The Postpartum Journey
Give yourself a break, take your time, and ask for help and guidance.
Having a baby is one of life’s greatest joys. But it is no easy task. I want to take a few minutes and talk about what really happens to a women’s body as a result of pregnancy and to some extent delivery. We all know that delivery can wreak havoc on the body. A vaginal delivery can be quite traumatic for the pelvic floor, as can a Caesarean section be quite traumatic for the abdominals, whether it was planned or an emergency. And while most women know that either of these deliveries will result in some changes to the body, the postpartum recovery goes much beyond the delivery and the 6 week recovery period that comes after.
If we think about pregnancy, the abdominal muscles are gradually stretched over time. Once a women delivers her baby, the abdominal muscles are no longer supported by the baby and the amniotic fluid, but unfortunately they are still in a stretched position. The muscles all of a sudden do not know how to fire effectively. For someone who was physically active before pregnancy and throughout pregnancy, and for someone with good body awareness, the difficulty still lies in activating these muscles (transverse abdominus, rectus abdominus, obliques and the muscles of the pelvic floor). So you can think about someone who maybe wasn’t aware of how to activate their core prior to, or someone who wasn’t necessarily active during their pregnancy. They probably will struggle even more learning to activate these muscles after delivery.
So then comes 6 weeks after and women, generally speaking, have ‘recovered.’ A follow up with their physician usually is brief and not very often does it include any kind of assessment on your true readiness for exercise or activity. Few women are assessed for diastasis recti (abdominal separation), sacroiliac (SI) joint dysfunction, or symphysis pubis diastasis and these are just a few of the common injuries that occur as a result of pregnancy. Injuries aside, let’s be realistic for a second. Your core is probably horrible, ligaments still lax (loose) especially if your breastfeeding, plus you’re not sleeping so your body is exhausted. You may have recovered from the trauma endured during labour and delivery, but the return to physical activity and exercise is an entirely different thing. The sedentary aspect of the 6 weeks post-delivery is another topic of discussion, because that 6 week period of recovery is where I lost my cardiovascular stamina – not during my pregnancy. During that 6 week period, mothers are often less active as they recover from labour and delivery and are learning to feed and care for their newborn.
So now all of a sudden at the 6 week mark, you’re allowed to exercise again. Depending on your doctor you may get some recommendations like low impact activity, but often exercise and physical activity isn’t even discussed, whether that be frequency, intensity, time and type (also known as the FITT Principle). It’s not their specialty. It’s not their job to prescribe exercise or give recommendations based on the FITT principle. So this is the point that I want to really discuss. If you’ve been more sedentary than you typically ever have been, you’re core doesn’t know how to fire and you’ve had some trauma to your pelvic floor or abdomen, how can you safely jump back into working out? How do you get back safely to physical activity levels that you once endured, and to that pre-baby weight? Here are just a few things to consider on your personal postpartum journey:
1. You should not pee your pants. It’s not ok and it doesn’t have to happen. If this is happening, it could be as simple as you’re doing too much too soon. Or the type of activity might not be right for you. But perhaps you have suffered from some more serious injury to your pelvic floor which could entail varying degrees of prolapse. Should you suffer from prolapse, this requires a diagnosis and much more attention than a typical postpartum recovery. Seek medical advice.
Working with an exercise or rehabilitation person to address incontinence is a great option. However, if you are just being given a simple cue of “tighten your pelvic floor” or do a Kegel, this is just the tip of the iceberg really. I was guilty of doing this as a trainer a few years ago. And while some trainers and other specialists might not even cue you on these, the pelvic floor is so much more than just one simple cue. It is not this simple. Addressing incontinence can go far beyond just the cue or act of ‘stopping your pee mid-stream’. When we talk about the inner core unit, there is a relationship between your pelvic floor, your transverse abdominus, and your diaphragm. If you’re not working all of these components into your rehab and retraining, you’re missing a huge component of the recovery process and could benefit so much more from someone who specializes a little more in this area. I encourage you to find someone.
2. You don’t have to have back pain or pubic pain. Whether this pain started during or after pregnancy it is all too common. With the laxity that our joints have and the poor core stability it is no wonder women experience back and pelvic pain. Our backs definitely undergo a lot of stress through pregnancy, labour and delivery - namely our sacroiliac joint (SI joint) and our pubic symphysis (where our pelvis meets in the front). These joints have a lot of stress put on them particularly in the third trimester and labour/delivery. In most cases, these joints will return to normal relatively quickly. But with lingering pain and discomfort comes the need for action. Avoiding certain positions and movements might be key, but treatment recommendations should be sought out from a rehabilitation specialist so you can begin to live pain free. I’m not about to get into recommendations specifically because I think all too often we rely on ‘google’ to fix things when really a trained professional will make the world of difference! As long as they don’t just put heat on you, use some tens or ultrasound and tell you to rest, you should see some improvement. If that is what your rehab plan consists of you may want to consider finding another practitioner who can help in a more proactive way and provide you with a home exercise program (yes I said it, you need a home exercise program).
3. Don’t think you should start with the same workout you used to do. And definitely don’t beat yourself up over this. The changes that the body goes through is incredible, but we can be so harsh on ourselves and set up unrealistic expectations. Slowly work back into exercise, and you’ll enjoy the process so much more. Everybody is different. Every woman is different and every pregnancy is different. Life after one child is very different than life after two children and so on. Sometimes we need to remind ourselves that health is not measured by a number on a scale, your pant size nor how long you take to lose your ‘baby weight’. Set appropriate goals and strive for success towards a healthy postpartum recovery. Strive for healthy living and a balanced lifestyle.
So overall I really want to encourage one take home message. Get help. Find someone who can help. Don’t suffer from leakage, don’t suffer from pain. Don’t beat yourself up when things aren’t the same because things aren’t the same. It may take time and that’s ok because you’re most important task is to focus on your health and your baby’s health. Don’t add stress to it by pushing yourself too fast or too hard. And certainly don’t ever feel ashamed that you are not the same person physically as you were before you had a baby. You are a mom now, which is an amazing feat, but you can get your body back it may just take some time and patience. Long term benefit will come from patience and persistence and your future self will thank you for this.
Carrie Mussbacher CAT(C), BPE, CSEP-CPT, PPFS
Certified Athletic Therapist & Personal Trainer
Pre&Postnatal Fitness Specialist