Caesarean Births and TOLAC: Prehab, Rehab & Planning for your recovery

Whether you’re planning your first caesarean, you’ve had one before, or you’re hoping for a TOLAC (Trial of Labour After Caesarean), there are things we can do before and after birth to help you feel stronger, recover well and return to the activities you love with confidence.

Birthing is hard work no matter how it’s done. Anatomy has to do all sorts of things to achieve the end result. My two birthing experiences both ended in caesarean but were completely different. My first was a three hour 2nd stage was accompanied by an episiotomy, ventuse, forceps and then finally an emergency caesarean. My second was a planned caesarean but he came early so I got to labour with him for a couple of days before he decided to really come out and then we re-elected caesarean as I was too afraid to have another stuck baby and repeat the original trauma. Both different experiences, different headspace, different knowledge base, different hospital all further along in life. Those two experiences allow me to think deeply into what women should have in prehab and rehab especially around caesarean births and TOLAC/

VBAC.

I think the biggest thing to remember is this:

There is no one-size-fits-all recovery plan.

Every pregnancy, every birth, every scar and every body is different. Your plan should reflect your goals, your symptoms and your individual journey.

Prehab: Preparing Before a Caesarean Birth

Think of prehab as preparing your body for surgery and recovery.

The stronger and more connected you feel beforehand, the better equipped you’ll be to navigate those early weeks after birth. It’s not about training harder or doing endless exercises it’s about building a solid foundation.

Depending on your pregnancy and individual circumstances, prehab may include:

• Deep abdominal and core activation

• Pelvic floor awareness (learning both how to contract and how to relax)

• Breathing strategies

• Maintaining strength through your hips, glutes and legs

• Improving posture and movement patterns

• Learning safe ways to get in and out of bed after surgery

• Preparing for lifting, feeding and caring for your baby

• Planning your recovery environment at home

• Planning your recovery garments

• What to do with family and friends that visit

Many people are surprised to learn that abdominal exercises are still appropriate during pregnancy. They just need to be the right exercises at the right time and listening to why your body is telling you.

Having good abdominal awareness before surgery often makes reconnecting with those muscles afterwards much easier. There are loads of studies proving this. If you want to read any of these, I’m happy to look them up for you or a simple pubmed search will find them.

What About Pelvic Floor Exercises?

One of the biggest misconceptions is that if you’re having a caesarean birth, you don’t need to think about your pelvic floor.

Pregnancy itself places significant load on the pelvic floor for many months. Hormonal changes, the weight of your growing baby and changes in posture all affect these muscles, regardless of how your baby is born.

That means pelvic floor symptoms can still occur after a caesarean birth, including:

• Heaviness or pressure

• Bladder leakage

• Urgency or frequency

• Difficulty emptying the bladder or bowel

• Pelvic pain

• Pain with intercourse

Not everyone experiences these symptoms, but they are common and it’s worth assessing and addressing them as part of your recovery.

Importantly, not every pelvic floor needs strengthening. Sometimes the muscles need to learn how to relax and coordinate better instead. That’s why an individual assessment is so valuable.

Early Rehab: The First Few Weeks

Recovery starts immediately after birth but that doesn’t mean jumping back into exercise. There’s way more to recovery than exercise. At this stage rest is sooooo important.

The early weeks are about rest. Active rest and passive rest.

Your body has undergone major abdominal surgery while also adjusting to caring for a newborn and maybe an older kid as well. The family has changed. Your brain has changed. Your nervous system has been assaulted. It’s okay. We planned for this…

Early rehabilitation often focuses on:

• Gentle breathing exercises

• Reconnecting with your deep abdominal muscles

• Gentle pelvic floor exercises where appropriate

• Walking within your comfort level

• Managing pain and swelling

• Comfortable movement strategies

• Protecting the incision while it heals

• Gradually increasing activity as your body allows

• Pressure management and garment support

• Nutrition, hydration, and nutrition!

Some days you’ll feel fantastic. Other days you’ll feel like you’ve taken a step backwards. That’s completely normal.

Listening to your body is an important part of recovery.

When Should You Start Scar Massage?

This is one of the most common questions people ask.

Scar work should only begin once the incision is fully healed and there are no signs of infection or open areas. For many people this is around 6–8 weeks, but healing timelines vary. My first scar seemed like it never healed, my second felt like it was healed the first week. Two completely different scenarios.

Scar rehabilitation isn’t just about how the scar looks.

We work to improve how the tissues underneath move, helping reduce tightness, pulling sensations and sensitivity while improving comfort during everyday movement.

Scar treatment may include:

• Gentle scar massage

• Mobility work around the surrounding tissues

• Desensitisation techniques

• Improving abdominal movement

• Addressing any discomfort or restrictions

Every scar behaves differently, so treatment is always individualised.

Your 6–8 Week Check-In

One of my favourite appointments is seeing people around six to eight weeks after birth.

By this stage we can usually assess how your body is healing and create a plan for the next stage of recovery.

This appointment may include:

• Checking abdominal recovery

• Assessing your pelvic floor

• Looking at scar healing and beginning scar treatment if appropriate

• Discussing any pain or ongoing symptoms

• Addressing bladder or bowel concerns (lots of women realise that can’t feel when they are full. This usually comes back but it’s nice to rehab it)

• Creating a safe return-to-exercise plan

• Answering all those questions that inevitably come up once life with a newborn settles a little

Whether your goal is walking comfortably, lifting your toddler, returning to the gym or running a marathon, your rehabilitation should match your goals.

What Is a TOLAC?

TOLAC stands for Trial of Labour After Caesarean.

This means planning to labour after a previous caesarean birth, with the hope of achieving a vaginal birth if it is safe to do so.

Some people will go on to have a successful vaginal birth after caesarean (VBAC), while others may still require another caesarean.

Prehab for a TOLAC

Preparing for a TOLAC is a little different because your body needs to be ready for labour while also considering your previous surgery.

Prehab may include:

• Pelvic floor preparation

• Perineal flexibility training (perineal massage)

• Core strength and abdominal control

• Breathing strategies for labour

• Hip and pelvic mobility

• Maintaining overall strength and endurance

• Education around pushing strategies

• Preparing for both possible outcomes; a vaginal birth or another caesarean

One of the biggest advantages of preparing this way is that you’ll have a recovery plan regardless of how your birth unfolds.

Rehab After a TOLAC

Recovery depends on how your birth happens.

If you have a vaginal birth, we’ll guide your recovery based on your pelvic floor, abdominal muscles, birth experience and symptoms.

If you have another caesarean birth, your rehabilitation will follow similar principles to a caesarean recovery while taking your previous scar and history into account.

Either way, the same thoughtful assessment and individual care should given.

Every Recovery Is Different

It’s easy to compare your recovery with someone else’s, but recovery isn’t a competition. Mothers groups are the worst at this. We are all so vulnerable and we listen to each other’s birth stories and feel elated or deflated by what others are saying. Listening to stories is a great way to learn about others as well as ourselves but we all need to understand that we only have it together just as much as the next person. What’s easy for one person is a challenge for another. Our hormones are all over the place and our brains have changed. It’s a rough time. I saw somewhere (probably on IG so it may not be true) that a man would have to age 127 years in one day to feel the way a woman feels 24-48 hours after giving birth.

It’s also the best time and time for personal growth and understanding how powerful you actually are.

Now back to rehab…

Two people can have identical births and completely different experiences afterwards.

That’s why I don’t believe in generic recovery plans.

Your rehabilitation should be based on:

• Your birth

• Your symptoms

• Your scar

• Your pelvic floor

• Your abdominal recovery

• Your goals

• Your lifestyle

Whether you’re preparing for your first caesarean, recovering after birth or planning a TOLAC, the right plan can help you feel stronger, move more confidently and support your body through every stage of recovery.

Yours in rehab planning,

Dr Camille Rains- Physiotherapist

Novella Health- Whitsundays: Cannonvale, Proserpine, Bowen