Pulling Back the Curtain on the 6 week Postpartum Check-up

6 week check-up pelvic floor physical therapy postpartum Sep 16, 2022

Woohoo!!! You made it to the 6 week postpartum check up with your midwife or OB. You are “cleared” to have sex, return to exercise,and resume life as normal! 

Stop…Wait…Rewind! 

Go put that pre-printed checklist in the trash. I mean it. It’s absolute garbage advice.

Let’s take the “6 weeks postpartum checklist” and turn it on its head. 

Yep, you heard me right, in other words let’s throw it out the window with the bathwater, but keep your baby ;)

WE ARE REWRITING THE POSTPARTUM STANDARD OF CARE!

Why is the “6 weeks postpartum check up” a thing? Well, first off, it is the time frame that your uterus and cervix should be healed from birth and any tearing or incisions should also be healed/healing very well from a medical perspective 

When you give birth to your baby, you also have to give birth to the placenta. This leaves a dinner-size plate wound in your uterus. The placenta is the organ that acts as your baby’s lungs, kidneys and liver until birth. lIt allows for the exchange of oxygen and nutrients between you and your baby while filtering out harmful waste. It is a temporary organ that grows and connects your baby to your uterus during pregnancy. The uterus (specifically the wound from the placenta) and cervix need about 6 weeks to heal from birth.

The biggest risk from 0-6 weeks postpartum is infection which is why you should wait until you have stopped bleeding and have been cleared by your Midwife or OB to have anything intothe vaginal canal.  This is true whether you’ve had avaginal or c-section birth. Other than this, 6 weeks means nothing from our perspective as pelvic rehab providers. 

Let me elaborate.

If you were to have an ACL reconstruction surgery or a rotator cuff repair, when would you start rehab? 

In the hospital and right away after!

How long would you do rehab for?

MONTHS!!!

So, who on earth thinks its a good idea to just tell Mom to go home, take care of baby, wait 6 weeks and then return to sex, exercise, and all the other things?!!? 

Growing a human being and giving birth is THE BIGGEST MUSCULOSKELETAL CHANGE OF YOUR LIFE and WE SOMETIMES DO IT MULTIPLE TIMES!!! 

As a physical therapist, I would never want to deliver someone's baby, that is not my expertise AT ALL! So why would you want your OB or Midwife to deliver your pregnancy and postpartum rehab????

AHHHHH!!!!!

It just doesn’t make sense?!? Nothing gets me more fired up!. Seriously…

This isabsolutely a total disservice to anyone who gives birth.. 

At Reborn Pelvic Health & Wellness, we are rewriting the standards of care for before, during and after pregnancy. 

What should it look like?

So glad you asked, I am going to tell you ALL THE THINGS! 

Below is what optimal pelvic health and wellness looks like before, during and after pregnancy. Remember it is never too early and it is never too late to start. Even decades after childbirth,  even if you have neither had nor want to have children, you can still benefit from pelvic floor therapy. 

BEFORE PREGNANCY - In our opinion, you should start before you get pregnant. If you have pain with intercourse, leak when you cough, sneeze, jump, run, lift etc., you can’t insert a tampon or you experience any other orthopedic dysfunction with low back pain, tailbone pain, pubic pain or SI joint pain, you belong in our office before you get pregnant. Do you have painful periods, endometriosis, PCOS? Yep, we are here for those  struggling with these conditions as well, to do the prep work before you get pregnant. It’s called pre-hab. Why wait until  problems arise , when you can work ahead of time to prepare and potentially prevent the problems from happening in the first place??

Another reason to start pelvic floor therapy before you get pregnant is to get an accurate baseline of where your musculoskeletal system is both inside and outside the pelvis before everything starts to change. We can spot things ahead of time that may need some maintenance work during pregnancy to  improve your overall experience throughout your journey. 

DURING PREGNANCY - You should also be doing pelvic rehab during pregnancy. Why? Because it is the biggest musculoskeletal change of your life! Any old injuries that you no longer notice, have healed or were thought to be a thing of the past, can begin to resurface. Pregnancy takes a magnifying glass to anything that is dysfunctional and exposes it on  a whole new level. Take for example an old SI joint injury that you haven’t heard a whisper from in over 10 years - all of a sudden it comes rearing its ugly head worse than it ever has and all you did was bend over to pick something up. 

Think of pelvic rehab as routine maintenance work that can and should be done as your body changes so that you can stay active and not get sidelined by injuries of the past.. If you want to stay active during pregnancy, we are your people! Please don’t settle for someone telling you it's “normal” and “it will go away when you're not pregnant.” It simply isn’t true and so much can be done to get rid of your aches and pains during pregnancy. Trust us on this one ;) We know that moms-to-be who regularly workout have happier and healthier pregnancies and deliveries as well as happier and healthier babies.  We want you to stay active for the health of both you and your baby.. 

BIRTH PREPARATION - We have so much to offer during this time. We love to help you prepare for birth! We want you to know how to push properly. We want your pelvic floor to be mobile and able to stretch to accommodate the baby. We want to help you get into a deep squat easily. We want to teach you about birthing positions and what is optimal for your pelvis. We want to teach you what positions to be in while you labor and how that is different from when you are pushing. We want your core and glutes to stay strong and activated. We want to help your low back, hip flexors, and pelvis be in optimal alignment for optimal baby positioning. We want to minimize the risk of tearing during delivery. We want to help you have a VBAC (vaginal birth after c-section). We want to educate you on breathing, core and glute activation so that you know what to do immediately postpartum to get things “back online” so to speak. Most importantly, we want to empower you and help you become the expert of your own body so you can feel prepared, confident and powerful during your labor and delivery.

IMMEDIATELY POSTPARTUM - We want you to take the appropriate recovery time to focus on icing, resting, swelling, pain control, and easy bowel and bladder function. We want you to be equipped with gentle mobility, good activation patterns and good body mechanics. We want you to focus on rest, sleep, nutrition and bonding with your baby. We cover all of these things before you deliver, so that the first 0-4 weeks of your postpartum journey you already know what to do, what to expect and when to reach out for help.

2-4 WEEKS POSTPARTUM - We have you come back into the clinic. We start with a full external assessment doing a full body movement analysis and diving into each area of your body: spine, rib cage, breathing, abdomen, organ mobility, diastasis recti, incisions/scars, pelvis, hips, SI joints, pubic bone, tailbone, strength, activation, movement patterns, as well as an external pelvic exam (no internal until 6 week clearance from midwife/OB and no more postpartum bleeding). We start light to moderate tissue loading, primarily the reactivation of muscles with breath work and light core/glute activation. We also start external pelvic floor mobility work. Research shows us that we should start scar mobilization around 3 weeks for optimal tissue recovery, so that is what we do. We start with gentle mobility work once the incision is fully closed, stitches are dissolved and everything looks good. 

4-6 WEEKS POSTPARTUM - We focus on progressing and coordinating exercises, meeting your body where it is most limited.. Sometimes that is pelvic floor, sometimes that is core, sometimes that is your breathing patterns and rib cage flare, sometimes that is just lack of sleep or mental health. We make sure to keep you working on the building block that needs the most support as you continue to get back to things. The reason we do it this way is to give you a solid foundation to build upon. Postpartum is an opportunity to literally be stripped down to bare bones and have to build from the ground up. When is there a better time to build the most solid foundation of movement than postpartum??? We think it is the best time to do so with a clean slate!

6 WEEKS POSTPARTUM -  Once you have been “cleared” for intercourse, meaning the uterus is  healed and the cervix is closed and things can go in the vaginal canal without risk of infection, we do our internal exam. When we do an internal exam, it is completely different than your midwife or OB. We are looking through the lens of a PT, meaning, we look at strength, range of motion, scar tissue, trigger points, prolapse, coordination, endurance and pressure management. We assess what is going on from a musculoskeletal stand point. If we saw you before pregnancy, we can compare where your pelvic floor was before to where it is now after giving birth. This gives us and you an idea of where you are in your recovery. We then get to work on the remaining things that you need worked on so that your pooping, peeing and sex life can get back to normal as soon as possible. 

PASSING THE 6 WEEK MARK - You are not magically healed to start running or lifting. It usually takes more time for you to be ready for higher level activities. Some people are unicorns and can return to running sooner than others, but our advice is to work specifically with an expert, like one of our therapists, to guide you through this process and to wait for our blessing before you return  to those higher level activities. General guidelines for return to run are at 12 weeks postpartum. We individualize this depending on your recovery, your delivery and your previous exercise experience. Some start sooner than this and some later. 

6 WEEKS TO 6 MONTHS POSTPARTUM  - This is the major time frame for building on your now solid foundation and putting in the work. We continue to load you appropriately and progressively into more advanced exercises. We focus on functional strengthening, endurance and motor patterns. We add weights, stability work, and complex movement patterns. We then work  into progressive overloading exercises like jumping, running and lifting more and more weight without dysfunction, pain or leaking.

6 WEEKS to 1-2 YEARS POSTPARTUM - We dial things in more and more with advanced training, depending on your health, fitness and athletic goals. Many people are in a very good spot 6 months postpartum, but many of us (myself included) want to get back to what we were doing before getting pregnant and have bucket list items to check off, like a marathon, ironman, or crossfit games just to name a few. We are here for it all!

BEYOND - Lastly, we are here for you for your next pregnancy/postpartum journey and for any needed tune-ups along the way. You only have one body as your vehicle for life, you can’t trade it in like your actual car, so we want to help you take care of it for a lifetime :)

We need your help to change the standards of care for before, during and after pregnancy. Can you do us a favor? Please share this blog post with a friend so that they can be educated on what the standards of care should be. ?

We thank you for your help  as we focus on changing the world one vagina at a time!

For more FREE resources please download our comprehensive guides:

 

Return To Exercises Postpartum Guide: https://www.rebornphw.com/Return-to-Exercise-Postpartum-Guide-opt-in

Return to Running Postpartum Guide: https://www.rebornphw.com/Return-to-Running-Postpartum-Checklist-opt-in

C-Section Guide: https://www.rebornphw.com/free-c-section-guide-lead-magnet



 

Do you have pelvic floor dysfunction? Let our expert pelvic health physical therapist start your journey off on the right foot! We are here to help.

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