Effects of Cesarean Section and Vaginal Delivery on Abdominal Muscles and Fasciae

Written in 2020 by: Chenglei Fan, Diego Guidolin, Serena Ragazzo, Caterina Fede, Carmelo Pirri, Nathaly Gaudreault, Andrea Porzionato, Veronica Macchi, Raffaele De Caro, Carla Stecco

Childbirth is a transformative experience for women, both emotionally and physically. The method of delivery, whether cesarean section (CS) or vaginal delivery (VA), can have varying impacts on a woman’s body. One of the areas affected by childbirth is the abdominal region, specifically the muscles and fasciae. Recent research has shed light on how these two delivery methods influence the abdominal structures.

Understanding the Abdominal Region

The abdomen houses vital organs and is protected and supported by layers of muscles and fasciae. The primary muscles include the rectus abdominis (RA), external oblique (EO), internal oblique (IO), and transversus abdominis (TrA). These muscles are enveloped by the fasciae, which are connective tissues that provide structural integrity and support.

Research Insights

A study conducted by Fan et al. (2020) aimed to understand the effects of CS and VA on the abdominal muscles and fasciae. Here are the key findings:

  • Abdominal Muscle Alterations: CS women exhibited significant changes in their abdominal muscles. They had a thinner left RA and a disparity in the thickness of the IO muscles. On the other hand, VA women primarily showed alterations in the RA and left total abdominal muscles, mainly due to changes in the left IO.
  • Fascial Changes: Fasciae play a crucial role in supporting the abdominal muscles. The study found that CS women had a wider inter-rectus distance (IRD) and thicker right rectus sheath (RS) and abdominal perimuscular fasciae (APF) compared to nulliparous women. VA women, however, did not show significant changes in their fasciae.
  • Pain Correlation: There was a notable correlation between the duration of pain and the affected fasciae/muscles in women who underwent CS.

Implications of the Findings

The alterations in the abdominal muscles and fasciae after childbirth can have several implications:

  • Physical Health: Changes in the abdominal region can affect posture, movement, and overall physical health. It can also lead to conditions like diastasis recti, where the RA muscles separate.
  • Pain Management: Understanding the changes can help in devising targeted pain management strategies, especially for CS women who might experience prolonged pain.
  • Rehabilitation: Postpartum rehabilitation can be tailored based on the delivery method to address specific issues related to the abdominal muscles and fasciae.


Childbirth, whether through CS or VA, brings about changes in the abdominal region. Understanding these changes is crucial for postpartum care and rehabilitation. As research continues, healthcare professionals can offer better guidance and support to new mothers, ensuring their physical well-being after childbirth.

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