Postpartum recovery timeline

Having a baby is an exciting and important life event, so you should give yourself adequate recovery time. It demands a lot of you both physically and mentally. In time, you may be ready to return to working out. Rather than focusing on what you can't yet do, at DraagKracht (literally meaning carrying power in Dutch) we focus on what you can :-)

Join our 6-week Core Restore program as a great way to start your journey back into exercise!

Women often have understandable questions when it comes to returning to exercise after giving birth:
▸ When can you start?
▸ Can you immediately go back to what you were doing before?
▸ What are the most important things you need to take into account?

There are many answers to these questions, but they can be hard to find. I've tried to compile a comprehensive list and overview of all the most important things to keep into consideration.

First, some statistics:

  • 15% – 30% of first-time mothers experience urinary incontinence
  • 50% of women who had a vaginal birth have a loss of strength and support in the pelvic floor.
  • 75% of all women who jump rope have urinary incontinence

Women who participate in high-impact activities, like running and jumping, have a higher risk of symptoms and complaints later in life (after menopause).

Women who engage in high-impact activities such as running and jumping are at a greater risk of experiencing symptoms and issues later in life, particularly after menopause.

I want to share these statistics with you not to frighten you, but to highlight the fact that problems related to the pelvic floor, such as incontinence or prolapse, are quite common. Unfortunately, these issues are often not openly discussed or are seen as a normal part of being a mother, like leaking urine when jumping.

The pelvic floor plays a crucial role during pregnancy and childbirth. It consists of a group of muscles that literally form the bottom of the body and have various functions:

  1. Supporting the organs in the abdominal cavity, including the bladder, uterus, and intestines.
  2. Controlling the opening and closing mechanisms. The sphincter muscles in the pelvic floor enable urination and defecation, as well as the ability to stop these processes when necessary.
  3. Contributing to sexual function.
  4. Being a part of the deep core system, which includes the muscle corset.

Throughout pregnancy, the pelvic floor faces many challenges. As the baby, placenta, and amniotic fluid increase in weight, the pelvic floor bears more and more pressure, leading to increased stress. Hormonal changes during pregnancy cause ligaments, tendons, capsules, and connective tissue to soften. This is necessary for the baby to pass through the pelvis during birth. However, this softening also makes the pelvic floor more vulnerable to the growing pressure. The load capacity decreases while the load (weight) increases.
During a vaginal delivery, the baby passes through the pelvic floor, causing significant stretching of both the pelvic floor and perineum (area between the vagina and anus). The muscle can stretch up to five times its normal length. In some cases, a tear or episiotomy may occur during childbirth, leading to additional damage to the muscle.
Childbirth can essentially be seen like any other sports injury, and it only makes sense that proper and careful recovery is necessary. For the purpose of this article I won't dive into diastasis, if you want to read more on that topic you can do so here.

Recovery after childbirth

So, giving birth is like a sports injury that requires recovery. Normally, when dealing with an injury, you would receive guidance and rehab from a physiotherapist, along with guidelines and a progressive schedule, right? Unfortunately, this is not typically the case when it comes to childbirth. However, guidelines have been developed based on scientific research and connective tissue repair, and I'm here to share them with you.

It is NOT wise to engage in activities like running or high-impact exercises (such as jumping, box jumps, jumping jacks, etc.) soon after giving birth. These movements increase abdominal pressure and pressure on the pelvic floor, and the muscles and connective tissue need to be sufficiently strong to handle it. You should wait at least 3-6 months before engaging in such activities, and even then, it's important to build it back up. Even elite athletes need to gradually rebuild their strength and endurance after pregnancy. Just think about the fact that each step puts approximately seven times your body weight of impact on the pelvic floor, so it requires fully recovering before exposing it to this kind of pressure is non-negotiable.

The recovery process varies greatly from person to person and is influenced by numerous factors, including how the pregnancy and delivery went, physical condition, breathing techniques, mental well-being, diastasis (abdominal separation), breastfeeding, weight, sleep patterns, and more. Therefore, it's important not to compare yourself too much with others or your previous pregnancies. Instead, focus on yourself and allow yourself the necessary time to heal. The saying '9 months in, 9 months out' is true for many reasons. Your body needs that time to heal, and trying to rush the process won't make it go any faster. In fact, it could slow things down. You're better off investing in your long-term well-being rather than pushing yourself too quickly and potentially facing setbacks as a result.

Below, you'll find a postpartum recovery timeline, which can serve as a general guideline. However, it's crucial to remember that the recovery process can be different for each individual.
Important to keep in mind: During your recovery phase, pay attention to the following possible red flags in both physical activities and daily life:

  • No pain or discomfort.
  • During exercise, your abdomen doesn't show signs of excessive coning or doming.
  • No urinary incontinence.
  • No sensations of pressure or heaviness in the pelvic floor or vagina.

You can read more about these red flags here.

0-2 weeks

▸ For the first few days after giving birth you should be prioritizing rest. It's important to stay in a flat position as much as possible to allow for proper recovery of the pelvic floor.

▸ Starting around 4 days after childbirth, you can begin doing some light mobility exercises (sorry… Dutch) and breathing exercises. These exercises focus on pelvic floor recovery through breathing and relaxation, promoting coordination between the diaphragm and pelvic floor.

▸ Avoid excessive exercise at this stage. Both the pelvic floor and abdominal muscles are still weakened and lack sufficient stamina. Gradually build up your exercise routine, starting with a maximum of once per day initially..

▸ Incorporate mobility exercises to prevent stiffness and pain in the back, shoulders, and neck.

2-4 weeks

▸ Continue focusing on pelvic floor recovery and practicing breathing exercises.

▸ You can now include short walks in your routine, but be mindful not to overdo the distance. If you feel pressure or heaviness in the pelvic floor or vagina, it's a sign to take more rest or that the walk was too long that day.

▸ f you carry your baby in a carrier, gradually increase the time you use it as it can become pretty heavy on the back and core. After the walk, perform some stretches like the cat cow and windmill to prevent stiffness and pain.

▸ Start incorporating exercises exercises that activate and strengthen your inner core

▸ Experiencing muscle soreness is normal, but if it persists for more than 24 hours or if you feel pain in the abdomen, pelvic floor, or back, it's likely that the intensity of your activities is too high.

4-6 weeks

▸ Currently, recovery of the connective tissue is only at 10-20% of its original strength.

▸ Continue walking and gradually increase the distance. If you feel comfortable, you can also incorporate cycling into your routine, either using a road bicycle or a cardio device.

▸ Expand your mobility exercises, stretches, and exercises for activating and strengthening the inner core. You can now introduce gentle exercises like bodyweight squats to your routine.

▸ Pay attention to any pelvic pain. While muscle soreness after exercise is normal, be cautious of persistent aches and pains.

6-12 weeks

▸ Pay attention to any pelvic pain. While muscle soreness after exercise is normal, be cautious of persistent aches and pains.

▸ Visit a registered pelvic physiotherapist to assess the progress of your pelvic floor and abdominal muscle recovery. Consider it as an overall check-up for your body before subjecting it to any additional exercise. This is recommended even if you have no other complaints.

▸ Continue with all the exercises mentioned earlier.

▸ Under the guidance of a pre- and postnatal trainer, you can now begin your active recovery phase.

▸ Ensure that your trainer assesses your abdominal muscles to monitor any diastasis you might have and adjust the program accordingly.

▸ You can increase the pace of your walks, aiming for a higher heart rate.

▸ Begin focusing on muscular endurance. For strength training, start with lighter weights and higher repetitions (10-20).

▸ Maintain your focus on the pelvic floor muscles and inner core. Remember to incorporate relaxation exercises for the pelvic floor muscles after training, rather than solely focusing on tightening them. You can also join a 6-week program like Core Restore.

3 – 6 months

▸ Around 4 months, the recovery of the connective tissue reaches about 75% of its original strength. However, full recovery typically takes 9-12 months.

▸ If you have consulted a pelvic physiotherapist or have no complaints, you can now begin incorporating running and high-impact activities into your routine.

▸ Before starting, it is advisable to undergo a series of tests with your pre- and postnatal trainer to assess your readiness for these activities.

▸ his series of tests aligns with the guidelines for gradually reintroducing high-impact activities after childbirth, as outlined in the document ‘Returning to running postnatal – guidelines for medical, health and fitness professionals managing this population’

▸ When engaging in high-impact activities, be mindful of the red flags mentioned earlier.

▸ When resuming running, gradually increase the intensity and duration. Remember that running demands more from your body than just being in good shape. It places a significant load on your muscles, tendons, and connective tissue, so it's important to prepare through strength training.

▸ Continue working on muscle strength, balance, overall fitness, and don't neglect your abdominal muscles.

6 – 9 months

▸ Your endurance and stamina are improving, allowing you to participate in your favorite sport without requiring modifications.

If you would like more information on getting started with maternity bed exercises or training as you progress further, please don't hesitate to reach out to us for a free consultation.

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