Lets stop focusing on putting out fires and start trying to prevent them!
Postpartum symptoms are common & minimized…
Postpartum, it is very common for postpartum women to experience symptoms like:
- Peeing their pants while coughing, sneezing or jumping on a trampoline
- Pelvic organ prolapse (the feeling or sight of an organ slipping down)
- Sex doesn’t feel the same and is, possibly, even painful
- Feeling very weak (especially in the core)
- Low back, hip or pelvic pain
- Diastasis recti
When you really stop and think about these symptoms, is it a big surprise?
Look at how much the female body changes during pregnancy and then we push a baby out a tiny hole in our pelvis OR have a major surgery to deliver a baby via C-section!!
These postpartum symptoms are common because of the physical demands on the pregnant body, followed by ‘injury’ during delivery.
Would you be surprised if you tore your ACL in soccer, required surgery and then had pain and weakness after….NO!
The biggest difference….. knee, hip or shoulder injuries are recognized as muscular injuries and are provided with guidance and physical therapy for rehabilitation.
Postpartum issues… swept under the carpet. “It’s part of being a mom”.
As a pelvic health physical therapist, I believe we can change this.
Why postpartum rehab is so important…
Traditionally, women don’t talk about their postpartum symptoms because they are embarrassing and usually nobody asks.
During a vaginal delivery, babies pass through an opening in the pelvic floor, requiring this group of muscles to stretch over 200%.
During a C-section delivery, many layers of our abdominal tissues and muscles are cut or pulled to the side. These muscles and tissues are very important for core strength and being close relatives to all muscles below them, C-sections affect the pelvic floor.
Why does this matter?
These muscles which have been stretched to their max during a vaginal delivery or have been surgically cut during a C-section, are the muscles that:
- Make sure you don’t leak pee or poop
- Support your pelvic organs (uterus, bladder, rectum)
- Make up your inner core
- Ensure sex is pleasurable
Let’s go back to my example of the ACL tear that undergoes surgery. Rehab is done to help gain range of motion and strength in your knee so that you are able to walk and subsequently run and jump again successfully.
We acknowledge the importance of this all the time. Immediately after surgery, we teach these clients to rest but keep their toes and ankles moving to promote blood flow, then early on we start the knee with range of motion by bending and straightening gently, progress the strength of the knee and the joints around the knee and then we progress to putting more and more weight through the leg. Finally, building running, jumping and cutting as the client is ready.
We need to start doing this for postpartum women.
Steps to better postpartum rehab…
Start by acknowledging what the female body goes through during pregnancy and delivery because the muscles involved are responsible for some major bodily functions.
We need to educate women about the pelvic floor and core and the changes expected during this time. It’s important that women understand that the tissues involved are muscle and muscle can recover and improve.
Just like you would seek out a physical therapist for your knee injury, you should seek out a pelvic health physical therapist. These are therapist with specific training to support pregnant and postpartum women with symptoms listed above.
Support women in the early postpartum healing phase, a time when their body feels foreign.
It is normal to have vaginal or abdominal soreness, feel hard to control your bowel and bladder, experience core weakness and the feeling of “being disconnected”. However, these symptoms should all improve with time and rehabilitation.
Provide guidance to promote healing of the core muscles and pelvic floor in a safe way to encourage blood flow and gentle movement so that these muscles can start back to their very important jobs.
Even through rest is important for the abdominal muscles post C-section and for the pelvic floor post vaginal delivery, the reality is, these muscles still HAVE to work every time you get out of bed, sneeze, cough, or lift your baby. They have to work, so we should support them the best we can.
The pelvic floor and core muscles are no different than our leg muscles in that sometimes they need to be able to relax and sometimes they need to tighten. After an ‘injury’ during baby delivery, these muscles have often lost their way. In some, they have an issue tightening, and in others it may be that they are in shock mode and holding themselves tight as a way to protect. I believe in starting with working on range of motion of the pelvic floor and recognizing what tasks in the day require opening (toileting) or tightening (sneezing).
Reminding these muscles of their role in the day is a great way to get gentle movement back again.
Start strengthening them gently .
Once the pelvic floor and core feel like they have their bearings, you will notice more reliable bladder and bowel function, and reduced vaginal pain, pressure/heaviness. If so, your body may be ready to start progressing.
Just like you wouldn’t start with running and jumping on your healing knee, you should not start with the hard stuff on your pelvic floor and core either.
There is immense social pressure to ‘lose the baby weight’ ‘get in shape postpartum’ and I can’t tell you how many of my clients start off their postpartum recovery by signing up for a half marathon or joining a mom and baby bootcamp. I am not saying these are unrealistic goals, but I do urge you to think about progressing your postpartum body to be able to hold up to these challenges. This ‘too much too soon’ mentality often results in setbacks or injuries.
By drawing parallels between muscles of pregnancy and postpartum to other muscles in our body, it becomes easier to understand the need for improved guidance for postpartum moms.
Did you know that in France, postpartum women are automatically provided the support and guidance of a pelvic health physical therapist. This is even funded by their medical system that acknowledges the benefits of a proactive approach.
In North America, these issues are rarely spoken of and instead, women are told to be thankful they have a baby and deal with their symptoms until they are old enough to justify surgery. WTF???
If you really start to listen, you will hear pelvic health physical therapists everywhere jumping up and down to get your attention. Most of us have found our way to this area of practice after our own postpartum recovery issues.
I personally am doing my best to educate women. Having a baby is a miracle, but one that takes a toll on our bodies. Our bodies are important because they help us enjoy life and activities that we enjoy so we need to love our bodies and help them recover from pregnancy and childbirth.
Resources for recovery…
I am doing my best to make these taboo topics less embarrassing to talk about by educating in a fun way on Instagram, Facebook and Pinterest. Join me there to learn more about the pelvic floor and core during pregnancy, postpartum and everything after.
A series of 4 short videos and an accompanying eBook. It will help you understand the pelvic floor muscles that baby passes through, why kegels should not be your focus, how to prepare these muscles to stretch and deliver a baby.
An online 6 week program that is meant to serve as your early days rehab. This program consists of video education, self care tips and gentle follow along exercises that are aimed at making your pelvic floor and core muscles feel comfortable moving again and prepare them for more intense exercise.
Melissa is a pelvic health physical therapist in Kelowna, British Columbia, Canada.
Her practice involves treating primarily pregnant and postpartum women who commonly experience leaking, painful sex, prolapse, diastasis recti, tailbone pain and core weakness. She is an active mom of 2 young kids. Her own experiences with postpartum recovery have made her passionate about helping other moms.
She is passionate about moving towards proactive care in the pregnant and postpartum stages, empowering women through education and exercise.
Feel free to send her an email at: [email protected]