So you just had a baby? CONGRATULATIONS! Now, rehab your body like an athlete who just had ACL reconstruction. Well, not EXACTLY like that but the point is, rehab after having a baby is just as important to your quality of life and function as is rehabbing after a major orthopedic surgery. Why? Pregnancy and childbirth are beautiful and natural things that women have been doing since the beginning of human history but it is also 9 months of muscles stretching out, increased lordotic pressure on your low back, and ligaments becoming more lax, to name a few. For as long as women have been having babies, they have also been having pain and dysfunction that result from the childbearing process. Again, childbearing is beautiful and natural, but what if we approached it like we approach orthopedic surgeries? A good orthopedic surgeon will instruct you to attend a few physical therapy sessions prior to your surgery in order to learn the exercises and strengthen before you go through the surgical trauma. After the surgery, the orthopedist will IMPLORE you to follow a specific rehabilitation protocol with the guidance of a physical therapist for multiple weeks, if not months, to ensure you return to your pre-injury self. Now don’t get me wrong, I’m not saying childbearing is an “injury” or women’s bodies are fragile and on the verge of shattering during pregnancy. I believe the complete opposite! Women’s bodies are AMAZING and do incredible things….like CREATE HUMANS! We are anything but fragile. However, it is just plain science; growing a human in your body and then either pushing it out vaginally or having it surgically removed via a C-section, is harsh on the body and no matter how strong that body is, rehabilitation afterwards would do that body good! Just like even the strongest athlete will still need to follow a rehab protocol after having ACL surgery, a woman would greatly benefit from following a simple rehab program after having a baby.
Here are a few points on why I think pelvic floor physical therapy is so important for the pregnant and postpartum momma:
The pelvic floor is made up of muscles, tendons, ligaments, blood vessels, nerves, and bones just like any other joint/area of our body…so why not treat it like we do the knee or shoulder when it gets injured or stressed?
Prehab physical therapy helps the brain learn what it will need to do after surgery/childbirth when the connection is “fuzzy” : When the body goes through a traumatic event, like ACL reconstruction or vaginal child birth, the muscles around the trauma site will seize up, freeze, and stop working properly. One of the first exercises you would do in ACL rehab is a Quad set. This exercise is an incredibly simple contraction of the thigh muscle but, post-ACL reconstruction, it can be unfathomably difficult to perform. It is very helpful to already have a knowledge of this exercise prior to surgery so that when you start rehab, your brain will “remember” that exercise and you will have an easier time recruiting the muscle again. This same thought process can be applied to kegels (pelvic floor muscle contractions). If you are proficient at kegels prior to childbearing because you saw a pelvic floor physical therapist, your ability to re-recruit these muscles after giving birth will be much easier and your strength will return more quickly. Prehab has been shown to improve outcomes after ACL reconstruction. If it works on the knee joint and surrounding muscles, why can’t prehab help improve outcomes after childbirth? IT CAN and IT DOES!
In France, pelvic floor physical therapy is prescribed to every momma after giving birth, no matter what, and that is how it should be here too! Not every woman will need extensive therapy, but every woman should be checked by a physical therapist to make sure strength of the pelvic floor muscles is returning to normal and screen for prolapse and other dysfunctions that could lead to issues down the road.
We are doing a total disservice to women by telling them to “do nothing” for the first 6-weeks postpartum. Many women are told to “do nothing” for the first 6-weeks postpartum and then told they can go back to “life as usual” after the 6-week checkup. First of all, I don’t know any women who are able to “do nothing” for the first 6-weeks postpartum as they are caring for their newborn. ESPECIALLY those mommas who have other children. At the very least, momma is squatting to sit on the toilet and into and out of chairs, carrying a car-seat with their infant (for a likely total minimum of 20 lbs) around to the multitude of doctor appointments that the baby gets after being born, and bending over countless to lift baby up from where they were sleeping. This is NOT NOTHING and, most of the time, is unavoidable. So why not say, instead of “do nothing for 6 weeks”, “Hey momma, your body just went through a lot. You did great! But also, it would be really beneficial if you focused on some rehab exercises with a pelvic floor PT for these next 6-weeks so that when you are carrying that 20+lbs car seat with your baby in it, you don’t develop prolapse, incontinence, or other issues that can come up after giving birth!”
We are doing a total disservice to women by telling them to return to “life as usual” at the 6-week mark, after 6-weeks of “nothing”. On the flip side, returning to “life as usual” after following your doctor’s orders of “doing nothing” for 6 weeks can lead to injury and dysfunction. You don’t sign up for a marathon and then run it the next day (hopefully). You sign up for a marathon and then train for it for 3 months. Many women self-limit their exercise and activity as they progress in pregnancy due to discomfort and fatigue. If you stopped doing most exercise at 8 months of pregnancy, and then took the following 6 weeks off postpartum, that’s over 3 months of unusually sedentary life. Jumping right back into what you did before you were pregnant is a recipe for injury!
Pelvic floor physical therapy after having a baby is not rocket science; the wheel has not been reinvented. The only difference is that the rehab is generally in a more sensitive area of the body. The concepts around muscle healing and strength gaining are the same. Rehab your body like an athlete! It is the only body you have! It does amazing things but sometimes, it needs a little extra help along the way.
Interested in postpartum rehab? Find more information on the programs that I developed to specifically bridge the gap for the postpartum woman here: Verity Postpartum Rehab Programs