Is the 6-week postnatal check preventing you from healing?
By Bernadette, Midwife, Personal Trainer and Owner - Core and Floor Restore
At the six-week check women are often given the “all clear” from their midwife or doctor to return to exercise. But is it preventing you from healing? Could you be working out sooner? And, what exercises should you be returning to?
Is it preventing you from healing?
In short, yes, it is.
Getting the “all clear” may lead you to believe that your body has repaired to its pre-pregnant state and it’s all systems a go! Spoiler alert, it is not!
Here’s the reality:
- The pelvic floor can take up to 6 months to heal after birth. Even after this time, one in three women will experience urinary incontinence (leaking urine when they cough, sneeze, jump etc)
- One in five women experience faecal incontinence at one-year post birth.
- At 3 to 6 months post birth, up to 56% of women have a pelvic organ prolapse. Up to 75% of women will experience one in their lifetime. A prolapse is where one or more of the pelvic organs (bladder, uterus or bowel) have moved downwards into the vagina, some to the vaginal opening (introitus) and some externally. This is often undiagnosed and may be without symptoms in the beginning.
- 45% of women at 6 months and 32% at 12 months still have diastasis recti (abdominal separation where the connective tissues between the bellies has been compromised)
- Diastasis recti and pelvic floor dysfunction (incontinence and prolapse), do not heal without treatment
- Healing can take longer if you are breastfeeding due to the hormones involved
Now these stats aren’t here to scare you. You’ve grown a human in your body, you’re totally capable of healing, #yesyouare! They’re here to help you understand that the healing and strengthening process takes time and requires effort.
Unfortunately, returning to your favourite exercises is not as simple as just waiting until your baby is 6 weeks old. Jumping into exercises before you have healed and strengthened, can make your conditions worse or cause you to experience diastasis recti or pelvic floor dysfunction.
Could you be exercising sooner?
You sure can. Most people are unaware that you can actually start exercising prior to the 6-week check. It’s not about when to start, it’s about what to start with and how you do it.
You can start activating your core and pelvic floor within the first few days post birth (if you have a catheter, pelvic floor activation should not be commenced until it is removed. If you’ve had a caesarean, you’ll take it slower). This activation actually needs to occur if you want to prevent injury and/or lessen the degree of injury you already have. This is because you start exercising from the moment your baby is born. You get up for your first shower (best shower of your life), sit down to feed, get back up again, go to the toilet, and spend your night getting in and out of bed. You then put this on repeat (for the next year or so) with the additional weight of that scrumptious human you just birthed. The normal birthweight range of Australian babies is 2.5kg to 4.5kg. The majority of people do not carry this type of weight (that gets heavier and heavier) around with them all day and parts of the night, seven days a week, #youreasuperhuman!
Along with continuously lifting and holding your baby, there is all that time you spend getting down and up off the floor. Never have I spent so much time on the floor as when I had a newborn! Oh, and did I mention the equipment. All. That. Equipment. Capsules, prams, rockers, bassinets and cots – why are they so heavy and awkward?
So here you are, trying to recover from pregnancy and birth, and you’re moving around whilst holding an extra weight (luckily its super snuggly and smells delicious!). Now, would you expect anyone else who is trying to heal to do what you’re required to do as a new mum? No, we’d let them rest. Unfortunately, that’s not going to happen for the majority of us in our society, so the important thing is to ensure you are moving correctly (another spoiler alert, most of us aren’t!).
Our creature comforts (high beds, cars, couches, tables and chairs), require us to move in ways and hold positions we weren’t designed to do. This leads us to stop moving functionally which in turn causes our muscles to be weak and our core and pelvic floor to be strained. Have you ever noticed when you get out of bed, your belly coning or doming down the middle? That’s your body shifting pressure to be able to complete the movement. This pressure weakens the core and pelvic floor.
So, all that moving you’re doing in order to mother a newborn, requires core and pelvic floor activation aka protection. This will help you to not only prevent injury but to heal and strengthen at the same time.
As well as adding this activation to your daily movements, you can start with very gentle exercises to assist strengthening other much needed muscles (cue booty and back!). Gentle walking is also a great exercise to start with. Start by walking to your mail box, then the next-door neighbours, then the end of the street (depending on how long your street is!). Be really careful if you are baby wearing here as you’re adding extra weight to your body and therefore putting more pressure on your pelvic floor and core. You may also be altering you posture. I’m a huge fan of baby wearing but the extra weight can be a hinderance when healing. Make sure your carrier has been fitted properly to your body.
When can I return to the exercises I love?
This will be an individual thing. You’ll need to ask yourself:
1. Have I healed? If your favourite exercises cause you to leak urine, feel a bulging in your vagina or your back to ache, you need to take a break from them (Ross and Rachel style), heal, strengthen and then get back into it.
2. Have I regained the strength needed to ensure correct technique for each exercise? So many people feel “ok” and don’t have any of the above symptoms but they haven’t regained the strength needed for the exercise/s. They charge back into it and then find themselves injured soon after. If you can’t activate your glutes then there is no point returning to running. If you can’t squat without your knees folding inwards, you shouldn’t be playing netball (or doing anything else that requires squats). If you can’t engage your core properly (and this does not involve pulling your belly button into your spine) then you shouldn’t be doing core work. Got it? #yesB
How long this takes and what it looks like will be different for every woman and dependant on many factors such as age, how many children you’ve had, issues experienced in pregnancy, your labour and births, if you’ve had a multiple pregnancy (twins, triplets etc), if you’ve healed between pregnancies and what you’ve done during your pregnancy.
It’s not about fitness, it’s about correct activation. I’ve worked with many extremely fit women who have had severe issues because they have kept active during their pregnancy but they’ve been working against their core and pelvic floor muscles rather than with them. Most of them don’t notice until post birth when they are unable to return to the exercises they love.
What else should you incorporate in your restorative journey?
Please, please, pretty please, consult with a women’s health physiotherapist and/or osteopath. These health professionals are specialised in women’s health and are the best professionals to assess you for conditions such as diastasis recti, prolapse and incontinence. They can also assist with your body healing and restoring to correct alignment and function. Physiotherapists can also assess your strength prior to returning to exercise. I’m a huge fan of osteopaths and physiotherapists (for myself and women I work with) and suggest alternating treatments as their work complements the others.
Massage – if you’re a big fan of massage than this is good news for you! Massage can really help with muscle tightness and releasing muscles that foam rolling and spikey ball massage just can’t get into. Whilst we often talk about strength, a healthy muscle is one that can relax and contract. Tight muscles (and fascia) will prevent healing and activation of surrounding muscles. So, muscle release is an important part of your healing and strengthening process.
If you’re reading this as a pregnant person, you don’t have to wait until post birth to start helping your body. You can learn how to correctly activate during pregnancy so that you move into the postnatal period with the knowledge and skills to heal.
Bernadette is a Midwife and Personal Trainer with a Master in Public Health. After her own struggles with incontinence during her first pregnancy, she developed Core and Floor Restore (www.coreandfloorrestore.com.au), an 8-week postnatal recovery program that includes theory as well as exercise. Bernadette believes that knowledge is power and so her program not only teaches you the how but also the why. You’ll be given the knowledge and techniques to heal, feel stronger, restore your core and pelvic floor and return to exercises you love!
Her pregnancy program is designed to mentally and physically prepare women and their support people for labour, birth and beyond. It includes antenatal education classes as well as an epic exercise program to enable you to protect and strengthen during your pregnancy. For more information, please check out her program at www.coreandfloor.com.au or email firstname.lastname@example.org