Giving birth is hard work. And it’s hard on your body. So it’s to be expected that you will need time to recover. And that’s the key — you should recover.
But too many women spend months and even years after childbirth dealing with pain or embarrassment about incontinence. They think it’s normal. That it’s just what happens to the body after childbirth.
It’s not. Physical therapy can ease pain and discomfort during pregnancy, labor, and delivery. And there are ways to treat postpartum problems so you can fully enjoy life with your new baby.
Postpartum problems can affect quality of life
Postpartum problems can be traumatic for women – physically and psychologically. We once treated a patient who had a severe laceration of the vagina and significant scar tissue that became infected. She was treated, but it remained painful. The thought of another pregnancy scared her – not just because sex was painful, but because she was worried about reinjuring it during childbirth.
We taught her some gentle yoga poses and how to use intravaginal massage to soften the tissue and ease her pain. When she became pregnant again, we worked with her throughout the pregnancy to keep the tissue soft to decrease the likelihood of tearing. She did wonderfully during and after labor and delivery.
While you may have a six-week postpartum visit with your doctor, you likely won’t see a physical therapist – in the United States anyway. Physical therapy is included in postpartum care in some countries.
We look forward to a day when this is common practice here as well. In fact, a July 2016 article in Cosmopolitan discussed how we are (slowly) waking up to the fact that women don’t have to live with these problems.
Let’s take a look at a few issues you may face after giving birth and what you can do to get back to your life again.
Confusion about exercise
For many years, women were advised not to exercise until after their six-week postpartum appointment. Recent recommendations you can start when you feel ready. But start slowly. Your body is healing. Take your baby for a walk in the stroller. Try some gentle yoga, or go swimming. Avoid cycling or high-impact sports such as running or CrossFit.
If you had a cesarean section, you will need more time to recover. Remember, you had major surgery. Talk with your doctor about what you should and shouldn’t do.
If you’re breastfeeding, try to nurse or pump before you exercise so your breasts aren’t full. Make sure you have a supportive bra with nursing pads. But don’t leave the bra on after exercise because prolonged compression can lead to a clogged duct.
And finally, stay well hydrated, especially if you’re nursing.
Your abdominal muscles have stretched. If you had a C-section, they’ve been cut. You may have diastasis recti, in which a gap between your abdominal wall muscles can cause a protruding belly. This all compromises ab function and puts additional stress on your back and pelvic floor muscles.
You need to strengthen those muscles and retrain them how to contract and properly brace yourself during daily activities.
Start with a basic position such a sitting, concentrating on posture. Then move to standing and squatting. You can even do mini squats holding your baby!
Planking is a great core exercise. This helps strengthen your abdominals and lower back in addition to your upper body and arms, which need to be strong to lift and carry your baby!
When you feel ready, start slowly with a modified version. Place your hands on the floor directly over your shoulders like you’re about to do a push-up. Rest your knees on the ground, keeping your back flat and abs tight. Your head should be in line with your back. As you progress, you can extend your legs and raise yourself up on your toes for a full plank.
Hold the plank for 10 to 20 seconds, increasing up to a minute as you get stronger.
In physical therapy, we may ask you to bring your baby to practice picking them up or putting them in a car seat. You do these things over and over, but if you do them incorrectly or you don’t have the proper strength, you could be setting yourself up for injury.
Your pelvic floor muscles may be too weak or stretched out after childbirth to support the bladder and keep the urethra (the tube urine comes through) closed.
We recommend starting gentle Kegel exercises right away. Your pelvic muscles may be a bit stunned after birth, and gentle contractions can be helpful to improve blood flow and promote healing.
Try a Kegel exercise with a lower abdominal contraction. Lie down with your knees bent and feet on the floor. Slowly inhale, then exhale. Pull your navel toward your spine and tighten the pelvic floor muscles. Repeat this 10 times two to three times a day. If doing this increases your pain, stop and consult with your physical therapist.
You may experience postpartum incontinence when you cough, sneeze, or laugh. You can retrain your timing coordination so that it once again becomes an automatic reflex with the “knack” technique, a well-timed contraction of the pelvic floor muscles.
Sit or stand tall with your chest lifted. Squeeze your pelvic floor muscles and contract your urethra, vaginal muscles and anal sphincter. Maintain this contraction as you cough. After you cough, relax the pelvic floor muscles.
A physical therapist trained in pelvic health also can advise you on lifestyle modification and hydration habits that may help.
If you had tearing, an episiotomy, or a C-section, you can begin scar massage six weeks after giving birth. Scar tissue massage stretches the tissue surrounding and on the scar so it doesn’t adhere to the underlying tissue and allows you to move freely without pain.
Start by lightly touching or stroking the scar and general area of the incision – first with your palms and then your fingertips. Talk with your physical therapist for more specific guidelines on scar tissue massage during the stages of your healing.
A physical therapist also can train you to use a vaginal dilator to relax the muscles and prepare the tissue for sexual intercourse. These devices look like tampons and come in various sizes. We’ll also teach you some relaxation strategies.
Child’s pose and deep squats also can help lengthen and relax pelvic floor muscles that may be causing you pain.
If you experience physical problems that prevent you from fully enjoying life, talk to your doctor or physical therapist. Don’t accept it as normal. Reclaim your body after childbirth!
To talk with a physical therapist about care before, during, or after pregnancy, request an appointment online or call 214-645-8300.