Taking care of yourself during the early postpartum period is often something that gets overlooked, but optimizing your physical and mental well-being will help you optimize your ability to care for yourself and your family. No matter if you have had a vaginal birth or cesarean section check out the information below for ways you can optimize your pelvic health during the first two weeks postpartum.
Early Postpartum “Red Flag” Screening
Although during the early postpartum period many symptoms that are otherwise considered to be abnormal, such as urinary incontinence, pelvic discomfort and vaginal bleeding, are normal to an extent to experience it is important that you are able to recognize signs and symptoms which may warrant immediate medical attention. Check out this link for information provided by March of Dimes regarding warning signs to look out for during the postpartum period.(1)
Normal Tissue Healing Timeline
With regards to postpartum healing, a common misconception is that by the 6-week mark your body is “healed” when in reality by this time healing has only just begun. In accordance with the literature, with an uncomplicated vaginal birth the recovery time frame of these tissues is understood to be 4-6 months.(2) Additionally, following a cesarean section, the abdominal connective tissue has only regained just over 50% of its original tensile strength by 6-weeks post-surgically with 73%-93% of its original tensile strength having returned by 6-7 months. So what does this mean? What this indicates is that tissue healing is not something that is going to take a couple of weeks or even a couple of months, but by ensuring that you are taking care of yourself during the early postpartum period you will be ensuring that you will be headed in the right direction.
Toileting Behaviors
If constipation occurs, to reduce placement of further strain on the pelvic floor musculature discuss with your physician appropriate management strategies. Ensure that you are urinating and attempting a bowel movement seated on the toilet with use of a foot stool so that the knees are slightly above hip height and slightly wider than hip width. With toileting, do not bear down but instead focus on use of a belly breath to help optimize voiding ease and efficacy. Ensure that you are maintaining a good nutritious diet with adequate water intake and regular movement and activity to help maintain bowel regularity.
Reconnection with the Muscles of the Inner Core
Over the course of your pregnancy your body has made modifications to accommodate the growth of the growing fetus and help prepare your body for birth. Now that you have successfully grown and birthed a child, the recovery process can begin! During the immediate postpartum period it is important that you reconnect with the muscles of your inner core, specifically to include the diaphragm, the abdominal musculature, specifically the Transversus abdominis, and the pelvic floor musculature to optimize healing and abdominal pressure management strategies. Check out this instructional video below to learn how to perform diaphragmatic breathing properly and reconnect with your inner core!
Promotion of Spinal Mobility
With the anatomical changes that occurred during pregnancy and the change in routine postpartum that ensued due to the requirement to care and tend to a young infant, women often times may find themselves in a forward flexed posture. Research has shown that when we sit in a slumped posture, our pelvic floor muscle activity is significantly less than when we are sitting tall.(3) Additionally, slouched sitting postures decrease the activity of your transverse abdominal muscles, one of the muscles of your ‘inner core’.(3,4) This is relevant as co-contraction of the transverse abdominals and the pelvic floor muscles play a key role in enhancing bladder control.(5) Perform gentle spinal stretches in all directions during the early postpartum period to help head off some of the aches and pains that may ensue due to positional and routine changes postpartum.
Light Cardiovascular Exercise During the Early Postpartum Period
Light cardiovascular exercise such as walking has been found to be beneficial during the immediate postpartum period with benefits to include, but not limited to, reduction in risk of blood clot formation, reduced risk of development of postpartum depression, generalized strengthening and boosting one’s energy/mood. During this early postpartum period it is recommended to avoid high-impact activity and use of a stationary or road bike as part of your cardiovascular routine. Walking should feel comfortable to you, with this something that will be different for every person, but the general rule of thumb is to not walk into and/or through pain and monitor the influence of gentle, low-impact exercise on postpartum bleeding.
Conclusion
During the immediate postpartum period women are often fearful of movement thus leading to the development of maladaptive movement patterns and potentially contributing to the development of longer term pelvic health complications. During this time period it is just as important to ensure that you are taking care of yourself as it is to ensure you are taking care of your new child! And if you finding yourself with more questions than answers then reach out to a pelvic physical therapist so that they may be able to help you navigate through this time period of your life and help you optimize your pelvic health.
References:
1. Warning signs of postpartum health problems. (n.d.). Www.marchofdimes.org. https://www.marchofdimes.org/find-support/topics/postpartum/warning-signs-postpartum-health-problems
2. Goom, T., Donnelly, G. and Brockwell, E. (2019) Returning to running postnatal – guideline for medical, health and fitness professionals managing this population. [https://mailchi.mp/38feb9423b2d/returning-to-running-postnatal-guideline]
3. Sapsford, RR. et al (2006) Sitting posture affects pelvic floor muscle activity in parous women: an observation study. Aust L Physiother. 52(3):219-22
4. Reeve, A., Dilley, A., (2009) Effects of posture on the thickness of Transverse Abdominal Muscle and Pelvic Floor Muscle Exercises for Stress Urinary Incontinence: A Randomized controlled Trial. J Phys Ther Sci. 26(8): 1161-1163.
5. Kimiko T. et al (2014) Effects of Co-contraction of Both Transverse Abdominal Muscle and Pelvic Floor Muscle Exercises For Stress Urinary Incontinence: A Randomized Controlled Trial. J Phys Ther Sci, 26(8):1161-1163