A CAESAREAN IS MAJOR SURGERY. Why isn’t rehabilitation built into recovery?
- 6 days ago
- 24 min read
Updated: 5 days ago
Physiotherapist and scar rehabilitation specialist Laura O’Byrne believes the conversation around caesarean birth is focusing on the wrong problem.
Caesareans are not the problem, she argues. The gap comes afterwards: too many women leave major abdominal surgery without a clear rehabilitation pathway.
There is something unusual about the way we talk about caesarean birth.
We recognise that it takes place in an operating theatre. We know it requires anaesthesia, surgical incisions, pain relief and a period of physical healing. We know there can be complications and that recovery takes time.
And yet, once the baby has been delivered, we can very quickly stop talking about surgery and start talking only about motherhood.
For physiotherapist Laura O’Byrne, that disconnect sits at the heart of a much bigger conversation about women’s health.
“Caesareans are not the problem. The missing rehabilitation pathway is the problem.”
Laura’s concern is not that women are having caesarean births. In some circumstances, caesarean delivery is medically necessary and can be lifesaving; in others, it is a planned and informed choice. Her argument is that whatever led to the surgery, the body afterwards still deserves the sort of recovery support we instinctively associate with other significant operations.
This is not simply a matter of terminology. The National Health Service (NHS) in England explicitly describes a caesarean as a major operation.[1] The American College of Obstetricians and Gynecologists (ACOG), the leading US professional membership organisation for obstetrician-gynaecologists, describes the procedure as involving an incision through the skin and abdominal wall, separation of the abdominal muscles where possible, followed by an incision through the uterus before the baby and placenta are delivered.[2]
Importantly, not every tissue encountered during a standard caesarean is simply “cut through”. The abdominal muscles are commonly separated rather than transected. Nevertheless, multiple tissue planes are opened, stretched, separated and subsequently required to heal. The fact that caesarean birth is common and generally very safe does not turn it into a minor physical event.
The question Laura wants us to ask is therefore deceptively simple: if this is major surgery, why is rehabilitation not routinely built into the way we think about recovery?
The postnatal gap is bigger than one operation
Laura’s frustration sits within a much wider issue in maternal healthcare.
The World Health Organization (WHO) describes the first six weeks following birth as a critical period for women and newborns, while also identifying the postnatal period as one of the most neglected phases in the provision of quality maternity care.[3] That neglect becomes particularly significant when we consider that recovery from pregnancy and birth frequently extends far beyond the period covered by routine postnatal services.
In 2023, WHO reported research estimating that at least 40 million women each year are likely to experience a long-term health problem associated with childbirth. The conditions identified included low back pain, urinary and anal incontinence, pain during sex, perineal pain, anxiety, depression and other problems capable of persisting for months or years after the birth itself.[4]
For Laura, these figures reflect something she sees repeatedly in clinical practice. Once the immediate medical concerns surrounding birth have passed, the expectation can become that a woman should simply recover in the background while simultaneously adapting to caring for a newborn.
Some women do recover exceptionally well with relatively little intervention. Others find themselves frightened to move, unsure how much pain is normal, struggling with the scar or abdominal wall, experiencing pelvic-floor symptoms, or simply unable to return comfortably to ordinary physical activity.
Still others only seek help much later because they never realised that what they were experiencing was something that could be assessed.
That is why Laura wants to challenge the idea that postnatal recovery is simply something women need to “get through”. Recovery should not only be measured by whether a surgical wound has closed or whether an immediate medical complication has been avoided. It should also consider whether a woman understands her body, can move confidently and is progressively returning to the activities that matter to her.
A positive caesarean birth is still possible
There is a tendency for conversations about caesareans to fall into one of two extremes. Either caesarean birth is normalised to such an extent that the physical consequences of surgery are minimised, or it is presented as the outcome women should fear when preparing for birth.
Laura rejects both positions.
She has experienced a caesarean herself and describes it as a wonderful birth experience. That does not mean it was not surgery; it means that major surgery and a positive birth experience are not mutually exclusive.
This distinction becomes especially important for women whose caesareans are unplanned. When months of antenatal preparation have focused almost entirely on vaginal birth, a late change of plan or an emergency caesarean can leave somebody waking up after an operation she has barely considered and for whose recovery she feels entirely unprepared.
Laura does not believe women should spend pregnancy anticipating everything that might go wrong. She believes they should be given enough information to respect the possibility that plans sometimes change.
Preparing for a caesarean is not the same as expecting one.
Preparing for a possibility is not expecting the worst
Antenatal preparation understandably follows people’s preferences. Someone hoping for a vaginal birth may learn about labour positions, pain relief, breathing, perineal preparation and the stages of labour. Laura sees no reason to remove any of this.
She would simply add another layer: what would I need to know if the plan changed?
That might include understanding how to get out of bed after abdominal surgery, how to support the incision when coughing or laughing, why early movement is encouraged, what discomfort can reasonably accompany healing, what symptoms warrant medical review and who can help if mobility or pain becomes difficult.
For a woman who already knows she will have a planned caesarean, preparation can be more specific. Laura encourages women to think about physical conditioning during pregnancy, their home environment and the realities of the first few weeks after surgery rather than waiting until afterwards to discover what is difficult.
ACOG recommends aerobic and strength-conditioning exercise during uncomplicated pregnancies and notes benefits associated with maintaining physical activity throughout pregnancy and the postpartum period.[5] This does not mean that being fit guarantees an easy caesarean recovery. Infection, surgical complexity, anaesthesia, pain and individual healing responses remain unpredictable. What preparation can do is give the body a stronger functional starting point and help a woman understand what recovery is likely to demand of her.
This is an important distinction because preparation should never become another measure against which women judge themselves. There is no prize for recovering fastest, and a difficult recovery does not mean somebody failed to prepare correctly. Prehabilitation is about improving capacity where possible, not promising an outcome.
Watch Laura explain why rehabilitation should begin before there is a problem
In the accompanying conversation, Laura explains why she believes caesarean recovery should be viewed through the same rehabilitation lens as other major surgery. She discusses what preparation can realistically look like, why the earliest stages of rehabilitation are often about movement and education rather than exercise, how scar rehabilitation develops over time and why fear itself can alter the way somebody moves following surgery.
Watch the conversation to hear Laura explain why preparation, education and rehabilitation should form one continuous pathway around caesarean birth.
Rehabilitation begins with something much simpler than exercise
When people hear the word rehabilitation, they often imagine an exercise programme beginning several weeks after surgery. Laura is describing something that starts much earlier.
In the beginning, rehabilitation may simply mean learning how to move.
Getting from lying to sitting, standing from a chair, using the toilet, coughing, laughing, reaching for the baby and walking around the room are ordinary activities that can suddenly feel highly technical when the abdominal wall is painful and the person performing them is worried about damaging a surgical wound.
This is why Laura distinguishes between helping somebody get out of bed and teaching somebody how to get out of bed. Assistance solves the immediate problem; education gives the woman something she can use when she is back at home without an electric hospital bed or a healthcare professional standing next to her.
Established postoperative physiotherapy follows precisely this principle. Cambridge University Hospitals, an NHS teaching hospital, advises abdominal-surgery patients on supported coughing, deep breathing, circulation, bed mobility and progressive walking, while also explaining why each activity forms part of recovery.[6]
The aim is not aggressive exercise immediately after surgery. It is the gradual return of safe, confident movement.
Wound support can make movement feel possible again
One of Laura’s most practical techniques is wound support: using the hands, a folded towel or a pillow to provide comfortable external support across the surgical area during coughing, sneezing, laughing or certain movements.
This is an established postoperative technique rather than an unusual intervention. Guidance from the Royal Free London NHS Foundation Trust explains that supporting an abdominal incision while coughing can reduce pain, improve the effectiveness of the cough and reduce anxiety around coughing.[7]
For Laura, its importance extends beyond the physical support itself. It gives the woman a practical strategy at precisely the point when she may feel that her body has become unpredictable.
Rather than believing that she must avoid movement because movement might harm her, she can begin to understand how to move while respecting the fact that she has just had surgery.
That subtle shift - from avoidance to informed movement - is one of the foundations of rehabilitation.
Movement matters, but knowing why you are moving matters too
Current post-caesarean guidance encourages women who are medically stable to mobilise relatively early after surgery. KK Women’s and Children’s Hospital (KKH) in Singapore advises early walking after caesarean birth to assist recovery and reduce the risk of venous thromboembolism, while the UK’s National Institute for Health and Care Excellence (NICE) similarly incorporates mobility into its recommendations for post-caesarean recovery.[8][9] NICE is the independent organisation responsible for developing evidence-based health and care recommendations for England and Wales.
The difficulty is that “get moving” can still feel like an abstract instruction when somebody is in pain.
Laura would rather translate it into practical questions: How do you roll before you sit? Where do you place your hands? What should you expect to feel as you straighten up? How do you pace walking? What happens if coughing hurts? Which symptoms are uncomfortable but expected, and which should trigger a call to the medical team?
That is the difference between simply issuing instructions and building confidence.
Fear can become part of the physical recovery
Fear features repeatedly in Laura’s work with women after caesarean birth. It may be fear of pain, fear that the wound will reopen, fear of coughing, fear of standing upright or fear generated by a previous infection or difficult birth experience.
These concerns can influence the way somebody moves. She may hunch forward, brace continually through the abdomen, avoid rotation, hold her breath or reduce activity far beyond what her medical team intended.
Physiotherapists commonly refer to this protective response as guarding. In the early stages it makes sense: an area has been injured and the body wants to protect it. The difficulty arises when protection becomes a persistent movement strategy after the tissues have progressed through healing.
Laura’s response is not to dismiss that fear. She wants to understand exactly what the woman believes is going to happen and then give her enough information and graded physical experience to rebuild confidence.
As she puts it: “The only combat to fear is education.”
The wording is characteristically Laura, but the clinical principle is significant. A highly capable, intelligent person can still have very limited knowledge of postoperative anatomy. Health literacy is not the same as general intelligence, and nobody instinctively knows how a caesarean wound is constructed or how it heals.
The job of rehabilitation is partly to make the body understandable again.
One patient changed how Laura thought about recovery
Laura remembers a woman she encountered early in her physiotherapy career who had become extremely frightened of moving or coughing following a caesarean because she believed she might tear open her stitches. The woman subsequently developed a serious chest infection that progressed to pneumonia.
A single clinical experience cannot establish that immobility caused that pneumonia, and Laura does not present it as proof that the same sequence would occur for another patient. What stayed with her was the extent to which fear and lack of information had shaped the woman’s behaviour.
The wider postoperative evidence helps explain why that experience resonated. Abdominal-surgery rehabilitation routinely incorporates deep breathing, effective coughing and early mobilisation because anaesthesia, pain and inactivity can affect respiratory function, while mobilisation also contributes to reducing the risk of blood clots and restoring independence.[6]
For Laura, the lesson was simple: somebody recovering from surgery should not be left so frightened of ordinary movement that avoidance becomes their only strategy.
Six weeks is an important checkpoint, not the end of recovery
The six-week point has acquired enormous significance in postnatal culture. Women often hear it in conversations about driving, exercise, lifting, sex, wounds and the postnatal medical check, and it can begin to sound as though the body is expected to cross an invisible line between “recovering” and “recovered”.
Healing does not work that neatly.
For many women, the six-week period represents substantial progress. The incision may be well healed and some normal activities can be gradually increased. However, both ACOG and NHS guidance recognise that return to physical activity after birth should be progressive and influenced by mode of delivery, complications, symptoms and individual recovery rather than a single date.[5][10]
Laura therefore sees six weeks as a useful review point. It provides an opportunity to consider what happens next: how the woman is moving, whether pain remains, whether the abdominal wall is functioning comfortably, whether there are pelvic-floor symptoms and what physical demands she is hoping to return to.
For one woman that may mean being able to walk further without discomfort. For another it is getting onto the floor with an older child. For somebody else, the eventual goal may be running, strength training or returning to competitive sport.
A date tells us how much time has passed. Function tells us how recovery is progressing.
That distinction also matters because the tissues involved in surgery continue changing long after six weeks. NHS scar guidance notes that scars may take around 18 months to two years to mature fully.[11] Internal healing following caesarean surgery similarly continues for months after the skin has closed.
This is why Laura believes rehabilitation after caesarean birth should be considered a progression rather than an event.
The scar we can see is only part of the picture
Scar rehabilitation is an area of particular interest in Laura’s practice.
A fine, pale caesarean scar can look extremely reassuring, and cosmetically it may represent an excellent result. But the appearance of the skin does not tell us everything about the way that area feels and functions.
Scars can remain numb or hypersensitive. They can feel tight or less mobile than surrounding tissues. Some women notice pulling during certain movements or feel uncomfortable touching the area. Others unconsciously protect it even after the wound itself has healed.
None of this automatically means that something went wrong during surgery.
Scar formation is a biological process influenced by healing, tissue tension, collagen production, infection, individual skin characteristics and many other factors. NHS specialist scar guidance notes that scars can remain sensitive, raised, itchy, numb or less mobile as they mature, and that they may take up to two years to reach their mature state.[11]
For Laura, this is why a visually beautiful scar and a completely rehabilitated abdominal wall should not automatically be assumed to be the same thing.
The question is not only, “How does the scar look?”
It is also, “How does the person move and feel?”
Scar mobilisation is becoming an increasingly interesting part of rehabilitation
The evidence around scar mobilisation is still developing, but what we have so far is encouraging.
A 2022 study examining standardised soft-tissue mobilisation in 32 women with caesarean scars found measurable improvements after treatment in several areas, including scar stiffness, elasticity and pressure-pain thresholds. The authors concluded that two sessions of scar mobilisation appeared to have beneficial effects on some physical properties of the scar and on pain.[12]
That study is relatively small, so it does not settle every question about scar rehabilitation. It does, however, support what clinicians such as Laura have observed in practice: a scar is responsive tissue, and targeted intervention may alter how it moves, feels and tolerates pressure.
This is reinforced by established scar-management guidance within NHS rehabilitation services, which advises that once a wound has fully healed, progressive touch and massage can be used to improve scar mobility and reduce sensitivity.[11] The Royal National Orthopaedic Hospital describes massage as a means of helping scars become softer, more mobile and less sensitive once healing is sufficiently established.
For Laura, scar treatment is therefore not an aesthetic add-on. It can be part of restoring function.
Assessment might include the mobility of the superficial tissues, sensitivity, abdominal movement, breathing, strength and the way someone performs ordinary activities. The treatment is then directed towards what that individual is actually struggling with rather than towards making every scar look or feel identical.
The developing evidence gives women an important message: persistent tightness, sensitivity or discomfort around a healed caesarean scar does not necessarily have to be accepted as permanent simply because the operation happened months or years ago.
Internal adhesions deserve more attention too
Deeper postoperative adhesions are different from the visible skin scar, but they are a recognised consequence of abdominal and pelvic surgery.
An adhesion is a band of scar-like tissue that forms between internal structures that would not normally be connected. Research into repeat caesarean surgery has consistently demonstrated that the likelihood and severity of adhesions rises with successive operations. A recent Asia-Pacific expert consensus, drawing on the wider surgical literature, reported adhesion rates ranging from approximately 24–46% at second caesareans, 43–75% at third caesareans and 48–83% at fourth caesareans.[13]
This does not mean that every woman with a previous caesarean has symptomatic adhesions, nor that every pulling sensation can be assumed to come from them. It does mean that internal tissue change after abdominal surgery is a genuine biological phenomenon rather than an invented explanation for women’s symptoms.
The emerging rehabilitation evidence is also promising. A 2025 systematic review examining manual therapy for adhesion-related symptoms after abdominal surgery included nine studies and concluded that manual therapy shows potential as a non-invasive adjunct for managing symptoms associated with postsurgical adhesions, gastrointestinal problems and related musculoskeletal dysfunction.[14]
This is an area in which research is likely to develop considerably. At present, it would be too simplistic to say that a therapist can definitively identify and physically “break” a particular deep internal adhesion through the abdominal wall. What the evidence does support is a much more optimistic position than simply telling somebody nothing can be done: hands-on treatment, movement rehabilitation and work on the surrounding abdominal tissues may have a role in improving symptoms and function even after abdominal surgery has healed.
For Laura, the practical implication is that the entire area should be considered rather than treating the skin scar as the beginning and end of recovery.
A caesarean does not make the pelvic floor irrelevant
Avoiding vaginal delivery does reduce the risk of some pelvic-floor disorders. Large observational studies have found lower rates of stress urinary incontinence and pelvic organ prolapse following caesarean birth when compared with vaginal delivery.[15] That difference is real and should not be minimised.
However, lower risk does not mean that the pelvic floor becomes irrelevant.
Pregnancy itself places changing mechanical demands on the pelvic floor and abdominal wall, and women who deliver by caesarean can still experience leakage, pelvic heaviness, pain, bowel symptoms, sexual symptoms or difficulty managing pressure during exercise.
Laura’s position is therefore not that every woman who has a caesarean has a damaged pelvic floor. It is that the route of birth should not be used as a reason to dismiss pelvic-floor symptoms when they occur.
This is particularly relevant when women return to exercise. Someone may have a beautifully healed abdominal scar yet find that running produces leaking, lifting produces pelvic heaviness or sexual activity remains painful. These symptoms require their own assessment rather than an assumption that the pelvic floor must be fine because the baby did not pass through the vagina.
What would a better caesarean rehabilitation pathway look like?
Laura’s proposed model is not a programme in which every woman is automatically prescribed months of treatment. It is a pathway in which rehabilitation is anticipated and accessible rather than discovered only after something has gone wrong.
During pregnancy, women would know where to seek help for musculoskeletal problems rather than assuming pain is simply part of being pregnant. Antenatal education would acknowledge caesarean birth as a possibility and provide enough practical information to make an unexpected surgical birth less disorientating.
If a caesarean became planned, preparation could include physical conditioning where appropriate, practical arrangements at home and education around the early postoperative period.
Following surgery, Laura would like women to receive clear instruction about movement, wound support, breathing, circulation, pain, warning signs and the transition from hospital to home. She would ideally like an individual physiotherapy touchpoint before discharge so that somebody can establish whether a woman is moving safely and confidently and whether additional rehabilitation is required.
Later input could be determined by need. That may include scar rehabilitation, abdominal-wall function, pelvic-floor assessment, pain management or progression back towards exercise, work and sport.
The underlying principle is not that every woman needs the same treatment.
It is that every woman should know that rehabilitation exists.
Singapore already has many of the pieces
Singapore is not starting from zero.
KK Women’s and Children’s Hospital already provides physiotherapy within women’s wards and describes services including antenatal and postnatal education, pelvic-floor exercise, respiratory and musculoskeletal physiotherapy, anti-embolism stockings and pre- and post-surgical management of pregnancy- and delivery-related conditions. KKH also operates an inpatient postnatal physiotherapy programme and notes that ward nurses and physiotherapists can assist women who experience difficulty mobilising after a caesarean.[8][16]
The opportunity Laura identifies is therefore not simply the introduction of a service that does not exist. It is the development of a clearer and more consistent pathway around the expertise that already exists.
Could rehabilitation education become an expected component of caesarean care rather than something associated primarily with an identified problem? Could women leave hospital knowing what specialist support is available and when they might need it? Could postnatal physiotherapy be discussed proactively rather than discovered months later through a friend, a Google search or persistent pain?
These are the questions at the centre of Laura’s argument.
Current guidelines leave room for that conversation
It is also worth distinguishing Laura’s proposal from current minimum standards.
NICE guidance on caesarean birth includes postoperative recovery, mobility, thrombosis prevention, pain management and follow-up, but it does not currently require every woman who has an uncomplicated caesarean to receive an individual physiotherapy consultation.[9] NICE also advises against routine respiratory physiotherapy after caesarean under general anaesthesia where there is no specific clinical indication, because evidence has not demonstrated improved respiratory outcomes from providing it universally.
That does not undermine Laura’s proposal. It defines where current guidance ends and where a broader rehabilitation model could begin.
Her argument concerns functional education and individual assessment: teaching movement, identifying fear or difficulty, recognising when further rehabilitation is appropriate and giving women a clearer route back to activity.
The relevant policy question is therefore not whether Singapore is failing to follow an existing international rule. It is whether maternity systems could now go further than the minimum postoperative pathway and make rehabilitation a more visible part of women’s recovery.
Other healthcare systems show that postnatal rehabilitation can be treated as healthcare
France is frequently discussed in relation to postpartum rehabilitation because its national health-insurance system explicitly provides routes into pelvic-floor and abdominal rehabilitation after birth.
Current guidance from Assurance Maladie, the French national health-insurance system, states that postnatal perineal rehabilitation can be prescribed following the postnatal consultation and is reimbursed through the public system. It also makes an important distinction: rehabilitation is not considered necessary for every woman, but it can be offered when postpartum symptoms or functional problems indicate a need.[17]
For Laura, the interesting part is not whether Singapore should reproduce the French system appointment for appointment.
It is the principle behind it.
Postnatal rehabilitation can sit within mainstream healthcare rather than being considered a luxury service, a cosmetic treatment or something concerned primarily with “getting your body back”.
Recovery after birth is healthcare.
The best pathway is multidisciplinary
Physiotherapy is only one part of that recovery.
The obstetric team remains responsible for medical and surgical assessment. Nurses and midwives are critical in acute postpartum care. Lactation professionals offer specialist feeding support. Mental-health professionals are needed where anxiety, depression or birth trauma require specific treatment. Physiotherapists contribute expertise in movement, pain, function, pelvic health and rehabilitation, while postnatal doulas and other support professionals can provide practical and emotional assistance within their own scope of practice.
Laura sees considerable value in these roles working together because postnatal recovery rarely fits neatly into one professional speciality.
A woman experiencing breast pain needs a different pathway from one experiencing urinary leakage. Someone with increasing wound redness needs medical assessment, not scar massage. Someone who is medically well but cannot get comfortably off the floor may need rehabilitation rather than another surgical review.
A good healthcare pathway should not require the new mother herself to understand all of those professional boundaries before she can find the right person.
We also need to stop moralising the route of birth
Alongside the physical recovery is a cultural problem that Laura believes needs to disappear.
Phrases such as “too posh to push” or suggestions that caesarean birth represents an easy option continue to place moral judgement around the method by which somebody gives birth.
Some caesareans are emergencies. Some become medically recommended during pregnancy. Some are chosen following previous traumatic experiences. Some relate to maternal or foetal health. Some are elective decisions reached after an individual woman has considered the risks, benefits and her own circumstances.
None of these women become less deserving of good postoperative care because of the reason their caesarean took place.
An elective operation is still an operation.
Choice does not cancel recovery.
Birth stories should not become predictions
Laura is equally careful about the power of other people’s birth stories.
Women who have had profoundly difficult caesarean experiences deserve to tell those stories. Women who have experienced calm, positive caesarean births deserve to tell theirs too.
The problem occurs when one person’s experience becomes a prediction for everybody else.
A difficult caesarean does not mean the next woman’s will be traumatic. A straightforward first caesarean does not guarantee an equally straightforward second one. A woman who recovered quickly does not prove that someone who struggled failed to prepare, exercise or try hard enough.
Laura can recall women whose recovery following planned caesarean appeared remarkably rapid. She can also identify those outcomes as unusual. Good preparation can support recovery; it cannot eliminate individual biology or complications.
That balance is important because women need realistic optimism, not another standard to live up to.
Perhaps we need a broader definition of a successful outcome
Modern maternity medicine has rightly achieved extraordinary advances in the safety of mothers and babies. Laura’s argument is that the next stage of progress should include becoming more ambitious about what we expect for the mother after the immediate danger has passed.
A successful surgical outcome matters enormously, but recovery is not measured solely by whether the incision has closed.
A woman may be medically well and still struggling to move.
Her scar may look excellent and remain uncomfortable.
Her six-week check may be reassuring while she still feels profoundly weak.
Her baby may be thriving while she has no idea how to rebuild towards the body and activities she had before pregnancy.
None of these observations diminish the importance of medical safety. They expand the definition of what good postnatal care could achieve.
Instead of asking only whether the operation went well, we can also ask how she is moving.
Instead of asking only whether the wound is healthy, we can ask whether it is comfortable and functional.
Instead of asking only whether six weeks have passed, we can ask what she is ready to do next.
And instead of seeing the arrival of a healthy baby as the point at which the mother’s physical story ends, we can continue asking one deceptively important question:
How are you recovering?
Changing the narrative around caesarean birth
Laura’s argument is ultimately not about making caesarean birth sound frightening.
Taking rehabilitation seriously may actually allow us to speak about it with greater confidence.
We can recognise a caesarean as major surgery without framing it as a failure. We can prepare women for the possibility without teaching them to expect the worst. We can recognise pain without assuming catastrophe and encourage movement without dismissing fear. We can celebrate a wonderful birth while acknowledging that the woman who gave birth has significant healing to do.
Most importantly, women should not have to develop a substantial problem before rehabilitation becomes worthy of attention.
A caesarean can be a wonderful birth experience.
It is also major surgery.
Good maternity care should have space for both truths.
Frequently Asked Questions About Caesarean Rehabilitation
Is a caesarean really major abdominal surgery?
When should I start moving after a caesarean?
For an uncomplicated recovery, gentle mobilisation is generally encouraged relatively early once the medical team confirms it is safe. Timing varies according to anaesthesia, bleeding, blood pressure, pain and other clinical factors. Early movement supports recovery and contributes to reducing the risk of postoperative blood clots.[8][9]
What is wound support?
Should everybody who has a caesarean see a physiotherapist?
Current international guidelines do not universally require individual physiotherapy following every uncomplicated caesarean. Laura advocates for routine access to rehabilitation education and an early functional touchpoint, with ongoing physiotherapy determined by individual symptoms and needs.
Is six weeks enough to recover from a caesarean?
Six weeks is an important recovery milestone, but it should not be considered a universal finish line. Return to activity depends on healing, complications, symptoms, physical demands and previous fitness. Scar tissue itself continues maturing for many months and can take up to two years to reach its mature state.[5][11]
Can scar mobilisation actually make a difference?
There is encouraging early research. A study of 32 women found improvements in several measures of caesarean-scar stiffness, elasticity and pain sensitivity following two standardised mobilisation sessions. Specialist scar-management services also use massage and progressive mobilisation once wounds have healed to improve mobility and sensitivity.[11][12]
Can internal adhesions occur after caesarean birth?
Yes. Internal adhesions are a recognised consequence of abdominal surgery, and studies show that their incidence increases with repeated caesarean procedures. Not all adhesions cause symptoms, but their existence is well established.[13]
Can physiotherapy help symptoms associated with adhesions?
Research is emerging. A 2025 systematic review found that manual therapy showed potential as a non-invasive adjunct for symptoms associated with postsurgical abdominal adhesions. This remains a developing field, but the evidence provides a promising basis for further study and clinical application.[14]
Do I need pelvic-floor rehabilitation if I had a caesarean?
Not necessarily. Caesarean birth is associated with a lower risk of several pelvic-floor disorders compared with vaginal delivery. However, pelvic-floor symptoms can still occur following pregnancy and caesarean birth. Leakage, pelvic heaviness, pain, bowel symptoms, sexual pain or difficulty returning to exercise are appropriate reasons to seek assessment.[15]
What symptoms after a caesarean require medical attention?
Increasing or severe pain, heavy bleeding, worsening wound redness or swelling, pus or unpleasant-smelling discharge, fever, significant shortness of breath, or pain and swelling in one leg warrant medical review. Physiotherapy complements medical care; it does not replace assessment of possible postoperative complications.
About Laura O’Byrne
Laura O’Byrne is the Co-Founder and Principal Physiotherapist at Physio Therapy Singapore Collective. She graduated from the University of Nottingham with a BSc (Hons) in Physiotherapy in 2010, following an earlier degree in Health Science and Physiology, and has practised in Singapore since 2012 across public and private healthcare.
Her clinical work combines musculoskeletal physiotherapy with a particular interest in women’s health, including pre- and postnatal care. She also has a specialised interest in scar rehabilitation and lymphatic health, bringing together movement, functional rehabilitation and tissue-focused treatment according to the individual needs of the patient.
Laura’s approach to caesarean recovery reflects a broader philosophy in her work: clinical evidence matters, but so does understanding the individual in front of you - what they are experiencing, what they are afraid of, what their body needs to do and what a meaningful recovery looks like for them.
Website: https://www.physiotherapysgc.com/
Telephone: +65 8958 2823
References and explanatory notes
[1] National Health Service (NHS). The NHS is the publicly funded health service in the United Kingdom; NHS.uk provides public health information for England. Its caesarean guidance describes caesarean section as a major operation and covers indications, procedure, risks and recovery. https://www.nhs.uk/tests-and-treatments/caesarean-section/
[2] American College of Obstetricians and Gynecologists (ACOG). ACOG is the leading US professional membership organisation for obstetrician-gynaecologists and produces expert-reviewed clinical and patient guidance. Its caesarean guidance describes abdominal muscle separation, uterine incision and delivery of the baby and placenta. ACOG: About the organisation https://www.acog.org/about
ACOG: Cesarean Birth https://www.acog.org/womens-health/faqs/cesarean-birth
[3] World Health Organization (WHO). WHO identifies the first six weeks after birth as a critical period and describes postnatal care as a historically neglected part of maternal and newborn healthcare. WHO: Raising the importance of postnatal care https://www.who.int/activities/raising-the-importance-of-postnatal-care/raising-the-importance-of-postnatal-care
[4] World Health Organization / Lancet Global Health research. WHO reported in December 2023 that at least 40 million women annually are likely to experience long-term health problems associated with childbirth. WHO: Long-term health problems after childbirth https://www.who.int/news/item/07-12-2023-more-than-a-third-of-women-experience-lasting-health-problems-after-childbirth
[5] American College of Obstetricians and Gynecologists. Committee Opinion No. 804, Physical Activity and Exercise During Pregnancy and the Postpartum Period. ACOG recommends aerobic and strength-conditioning activity for women with uncomplicated pregnancies and gradual return to exercise postpartum when medically safe. ACOG: Physical Activity and Exercise During Pregnancy and Postpartum https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/04/physical-activity-and-exercise-during-pregnancy-and-the-postpartum-period
[6] Cambridge University Hospitals NHS Foundation Trust. Post-abdominal-surgery physiotherapy guidance covering breathing exercises, supported coughing, circulation, bed mobility and progressive walking. CUH: Advice following abdominal surgery https://www.cuh.nhs.uk/patient-information/advice-following-abdominal-surgery/
[7] Royal Free London NHS Foundation Trust. Physiotherapy guidance explains supported coughing following abdominal surgery and identifies benefits including reduced pain and anxiety. Royal Free London: Physiotherapy after abdominal surgery https://www.royalfree.nhs.uk/patients-and-visitors/patient-information-leaflets/physiotherapy-advice-and-exercises-after-abdominal-surgery
[8] KK Women’s and Children’s Hospital (KKH), Singapore. KKH advises early walking following planned caesarean birth and notes that nurses and physiotherapists can assist women who have difficulties mobilising. KKH: Preparing for an Elective Caesarean Section https://www.kkh.com.sg/symptoms-treatments/preparing-for-an-elective-planned-caesarean-section
[9] National Institute for Health and Care Excellence (NICE). NICE is an independent public body producing evidence-based health and care recommendations for England and Wales. Its Caesarean Birth guideline covers postoperative mobility, recovery, thrombosis prevention and follow-up. NICE: Caesarean Birth recommendations https://www.nice.org.uk/guidance/NG192/chapter/recommendations
[10] NHS caesarean recovery guidance. NHS information explains that recovery following caesarean generally takes longer than recovery following vaginal birth and that return to activities is progressive. NHS: Caesarean section https://www.nhs.uk/tests-and-treatments/caesarean-section/
[11] Royal National Orthopaedic Hospital NHS Trust / Frimley Health NHS Foundation Trust. Specialist scar-management guidance describes numbness, sensitivity and reduced scar mobility, advises progressive scar massage once healing is established, and notes that scar maturation can take around 18 months to two years. RNOH: Scar Care After Surgery https://www.rnoh.nhs.uk/patients-and-visitors/patient-information-guides/scar-care-after-surgery-1
[12] Wasserman JB et al. / caesarean scar mobilisation study. Exploring the Effects of Standardized Soft Tissue Mobilization on the Viscoelastic Properties, Pressure Pain Thresholds, and Tactile Pressure Thresholds of the Cesarean Section Scar. Thirty-two participants completed the study; improvements were reported in several measures of stiffness, elasticity and pressure-pain threshold. Read the study in PMC https://pmc.ncbi.nlm.nih.gov/articles/PMC9051872/
[13] Asia-Pacific expert consensus on postoperative adhesions. The consensus review reports increasing incidence and severity of adhesions with successive caesarean sections and summarises evidence concerning adhesion-related surgical complications. Read the consensus paper in PMC https://pmc.ncbi.nlm.nih.gov/articles/PMC11726167/
[14] 2025 systematic review of manual therapy and postsurgical adhesions. The review included nine studies and concluded that manual therapy shows potential as a non-invasive adjunctive approach to adhesion-related symptoms following abdominal surgery. PubMed: Manual therapy for adhesion-related symptoms https://pubmed.ncbi.nlm.nih.gov/41316557/
[15] Pelvic-floor outcomes and mode of delivery. Population and cohort studies have found lower rates of stress urinary incontinence and pelvic organ prolapse following caesarean birth than vaginal delivery while confirming that mode of delivery is only one factor in pelvic-floor health. PubMed: Delivery mode and later pelvic-floor disorders https://pubmed.ncbi.nlm.nih.gov/36917258/
[16] KK Women’s and Children’s Hospital Physiotherapy Service. KKH describes obstetric physiotherapy provision including antenatal and postnatal education, pelvic-floor rehabilitation and pre/post-surgical management. KKH: Physiotherapy services https://www.kkh.com.sg/our-specialties/allied-health-specialties/physiotherapy
[17] Assurance Maladie, France. French national health-insurance guidance provides for prescribed postpartum perineal rehabilitation and notes that abdominal and perineal rehabilitation can be offered according to clinical need rather than being necessary for every woman. Assurance Maladie: Postnatal follow-up and rehabilitation https://www.ameli.fr/assure/droits-demarches/famille/maternite-paternite-adoption/accouchement-retour-domicile
About this article
This article was created from Laura O’Byrne’s recorded conversations with Pregnant and Popped, supported by her original voice notes and a follow-up editorial discussion. It has been shaped for clarity and readability while preserving Laura O’Byrne’s ideas, experiences and intended meaning.
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