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Nothing magical happens at 6 weeks postpartum. So, how long does it really take for your pelvic floor and core to heal after birth?
Well, it depends!
If you’ve had a vaginal delivery:
-Your pelvic floor stretches up to 3.5x its length to deliver your baby’s head and shoulders! (Hoyte)
-The nerves that talk to your bladder and sphincters undergo this same stretch and the ability of the nerve to communicate with these structures is still delayed at 12 weeks postpartum (Tetzschner)
If you’ve had an abdominal delivery:
-The uterine scar healing is still healing at 6 weeks postpartum suggesting the process of scar remodeling after cesarean extends beyond the traditionally accepted 6-week mark. Scars can take up to 1-2 years to fully heal!
-Abdominal fascia has only regained 51-59% of its original tensile strength by 6 weeks post cesarean and 73-93% at 6-7 months postpartum.
The reality is that for some birthers, healing is quite quick: just a few weeks. For others, the road is months and years long. The best thing you can do to support your body’s healing after delivery is rest and a gentle return to movement and exercise under the guidance of a postpartum rehab specialist or Pelvic Floor PT.
Rest
Taking care of your pelvic floor in the few weeks after giving birth is essential for your overall postpartum
recovery. The pelvic floor plays a crucial role in providing support to your internal organs and maintaining urinary and bowel control. And, whether you had a vaginal birth OR cesarean, your pelvic floor has been carrying a LOT of load for 40-ish weeks.
After your baby is born, there are tremendous changes taking place: your blood volume is shifting, your pelvic organs are recovering, your uterus is contracting back to its pre-pregnancy size, your metabolism is shifting and your emotions are also shifting. You also may be producing milk and figuring out how to feed and latch your baby. Your body is going through a LOT physically and emotionally. It is a time that is wonderful and magical, but it is also a time that is HARD.
Let’s follow the story of one of our patients, let's call her Janet. Janet is a mom of 3 with a newborn. At 1 week postpartum, she was carrying the baby in the baby carrier up a flight of stairs when she felt a dreaded shift in her vagina. That bulky, heavy car seat was just too much for her healing pelvic floor and her bladder prolapsed or shifted down in her vagina. She had NO IDEA that she should not be lifting that car seat upstairs at this stage. A lot of newly postpartum moms are told not to lift anything heavier than their baby during those first 6 weeks, but some are not given any guidance on how to modify physical activity. Luckily for Janet, she recovered after physical therapy, but she definitely regretted being so active so early postpartum. And she loves to share her story to remind new {m}others to follow the old midwife’s adage: 1 week in the bed, 1 week on the bed, 1 week around the bed.
To our Western culture, this may sound extreme. But, there are many cultures that follow a 30-40 day lying-in period and we can learn a thing or two about the benefits.
Rest gives your pelvic floor and core time to heal. With vaginal delivery, perineal tearing occurs in 50-75% of vaginal births. Even if you did not have a severe tear or even a tear at all, your pelvic floor muscles have to expand up to 3.7x their usual length to pass your baby’s body! Those muscles need some time to rest and recover!
Abdominal or cesarean delivery is a major abdominal surgery! Physically- no matter the route your baby was born, your body needs to rest. Excessive fatigue also has a negative effect on oxytocin secretion, which is a hormone necessary for breastfeeding. Physical fatigue also impacts immune function, which is linked to mastitis, and gives your body rest to help your body’s big job of recovering physically and potentially producing milk.
Not only is your baby newly born, but so are you! Allow (and encourage) others to take care of you: provide you with nourishing meals and water, come to you for some snuggles, and help you with what YOU need. I am by no means saying this is easy. I learned the hard way myself from my first to my third baby on setting realistic and kind boundaries to protect my ability to bond with my new baby and my children to bond with their sibling (so hard!). Everyone wants to hold the baby, but we also need to hold the {m}other.
Gentle return to activity
When I had my 6-week check-up, the advice went from “no exercise” to “green light for everything.” Each birther is unique and your obstetrician/midwife does not have the expertise (or time!) to fully assess your exercise readiness. 6- weeks is likely too long to wait for low-intensity exercise (Evenson), yet 6 weeks is likely too early to begin full-intensity exercise like running, jumping, and heavy weight lifting. Every birther really needs individualized assessment and guidance by an experienced pelvic floor therapist.
The first 2 weeks: Take it easy!
Avoid heavy lifting early postpartum to allow your pelvic floor to heal
Avoid high impact (running, jumping) early postpartum as well
It can be so healthy to move! Short walks at home and gentle stretching are wonderful. Breathing exercises can also be used to begin core strengthening
Anything that produces pain, leaking, or increases bleeding is too much and you should discuss that with your midwife or obstetrician
If you need or want individualized support for movement, core healing and postpartum care, we see people in person in Richmond, Virginia or virtually anywhere
We have an online school for postpartum core recovery including an early postpartum breathing and core connection yoga class
Weeks 2-6: listen to your body and begin moving a little more
Anything that produces any type of pain, leaks, or increases your bleeding is too much. You should discontinue and discuss with your provider.
Slowly add some distance to your walking and stretching routines
You can begin gentle core strengthening focusing on breathing and the transverse abdominus
Be sure to hydrate
manage the depletion of sleep deprivation with naps and rest
6 weeks postpartum:
Nothing magical happens at 6 weeks postpartum
Every birther should be offered a pelvic health assessment, regardless of delivery mode (Goon) to assess the abdominal wall and pelvic floor
Following a cesarean, uterine scar healing is still increased at 6 weeks postpartum suggesting the process of scar remodeling after cesarean extends beyond the traditionally accepted 6-week mark
Abdominal fascia has only regained 51-59% of its original tensile strength by 6 weeks post cesarean and 73-93% at 6-7 months postpartum (goon)
Low-impact exercise should be performed for the first 12 weeks postpartum (so, no running, jumping, HIIT… yet… for most birthers!)
12 weeks postpartum:
A return to impact (running, HIIT, weights) activities can be started
Remember: a referral to a pelvic health physical therapist is essential if you have
Any vaginal or pelvic heaviness or dragging
Leaking any urine, gas, or bowel movements
A pendular abdomen (often called a shelf)
Pelvic or low back pain
Or if you just want assessment and individualized guidance
Giving your pelvic floor some TLC postpartum:
Peeing postpartum:
Make sure you have increased your fluid intake in the postpartum period, especially if you are breastfeeding. This will help your urine be less “sting-y” as well as help your overall recovery. If your urethra or vagina is tender or stings when you pee, it can be useful to spray warm water in your peri bottle as you are peeing. When you are done, you can use that same warm water to clean off or pat yourself dry instead of wiping.
Occasionally new moms might find it difficult to start the stream of urine after birth. If this is the case, reach out for a quick virtual session (link to contact form) to guide you through some strategies to help.
Pooping postpartum:
Avoid getting constipated with great hydration, great fiber intake, and/or using stool softeners as directed by your provider… or nature’s stool softeners like prunes and dried figs. When you poop, some find it more comfortable to support any stitches or sore areas in the vagina with a clean pad or toilet tissue to offer it a little support. If you DO get constipated, do NOT strain! Your pelvic floor is recovering. Instead: improving your motility by drinking lots of water and performing belly massage to stimulate your digestion can be really helpful (link to virtual visit). You can clean yourself with a peri bottle (just like a handheld bidet!) or wet wipes (just don’t flush those down the toilet!)
Bathroom squatty potty:
Are you sore down there? Making your own padsicles (pad + ice) can be a lifesaver!
Recipe:
Absorbent maxi pads (overnight absorbency)
Aloe vera
Witch hazel
Lavender essential oil (optional)
Unwrap each of the pads leaving the sticky liner and wings in place and generously spread aloe vera up and down the pad side- apply liberally so it freezes nicely! Then, spread the witch hazel on the pad; add a few drops of lavender essential oil to the pad if you’d like, spread it all around so it is evenly distributed, place it in a ziplock bag, and freeze!
For more resources, head over to our cesarean blog, diastasis blog, severe tears blog, or our online school for our postpartum yoga classes and diastasis course.
The first few weeks after having a baby are a whirlwind of emotions and adjustments. By prioritizing rest, bonding with your baby, seeking support, and taking care of yourself, you can navigate this period with more confidence and grace. Embrace the journey of parenthood, and remember that you are not alone in this adventure. Cherish every moment, and don't hesitate to seek help and guidance when needed. Congratulations on your new arrival! Remember that if you are struggling, come see us in Richmond, Virginia or book a virtual visit for individualized guidance at any time.
Resources:
Lennox Hoyte, Margot S. Damaser, Simon K. Warfield, Giridhar Chukkapalli, Amitava Majumdar, Dong Ju Choi, Abhishek Trivedi, Petr Krysl, Quantity and distribution of levator ani stretch during simulated vaginal childbirth, American Journal of Obstetrics and Gynecology, Volume 199, Issue 2, 2008.
Pardo, E., Rotem, R., Glinter, H. et al. Recovery from pelvic floor dysfunction symptoms in the postpartum is associated with the duration of the second stage of labor. Arch Gynecol Obstet 300, 127–133 (2019). https://doi.org/10.1007/s00404-019-05173-1
Romano M, Cacciatore A, Giordano R, La Rosa B. Postpartum period: three distinct but continuous phases. J Prenat Med. 2010 Apr;4(2):22-5. PMID: 22439056; PMCID: PMC3279173.