A Roadmap To Your Physical Recovery From Birth– 0 to 6 Months and Beyond.

Hey Mama.

Let's talk about YOU!

This is YOUR guide to the first 6+ months of your postpartum physical recovery. At this time, you may have noticed that a lot of the focus has been off you. Away from your needs, your health and your healing. Of course, WE LOVE the new focus– It's cute and cuddly, but that doesn't mean that we suddenly don't have needs. 

I have a little secret: the more you take care of yourself, the more you will be able to give day in and day out. Taking care of your baby requires a high level of physical demand. You spend the day bouncing, moving up and down, and getting into awkward positions nonstop. You CAN train for this. You CAN help your body FEEL GREAT as you move through motherhood. And, of course, there's always a few bumps along the way, but this guide will help you learn to navigate aches and pains along the way by supporting your body and finding the right help when needed. 

The First Few Days

Mindset: Breathe & Recover. Take care of the essentials and that's it.

The Essentials:

• Eat: Nourishing foods. Whole foods. Warming Foods. Protein. Building blocks to regenerative cellular growth. 
• Hydrate: Water and electrolytes. 
• Try to get up and walk around every hour that you are awake to keep good blood flow. 
• If you're feeling overwhelmed, anxious, or you simply want to center yourself, breathe into your lower rib cage and feel it expand in all directions.
• Support healthy poops for a healthy pelvic floor- hydrate, meds, supplements, squatty potty, try to go with the first urge.
• Take a few minutes each day to lie flat with your arms out to the side– this gives you a moment to breathe and is a great way to open/stretch the chest and shoulders.
• Rest.

Further Support (Optional):

• Support bloomers
• High wasted clothing to reduce irritation to cesarean incision

At this point its normal to:

• Feel like things are tender around the vaginal opening
• Have sensitivity around any tears, incisions or stitches (at the perineum or cesarean) 
• Experience bleeding from the vagina– this is known as lochia and will take about 3-6 weeks to stop. It should gradually go from red to pink to yellow over time. 

Let your doctor, nurse or midwife know if you note:

• Substantially bleeding (ie big clots or going through more than one pad per hour)
• Significant pain
• Dark urine
• That you haven't had a bowel movement in 2 days
• Redness/ swelling in one or both legs
• Shortness of breath 
• Fever
• Unexplained pain
• Weakness
• Headache that doesn’t go away
• Thoughts of hurting yourself or anyone else 

When in doubt, call your doctor. You DESERVE postpartum care so that you feel safe and comfortable. 

The First Few Weeks

At this point, recovery is still focused on rest. Do what you can to rest amidst all the activity that naturally needs to happen in the early days of caring for your baby. 

Continue to take short walks throughout the day, starting with around the house and gradually increasing your distance as you feel able. Everyone will hit their limit for how much walking is "right" for them at this stage. If you start to notice more pressure or heaviness around the vagina then try to take a break and lie down. You can even kick you feet up on a wall or couch and place a pillow under your rear to prop up your hips.

Some will benefit from a more "active recovery" that includes exercises. If you feel that to be the case (like if your body feels better after moving), here's a couple helpful tips on where to start. 

1. Start with exercises that mimic movements you're already doing in your daily life. For example: steps ups because you already know you can walk up stairs. Bodyweight squats, because you're sitting to and from chairs anyways. 
2. Do a small number or amount of movement and gradually ramp up. For example, if walking feels good, start with walking to the end of the block and back before going around the whole block. Or, start with 5 repetitions of an exercise before attempting more. 
3. Assess yourself for 24 hours following the addition of anything new to your routine. If you notice that you're feeling funky symptoms in your pelvic floor (like difficulty holding in urine/ gas or a sense of pressure/ heaviness) then you may need to back off a little bit. 
4. Start with exercises that don't put a large demand on the abs and pelvic floor. These areas of the body just went through a major change, so even if the rest of you feels ready, these muscle groups need time to recover and catch up. Here are some examples of exercises that don't require a ton of core: clam shells and other sidelying hip exercises, bridges, seated overhead presses, rows. 
5. Give yourself plenty of rest between bouts of exercise and prioritize sleep. Any exercise done at this stage should be done with the mindset of what "lifts you up" and brings you energy and enjoyment. What helps to stabilize your mood. Anything at all that you decide to do is amazing– including doing nothing at all!

If you've had a cesarean, then you want to make sure you're not using your abs too much to allow the incision to heal. No heavy lifting or direct ab work for the first 6-8 weeks or until fully healed and cleared by doctor. 

At this point, it's common to experience:

• Occasionally feel some pressure downward on the pelvic floor with laughing, coughing or walking.
• Leaking of urine, gas or vaginal flatulence at unintended times
• Have sensitivity with wiping after using the bathroom (use gentle wipes and peri bottle!)
• Feel disconnected from your abs and pelvic floor

If you are experiencing these symptoms, start to think about calling a pelvic health PT. It often takes a while to get an appointment, so it's good to be on ahead of the game. Your body is still in the early phase of healing though, so please don't worry or hyper-focus on any of these sensations. They are COMMON and they get better!

Let your doctor, nurse or midwife know if you note and of the red flags that were listed in the above section. And again, when in doubt, call your doctor. You DESERVE postpartum care so that you feel safe and comfortable. 

Six-Week Mark (Are We REALLY "All CLEAR?")

The six-week check up can be a bit of a confusing time for mamas. This eagerly awaited appointment where someone will FINALLY be checking up on YOU and assessing your recovery often leaves a bit to be desired. There's usually enough time to make sure you're doing fine, things have healed well enough and to see if you want to be on birth control. Very rarely will an assessment of the pelvic floor and abdominal muscles be done but nonetheless you'll likely be cleared to exercise and have sex.

If the idea of exercising and having sex sounds daunting at six weeks, YOU ARE NOT ALONE. Those are incredibly challenging activities to get back to a mere six weeks after childbirth. It can absolutely be done, but MOST WOMEN need guidance to truly feel good with these activities.

This is where pelvic health physical therapy can be so helpful. Scheduling a session with a pelvic health expert for around 6-weeks postpartum is great for checking up on the function of your muscles, scar tissue and organs. It is effective for addressing incontinence (leaking), odd sensations like pressure or heaviness around the vaginal opening, many types of pain including pain with penetration, general full body wellness and more. It can often take weeks to get an appointment, so be sure to call and book as soon as possible. 

Here are some things that you can start to do at this time frame or once you are cleared:

• Scar tissue Mobilization– This is a type of massage that involves moving healed scars to help the tissues loosen up and move better since they often heal stiff after an injury. You can move the tissue in all directions and in circles starting with a light touch and gradually working deeper. Some scars are very sensitive in which case you won't want to start with any pressure at all. You can start by gently rubbing the scar with a soft blanket, makeup brush or wash cloth and gradually increase the pressure as it desensitizes. A physical therapist can provide more nuanced, specific instructions for this.
• Abdominal Function Self Assessment– (link to details coming soon)
• Pelvic Floor Self Assessment– (link to details coming soon)

In summary, it is normal to not feel ready/ recovered at 6 weeks. You're not flawed... the expectation that women "bounce back" so quickly is what's flawed.

The First Few Months

During this time, a little goes a long way. You're not gonna have time to do a lot, but just keep moving in little bits when you get a chance. Even just 5-10 minutes of thoughtful movement throughout the day can help! 

Focusing on "corrective exercises" early on can help pull your body out of uncomfortable positions that you may have gravitated towards during pregnancy or that you find yourself in for long hours throughout the day. They also build stability around your core and joints. Here are some examples with links to videos (links coming soon!):

• Shoulder openers
• Scapular Retractions
• Rib cage mobility
• Breathwork
• Hip openers
• Pelvic floor and abdominal bracing
• Hip strengthening
• Heel Raises

A couple guidelines to follow:

• Gradually build up over time– ramping up things like amount of time spent on an exercise, distance traveled, weight, repetitions.
• Start off easier than you expect to have to. This will help you get a baseline for what your body currently can handle. It may not be what you expect, but that's OKAY in this season (you just had a baby!). You will improve and it's much easier to improve gradually than to exceed your current ability. 
• Wait at least 3 months to return to running or other high impact activities. This allows time for the connective tissues to heal. Some women do return earlier without problems, which is why I call this a guide, not a rule book. If you do want to do this sooner, be sure to be symptom free during the workout and note if anything pops up within the following 24 hours. Ease up if so! You also might consider running uphill or stairs and walking back down (ie Stadiums or hill repeats) if you're really eager to run. Going uphill creates a lower impact situation, which can be gentler on the pelvic floor while still getting in cardio. Also note that it might take a lot longer than 3 months to get back to running/ high impact. The time frame for recovery is variable. 

• Build up your strength prior to jumping back into more dynamic, explosive movements, like jumping! This will help support your joints (and pelvic floor!) as you get moving faster.

• You don't have to have a perfect plan to progress through this stage. It's okay to simply move when you feel like it. Give yourself grace, even if you're not as consistent as you'd like to be. A lot is shifting in your life right now. Try to enjoy movement without the need to make it a priority. 

Three Months And Beyond

At this point in time, you may feel like postpartum recovery is a roller coaster ride. There are a lot of ups and downs and that can be really discouraging. Even for the healthiest, most fit mamas, it can feel like you're always taking two steps forward and one step back. Approaching this time with the right mindset and understanding of what's realistic can be really helpful. Here are some tips:

• Focus on things that are GOING WELL rather than what's not. For example if you no longer leak urine when you run but you did 3 weeks ago, remember that to help you feel encouraged if you get sidelined by something else like back pain. 
• Know that this is SUPPOSED to be a long process. It took 9 months to grow your baby, it should and will take that amount of time (or longer) to recover. The time frames I give in this guide are vague intentionally. What takes 3 months for some, will take over a year for others because every experience is so different. 
• The higher your goals are, the longer you will perceive your recovery to take. For example, if your goal is to walk around the block, you may have already achieved it. But if your goal is to run a 10k or do pulls ups, of course getting there will take longer!
• Don't compare yourself to others. Postpartum recovery is a very individualized journey. Everyone's motherhood journey looked different and everyone will have a different set of hurdles to navigate. Not to mention, what you see others doing may not be the full picture of how they're really doing.
• Understand that other factors in life will effect your perceived fitness. So if you have a bad day, where your workout just doesn't feel great, it doesn't mean you lost fitness. Think about other challenges you may be dealing with like life stressors, lack of sleep, hormonal fluctuations or improper fuel (food and hydration). 

Give yourself grace. It's normal for things to fluctuate. To feel great one day and not the next. Keep going. Even though it's up and down, the big picture trend IS UP. 

At any point in your journey, if you're feeling frustrated, like you're broken (you're not), in pain, or confused with how to take care of your body, reach out to a pelvic PT. It's never too late. Here's a little more info about what we can help with. It can be difficult to take that step and spend time and money on yourself. But you won't regret it when you feel the value of support that helps you feel great.

You are worth it. Period. Full Stop.