Does C-section Recovery Time Apply to Runners?

Even runners need to significant time to recover from major surgery.
Even runners need to significant time to recover from major surgery.

According to the CDC, in 2013, C-sections accounted for 32 .7% of US births[i].  That’s one in three births, people.  No matter how fit we runners are, even we are very likely to deliver our babies via c-section.

However, as runners, there’s one thing we are also likely to do: disregard medical advice, especially when it comes to things like rest and recovery time. Those recommendations are for average people and we runners are anything but … or so our thinking goes.

When it comes to c-section recovery, doctors recommend a 6 week break from exercise. SIX weeks off?! You’re joking, right?

Let’s discuss whether this six weeks break applies to highly trained runners, too. 

Turns out that the evidence behind the mandatory, across-the-board 6-week off timeframe is scant and non-specific[ii],[iii].  [editor’s note: we don’t often use footnotes, but because this is a serious medical issue, we are using them to cite our sources.] It seems strange to me that a highly trained runner who ran almost her entire pregnancy has to wait as long as a deconditioned, non-runner before she is advised to begin running after her c-section. The American Congress of Obstetricians and Gynecologists (ACOG) statement reads:

Prepregnancy exercise routines may be resumed gradually as soon as it is physically and medically safe. This will vary from one individual to another … There are no published studies to indicate that, in the absence of medical complications, rapid resumption of activities will result in adverse effects.[iv]

(Disclaimer: the statement does not specify whether it is referring to vaginal or caesarian births. My guess, though, is that they are referring to both types.)

So does that mean a seasoned runner can resume running before the 6 week mark? Not exactly. Most midwives and OBGYNs still recommend 6 weeks off to everyone, but the way I interpret this statement is that we post-partum athletes can question this advice.

This is exactly what I did. After my c-section, I asked my OBGYN when I could resume running. I LOVED the answer he gave me: “When you are ready. I am not going to give you a timeline.”  So I took that VERY liberally and did not ask again, since he already gave me the answer I wanted.

I decided to make myself a case study in athlete c-section recovery! I am now 7+ weeks out, and ran 10 miles literally pain-free last Saturday. I admittedly started running sooner than I should have and I paid for it for sure! But my end result has been great and I am thrilled with how good I am feeling. I will blog my week-by-week training logs here, so you can see how I’m progressing. I also, as I discussed in a previous post, I laid several ground rules for myself in preparation for my return to running.

Even when I was a toddler I disregarded medical advice. I don't think the doctor would have wanted me on that motorcycle with my obvious recent "concussion" (aka bandaid on my forehead).
Even when I was a toddler I disregarded medical advice. I don’t think the doctor would have wanted me on that motorcycle with my obvious recent “concussion” (aka bandaid on my forehead).

It’s important to understand that my decision was based on my experience. My c-section was very uncomplicated. It went as smoothly as could be.  There are many scenarios which will slow return to running and recovery time, and in those cases, even 6 weeks off may not be enough.

My next post will be a summary of some of those issues, such as c-section type, incision type, and post-operative complications. I would also like to add that this post, nor none of my upcoming posts, are official medical advice. Every person, body, runner, surgery, case, pregnancy is different. The most important thing to consider when returning to physical activity is the advice of your personal healthcare provider. And equally as important as listening to your healthcare provider is listening to your own body, since we runners tend to know our own bodies very well.

What do you think, Salty readers? Has a baseline of good physical fitness helped you recover sooner from an injury? Have you ever disregarded medical advice? If yes, did this hurt or help your recovery?

 

References:

[i] CDC Fast Stats. Retrieved online 4 Oct 15 from http://www.cdc.gov/nchs/fastats/delivery.htm

[ii] Evenson KR, Mottola MF, Owe KM, et al. Summary of international guidelines for physical activity after pregnancy. Obstet Gynecol Surv 2014; 69:407

[iii] Berghella, V. (2015). Cesarian delivery: postoperative issues. Retrieved online from Up-to-Date on 1 Oct 2015 from http://www.uptodate.com/contents/cesarean-delivery-postoperative-issues?source=machineLearning&search=c+section+post+operative&selectedTitle=1%7E150&sectionRank=1&anchor=H2#H124488547

[iv]Exercise during pregnancy and postpartum period.  American Congress of Obstetricians and Gynecologists. ACOG committee opinion Number 267, 2002. Reaffirmed in 2009.

I am a 30-something new mother (pet mother too), marathon and ultramarathon runner, healthcare professional, and outdoor enthusiast. I'm working on completing a marathon in all 50 states. I will be blogging about motherhood, running, and any random running-related rant I might come up with.

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21 comments

  1. The standard advice is to take 6 weeks off of exercise after a vaginal birth too and just about every runner I know has ignored that, often with the support of her ob. My midwife said I could start back when I felt like it and I did … walking within a few days and back running in 3 weeks. I think it’s a great point that these directions are one-size fits all and catered to more the lowest common denominator – in our case that would be sedentary women. I am with you … make sensible guidelines for yourself and ease back in as you feel is warranted and if at all possible do that with the advice and support of your doctor.

    Great post!

  2. For my wife, the first C-section she had lost all weight and was in best shape of her life within 6 months, and her OB encouraged her to be active and do what she could – but listen to her body.

    For the second C-section she was 9 months before she was reasonably recovered an 18 years later her body still has the impacts (but as I say, there was a point at which it wasn’t clear that either baby or mother would survive, so this is unusual).

    My concern is that aside from not listening to doctors, many runners I know don’t listen to their own bodies! Or they shrug off pain and discomfort and then act surprised when they end up with an injury. With a C-section the decision to do this can have an impact that you won’t know about for years (scar tissue, adhesions, etc).

    So like anything my advice to any runner is that being honest with yourself is always a key.

    1. This is a great point. Being honest with yourself and erring on the side of easing back slower than you think you should are both really really important when coming back from any lay-off due to injury, illness, surgery, child birth, etc!

    2. Wow. Thank you so much for your reply! My next post talks about how different factors can really affect your recovery. I am guessing that since your wife’s c-section was 18 years ago, and an emergency (at least it sounds like it was an emergency), she had the “classical incision”? (Eg the incision type that goes vertically down your entire abdomen). That is a LOT different than the low horizantal incision that they do for non-emergent c-sections.

      My c-section was as uncomplicated as can be, with a low horizantal incision, so I can only talk to that. The reason of this post is to open awareness and let people undergoing c-sections know what other people’s experience was in recovery. Since your wife had one of the most complicated sections there could be, I would LOVE it if you could share more information about her recovery. What repercussions did she have in short term, and which does she still suffer from today? What factors seemed to help/hinder her recovery along the way? What advice would she give to someone undergoing an emergent c-section?

      So glad for your input, thank you (and mostly to your wife of course) for the information sharing!

      1. Actually both C-sections were non-emergent, we just woke up, drove into Boston and said ‘were scheduled to have a baby at X time today’ 🙂

        So they were able to go into the original incision, but because of how she heals and scars and how the baby was positioned and that her body never restarted after the spinal, and on and on … just an unexpected nightmare.

        Her healing process was very slow because of trying to get her digestive system and organs working correctly again (she was in Brigham & Women’s for 2 weeks!) resulting in more scarring than expected, and she already had loads of scarring issues from the first one – just how her body deals with things. The outcome led to more food sensitivities, ‘adhesion pains’ and other things when ovulating and PMS, and discomfort as she is going through menopause (she had an OB apt yesterday and they’re doing an ultrasound in a couple of weeks to form a plan).

        As we look back it is hard to draw a more stark contrast between the two – first C-section was like a party, second one was intense and serious. Same people, same doctors …

        1. Thanks so much for sharing! A great reminder to all of us that every body is different, and every surgery experience is different! I really appreciate your sharing this. I am hoping that your wife’s appointment went well and for improved health in days to come!

  3. Reading horror stories about incisions re-opening when women pushed themselves to exercise before their body was ready (also: those incisions on the inside take longer to heal up than the incision on the outside) kept me from trying to run before 8 weeks post-op. Not to mention barely sleeping and taking care of a new born baby. Honestly, we’ve got the whole rest of our lives to run and get in shape, why risk injury or infection?

    1. Danielle, you have a great point about having the whole rest of our lives to get in shape. SO true. For me, I had to return to running because I needed a sense of normalcy after having a baby!

      That being said, you bring up another point about the fear of activity that the medical community instills into us after surgeries. The problem is, it would be unethical to have a study where you had some women lift weights and run after a surgery, and have others do no activity, and then see who has a wound reopen. Good luck getting that through the IRB!!! One study showed that doctors give VASTLY different advice about what activity is acceptable after surgery. In some countries, they encourage activity right away. There is also strong research that shows inactivity after surgery slows down recovery and increases complications.

      So I think it falls to us women who have been through c-sections to share our experience. For me, I just did as much activity as I felt comfortable with during my recovery. I was comfortable with running, but not comfortable with lifting weights or holding my dogs leashes. I am now 11 weeks out, and I still don’t dare hold my dogs leashes since I can feel burning in the incision when they pull.

      I would love to hear more information about your return to running and other activities, and what your experience was. What did you experience when you returned to running? How did you resume other cross-training activities? The more information we can share for eachother, the better! 🙂

  4. I’ve had five children and each postpartum period has been different. I’ve never had a c-section, though. I was in amazing shape after having my first, but it took me months to even be able to walk again. After another I was running within a few weeks. After another it took me months and months before my insides were healed enough. I’ve had a postpartum hemorrhage before and it is not pretty and you can feel perfect and then the bleeding can start again in full force and not stop and land you back in the hospital or worse.

    It’s tempting to start right away, but worth it to let your body heal.

    1. Thanks so much for your comment, Erin! I would love to hear more about your experiences and return to activity. How/when did you know when it was ok to resume activity? Pain levels? Stopping bleeding? Since you have “been there done that” FIVE times, your input would be so helpful!

  5. I had an uncomplicated, planned c-section due to a breech baby. I started running three weeks post-op. I had wanted to run at two weeks because I had been walking several miles a day, felt good, and knew 14 days is a good average time for incisional wound healing. My midwife and I negotiated. I started back easy and slowly built up, but never had any issues and was back to routine mileage fairly quickly. But my caveats are these a) I was very fit going into my delivery (1/2 marathon run at 32wks; ran through 36 wks) b) my pregnancy and c-section were both uncomplicated and c) I was fully prepared to scale back or hold my running if I felt discomfort or had any issue. I agree that the post-op advice is one size fits all. I agree that doctors and midwives often have to shift gears (and some have trouble doing so) with patients who are athletes. We aren’t the norm and there isn’t a lot of study/ research on the topic. I also agree the most important thing is to really listen to your body, to educate yourself on what signs/ symptoms are an expected part of recovery, and heed those that indicate a problem.

    1. Monika, thanks for yoru reply! It sounds like we had very similar experiences! Mine was also an uncomplicated c-section for breech baby. I also started running 3 weeks out :). Although in hindsight, I was still too sore after 3 weeks and if I went through c-section again, I would probably wait 4 weeks. That was when I finally felt comfortable.

  6. I’m following this with interest because I will be scheduling abdominal surgery next week. Not a baby but having a partial hysterectomy due to fibroids. I’m really freaking out about not bring able to run for “6 weeks”, but I’m not going to be stupid and push things. I guess I wonder if my recovery will be similar to a section, and never having abdominal surgery prior, it’s truly the fear of the unknown.

    1. Wow! Please keep us posted about your experience, how the surgery goes, and your recovery afterwards. Your input would be great for the benefit of future readers undergoing a hysterectomy!!

      My only advice would be to wait to return to running until you are off pain meds. Otherwise, the pain meds might mask something important that your body is trying to tell you! Pain can be a warning sign. You’ll note that I didn’t say to wait to return to running until you are pain-free. The pain will be with you for several months, and for me, running helped with the pain. Rather, just make sure that the pain is to a TOLERABLE enough level that you don’t need the meds. The reason for that is so you can be in tune with your body more during the run 🙂

      BEST OF LUCK and KEEP US POSTED!

  7. I will be having a hysterectomy in December & I am totally freaking out about the recovery & how it will impact my running. I would appreciate any advice.

    1. CIndy, please see my reply to Nancy above 🙂 I would give you the same advice! And also please keep us posted on how your recovery goes. I am pretty sure other readers who are undergoing a hysterectomy will benefit from hearing your experience!

      Just thought of one more piece of advice… no matter how bad it hurts, stand up straight in the immediate post-op days. Your inclination will likely be to hunch over, but if you spend the first few days hunched, that is how the scar tissue will develop! Then you will have to break up that scar tissue later so you can stand straight. So force yourself to stand up straight. It will help, I promise!

      BEST OF LUCK and KEEP US POSTED1

    2. Hi Cindy, not sure if you are still reading Salty running, but I would love an update to hear how your recovery from hysterectomy went. I hope all went well!

  8. First of all, I want to say how much I enjoy reading everyone’s experiences with pregnancy, running and c-sections. Both of my c-sections were planned and fairly uncomplicated. My first pregnancy I quit running when I was about 4 months along. I had pain issues with a large fibroid that was shacking up with my baby in my uterus. It bothered me a lot off and on during my 1st and 2nd trimesters, plus I looked like I was having twins! The fibroid plus my baby being breech was the reason for my first c-section. The operation went well, my horizontal incision was a bit longer than the usual and I had staples, but my recovery went reasonably well. I started walking after 2 or 3 weeks and then running after another 9 or 10 weeks. I had no issues returning to running, just some pulling/burning for a while and I lost all my pregnancy weight (I gained 50 lbs) plus 10 more lbs. I felt great! I ran lots of races and my first marathon 2 years later. The second pregnancy I ran until I was about 30 weeks along, still gained 50 lbs, and delivered by c-section at 36 weeks (planned, uncomplicated, no fibroids). I didn’t walk as much after the second (so much harder to get out with 2 kids), but returned to running after 8 weeks. It went okay, but then I developed a lot of pain and stiffness in my hip flexor muscles and pelvis. It bothered me for months and I had to stop running for a few weeks here and there. When I realized that it wasn’t getting any better with rest and stretching, I figured the pain and stiff-feelings were probably due to adhesions from my c-section and maybe a muscle imbalance from running while I was pregnant? Not sure, but I decided to power through it, kept running, and started cycling and taking a weekly power yoga class. Finally, 10 months after my last c-section, I was able to run pain free and ran a decent (for me!) half marathon. I don’t know why I had a harder time with recovery after my second – and I’m still 15 lbs away from my pre-pregnancy weight and it’s been over a year, ugh. I had my first baby when I was 30 and my second when I was 33, maybe it’s just me getting older? Anyway, that’s my story. Thanks for listening and thanks everyone and Cocoa for sharing you stories. I read all of Salty’s pregnancy advice when I was pregnant; so helpful! Glad there’s now a space to talk about c-sections and running too!

    1. Daneille,
      Thank you so much for sharing your experience! It is a good reminder that every surgery goes differently. It sounds like you have been very persistent and dedicated in your return which is awesome. I really appreciate you sharing your experience!!