In this case, your brain might create a breathing pattern that is less painful, but which uses the wrong muscles. In my experience, helping a new mum to breathe correctly should be the essential aspect of helping her recover from a C-section, episiotomy and any other damage to the pelvic floor.

Why do scars cause problems?

It’s really a matter of communication and, just like when two people have had an argument, getting them to talk can resolve the situation. So if the brain sends out a signal to use the abdominal muscles and it’s met with a wall of fuzziness, it knows the muscles are there, but the scar is creating a wall of confusion and the signals coming back from the area are not as good as they could be.

One of the problems with the C-section scar is that, as it runs between the pelvis, it can be distorted with each step we take. Your body may work hard to make it seem as if it has recovered but, as with the breathing example above, this may be because your body has simply found another way to function. As such, other muscles might become overworked, such as the lower back or neck muscles, allowing your body to cheat to achieve a movement.

The emotions of scars

Given the highs and lows of pregnancy and giving birth, emotions may need to be considered when talking about healing and improving function. Some clients often report an uncomfortable sensation when touching the scar, or even thinking about the scar. Even these sensations to touch, and negative thoughts about the area, can make it harder for the body to heal.

What should you do?

Taking charge of your own health is essential. When you feel ready, do as much exercise as you need to. Less is often more in these cases. Many women often want to rush back into a fitness programme to lose weight. But the stress on the body from pregnancy, giving birth and breastfeeding is often underestimated and diving into an intense exercise may not be the right thing for you to do.

It’s been proven that there is an increasing link between pregnancy and hypothyroid issues. This can be exacerbated by an exercise regime that is too intense for you. A progressive stability and strength programme would be more appropriate – not just from a pain and movement perspective, but also from a hormonal perspective. You cannot beat fatigue and hormonal complications with exercise.

To determine if you may have an issue created by C-section scars, try a simple test. Choose a movement, such as touching your toes, bending backwards, or rotating your trunk, and see if you get any pain or restriction. Now place a hand on your scar, or rub it for a few seconds and then do the movement again and notice if there is any improvement. Does your pain or movement issue improve? If yes, then it is a sign that your scars are affecting you.

If you have pain from your scars, or your movement is compromised by them, you shouldn’t feel anxious about it as it can be easily remedied with the right approach. Similarly, if you don’t have any visible scars, but still feel as if your body is not returning to its pervious pre-baby strength and function, it’s also fixable – seek advice from someone who understands the importance of stability and structure.

Keith Littlewood is rehabilitation and neuromuscular therapist based in Dubai. Visit www.balancedbodymind.com or call 055 661 3061.

“There is a solution out there for us”

Mother-of-two Bushra Hassan went to see Keith at the recommendation of another specialist to try and correct the pain and movement issues she suffered following two Caesarean sections

“The biggest problem with C-section scarring is that I did not understand how it had impacted me, until I met Keith.

“I had always been reasonably fit. My pregnancies made me weaker and the subsequent weakness in my body was seen more as a continuing effect of difficult pregnancies, as opposed to the cuts in my abdomen. After the babies, I found it difficult to build my core muscle. There was excessive pressure on my lower back which travelled to my legs and knees.

“As time went on the pain in the entire body spread and my body overcompensated by using some muscles more than others. Luckily, I found a movement therapist who told me in my first meeting that I wouldn’t be able to fix my pain unless I met with Keith. The entire experience was life changing.

“Working with Keith is an unusual experience, but you have to have faith in him. Within one session, I was able to touch my toes, a feat I hadn’t be able to achieve since having my kids. Since then, I have been able to literally connect with and feel my abdominal muscles. My lower back is no longer in constant distress. At the slightest sign of pain, I know which muscles to engage and which ones to release.

“Most of us women do not understand the disadvantages of C-sections and the long-term impact it has on our lives. The inability of the muscles to reconnect in the abdomen, and to connect with the neural signals is a complicated science. The important thing is to recognise that C-sections have long-term impacts on the quality of our life and our overall wellbeing.

“Also as soon as we become mothers, we tend to stop caring for ourselves and tending to our bodies. We are afraid to touch our scars and we hardly, if ever, massage the area. I wish more women knew or understood the impact of C-sections on our bodies – especially now that I know there is a solution out there for us.”