Postpartum Recovery: A Pelvic Floor PT’s Guide to Recovery After Birth

February 16, 2022

At Every Mother, we know first hand that postpartum recovery is not a straight line; we zig, zag, dip, and dodge as we reconnect with our bodies, rebuild strength, care for a newborn, adjust to new motherhood, and all the new normals that come along with it. Some of the most pressing questions surrounding recovery after birth are WHAT do I do to recover postpartum? HOW long will it take to recover after birth? And WHEN will I feel normal and be healed? So, we connected with Rachel Gelman, DPT, an expert in pelvic health to answer some of our most burning questions about postpartum recovery.

EM: What are the common misperceptions you have seen among your patients or the general public about recovery after birth?

Rachel: That after the 6-week check-up with their doctor, they should be feeling 100% and back to how they were pre-baby; that things like urinary incontinence, pain during sex, urinary urgency/frequency, and feeling weak/unstable are their new normal.

EM: What is a realistic postpartum recovery timeline after giving birth, and what tissues are most impacted? 

Postpartum Recovery: A Pelvic Floor PT’s Guide to Recovery After BirthEvery Mother. Pelvic floor muscles.
Pelvic floor muscles

Rachel: There are many factors that impact how long it will take to recover after birth. In fact, two people may have the same exact delivery, but one person will feel fully recovered after 6 weeks, and another may not feel recovered for 8 months. Everyone is different and heals at a different pace. The way I view it, the body undergoes a lot of changes over the course of ~40 weeks, so I would expect the body to take more than 6 weeks to recover, especially when the person “recovering” is caring for a newborn.

As far as the tissues impacted by childbirth, the pelvic floor muscles stretch a significant amount during delivery. The vulvar tissue is also impacted due to the hormonal changes that occur postpartum. These tissues rely on estrogen to stay happy and healthy. Postpartum, a person’s estrogen levels are very low, which means that the tissue of the vulva (urethra, vaginal opening, etc.) are not getting what they want. This can lead to things like urinary dysfunction, pain with sex, and vaginal dryness.

EM: How does a C-section recovery differ from recovery following a vaginal birth?

Rachel: Both are a big deal and require a lot for the body to recover. Keep in mind a c-section is major surgery and can take six weeks or more to heal internally. Scar tissue from the c-section can be painful, and sometimes nerves near the scar may get irritated and lead to pain that radiates down the leg or into the labia.

EM: What practices or choices during pregnancy can help pave the way for a smoother recovery after birth?

Rachel: Assuming their doctor says it is ok to exercise, a person should try and stay active during pregnancy. If someone wasn’t exercising prior to pregnancy, it is important to start slow and consider working with a physical therapist that specializes in working with peripartum patients. 

Compression stockings and/or compression garments can be useful to reduce swelling of the lower extremities and the symptoms of varicosities.  

Perineal massage is something that has mixed evidence, but it has not been shown to be detrimental, and some studies show it can be beneficial in reducing perineal trauma during vaginal delivery. 

See a pelvic floor physical therapist; they can help with labor preparation by reviewing correct pelvic floor motor control and options for positioning during delivery. 

EM: What are some steps women can take to support recovery after birth?

Rachel: See a pelvic floor physical therapist; they can address anything from diastasis recti to urinary incontinence or pain with sex. They can also work on any scars from a c-section, episiotomy or perineal tears from delivery, and teach you how to work on the scars at home. 

Postpartum Recovery: A Pelvic Floor PT’s Guide to Recovery After BirthEvery Mother. Pelvic floor physical therapy.
Pelvic floor physical therapy

Invest in a good quality water-based lubricant and use it with any penetrative sexual activity. Due to the hormonal changes that occur postpartum, vaginal dryness is common. So be prepared with a good lubricant. People can use vaginal moisturizers on a regular basis to help with dryness as well. 

Be kind to yourself! Healing takes time! 

EM: What (if any) physical changes are simply the “new normal” of motherhood, and what common pregnancy adaptations / postnatal symptoms can we expect to resolve with therapeutic intervention?

Rachel: Again, everyone is different. Things patients often report to me postpartum include:

  • Urinary/fecal incontinence
  • Urinary frequency
  • Constipation
  • Pelvic pain
  • Pain with sex
  • Decreased libido
  • Feelings of vaginal heaviness
  • Low back pain
  • Hip pain
  • Pubic symphysis pain 

All of these things can be common but don’t need to be someone’s new normal! Unfortunately, there is no guarantee that anyone that receives treatment will be 100% symptom-free. Still, there is a very high likelihood that they will get better if they seek treatment vs. not getting any intervention at all.

Are you interested in paving the way for a smoother recovery after birth? Stay active and safely build strength and stamina with EMbody Prepare, our OB-endorsed fitness program with trimester-specific exercises designed to prepare you for an easy labor, delivery, and recovery.

Reviewed by Dr. Rachel Gelman PT, DPT in 2020

Dr. Rachel Gelman is a clinician, writer, and educator. She holds a Doctorate in Physical Therapy from Samuel Merritt University. She specializes in treating pelvic floor dysfunction with an emphasis on sexual health/dysfunction. She is a member of the International Pelvic Pain Society, the International Society for the Study on Women’s Sexual Health, and the International Society for the Study on Sexual Medicine. She is an adjunct instructor at Samuel Merritt University, where she teaches the pelvic health curriculum in the Doctor of Physical Therapy program. Outside of the clinic, she has written and consulted for various businesses in the sexual health/tech space.

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