Almost everyone we see after a cesarean has a sore back, and almost none of them hurt their back. The surgery went through the front. The back is just the part that got handed the job.
Here's what we mean. The abdominal wall was opened, stitched and is now swollen and guarded. You won't use it, not because you're weak but because it hurts to. So every time you sit up, stand, lift the baby or cough, the muscles along your spine do it instead. Add a day of feeding with your shoulders rounded, a car seat carried out to the side, and getting up four times a night by hauling yourself with your arms, and you've got a back that's been on duty for two weeks straight.
There's usually more than one spot. The upper back ache sits between the shoulder blades, often worse on the side you feed from more. The low back ache is across the beltline and sometimes into one buttock. And there's often a small tender place right where the spinal or epidural went in, which feels like a bruise when you press it and usually fades over a couple of weeks on its own.
Before anything else: a few things that aren't ordinary soreness and need a call to your provider or 911. Bleeding that soaks a pad in an hour, a fever, chest pain or trouble breathing, pain or swelling in one calf, a headache that's bad when you're upright and better lying flat, numbness or weakness in your legs, trouble emptying your bladder, a painful bulge near the incision, or any thoughts of harming yourself or your baby. None of those are "wait and see."
The things that make it worse
Getting up wrong is the big one. In the hospital someone probably showed you the log roll and you probably forgot by day three. Bend both knees, roll onto your side as one piece, let your legs drop off the edge, push up with your bottom arm and top hand. Blow out as you come up. Do it every time, including at 3 a.m., including when the baby is screaming. The ten seconds it costs you saves you the hour of ache that follows a straight sit-up out of bed.
Carrying the car seat with the baby in it. It's heavy, it's held out to the side, and it twists you. For the first several weeks, carry the baby and let someone else carry the seat, or leave the seat in the car. Same with the stroller: fold it later, when you're not also healing.
Lifting anything heavier than the baby in the first weeks. Toddlers climb up onto you instead. Laundry baskets wait or get carried half full.
Feeding slumped. You bring the baby up to you, not your chest down to the baby. That means pillows until the baby is at the right height without you holding the weight, something under your elbows, your feet on a stool or a stack of books so your knees are a little higher than your hips, and your back actually touching the chair. Side-lying is worth learning for nights. Switch which arm cradles even if you bottle feed.
Standing tucked. A lot of women stand with their hips pushed under and knees soft because it keeps the incision from feeling stretched. It also puts the low back in a slump all day. Once the incision is closed, let yourself stand tall. A little pull at the scar when you straighten up is expected and is not harm.
Holding your breath. When something hurts, people stop breathing and brace. The brace goes straight to the back.
The things that make it better
Breathing first. Lie on your side or your back with knees bent, one hand on the side of your ribs and one low on your belly above the incision. Breathe in and send the air into the sides and back of your ribs so the hand on the ribs moves out. Breathe out slowly through pursed lips and notice the lower belly gently draw in and the pelvic floor lift a little, like holding back gas. No pushing, no sucking in hard. 5 breaths, several times a day. This is the first step to getting the deep abdominal muscle working again so the back can stand down. You can start this as soon as you're home.
Walking. Short and often. 5 minutes on flat ground, tall, arms swinging, then back to the couch. Build toward 10, then 20, over the weeks. If your incision throbs afterward or your bleeding picks up, you did too much, cut it in half tomorrow.
Heat on the back. A heating pad across the low back or between the shoulder blades, not over the incision, 15 minutes at a time. A warm shower with the water on your upper back does a lot.
Pillow between the knees in bed, and a pillow in front of you to hug when you side-lie. Rolling over in bed with the pillow held against your belly is easier too.
Get clearance from your OB-GYN or midwife before you add anything past breathing and walking. When you have it, a few things we'd add, all with an exhale on the effort and nothing that makes the incision sharp:
Bridges. On your back, knees bent, breathe out and lift the hips a few inches, lower. 8 reps. This wakes up the glutes, which have been doing very little, and the back aches less when the glutes take some of the standing and lifting.
Cat and cow on hands and knees, slow, 8 each way. If your wrists complain, do it standing with hands on the counter.
Open books. Lying on your side, knees stacked and bent, arms straight in front of you, breathe out and open the top arm up and over to the other side, following it with your eyes. 5 each side. This is for the between-the-shoulder-blades ache.
Scar work, once it's fully closed and your provider says yes. Fingertips just above and below the line, small gentle circles, a minute or two a day. A stiff scar changes how you stand and that shows up in the back.
No crunches, no sit-ups, no planks for now. They don't fix this and they load the one place that's healing.
Constipation matters too. Straining on the toilet hurts the belly and the back. Water, fiber, feet on a stool, and whatever your provider gave you for softening.
What usually changes, and in what order
The tender spot from the spinal goes first. The upper back ache goes fast once the feeding setup changes, often within days. The low back ache is slower because it lifts as the deep core comes back, and that's weeks of small daily breathing and walking, not one good stretch. We track it the plain way: can you get out of bed, lift the baby and stand for a feed without the back complaining? If you want somewhere to write that down, our free tool is at https://postpartumlibrary.com/tools/core-tracker.
If you're leaking, feel heaviness or a bulge in the vagina, have pain with sex when you're ready for it, or the gap down the middle of your belly isn't closing, ask for a referral to a pelvic floor physical therapist. Those are things we fix, not things you wait out.
If the back pain is still there at the point everything else has settled, that's also worth a visit. Usually it's a core that never came back online, and that's trainable.
If you want the routine we start people on once they're cleared, it's laid out in our guide, The 10-Minute Mom Pooch Reset.
The 10-Minute Mom Pooch Reset
The 12-week, 10-minute-a-day core and belly plan for exhausted moms: the gap check, breath-to-core, three phases, kitchen-counter and naptime routines, food that helps, and 6 printable trackers.
See the plan →Not sure yet? Take the free 2-minute quiz
Educational content from the Mom Pooch Reset team. Not medical advice for your specific situation. Get clearance from your OB-GYN or midwife before exercising after birth, and see a pelvic floor physical therapist for leaking, pain or a bulge.
