How a C-Section Changes Your Body

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When I discovered I was pregnant with twins, my husband and I burst into tears of joy, followed by utter panic. Two of them? I soon realized that carrying multiples meant I would likely wind up having a C-section (a typical procedure for twin pregnancies). However, the idea of a potentially long and painful labor and delivery—times two—was scary, so I was relieved when my obstetrician suggested we go with a C-section.

But the experience wasn’t all spinal taps and roses: In addition to a long and painful recovery, I was left with a surprising post-surgery souvenir: a brand new pooch that hovers right above my C-section scar.

Despite the fact that I exercised during my entire pregnancy, ate healthfully, lost my baby weight quickly (I was just six pounds above my pre-pregnancy weight at my six-week checkup), I was left with a pooch protruding from what had always been the flattest part of my stomach — kind of like waking up one day and finding that someone stuck a balcony on your building overnight. It’s hard not to stare at it and think, “How on earth did that get here and when is it going away?”

Unless you’re one of the lucky few who never developed a C-section “shelf,” you know exactly what I’m talking about.

Liposuction or tummy tuck aside, is it possible to get rid of the so-called C-section pooch? The honest answer: It depends. That’s because there are several factors that contribute to developing one: scar tissue, skin elasticity, fat, and how your individual body heals.

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First, let’s review some C-section basics: During the procedure, the surgeon cuts through multiple layers, including the skin, the subcutaneous fatty tissue layer, and then the fascia, which is a web of tough, fibrous tissue that covers and protects your organs and muscles. When your OBGYN closes you back up, the fascia is her top priority. “From a medical point of view, the fascia is the single most important layer regarding the recovery and safety of the mother,” Iffath Hoskins, M.D., a high-risk OB-GYN at New York University’s Langone Medical Center, tells Yahoo Parenting. “After we close the uterus, then we make sure the fascia is closed safely and correctly with the proper technique. After closing the fascia, we bring the rest of the body together.”

Although the outer incision on the skin is stapled or sutured, which leaves a noticeable scar on the surface, the fatty subcutaneous layer underneath may not be. It depends on how much fatty tissue the mother has (the more she has, the more likely she is to have that layer sewn up). In some cases, the fatty layer is left to come together on its own as the body heals. I recall my obstetrician saying during my postpartum checkup that after he closes up the patient, “how you heal is up to you.”

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For many women, that means scarring. “The reason women get the pooch is because of the subcutaneous tissue,” says Hoskins. “Whether I put sutures in it or it comes together on its own, any time there’s cutting, there will be healing by scar tissue. If you press on the pooch, you’ll feel it’s a little more firm than rest of your body. That’s the scar tissue.”

Diet and exercise can’t touch scar tissue. However, the scar tissue on the inside can soften over time, making the pooch less pronounced. The only way to remove adhesions and scar tissue is surgery, says Hoskins.

Stretchy skin is another culprit and unfortunately, that’s also not fixable by diet or exercise. Some women are blessed with highly elastic skin that helps them—and the overhang—bounce back, but many women do not. “When the mother’s abdomen gets distended because of pregnancy, it’s never anatomically perfect like a sculpture,” notes Hoskins.

What you can control is fat. Losing weight through a healthy, balanced diet helps reduce excess fat all over, which in turn, can help flatten the appearance of the pooch. Just keep in mind that you shouldn’t embark on a weight-loss plan until after you’ve stopped breastfeeding.

Exercise, including bridges, pelvic tilts and planks, can also help tone the abdominal area, but the effect is often subtle. After getting your doctor’s okay to exercise, it’s best to work out with a trainer who has postpartum experience to ensure you’re performing abdominal exercises correctly. But keep this in mind: “You can exercise, but it does nothing to the shelf of fat or the subcutaneous tissue,” says Hoskins.

Two years later, after eating right and exercising regularly, I’m maintaining my pre-pregnancy weight —but that little ledge is still there. Is it much smaller? Definitely. But it’s there. Hoskins notes that the bulge will diminish over time, but for most women, it will never completely go away.

It’s not what most moms, myself included, want to hear, but Hoskins suggests keeping things in perspective: “The reason you have this pooch is because of this beautiful child. What more could you want? If you were going to get a pooch, this is the best reason in the world.”

Looking at my twins’ faces, it’s hard to argue with that.

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