The childbearing year is a time of extraordinary change: after approximately 9 months of increasing weight, shifts in centre of gravity, and generally feeling unwell or cumbersome, the process of birth upends everything again.
Pregnancy was a process of hormonal changes and physical stretching and lengthening whilst baby developed and grew, whereas the postpartum period is signified by caring for baby including feeding and nurturing – all the while activating, shortening, and strengthening various muscle groups impacted by pregnancy.
giving birth comes at a cost to your pelvic regions
Irrespective of your mode of delivery, giving birth comes at a cost – caesarean section mums may find it more difficult to mobilise shortly after birth, whereas vaginal delivery mums may find it more difficult to control bladder and bowel function and experience more prolapse.
Once we have had more than one pregnancy, these differences become less obvious and women who have been pregnant are at greater risk of developing pelvic dysfunction than our nulliparous (never been pregnant) colleagues.
Recovery is required after all pregnancies, be it your first or fifth. It is a process and happens in roughly defined time frames. Essential aspects of postpartum rehab include reconnecting and activating the ‘core’ (abdominopelvic rehab) – this is to compensate for the stretching and relative weakening of muscles.
A variety of exercise modalities e.g., pilates and yoga, are beneficial due to their focus on ‘working in’ (as opposed to ‘working out’ – working in is deemed to be mindful exercise of bodily form and function, working out is cardiovascular exercise and resistance training).
Walking is considered excellent exercise and a good way to get moving and back in shape. Swimming is also an appropriate activity where the body is supported by water (buoyancy) rather than under the effects of gravity (weight-bearing).
Many new mums desire ‘quicker, faster’ exercise options and return to running postnatally should be undertaken with caution and under the advice of a physiotherapist with a special interest in pelvic and women’s health.
Guidelines exist and suggest that (depending upon many factors) caesarean section mums can return to running through a graded programme of walking/running at approximately 3 months, and vaginal deliveries at approximately 6 months post-delivery (Goom, Donnelly et al. 2019).
Many new mums are anxious about returning to sexual activity, and some may experience pain with penetration due to a variety of reasons including a lack of lubrication and sensitivity of the vaginal walls (Korzeniewski, Kiemle et al. 2021).
More ways to heal
It cannot be ignored that some mothers have a difficult pregnancy and/or birth and may require additional healing beyond the standard postnatal recovery.
Scars from caesarean incisions and episiotomies can cause ongoing issues if not managed appropriately. Scar massage and release are advised post caesarean, whereas a pelvic physiotherapist can assist with internal release of episiotomy scars.
Many women speak of trauma, either associated with issues in pregnancy or arising at birth – some will need additional support through this challenging time; please remember that your mental adjustment is as important as your physical recovery.
Pelvic girdle pain (PGP) is common in pregnancy and can persist postnatally. When PGP does not resolve spontaneously shortly after birth, additional therapy and support is indicated. Primary areas of focus are on sleep and stress.
Feeding: whilst we know that in the majority of cases ‘breast is best’, not all mums or babies are able to breastfeed; a qualified lactation consultant can assist on this precious journeys. Mums – please note: the hormones associated with breastfeeding can impact on libido, lubrication, and sexual enjoyment and as such, sexual function almost always improves when stopping breastfeeding. This is not to discourage breastfeeding, but to be aware of the hormonal effects and your subsequent expectations in the bedroom.
The approach to postnatal recovery and healing is one called “fit for purpose” start with little bits that you can do, do them repeatedly, gradually increasing either the duration, speed, distance etc. Always remember to listen to your body and be gentle with yourself. And do not underestimate the restorative powers of a good night’s sleep.
A variety of booklets related to postpartum recovery and healing are available for download on the Pelvic Obstetric & Gynaecological Physiotherapy (POGP) website at www.thepogp.co.uk/Resources/
References
Goom, T., G. M. Donnelly and E. Brockwell (2019). “Returning to running postnatal–guidelines for medical, health and fitness professionals managing this population.” Absolute Physio.
Korzeniewski, R., G. Kiemle and P. Slade (2021). “Mothers’ experiences of sex and sexual intimacy in the first postnatal year: a systematic review.” Sexual and Relationship Therapy 36(2-3): 219-237.
Corina Avni has been involved in pelvic health since the late 90s and consults with men, women, and children; after all, we can all present with pelvic dysfunction (pee, poo, pleasure, pain, periods, pregnancy, prolapse, prostate problems etc.). Her primary focus is chronic pelvic pain with everything going wrong at the same time (multisystemic comorbidity), often aggravated by stress and anxiety. She is busy with her PhD at UCT in Physiology, researching the relationship between background bodily functions and chronic pain.
