Rachelle Bonneville is a Pelvic Floor Physiotherapist and the owner of Frank, providing online education & workouts for pre and postnatal people.
Let’s be frank about what to expect early postpartum and how it relates to reintroducing movement in our bodies recovering from pregnancy and birth.
As a pelvic floor physiotherapist, I’ve often felt like there should be an additional chapter at the end of any birth prep book with the real truth about what to expect early postpartum. Maybe it comes with a trigger warning and can be up to the individual when exactly they choose to read it, but not talking about this stuff does a huge disservice to individuals going through something HUGE. So when it comes to postpartum recovery and movement, where do we begin?
Here are some of the main topics I like to call The Basics. I usually like to discuss these with pregnant clients getting ready for their early postpartum recovery as they are key to understanding our guidelines and boundaries around movement postpartum.
1. What’s the 6-week mark all about anyways?
2. Why aren’t things working that well?
3. What is safe to do during these early days?
4. How do I know if I’m doing too much?
5. The grand finale
1. What’s the 6-week mark all about anyways? Cue in: Healing Physiology
Why are we told to wait 6 weeks anyway? Well, imagine yourself as a tiny tissue sample in a petri dish in a lab. Under a microscope, the whole cycle of tissue healing from acute inflammation (5-10 days), proliferation (closing the wound), and remodelling (making the tissue resilient again) takes about 6 weeks or more.
Cool! The problem is that you are not an undisturbed petri dish. As a new parent, you may be short on time for sleep and proper self-care. You may also be feeling overwhelmed about how you feel physically and emotionally while navigating the unfamiliar territory of a newborn. Unfortunately, stress and healing don’t go well together. Truthfully, I hate this imposed “ready” date because no one is actually feeling fully recovered from birth, let alone ready to workout (or have sex?!) come the 6-week mark. Just remember, you are more than a petri dish and that is A-OK!
2. Why aren’t things working that well?
First, let’s cover a quick lesson. Our core and pelvic floor muscles create a pressure canister inside your trunk (see image). These muscles work together to contain intra-abdominal pressure and support pelvic organs when you laugh, cough, sneeze, stand, carry a baby, etc. No matter the method of your delivery, it’s important to remember that postpartum, your abdominal and/or pelvic floor muscles have sustained a muscle injury. To be frank, your pelvic floor probably won’t be doing a very good job at feeling supportive or holding in pees or farts (maybe poos) at the beginning – and that’s okay! Would we expect a torn bicep to be able to do bicep curls? No! With time, and progressive strength, things will start to feel much much better, especially with help of these tips below.
3. So what is safe to do during these early days
Rest: Remember that just standing up increases the pressure and demand on your core and pelvic floor. Consider spending the first few days (or week) in bed or resting to offload these injured muscles. A helpful rule of thumb is the 555 rule:
- First 5 days IN the bed (get water and meals delivered to the bed baby!)
- Next 5 days ON the bed (think on top of the bed, but adding a little more mobility)
- Last 5 days AROUND the bed (think in the house, near it or on the couch!)
When did we start expecting our bodies to “bounce back” from such an intense event? Ease into it, build up to it, ask for help, give yourself SO. MUCH. TIME. Set yourself up for success! There is absolutely no rush.
Calm: When a muscle is injured, it tightens protectively. The best thing you can do in these early days is to take gentle, deep breaths to slowly relax and mobilize these parts of your body. Bonus: your wound-up nervous system LOVES relaxed breathing!
Explore: As the inflammation begins to settle, start to connect to your core and pelvic floor (think gentle kegels). This can improve circulation and neuromuscular connection which is helpful for healing and strength development. This DOES NOT mean you should do 100 kegels right after giving birth. Try introducing a couple sets of 10 mindful, gentle, relaxation and contractions, starting at like 25% intensity, and progressing over time.
I made this ‘lil Deep Breathing & PF Range of Motion video to inspire points 2 and 3.
Make space: It’s common for our bodies to feel really stiff during these early postpartum days. Gentle mobility, led by your breath, focusing on your shoulders, neck, and eventually hips can be so beneficial. Let your body and breath tell you what’s right for you – nothing should be fast, sharp, or painful. Here are a few picture ideas to try but feel free to follow along to this 10 min mobility video.
Kneeling Cat Cow
Sidebody Stretch & Thoracic Twists
Support your body: Posture doesn’t need to be perfect, but it really can make a huge difference in how your neck, shoulders, low back and pelvic floor feel. More slouchy overtime equals more heavy, leaky, ouchy. In standing, think: weight over your heels, nice tall spine, unclench your butt, and in sitting, use so so many pillows to bring the baby up to you rather than vice versa. Match this with some stretches and your body will love you.
Pooing: Your first poo will be scary. And postpartum constipation (and hemorrhoids!) is absolutely a thing. Be mindful of staying hydrated, eating well, positioning yourself upright with your knees above your hips and thinking about pelvic floor relaxation (on and off the toilet). Try to let it out, not push it out.
Realistic Timelines: just a brief note fo the runners who may be reading this – research shows that we should not be introducing impact activity until 12 weeks (!!) and there are sooo many good reasons for that. The 6-12 week period can be great to progressively strengthen and load your body in preparation for dynamic activity.
4. How do I know if I’m doing too much?
Considering your newfound knowledge on anatomy, function & healing, you may now get why the following symptoms make sense when we’re straining the pelvic floor beyond its current abilities.
- More leaking
- Increased heaviness during but especially after activity
- New or increased bleeding (yes it’s common for some to bleed for several weeks postpartum)
This is especially relevant when you feel ready to go for a walk outside. Walking is a humbling workout for a recovering pelvic floor and your regular neighbourhood walk might be far more than these muscles are ready for causing an increase in symptoms. Remember that this is your pelvic floor telling you that was too much, and less so that you’ve done more damage. Start with short distance, see how your body feels and build up over time. And please, don’t clench the sh*t out of your pelvic floor. Try to trust it and let it do its thing.
5. The Grand Finale
The last thing I want to mention deserves its own section—there is absolutely ZERO, I repeat ZERO pressure to get back to intercourse or sex by a certain time. You can explore that decision whenever it feels right for you. And remember, intimacy comes in many different forms and you’ve just been through a LOT. For those of you who truly don’t want to, I want to quickly explain the possible reasons why that may be:
- You just birthed a baby and your body has a lot to recover from.
- You are spending 99-100% of your time holding, soothing, nursing, and caring for a baby. More physical touch may not be something you’re in the mood for right now.
- Your nervous system is currently in a state of fight or flight to ensure the safety of this baby. When your nervous system is set to run away from a tiger, it’s hard to also consider being sexy, slow and unguarded.
- If you’re chestfeeding postpartum, your estrogen levels are typically lower which leads to reduced lubrication and commonly causes dryness, burning, or itching with intercourse. Use lube!
- You may have just experienced a perineal tear which can feel extremely vulnerable and can be sensitive even once healed.
Know that 60% (probably more) of people 3 months postpartum experience pain with intercourse. Take your time. Ease into what feels tempting to you, and remember that there is plenty to enjoy between no sex and full penetration.
In conclusion, the first 6 weeks are really about rest, creating space and easing into your normal. Once you reach that infamous 6 week mark, visit your local pelvic floor physio to assess where your body is at. This is when the conversation of introducing movement really begins and that’s what Frank is all about.
I created the Frank Platform as an online, on-demand way to support pre and postnatal people through education and workouts. For those looking to get moving after having a baby, but wanting to do so safely, check out the Early Postnatal Basics; a 6 week program of progressive workouts to rebuild your strength from the inside out. Encompassing everything from core and pelvic floor basics to movements you’d find in most regular fitness classes, all with a focus on the fact that you just had a baby.
As a thank you for supporting Brood, click this link and use the promo code BroodstheBest to get 25%* off your first month at Frank!
Thanks for reading!
*note the discount does not apply to the 7-day free trial membership.
Photos by Erika Damberg.