Having a surgical birth can leave you physically exhausted and in pain. Good pain control the first few days after surgery will help you achieve a faster recovery. New cesarean moms often neglect adequate pain relief. They desire not to be medicated so they can enjoy their baby, and many are often concerned about the effect of medication on breast milk.

The First Few Days After Surgery

The exercises for the first few days after surgery really focus on prevention of complications. Learning to breathe after an abdominal incision is not as easy as it sounds. However, the more deep breathing you do, the less likely you are to have complications.

As you hold your incision with your hands or brace it with a pillow, inhale. Put enough pressure or support on your abdomen so that you don't feel your incision will open. Do this frequently in the first few days to help prevent problems with your recovery.

In addition, try these exercises:

• Walking

  The first few times you get up to walk after surgery are likely to be slow and painful. Use a pillow or your hands to brace your incision. While it may feel like your organs are going to fall out, you have many layers of stitches inside your body, as well as external stitches or staples. It doesn't sound like a lot of fun, but getting up and walking will speed your recovery. The first day or two you will need someone to help you. By the second postpartum day you will probably be asked to walk around the postpartum floor or nurses station several times a day.

Essential

If you've had a cesarean birth, keep in mind that you are not only experiencing the normal postpartum occurrences, such as changes in hormones and bleeding, but you are also recovering from major abdominal surgery.

• Abdominal Tightening

  As you lie in bed, or on the floor, have your knees bent and your feet flat on the floor. Tighten your buttocks and press your lower back into the bed or floor. As you inhale, imagine pulling your stomach down through your back to the floor or bed. Hold for up to five seconds. You can repeat this up to ten times.

• Leg Slides

  Lie down on your back, and bend your right leg up, leaving your left leg flat on the bed, toes up. Slide your right leg down to rest next to your left leg. Slide it back up to the bent position again. Repeat this exercise five to ten times. Then repeat it with your left leg. If you're more comfortable, try holding a pillow over your incision while you do this exercise.

The Second Week After Surgery

As your recovery progresses you will be able to do more and more. Do keep in mind that you have had major abdominal surgery, in addition to the joys of postpartum and new motherhood. Be sure to ask for help around the house and remember to allow others to do what they can. The less you do now, the faster you will heal completely.

These more advanced exercises can be tried in the second week postpartum:

• Pelvic Roll

  Lie on your back with your feet together. Your knees should be bent. As you hold your knees together, bring them up toward your chest. Roll them to your right side. Slowly roll them to your left side. This is a gentle rocking motion. You should avoid any jerking or bouncing while doing this. If this exercise pulls on your incision, stop doing it immediately. Repeat this up to ten times on each side.

• Abdominal Strengthening

  Lie down on your back with your feet together and knees slightly bent. Crisscross your arms over your abdomen, grabbing your waist on the opposite side.

  As you lift your head, pull your arms together, thus pulling your stomach muscles toward each other. Try to imagine that you have an apple under your chin to ensure proper head alignment during this exercise. Don't go too far up; your shoulders should barely leave the ground when doing this. Hold the pose for three to five seconds and then relax your head and arms to the original starting position. Repeat this exercise up to five times.

  Alert

  During the first two weeks' postpartum, you should refrain from walking the stairs more than about once a day. You should not drive your car. Do not lift anything heavier than your baby.

The Third Week After Surgery

By now you probably feel much better, though you still have some lingering pain and tension. Be sure to listen to your body and watch your incision. Add exercises slowly to the previous week's exercises as you build your body back up:

• Pelvic Tilt

  After about two weeks, you can begin to do your pelvic tilts. Assume an all-fours position, on your hands and knees. Think of holding your back in its natural alignment (see FIGURE 5-7). Then tuck only your pelvis in, bringing your pubic bone toward your neck. Be sure to move only your pelvis (see FIGURE 5-8).

  If it helps, have someone hold your pelvis so that you can learn to isolate this area. Later this exercise can be done in different positions. You need to do two sets of up to ten repetitions of the pelvic tilts. Later, you can add more to each set of repetitions.

  Essential

  The area of your incision may feel numb. Some women report that this numbness lasts for years, if not permanently. You might also feel like there is itching below the skin. This is also normal. The surgery requires that muscles and therefore nerves be cut, thus causing this damage. Always ask your doctor or midwife if your incision is bothering you.

After the beginning exercises of breathing and abdominal tightening of the first few days, you will slowly begin to feel better. Your recovery will usually not be as fast as your vaginal birth counterparts, but you can affect the length of time you take to recover by not doing too much.

Once you've been given the go-ahead for exercising, you will want to pay particular attention to your abdominal muscles. Even beyond normal separation from pregnancy, your muscles have been surgically cut. If you had a low transverse or bikini incision, you will not have as severe of an abdominal problem than if you required a classical or vertical incision. This type of incision will damage more muscles.