It’s time for a post about caesarean sections, stomachs, extra skin and what you can do about it. NOTE! This is a very long post but I hope you’ll understand that you CAN improve the situation. 

What happens during and after a caesarean section?

A few facts:

  • The abdominal muscles are not cut during a caesarean section.
  • Skin is cut, including blood capillaries, nerves and connective tissue.
  • The operation affects the entire abdominal wall.

And: the pelvic floor is very much affected even if you had a caesarean section because the weight of the baby affects the pelvic floor during pregnancy, and in the case of an emergency caesarean section you probably tried to push the baby out for many hours and went through several stages of labour as well.

Without knowing anything about this mother’s background (pictured above) but based on my own experience, I can say the following about her:

  • too much subcutaneous fat, i.e. the mother is overweight
  • stretched skin
  • stretch marks
  • weak core muscles
  • poor muscle tone
  • probably a wide abdominal separation
  • bad posture
  • never exercised (exercised sporadically)
  • weak pelvic floor

What I can’t see, but I know can occur:

  • badly stitched scar
  • infection around the scar
  • thickened wound, i.e. scarring has occurred
  • lack of sensation around the scar
  • constipation

How are the first points connected, and why do I already know so much about her? Well, I don’t actually know her – the picture was taken from the internet.


Skin quality depends on genes, age and hormones. Stretch marks during pregnancy are caused by the skin stretching, in combination with the pregnancy hormone relaxin which in turn affects the production of collagen and elastin – both of which are responsible for preventing stretch marks.
The skin is also largely composed of water – it is water that makes the skin and connective tissue supple. As we get older, the water content decreases, making the connective tissue less elastic.

Abdominal separation

Let’s talk about it in general terms – it doesn’t only affect women who have had a caesarean section:

  • The younger you are, the faster an abdominal separation can be reduced because the production of collagen and elastin is greater when you are younger.
  • How long ago did your abdominal separation occur? A mother with a six-month-old baby will get faster results than a mother with a two-year-old child.
  • How does the connective tissue feel when you test your abdominal separation? Greater resistance indicates a better starting point.
  • What about your abdominal strength before pregnancy? Did you have time to tone up your stomach muscles between pregnancies? Your stomach will recover much more quickly if you had strong abdominal muscles before getting pregnant.
  • How long was the time between your pregnancies? You have to remember that connective tissue needs time to heal and strengthen, so frequent pregnancies can definitely affect how quickly the stomach regains its shape.

How do I know if my pelvic floor is weak?

There are indications that the quality of your skin is related to your pelvic floor. Weak skin tone = weak pelvic floor.

So to summarise – the problems, both cosmetic in terms of loose skin and functional in terms of weak muscles, are greater in unfit women who are overweight than in fit women who are not overweight. Unfit and overweight women already have stretched skin before pregnancy due to their excess weight, and lack functional strength in their core and the rest of their body.
In contrast, women who are fit suffer an almost exclusively cosmetic problem – as I see it. There isn’t really a functional problem, although all mothers should definitely do core & pelvic floor strengthening exercises, but a purely cosmetic problem, where the skin hasn’t had a chance to recover at a slow pace and has been tightened in a certain area. This makes excess skin much more noticeable.

What should you do if you are unfit?

Lots of women are afraid to start exercising because they think their skin will sag even more. To be honest, yes, there’s a good chance that will happen. Stretch marks don’t disappear, but they fade with time. However, investing in your health is so much more important than how your skin looks. I know, it’s such a touchy subject and I wish I could give a different answer, but I can’t.

What should you do if you are fit?

Now, no one has ever said that fit mothers don’t get stretch marks – it’s quite common even in this group! – but with their weight under control, the problem doesn’t become so pronounced or get worse.

When can I start exercising after a caesarean section?

Make sure the scar is dry (healed) first – this takes different amounts of time for different people.
Generally speaking, you may feel a tightness in your scar during exercises such as glute bridges or where you move your leg backwards or do back bends (which you shouldn’t as a new mother anyway).

Photo iStockphoto