Post-partum: Your body after birth

I have been a pelvic rehab physical therapist for 17 years now. It has been exciting to see this specialized area of physical therapy grow with more research and education opportunities for physical therapists to treat pelvic conditions. What I am still amazed at frankly, is that there continues to be a lack of knowledge among some medical professionals that are caring for women post-partum. New mothers are often given little to no information about the changes in their bodies after birth and where to get help.

The 6-week post-partum assessment is often brief. I know these women have questions and concerns about their abdominals, their vaginas, why their bladder has a mind of its own, and why they have pain or feel uncomfortable pressure in their pelvis. There can be a feeling of isolation with their concerns, and they don’t always know who to talk to about it.

The World Health Organization (WHO) describes the postpartum period as the most critical and yet the most neglected phase in the lives of mothers. From 6 weeks to 6 months postdelivery is the time of restoration of muscle tone and connective tissue to the prepregnant state. It behooves caregivers to remember this timeline and to be available for support.

I think I can speak on behalf of my colleagues when I say that we, pelvic PTs, are here for you. We want to help you better understand and navigate the changes in your body. I will offer you this advice:

Know that your body will change …sometimes more than just a little. Think about this; you have been carrying around an additional 25 Lbs. or so during the previous months before giving birth. This comes with an increased amount of fluids and hormones pumping through your body. Being pregnant often stresses the pelvic floor muscles and then of course comes the birthing process. Having a little human pass through the pelvis and vagina (or you have abdominal surgery to give birth) is a very big deal! Your body has just gone through an incredible athletic event so let’s be gentle with ourselves.

In the following few weeks, it is common to have impaired control of your bladder and possibly changes in bowel function. There will be some amount of pain or soreness and some women feel pressure or heaviness in their pelvis. These symptoms should subside around the first month after delivery. If symptoms linger, however, or are not addressed early, this can increase the incidence of pelvic floor problems in the future. This is where we, as pelvic floor rehab specialists come in. I recommend EVERY postpartum woman to have an assessment by a pelvic floor PT (for those that had c-sections too!) Having a thorough musculoskeletal assessment can give you confidence in where your body is at in the recovery phase, and how to move forward with exercise.

Postpartum PT assessments can evaluate and treat:

• Diastasis Recti
• Pelvic/pelvic floor pain
• Back and hip pain
• Coccydynia (tailbone pain)
• Bladder/bowel dysfunction (incontinence, urgency/frequency)
• Pelvic Organ Prolapse
• Scar pain
• Dyspareunia (painful sex)

When to return to exercise? Some women post-partum can have an amazing and fast recovery and feel raring to go by that 6 weeks check-up with their OB or midwife. Fantastic! Their provider may “clear” them to resume exercise and all activities. This can go well if the provider tests the pelvic floor muscles, pelvic organ position, and abdominal integrity. My concern is that even these tests may not be adequate enough, for example, to slide on your running shoes when your body may not quite yet be ready to run. The pelvic floor and core could still be weak or lack the coordination needed for running and impact exercise. My additional suggestion is to prepare your body for that activity, such as hoping or jumping drills, timed plank, and balance control. When these drills can be done pain-free, leak-free, and pressure-free, you should be ready to start some running. It is recommended to wait at least 12 weeks to returning to running unless cleared by a pelvic floor physical therapist before 12 weeks.

If you are having concerning symptoms post-partum or would like the reassurance you are prepared to take the next steps with activity level, a physical therapy assessment can help. You do not have to deal with pain or leaking urine. Caring for your health is an important part of motherhood.

Please contact me to learn more about my post-partum services.