Pregnancy - The Marvel of the Human Body
Congratulations! You supported the growth of a human for 8-9 months and gave birth to that infant, either via vaginal birth or cesarean section, and now 6 weeks later you are good to go!
Whether you have given birth yourself or not, after reading this you should say “Huh?”. Pregnancy and labor and delivery are beautiful and something that will make you marvel in awe as to what the human body is capable of but we still need to respect the adaptations that our body has made to accommodate this physiological process and the postpartum tissue healing timeline.
The “Magical” 6 Week Postpartum Timeline
At the time of your 6-week postnatal appointment your medical provider will assess you, physically and emotionally, with this appointment providing the mother with the chance to discuss any concerns they may have which may warrant further evaluation such as pelvic pain, pelvic floor dysfunction, lactation support and postnatal mood disorders. As long as everything seems to be progressing, as deemed medically appropriate, at this appointment your provider will provide you with medical clearance with release back to work, previous exercise regime and penetrative intercourse. But as many women who have gone through this experience may remember, at 6-weeks postpartum you may still feel far from your antepartum self. The secret is… THIS IS NORMAL! So, let me explain why…
Postpartum Tissue Healing Timeline
The rate of tissue healing, from skin to muscle to connective tissue, is influenced by the degree of tissue damage therefore an exact timeline for recovery is unique to each individual based upon multiple factors related to pre-pregnancy comorbidities, pregnancy experience and labor and delivery mode and complications. You will see in the table below the approximate timeline for tissue recovery and more importantly the variability, paying close attention to the timeline for tissue recovery of skin, subcutaneous tissue (SQ), fascia (connective tissue) and muscles. (1)
During pregnancy and vaginal delivery, the Levator hiatus, the opening between the sling-like pelvic floor muscles which the infant exits during a vaginal birth, widens to accommodate birth with the recovery timeline for these tissues, not taking into consideration any complications, believed to be 4-6 months. (2)
Following a cesarean section ultrasound studies have found that uterine scar thickness is still increased at 6-weeks postpartum therefore suggesting that the process of tissue recovery extends well beyond the traditionally accepted 6-week mark. (3) Further research has found that after cesarean section the abdominal connective tissue (fascia) has only regained 51%-59% of its original tensile strength by 6-weeks with 73%-93% regained by 6-7 months postnatal. (4)
So What Does This Mean For Me Postpartum?
Returning to the beginning of this post, there is not one specific timeline which is recommended for all women to follow postpartum to enable a safe and successful return to exercise. What this does mean is that in accordance with our current body of literature, which is forever evolving, 6 weeks is not enough time for our body to heal postpartum. The current recommended timeline for return to running is 3-6 months postpartum, at the earliest. (5) There are not currently any specific recommendations regarding timeline for return back to resistance exercise but the general consensus among musculoskeletal experts is to initiate light resistance beginning 6-8 weeks postpartum with body-weight resistance only to be utilized prior to this timeline.
If you have read this blog and still have a laundry list of questions, know that this is normal and to be expected for as I have indicated, not every woman should progress postpartum in accordance with the same timeline. If you have additional questions and/or want to make sure that you are able to return back to exercise safely and effectively that is where we can help! Contact us today to set up an evaluation with a pelvic health physical therapy specialist so that we may be able to help you accomplish all of your goals, fitness-related and not, and most importantly enjoy this precious time in your life!
References
Kirkby Shaw, K., Alvarez, L., Foster, S. A., Tomlinson, J. E., Shaw, A. J., & Pozzi, A. (2019). Fundamental principles of rehabilitation and musculoskeletal tissue healing. Veterinary Surgery, 49(1), 22–32. https://doi.org/10.1111/vsu.13270
Stær-Jensen, J., Siafarikas, F., Hilde, G., Benth, J.Š., Bø, K. and Engh, M.E. (2015) Postpartum recovery of levator hiatus and bladder neck mobility in relation to pregnancy. Obstet Gynecol 125, 531–539.
Hamar, B.D., Saber, S.B., Cackovic, M., Magloire, L.K., Pettker, C.M., Abdel-Razeq, S.S., Rosenberg, V.A., Buhimschi, I.A. and Buhimschi, C.S. (2007) Ultrasound evaluation of the uterine scar after cesarean delivery: a randomized controlled trial of one- and two- layer closure. Obstet Gynecol 110, 808–13.
Ceydeli, A., Rucinski, J. and Wise, L. (2005) Finding the best abdominal closure: an evidence-based review of the literature. Curr Surg 62, 220–5.
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]