A caesarean birth is both childbirth and abdominal surgery. Recovery therefore involves more than waiting for the skin incision to close. Pain control, wound healing, mobility, abdominal-wall function, pelvic-floor recovery, sleep, infant-feeding demands and the gradual return to household, occupational and exercise tasks all require consideration.

Current guidance supports early gentle movement followed by an individualised, gradual and symptom-based progression. Neither prolonged bed rest nor an automatic return to unrestricted exercise at the six-week mark is appropriate for every patient (American College of Obstetricians and Gynaecologists [ACOG], 2020; Davenport et al., 2025; National Institute for Health and Care Excellence [NICE], 2025).

Understanding Recovery After a Caesarean Birth

The visible scar represents only the superficial part of healing. Deeper abdominal and uterine tissues continue to repair and remodel after the skin appears closed. During this period, pain, fatigue and temporarily reduced trunk control may affect rolling in bed, coughing, standing, lifting, feeding positions and walking.

Early rehabilitation should therefore focus on comfortable movement, circulation and protection from excessive strain rather than attempting to “strengthen the scar". Breathing, pelvic-floor function and abdominal-wall coordination should gradually be integrated into functional tasks (Bø et al., 2024; Cunningham et al., 2022).

Recovery is not identical for every patient. An emergency procedure, wound infection, haemorrhage, anaemia, hypertensive disease, general anaesthesia, multiple births, pre-existing pain, limited support or neonatal complications may slow progression.

NICE recommends that activities such as driving, carrying heavier items, formal exercise and sexual activity should resume when the patient feels physically recovered and pain or restrictions no longer interfere with the task. Clearance should therefore not depend on time alone (NICE, 2025).

Early Wound and Scar Care

Instructions from the surgical and maternity team should take priority because wound-closure materials and dressing protocols vary. Standard care includes monitoring body temperature and regularly checking the incision for the following:

Increasing redness, warmth or swelling
Worsening pain rather than gradual improvement
Pus or foul-smelling fluid
Separation or opening of the incision
Persistent bleeding or moisture around the wound

The area should be kept clean and gently dried. Scratching, forceful rubbing and applying unadvised oils, creams or cosmetic products should be avoided while the incision remains open, scabbed, moist or inflamed (NICE, 2025).

Loose, comfortable clothing may reduce repeated friction against the wound. During coughing, sneezing, laughing or getting out of bed, light external support using a pillow or folded towel may improve comfort. Regularly prescribed analgesia is also important because poorly controlled pain can discourage walking, breathing and infant-care activities. Medication choices, particularly during breastfeeding, should follow the treating clinician’s advice.

Scar appearance and sensation change during healing. Redness, firmness, itching, numbness or mild pulling may gradually settle as remodelling continues. Increasing symptoms, however, should not be assumed to be part of normal healing.

When Should Scar Mobilisation Begin?

Scar massage is not compulsory for every patient, and the supporting evidence remains limited. A small exploratory study found possible improvements in scar stiffness and pain following two sessions of standardised soft-tissue mobilisation. However, a broader scoping review found considerable variation in scar-massage techniques, treatment dosage and outcome measures (Gilbert et al., 2022; Scott et al., 2022).

Scar mobilisation should therefore be presented as an optional rehabilitation strategy rather than a proven method of preventing adhesions or guaranteeing a flat scar.

It should begin only when the incision is

Completely closed
Dry and free from scabs
Free from discharge, increasing redness or swelling
Considered adequately healed by the treating clinician

Initial desensitisation may involve placing the hand over clothing or gently touching the skin around the scar. Once this is comfortable, light skin movement can be introduced above and below the scar before working directly over it.

Gentle movements may be performed from side to side, vertically and in small circles. Pressure should remain comfortable and should not cause sharp pain, wound irritation, increased vaginal bleeding or prolonged soreness. There is no well-established evidence-based dosage, so forceful or lengthy self-massage is unnecessary. NHS patient guidance similarly notes that research on caesarean scar massage remains limited despite some patients finding it helpful.

Persistent tethering, marked hypersensitivity, pain during movement or distress about touching the scar warrants assessment by a pelvic-health or women’s-health physiotherapist rather than aggressive self-treatment.

Staged Return to Daily Activity and Exercise

The following stages provide a clinical framework rather than rigid clearance dates. Progression should be individualised according to wound status, pain, bleeding, pelvic-floor symptoms, movement control, fatigue and the patient’s response on the following day.

Early walking is generally encouraged because it supports circulation, functional recovery and gradual reconditioning. Several short walks may initially be better tolerated than one prolonged walk. The duration or distance can then be increased before significantly increasing speed or incline.

The six-week postnatal review is an important clinical checkpoint, but it is not an automatic fitness test. Heavy lifting, strenuous housework and high-impact exercise should not be introduced merely because six weeks have passed. A patient may be medically stable while still requiring rehabilitation for trunk strength, pelvic-floor function and load tolerance.

The 2025 Canadian postpartum guideline recommends progressing gradually towards at least 120 minutes of moderate-to-vigorous physical activity per week when medically safe. Aerobic and strengthening activities should be individualised and distributed across the week, with daily pelvic-floor muscle exercises where appropriate (Davenport et al., 2025).

Physiotherapy Assessment and Exercise Progression

Post-caesarean physiotherapy begins with screening rather than giving every patient the same exercise list. Assessment may include:

Breathing pattern and breath-holding
Bed mobility, transfers, posture and gait
Abdominal-wall control and diastasis recti
Pelvic-floor contraction and relaxation
Urinary leakage or vaginal heaviness
Scar sensitivity and mobility
Hip and lower-limb strength
Lifting, carrying and infant-care tasks
Response to low-impact and impact-loading activities

Caesarean birth does not remove the need for pelvic-floor rehabilitation. Pregnancy itself, labour before surgery and repeated postnatal lifting can affect pelvic-floor function. Daily pelvic-floor muscle training is included within current postpartum physical-activity guidance, but exercises should address both contraction and complete relaxation (Bø et al., 2024; Davenport et al., 2025).

Early exercises should coordinate breathing with low-load movement. For example, the patient may exhale while rolling, standing or lifting the baby, accompanied by gentle lower-abdominal and pelvic-floor activation. Maximal bracing, repeated breath-holding and constantly “sucking in” the abdomen should be avoided.

A possible exercise progression is:

Breathing and abdominal coordination → heel slide → sit-to-stand → bridge → supported squat → band row → step-up → loaded carry

Exercises should be progressed by changing one variable at a time, such as repetitions, resistance, range, speed or complexity. This makes it easier to identify which change produced a symptom response.

A return to running or jumping should also be criteria-based. Before starting a run programme, the patient should tolerate sustained walking, repeated lower-limb strengthening and low-level impact without urinary leakage, vaginal heaviness, pelvic or scar pain, abdominal-wall bulging or prolonged next-day symptoms. Expert consensus recommends gradual reconditioning and the ability to walk for approximately 30 minutes without pelvic-health or musculoskeletal symptoms before a formal running-readiness assessment (Deering et al., 2024).

Symptom Monitoring, Warning Signs and Referral

The immediate and next-day response should guide the rehabilitation dosage.

Seek prompt medical advice when the wound becomes increasingly red, hot, swollen, painful or open, or when it produces pus or foul-smelling fluid. Fever, severe abdominal pain, heavy vaginal bleeding, painful urination, calf pain or swelling, chest pain, cough and shortness of breath also require assessment.

These symptoms may indicate infection, haemorrhage, urinary complications, deep-vein thrombosis or pulmonary embolism and should not be treated as normal post-exercise soreness (NICE, 2025; National Health Service [NHS], 2023).

A physiotherapy referral is particularly appropriate when the patient has persistent scar pain, marked sensitivity, restricted mobility, abdominal bulging, urinary leakage, pelvic heaviness, difficulty returning to normal tasks or uncertainty about returning to running, sport or physically demanding work.

Viva-ready summary

Caesarean recovery should progress from wound protection and early mobility to breathing and pelvic-floor coordination, functional strengthening, low-impact conditioning and finally a graded return to impact or sport. Scar massage begins only after complete wound healing and remains optional because the current evidence is limited. Progression should be determined by pain, wound status, bleeding, pelvic-floor symptoms, movement quality and the immediate and next-day response rather than by time alone.

One-line recall point: Protect the healing wound, restore function gradually and progress only when immediate and next-day responses remain acceptable.

References

American College of Obstetricians and Gynaecologists. (2020). Physical activity and exercise during pregnancy and the postpartum period. Obstetrics & Gynaecology, 135(4), e178–e188.

Bø, K., Berghmans, B., Mørkved, S., & Van Kampen, M. (2024). Evidence-based physical therapy for the pelvic floor: Bridging science and clinical practice (3rd ed.). Elsevier.

Cunningham, F. G., Leveno, K. J., Dashe, J. S., Hoffman, B. L., Spong, C. Y., & Casey, B. M. (2022). Williams Obstetrics (26th ed.). McGraw Hill.

Davenport, M. H., Ruchat, S. M., Jaramillo Garcia, A., Ali, M. U., Forte, M., Beamish, N., Fleming, K., Adamo, K. B., Brunet-Pagé, É., Chari, R., Lane, K. N., Mottola, M. F., & Neil-Sztramko, S. E. (2025). 2025 Canadian guideline for physical activity, sedentary behaviour and sleep throughout the first year postpartum. British Journal of Sports Medicine, 59(8), 515–526. doi:10.1136/bjsports-2025-109785

Deering, R. E., Donnelly, G. M., Brockwell, E., Bø, K., Davenport, M. H., De Vivo, M., Dufour, S., Forner, L., Mills, H., Moore, I. S., Olson, A., & Christopher, S. M. (2024). Clinical and exercise professional opinion on designing a postpartum return-to-running training programme: an international Delphi study and consensus statement. British Journal of Sports Medicine, 58(4), 183–195. doi:10.1136/bjsports-2023-107490

Gilbert, I., Gaudreault, N., & Gaboury, I. (2022). Exploring the effects of standardized soft tissue mobilization on the viscoelastic properties, pressure pain thresholds, and tactile pressure thresholds of the cesarean section scar. Journal of Integrative and Complementary Medicine, 28(4), 355–362. doi:10.1089/jicm.2021.0178

National Health Service. (2023). Caesarean section: Recovery.

National Institute for Health and Care Excellence. (2025). Caesarean birth (NICE Guideline NG192).

Scott, H. C., Boothby, C. E., & Jones, A. (2022). Is massage an effective intervention in the management of post-operative scarring? A scoping review. Journal of Hand Therapy, 35(2), 186–199. doi:10.1016/j.jht.2022.01.004