Why you can’t just “bounce back” – postpartum recovery

A woman with a baby on an exercise ball

“Having a baby will change your life forever.” I’m sure we all heard these words before we had children but didn’t really appreciate what they meant until we had our own kids to wrangle. I think the same concept applies when thinking about how pregnancy and childbirth changes our bodies. We don’t realise how much things will change until we experience it for ourselves. Instagram is full of images of “yummy mummies” looking fit and fabulous (and well-rested!) within weeks of childbirth. This might be the case for a lucky few, but for most women, postnatal recovery actually takes far more effort, time and tears than they ever realised.

It’s actually a bit odd that we think our bodies can just bounce back from pregnancy and childbirth. After any other significant body change, like an injury or surgery, we normally seek rehabilitation as a matter of course. For example, if you had shoulder surgery or even a sprained ankle, you would be given a series of exercises to restore your movement and strength, gradually progressing to functional activities. So why do we treat recovery from pregnancy and birth differently? After all, our bodies spent 40 weeks growing another human being, and to do this they had to go through some enormous changes. And then there are the changes related to childbirth…

I recently listened to trainer Tiff Hall’s TED-X talk about postnatal recovery. I highly recommend it to any woman recovering from pregnancy and childbirth. Unlike many other women in the public spotlight, Tiff Hall made a deliberate choice not to push her body hard in the early months after her son, Arnold, was born. She realised her body needed time to recover. She resisted the pressure to restrict her diet and return to strenuous exercise too early to get her bikini body back, and instead took the time she needed to get to know her son, get some sleep and work on a slow, measured and sensible recovery program. As she says, it may not have made the sexy headline, but she ultimately ended up being better for it. She terms it “bouncing forward” instead of bouncing back. I love that idea.

So, here are my top 3 reasons why you may need postnatal rehabilitation – and what you can do to help your recovery.

1. It takes time for the body to return to normal after pregnancy.

This pretty much sums it all up. There is a good reason for the term “the child-bearing year”. It takes up to 3 months for many of the amazing changes of pregnancy to revert to their normal state.

  • The uterus usually takes around 6 weeks to return to its usual size. Those little twinges you get in the early weeks of breast-feeding are the uterus contracting. While the uterus contracts, it is also shedding its lining - the lochia or bleeding you get for 3-8 weeks after delivery. This can cause some mild discomfort and fatigue as your body loses blood and other fluids.
  • Some hormonal changes can take around 12 weeks to settle back to normal, including relaxin, the hormone that makes your muscles and ligaments a little softer and stretchier. If you are breast-feeding, oestrogen levels will remain reduced for this time, which can contribute to body aches, fatigue and low mood, amongst other things.
  • During pregnancy, you had more blood circulating but a relatively lower red blood cell count, which is why some women can have low iron or anaemia in pregnancy. This can take around 8 weeks to return to normal, accounting for some fatigue.
  • Even though your body was working hard growing that little person during pregnancy, chances are you were not able to maintain your usual level of exercise. Like any other time when you stop or reduce your exercise, you lose fitness and strength. And it always seems to take longer to get it back than it does to lose it!

What can you do to help?

Make sure you give your body time to recover and try to get plenty of rest. You are probably getting broken sleep, which makes recovery slower too. Try to eat healthily and accept all offers of help! Be kind to yourself and don’t try to be Superwoman. As USA sport star Tom Brady once said, “I firmly believe that sleep and recovery are critical aspects of an effective and holistic training program.”

Build up your fitness and strength in a sensible and graduated way. Above all, listen to your body – if you feel exhausted, a short nap may be better than an hour at the gym. Nonetheless, some exercise often helps fatigue, so try to do little amounts every day, gradually increasing what you can do over time. Walking, gentle Pilates and a specific postnatal class (like Mums & Bubs Classes) can be a great way to start.

2. Your abdominal muscles don’t regain their usual length and strength immediately.

They have been stretched over 40 weeks and this also makes them thinner and weaker.

  • Most women will develop a wider space between the abdominal muscles during pregnancy but may not notice this until after they have their baby, once the tension on the muscles is no longer there. This is called diastasis rectus abdominis muscles (DRAM), or abdominal separation, and can take 8 weeks or more to recover.
  • You may notice DRAM as a funny dome shape in the belly when you try to sit up from bed or lift. Often there will be extra loose skin in the abdomen too.
  • If you have had a C-section, your abdominal muscles will have been cut through, and the surgical repair takes around 6 weeks to heal.
  • Many women notice they feel “weaker” and less supported in their abdomen and pelvis while the abdominal muscles remain lengthened.

What can you do to help?

While the abdominal muscles recover, try not to load them too much, too early. Women are told not to lift anything heavier than their baby for 6 weeks after a C-section. I think this advice should be given to all women, regardless of mode of delivery - even without being cut, these muscles will still be weaker for some time.

Start by learning how to reconnect with your core. This involves learning to engage your deepest abdominal muscles, pelvic floor and breath. You can use this core contraction for support as you lift your baby, get out of bed or do anything else that requires more support.

Learn how to integrate your core muscles with your more superficial abdominal muscles for return to strength and function. This can be done in different ways, but carefully graded abdominal exercises, such as those found in Pilates, can be one way. A Physiotherapist specialising in Women’s Health and specific postnatal classes (like Mums & Bubs Classes) can an ideal way to get you started safely.

3. Your pelvic floor muscles may have taken a battering.

  • If you have had a vaginal delivery, you probably know all about this! Even if you only had a small tear or graze, it can still feel you have had a cheese grater up your woo-ha. The pelvic floor muscles will have been stretched (and sometimes torn) during delivery, and will feel swollen and bruised for some time, just like your ankle will be swollen and bruised when you sprain it. No wonder they don’t work so well for a while!
  • You are at greater risk of damage if you had a 3rd or 4th degree tear, a large baby (4kg or more), or a forceps delivery.
  • Even after a C-section the pelvic floor muscles take time to recover. Just being pregnant puts a fair bit of stretch on the pelvic floor, and the hormonal changes during pregnancy and breast feeding can contribute to these muscles feeling weaker too.
  • Symptoms of pelvic floor dysfunction include leakage of urine, feeling a bulge or heaviness down below or trouble controlling the bowels or wind.

What can you do to help?

Pelvic floor muscle training is the best way to start. But like any exercises, they need to be done correctly, and you need to know how many, how often and when to do your exercises. It is best to see a Physiotherapist specialising in Women’s Health and Continence to help with this.

Your Physio will not only teach you how to do pelvic floor exercises correctly. They can also teach you how to use your muscles in a co-ordinated way for function, for example, when coughing and exercising. Pelvic floor exercises also need to be progressed over time, just like other exercises, to get you back to the strength and support your body needs. Some women also benefit from other forms of help, like a support pessary for prolapse or vaginal oestrogen if low oestrogen during breast feeding may be contributing to your symptoms.

So now you know why you can’t bounce back straight after having a baby. However, if you rehabilitate sensibly and gradually, often with some guidance, you should be able to “bounce forward” instead!

Stay tuned next month for advice on rehab after gynaecological surgery!

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