How Your Core Muscles Change After A C-Section

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In Beyoncé's Vogue cover story, she wrote about her experience giving birth to her twins, Rumi and Sir. Beyoncé says she had toxemia, or preeclampsia, and had to have an emergency C-section as a result.
"After the C-section, my core felt different," Beyoncé wrote. "It had been major surgery. Some of your organs are shifted temporarily, and in rare cases, removed temporarily during delivery." Six months after the procedure, she was able to start preparing for her return performance at Coachella. "I am not sure everyone understands that," she wrote. "I needed time to heal, to recover."
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Not shockingly, Beyoncé is right about this. A C-section is a major surgery, and it can change a person's body and especially their core muscles in drastic ways, says Kira Kohrherr, an ACE-certified pre and postnatal instructor who developed the maternity workout program for the workout app, Aaptiv. "When you have a C-section, the physician creates an incision through five layers of skin, nerves, muscle and tissue," Kohrherr says. Usually, the incision is horizontal, but in emergency situations, a vertical cut is used, she says.
There's a common misconception that doctors cut through abdominal muscles when performing a C-section, but that's not actually the case, Kohrherr says. They separate the midline of your abdominals to gain access to the uterus, but they don't actually cut it, she says. Still, it's super common for people to have trouble regaining abdominal strength and activating their core muscles after a C-section, she says.
What even is the core? When we talk about the "core" we're really referencing a group of muscles that help to stabilize and support your spine: the rectus abdominis, transverse abdominis, internal and external obliques, erector spinae, and multifidi. Most people's midsection is already weak from the stress of pregnancy, and because many people don't have a strong core or pelvic floor before pregnancy, Kohrherr says. After the operation, scarring occurs on multiple levels of your abdominal wall after the layers are sewn together, she says. "Scarring in general affects the muscle’s ability to work effectively and efficiently during a muscle contraction," she says. This results in weakness and a lack of stability.
On top of that, sometimes the surgical cut damages nerves and blood vessels, which can lead to numbness at the incision site, Kohrherr says. "After the appropriate amount of healing time, I encourage clients to re-establish 'communication' between the brain and these core muscles," she says. Often that requires doing exercises that activate the pelvic floor, first, then moving on to abdominal exercises. If a person who just gave birth performs a safe and progressive exercise program consistently, then they should see improved strength after about 4-6 weeks, says Lauren Tadros, PT, DPT, WCS, a women’s health physical therapist at NYU Langone’s Rusk Rehabilitation. "It could however take anywhere from six months to one year to fully recover and return back to their prior level of fitness or activity," she says.
Everyone is different, so the time that it takes for people's core to feel back to "normal" varies. Beyoncé wrote that she is in no rush to get rid of her "mommy pouch," because she thinks it's real. "Whenever I’m ready to get a six-pack, I will go into beast zone and work my ass off until I have it," she says. "But right now, my little FUPA and I feel like we are meant to be."
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