Updated: Sep 7, 2020
You gave birth, you were sent home, and six weeks later you show up at your OB or midwife's office and they "clear" you for exercise and sex. Does this mean postpartum recovery lasts 6 weeks? It's now over? It's like nothing ever happened but somehow you have a baby?
Most people are medically "cleared" for sex and exercise at 6 weeks postpartum. Because of this, many develop the misconception that they should be back at their previous levels of activity and exercise at this time.
In reality, 6 weeks is just the beginning and having appropriately set expectations for postpartum recovery and exercise helps folks avoid the question "why didn't anyone tell me...?"
While every body is different, a more realistic expectation is a recovery lasting 6-12 months postpartum, with 24 months not being unusual.
Why is this? Well, let's think of all the changes your body undergoes during pregnancy.
These changes include: uterus increasing in size, blood volume increasing, hormonal, postural, gait, activity, energy and sleep changes (to name a few). Not to mention birth itself. After 10 months of your body adapting to these changes, it culminates in childbirth. During a vaginal childbirth, the pelvic floor muscles stretch 2-3x their resting length. Perineal tearing occurs in in ~85% of vaginal births. During a cesarean birth, the birthing person undergoes abdominal surgery, with the incision impacting all 7 layers of tissue.
Additionally, for as long as you are breast/chestfeeding, your body has not returned to it's pre-pregnancy hormone state. That makes sense right? It never produced milk before pregnancy. For as long as you are producing milk, your body may have reduced estrogen at the vestibule (opening to the vagina) and vulvar tissue. This can lead to decreased support for your pelvic floor and internal organs, contributing to leakage, heaviness in the pelvis and painful sex.
Let's pause here for a second and look at this through the lens of a different recovery: an ACL repair. Imagine this: You're out on a ski slope, feeling great. Boom. You fall. You tear your ACL. 30 minutes ago you were at your normal level of activity. Now, you're scheduling your ACL repair surgery. Your ACL recovery will likely take 8-12 months. You did not have 10 months of knee injury to navigate prior to this injury or surgery. Yet you will be guided from month to month progressions, with expected bench marks to hit as you progress through your recovery.
I don't know anyone who was given month to month progressions, bench marks and recovery expectations for their postpartum rehab. Is it really fair to expect that with less guidance, we recover from pregnancy and childbirth faster? Of course not.
More realistic timelines for postpartum recovery and exercise will vary from person to person depending on their level of activity prior to and during pregnancy, as well as their birth experience. It's true that some people feel fantastic as early as a few days following birth. It's also true some take a matter of 2+ years to feel "recovered."
Most folks are safe to begin gentle core and pelvic floor exercises as early as 1-2 weeks postpartum. While the first few weeks should be focused around rest, this is a great time to reconnect with these parts of your body.While it is always recommended that you speak with your medical provider prior to beginning any exercises, if you are asymptomatic, weeks 3-6 are a time to begin slowly increasing walking endurance and mat based strengthening.
At 6 weeks, if you have been spending your previous weeks on previously listed movement and exercise, you may be safe to slowly begin adding in resistance: bands and light weights. Additionally, focusing on balance, glute and hip strengthening, postural exercise and functional movement becomes important.
If you are symptomatic, having leakage, heaviness in your pelvis or any pain, check in with a pelvic floor PT if possible. Symptoms like these are signs that your body is working hard to recover and may benefit from an evaluation to determine what kind of exercise, movement or medical care is necessary for you to reach your recovery goals.
These are not signs that you will never recover, even if it feels that way now. They're signs that you need a little more guidance to get where you're going.
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