Your OB or midwife might tell you that everything looks great and you can return to all of your previous activities but what does that really mean? Maybe you used to run 10+ miles per week or did a 50 minute spin class 3-4 times per week. Should you just jump right back in? The short answer is probably not, and here’s why.
Before we go any further, I want you to stop and think about how much a human body changes from the start of pregnancy all the way until about 1-2 years postpartum. There are hormonal changes which lead to more laxity in the ligaments that stabilize our joints as well as weight and postural changes. Up until birth, the body must make room for the baby to grow (and to be born!). The abdominal muscles become overly lengthened and cannot contract in the same way they did before pregnancy. The center of gravity shifts forward and the pelvis tips forward as the belly grows. With these changes, the low back and glutes might start to work overtime for the lack of core strength and the hip flexors tighten as a result of the pelvis tipping forward.
Then comes birth! Birth is traumatic on the body, and no two birth stories are the same.
Whether you gave birth via vaginal or cesarean delivery, healing must occur in both cases.
Let’s first talk about a vaginal birth. During labor, the vaginal canal has to dilate or stretch to accomodate your baby. Following delivery, it naturally takes time for the vaginal canal to return to the pre-pregnancy state. Additionally, if there were any tears or trauma to the tissue or muscles in the pelvic floor during birth, this will also take time to heal. It is important to remember that even after the healing takes place, the muscles in the pelvic floor may need to be strengthened or retrained to activate at the appropriate time.
As far as having a C-section, this is a major abdominal surgery and should be treated as such! Several layers of tissue will be cut during a C-section and then have to be stitched back together. During the healing process, you will be told to avoid lifting objects over a certain weight so that you don’t disrupt the sutures. Be sure to splint your incision when doing things like coughing or sneezing by using a pillow to gently compress and support your scar. You might find yourself avoiding certain movements or activities that involve stretching or activating your core muscles out of fear of pain or discomfort. It is good to be cautious in the beginning but if this goes on for too long, muscle tightness and tissue restrictions around your scar.
A note on healing time: the 6 week rule for healing is how long it takes on average for a wound to fully close and tissue to repair but this may not be true for everyone. Certain conditions like hypothyroidism and diabetes can delay the time it takes to fully heal so please keep this in mind and never compare your healing time to another person!
So now you’ve made it to the 6 week mark and your OB or midwife “clears you” to return to activity. But what does this really mean? In most cases, during this follow up appointment, they are not assessing the strength, tone, mobility, endurance or coordination of your pelvic floor muscles. This is where your lovely pelvic PT comes in! In order to return to exercise or intercourse free of pain and dysfunction, your pelvic health specialist will take a look at your body from head to toe, including assessing for a separation between your abdominal muscles, also known as diastasis recti abdominis (DRA).
Core and pelvic floor retraining and strengthening are essential before returning to high impact activities. These two areas are the stable foundations of the body, and when they are not working optimally, dysfunction can pop up in a number of places as the body attempts to compensate. In rehab, your pelvic PT will teach you how to activate your deepest layer of abdominal muscle called the transverse abdominis (TA). This is the most important part of the rehab program to ensure you are activating your core properly which will also help to heal any separation or depth between your abdominal muscles. We will provide a comprehensive core progression program with new exercises to challenge your body every week.
At Wellest, we will get you on a path to return to activity safely and get you feeling strong again!
Dr. Kristin Stetzel, PT