the gap between delivery & your follow-up visit
It all begins with an idea.
Picture this: For 10 months you’ve grown your baby, your organs were squeezed and moved around, your diaphragm which is the muscle used to breathe got pushed up and most likely stopped working as it should, the pelvic floor had to handle great amounts of pressure from the growing baby, your Abs stretched out, your posture also changes.
Finally, your bundle of joy has arrived. If you’re anything like me you’re eager to return to your post pregnancy state but it’s not that easy; your Core feels weak, your pelvic floor feels heavy, your back aches from your weakened Core and Ab muscles and newly acquired posture, it’s difficult to hold your urine and the list goes on. If you had a c section, your recovery is likely more challenging, you had major abdominal surgery, cutting through about 6 layers to get your baby out; that’s no easy feat.
Your post pregnancy follow-up dialogue with your health care provider might sound something like this:
Health care provider: If you’ve had a c-section avoid lifting anything heavy and climbing the stairs. After 6 weeks, depending on how well you’ve healed, you’re cleared for exercise.
You: Is it safe to exercise and if so, what type of exercise do you recommend?
Health care provider: Continue to do what you did before pregnancy.
Those with a vaginal delivery will be given similar advice regarding exercise, however, the difference is that they will be cleared to exercise sooner.
While some of this advice might be useful, it is vastly lacking in value. Here are some of the gaps that need to be filled:
1. Encourage postpartum women to return to exercise safely. Do not tell women to “continue to exercise as you did before pregnancy”. Recommend someone trained in Pre and Postpartum fitness to aid in the return to exercise.
2. Encourage women to see a Pelvic Health Physiotherapist
RETURN TO EXERCISE
“Continue to do what you did before pregnancy” is not good advice. Here’s why:
Depending on where you are in your postpartum journey, you might not be READY for the exercises you did before. In the past, you may have engaged in intense workouts, maybe sit-ups and jack knives, pull ups and a lot of the traditional Ab exercises. Those may be great exercises, but they’re not so great if you’re dealing with certain pelvic floor issues, diastasis recti or recovering from a c-section. Here are some things to think about before you up the intensity of your workouts:
· How’s my pelvic floor functioning? Do I leak urine when I exert myself; when I cough, laugh, lift heavy?
· Do I have a Diastasis recti?
· How’s my c-section scar healing?
· Have I learned how to properly contract my Core?
If the answer to question 1 and 2 is “yes” and “no” to question 4 you might want to reduce the intensity on exercise. You’re eager to return to your regular high intensity workouts, you want to do your regular stress relieving run, you can’t wait to lose those extra pounds you gained in pregnancy. I know how that feels BUT please take the time to ease your way back into exercise with a focus on rebuilding your Core after birth. The reality is that if you jump back too quickly into “your regular exercise program”, you run the risk of injury. If you have a Diastasis Recti, crunches and sit-ups may make your gap wider. If you have pelvic floor issues, high impact exercises like Jumping jacks could exacerbate your symptoms. Take time to establish that Core reconnection, you will eventually return to your high intensity and all the exercises you love but remember it’s all a gradual process, be patient with yourself.
SEE A PELVIC HEALTH PHYSIOTHERAPIST
Whether you’ve had a vaginal delivery or c-section, your pelvic floor was impacted in pregnancy as the growing baby would have rested on it. It is common for women post pregnancy to complain of leaking urine when they exert themselves, constantly feeling the need to urinate and feeling like they might not get to the toilet in time. Some women also complain of a “feeling of heaviness” in their vaginal area after baby. These are all indications of pelvic floor issues. Did you know that some women continue to live with these issues for up to 20, 30 years postpartum? If nipped in the bud these issues may have been avoided. That’s why I believe strongly that every woman should see a Pelvic Health Physiotherapist after giving birth. Not every woman will require pelvic floor therapy but it should be the standard to get checked by a Pelvic Floor Physio. About 90% of postpartum women I’ve contact with say that their health care providers sent them away very little info, or resources about post pregnancy aftercare. Think of how much better we could carry out our roles as mothers if we had access to that vital information, think how much more optimally we would function!
During the birth process some women experience episiotomy, tearing, sometimes tearing of the pelvic floor muscles, forceps or vacuum delivery, major surgery in the form of c-section. These are all factors that affect her health and well-being. When someone damages a tendon, strains or tears a ligament, injures their rotator cuff, has A.C.L surgery; where do their doctors refer them for further treatment? Yes! To the Physiotherapist. So why is it that women who experience significant bodily changes due to pregnancy and birth, are not being referred to Pelvic Health Physiotherapists or other specialists? Why is it that they receive little to no guidance on how to rehab and return safely to exercise after birth? There’s a huge gap in the aftercare procedure and it needs to change.
This is not an attack on health care providers, the role they play in taking care of us as we navigate pregnancy and postpartum is truly appreciated. This article is meant to raise awareness around why women deserve better aftercare post pregnancy and to help health care providers see ways in which they can improve. Kudos to those health care providers who have made the effort to educate and guide their patients through the postpartum period!
My hope is that soon the gaps discussed will become filled with valuable information for postpartum women and that it will become the standard of care for these women to be informed of their options to see a Pelvic Health Physio and other professionals in the field of postpartum rehab and recovery.