The six-week post-partum visit is an important time to check in with your obstetrician, midwife, or other birth care professional to ensure that your body is properly healing after such a momentous physical event. Often however, women feel lost after this follow-up visit about how to help their bodies to continue healing. The belief that everything is supposed to be ‘normal’ at this point may not be made explicitly. Unfortunately, many women receive the impression, usually through no one’s fault, that they should feel normal and back-on-track not only physically, but mentally and emotionally at this point in their recovery....
The truth is that there is still so much healing that often needs to happen after the post-partum six-week timeframe. Whether your baby is your first or your fifth, your body needs periods of rest and recovery, and this timeframe plus methods of reintroducing activities looks different for each woman. To re-iterate: Every birthing experience is unique, and so this can look different for each woman, or even between different births for the same woman.
Many women’s bodies naturally recover. This is wonderful news, as sometimes it is not the message we receive through popular media, and because of the plethora of well-meaning post-partum programs suggesting that you need to boost your body with a particular program or you won’t recover properly. A woman’s body comes equipped knowing how to recover after childbirth. While this is true, because of so many variabilities in the birthing process, unforeseen complications, and unknown variables, physical (and emotional) injury can occur that would benefit from some guidance.
Being a women’s pelvic health physical therapist, I am a little biased, as I believe every woman should have a post-partum physical therapy visit. And, in other countries such as France, this is standard care for all women after childbirth (!!). However, in the United States, it is important for a woman to advocate for herself in order to receive this care.
So, what topics you can you address with your childbirth provider at your post-partum check-up to help you and your health care provider determine if you need physical therapy and advocate for a referral:
1) Bladder Leaking
Bladder leaking, or incontinence can be a symptom of change in the bladder position due to the childbirth process, pressure changes in the abdomen post-labor and delivery, prolapse, or other possibilities. The important point is that it is not normal. You may often hear of many women leaking urine after childbirth, and brush it off as a ‘badge of honor’ for delivering her baby; something she has to live with from her birthing experience. The truth is that many times post-partum bladder leaking or irritation can be conservatively managed, reduced, or even resolved with physical therapy.
2) Pelvic Floor Muscle Weakness
As your provider to check your pelvic floor muscle strength. While they are performing an internal vaginal exam to check for female organ healing, they can also ask you to squeeze the muscles of your pelvic floor to determine the strength. This is not always performed in the post-partum check, but you can ask them to do so as a screening tool. The muscles can be weak, or sometimes too tight after birth for a variety of reasons. Either way, left unchecked, pelvic floor muscle dysfunction may lead to a variety of other issues down the road.
As your provider to check for prolapse, which is a laxity in the vaginal wall, in the front or back, due to stretching of tissues that can happen with the birthing process. This is actually a common issue and there is help for it. Many women fear “prolapse” as a dreaded, unresolvable issue that will require them to stop doing everything they love for the rest of their life. This is simply untrue. There is help for prolapse, and while it can take time, it does not define a woman, her femininity, or her body confidence. Read this as: You are NOT broken if you experience pelvic organ prolapse. The earlier it can start to be addressed, the better, and with the 1-1 help of a pelvic health PT, or other post-partum professional trained to work with it, you can train to do anything you loved doing before. Many women with prolapse return to activities they love including CrossFit, long-distance running, and pretty much anything in between that you can think of.
4) Diastasis Rectus Abdominis (DRA)
DRA, or separated abdominals, is a common condition after the birthing process in which the belly has some midline separation vertically along the connective tissue in the lower part of the trunk. Your birthing professional can check this by having you lift your head while laying down and noting if you have a width to this gap that is greater than 2-2.5cm (or finger widths). Often DRA heals on its own, bu sometimes it doesn’t. This topic deserves a whole post of its own…and day-long courses are taught on it…so I will barely skim the surface in a few lines.
So much about what we know and don’t know about DRA is evolving. What we do know is that “closing the gap” so it looks better is not the primary purpose for addressing it. What is more important is if you can generate proper pressures in your abdominal cavity at the proper moments when you are doing the activities you want and need to do in lift. The other important thing if you have a DRA is if you are experiencing other symptoms with it: low back pain, prolapse, bladder leaking, to name a few. It might be a clue that pressure development in the abdomen is not quite at its best. A pelvic health therapist can help with this too.
Hopefully this post has helped you to consider issues that may increase the productivity and helpful information that you gather moving forward from your post-partum check-up. I have taken the liberty of over-simplifying some of these concepts for the sake of brevity. I also want you to know that if you feel you have any of these issues, they can be addressed. You are strong! You delivered a baby, or more than one! With skilled, therapeutic guidance, you can heal.
I would love to hear from you! How was your 6-week post-partum check-up? Did you experience your birthing professional routinely checking for these things? Are you a birthing professional who checks for these issues and discusses them with your patients? Email me at firstname.lastname@example.org to share your story.