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Postpartum Pelvic Floor Pain
The postpartum recovery period typically lasts well beyond common expectations. Guiding and supporting your postpartum patients and clients through this transitional period requires effective strategies tailored to their individual needs.
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Why the Postpartum Period Matters
While many people think of the postpartum recovery period lasting 6-12 weeks, the actual timeline to fully recover is more like a year. Pregnancy and birth have many long-term effects on the body: a recent systematic review found that gait changes in postpartum women persisted for up to five years. Pregnancy is one of the primary risk factors for pelvic organ prolapse, a condition that may not manifest until 15-20 years postpartum. This underscores the importance of comprehensive postpartum care for those who have given birth.
The postpartum period is also a time when parents are more susceptible to mental health issues like postpartum depression and other mood disorders–the combined stressors of a body undergoing massive changes, hormonal fluctuations, and the exhaustion of parenting an infant can be intense. The added stress of socioeconomic factors, such as a lack of parental leave or a lack of support at home, also hinders one’s ability to recover well.
It is important to help newly postpartum folks set realistic expectations for themselves about what postpartum recovery looks like, including a reasonable timeline for returning to exercise and other activities at the level they were accustomed to pre-pregnancy. The goal is for postpartum parents to have ample support to recover well, be patient with their bodies, and return to their regular activities at a pace that acknowledges the tremendous changes that happen during pregnancy and birth.
Understanding the Postpartum Period
The postpartum period follows some relatively predictable timelines for recovery. Each person’s actual recovery timeline depends on factors such as mode of birth and any complications that arose during birth.
Most people recover from a straightforward vaginal birth without much difficulty and begin feeling like the most intense physical discomfort resolves by about 6-8 weeks. However, long-term recovery takes much more time–as their body continues healing, most postpartum folks are simultaneously juggling household care, baby care, and self-care, not to mention maintaining relationships with relatives/partners and other children. In countries without guaranteed parental leave, many people are recovering while trying to work. They are doing all of this while healing a placenta-sized wound in the uterus, managing hormonal swings and trying to get two hours of sleep in a row.
If you’re a professional who works with pregnant and postpartum people, you can help support them through this process by helping them alleviate some of the stressors that affect their well-being. If you’re a physician, for example, following the guidelines given by ACOG in Committee Opinion Number 736: Optimizing Postpartum Care means you will check in on your postpartum patients more frequently.
If your area of practice does not include much training in postpartum care, you may wonder why this period of time is so important to the long term health of women and people assigned female at birth. Below are a few of the changes/processes that occur in the early postpartum period.
First 6-8 weeks:
- Uterus begins to return to its pre-pregnancy size–postpartum. Cramping, bleeding and discharge, called lochia, is common
- Tears, c-section incisions, or episiotomy sutures begin healing–this usually takes about 7-10 days for external wounds
- Lactation begins if breast/chestfeeding
- Sore nipples from lactation usually resolve in the first couple of weeks but may need attention if they’re interfering with feeding the baby
- Vaginal and perineal pain is common, especially with vaginal birth
- Changes in bowel movements, especially constipation, are common postpartum
Reasons your client should call a doctor:
- Symptoms of postpartum depression (see a comprehensive list here)
- High blood pressure, especially if accompanied by headache
- Blood clots larger than a quarter
- Discharge that is greenish or otherwise discolored or unusual
- Infection at incision sites
- Difficulty managing bowel movements–fecal incontinence
- Painful, hard, red areas in the breasts (mastitis)
For people who have a surgical birth (C-section), the early recovery timeline is extended to 8-12 weeks.
Physical Recovery after Childbirth
A full physical recovery from childbirth may take some people up to a year. But the truth is that once a body has experienced pregnancy and birth, that body will never be exactly the same as it was before. It’s particularly important to emphasize to your clients that this is, in fact, normal. While most people recover fully from pregnancy and birth, few do so without physical signs of what their body has gone through, from a few stretch marks to injuries that require significant rehabilitation, such as diastasis recti and pelvic organ prolapse.
If you were speaking to a client recovering from a knee injury, you would not urge them to get up immediately and resume their daily activities. Similarly, urging postpartum parents to bounce back to normal is misguided at best and harmful at worst.
A good rule of thumb for the first few weeks postpartum is five days in bed, five days around the bed, and five days near the bed. This practice gives a new parent time to adapt to the sleeping, feeding, and caregiving needs of a new infant while also allowing their body to rest and heal as much as possible. Giving the body time to adapt and adjust gradually is key to allowing any injuries from birth to resolve and for the internal organs to rearrange themselves after months of displacement.
Healthcare professionals can help their postpartum patients manage their symptoms by creating a safe space for patients to ask for help. This requires going beyond questions about how the baby is sleeping and eating and instead asking the parent(s) about what kind of support they have in and outside of the home, both in terms of meeting physical needs and in terms of emotional support.
Creating a Customized Postpartum Recovery Plan
Hold off on recommending exercise programs until after the first 6 weeks–if your client can get up and walk every day for a bit, that is plenty. You might offer gentle exercises and stretches that can help provide relief for the aches and pains of adjusting to a postpartum body, such as the exercises in this video.
After the immediate postpartum period ends, encourage your patients to begin incorporating intentional movement practice into every day, even if only for five minutes. At this point, movement should be about reconnecting with their body, gently engaging the core and retraining the pelvic floor. Sleep is more important at this stage than working out.
Once your client is 10-12 weeks postpartum and getting more regular rest and eating regular meals, they may be able to begin increasing the intensity and duration of exercise. However, continue to encourage them to be patient–the first year of postpartum recovery can be difficult and can feel very slow. Remind them that it took nearly a year to grow a baby and that recovering while parenting looks very different from what they might see in the media.
Throughout their recovery, check in on your patients’ mental health as much as their physical health–do they feel supported at home and/or at work? Are there barriers to their receiving the support they need? Who are the professionals and other people who make up your client’s care team?
When developing an exercise program, it is crucial to ensure that it is realistic and tailored to each individual’s specific needs and goals. For instance, if your patient has diastasis recti, are you equipped with the knowledge and skills required for their rehabilitation? If not, do you maintain a referral network of physical therapists or movement professionals who specialize in core and pelvic floor rehabilitation?
Supporting Your Clients’ Postpartum Journey
This approach to postpartum care emphasizes a cautious and individualized method, which contrasts with the more general guidelines of 6-12 weeks for recovery. By leading with curiosity about the client’s unique experience and acknowledging that healing timelines vary widely, caregivers can provide more sensitive and effective support. This involves considering many factors that could influence a client’s recovery beyond the most urgent medical concerns. It acknowledges that while the baby’s health is essential, the parent’s well-being is just as important.
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Hi! I'm Lauren
Nice to meet you
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