The 6-week postpartum mark has become known as “clearance” to return to activity, including exercise and sexual activities. This is also the time when most folks think they should begin pelvic floor therapy.

This expectation is problematic for 2 main reasons:

1)    Some postpartum moms feel like they should wait 6 weeks to do any physical activity (or are unsure what to do)

2)    Some postpartum moms will try to jump back into activities they were doing pre-pregnancy or pre-delivery that their body isn’t ready for yet, which can lead to injury, leaking, prolapse, and more.

The 6-week mark is used because of tissue healing guidelines, but nothing magical happens at 6 weeks that allows postpartum moms to just jump back into any activity they want. If they had any other surgery or major injury, they likely would be referred to physical therapy. Yet most postpartum moms still aren’t referred to any kind of pelvic floor therapy.

Some of the dialogue has changed to 6 weeks being more of the “starting point” of rehab. I don’t hate this mentality, but I also believe there is a lot you can do prior to 6 weeks to support your body and begin to rehab postpartum.

When should I see my pelvic floor therapist? 

I recommend my patients begin pelvic floor therapy at 4 weeks postpartum. I like 4 weeks because this gives time for some of the initial swelling to go down, for the family to adjust to their new addition (not that they aren’t still in the thick of sleepless nights and a lack of schedule – but they have had a chance to get to know their baby!), and I find most of my patients usually feel ready to start moving more and are excited to get started by 4 weeks postpartum.

I do not do an internal assessment (regardless of how the patient delivered) until 6 weeks postpartum. I like my patients to have clearance from their OB or midwife so we know that any tears have healed well enough to tolerate an internal assessment. And again, this allows for initial swelling to go down so we can better visualize our starting point in terms of pelvic floor muscle function.

What I DO cover at the 4-week visit is discussing their labor and delivery experience, answering any questions they have, discussing goals, watching them move, starting gentle core and functional strengthening exercises, and addressing any aches and pains they are experiencing. If they have a perineal or cesarean scar, we discuss how to care for their scar, and when to begin scar massage (for c-section moms this is closer to 10-12 weeks directly on the scar, but they can do some gentle abdominal work around the area sooner).

What can I do right away to promote healing?

There are a few simple things you can do in the first 6 few weeks to support your body and promote healing.

1)    Start moving right away. There has been some talk on social media about the “5-5-5 rule” for postpartum moms. This idea promotes 5 days in bed, 5 days on the bed, and 5 days around the bed. While well intentioned, please do not follow this guideline. We know that bed rest is not beneficial following injuries or surgeries, as it can increase the risk for blood clots and does not promote movement of fluids that is beneficial in reducing swelling.

I recently asked my Instagram audience what surprised them most in the first 6 weeks postpartum, and I had many c-section moms message me about how surprised they were by postpartum swelling. Movement will help the lymphatic system process and reduce swelling.

You can begin with short walks (think 5 minutes to start) as soon as you feel ready. Take it at a slow pace and if you have any increased pain, bleeding, or swelling, do less time/distance or walk slower the next time. You can also start with simple mobility exercises. Check out this link for a few exercises you can try.

2)    Begin breathing exercises right away. When we are talking about your “core”, picture a soda can. The top is your diaphragm, bottom is your pelvic floor, and the cylinder is your abdominal and back muscles. The core is a pressure system. As you inhale, your diaphragm lowers to pull air into your lungs. At the same time, your pelvic floor lengthens. This helps to maintain proper pressure in your abdomen. When you exhale, your diaphragm ascends and your pelvic floor muscles naturally lift. Therefore, beginning to train your diaphragm is step one in rehabbing your core and pelvic floor postpartum.

Deep breathing is also great to activate your parasympathetic, or “rest and digest” nervous system. This is important to help with digestion and relaxation postpartum. I also find that many of my postpartum mama’s come in at 4 weeks with neck and mid thoracic tightness from holding and feeding their baby. Proper diaphragmatic breathing can help reduce tension in the neck and mid back as well. Check out the video below for some diaphragmatic breathing tips and techniques.

3)    Stay hydrated. Hydration is incredibly important for healing, as well as bowel and bladder health. Constipation is common postpartum, and dehydration can make stool harder to pass. If you are breastfeeding your hydration needs are even higher, so make sure you are getting plenty of water!

4)    Eat well. If friends offer to bring meals, I recommend requesting healthy snacks and meals. If you are local to Memphis, The Kitchen Doula is an amazing resource for healthy postpartum meals. I am not a nutritionist – but I do know fueling your body properly helps with recovery. Make sure you are getting plenty of fiber and protein, and seek out help if you aren’t sure what to eat!

When should I start exercising? 

As you can see from the section above, I advocate for my postpartum patients to begin moving right away. This doesn’t mean starting a vigorous exercise or walking routine, but simply moving your body and reconnecting to your diaphragm, deep core, and pelvic floor in the first 4-6 weeks can help you prepare for more advanced functional exercises.

In general, I recommend spending the first 4 weeks on breathing, deep core (TA) activation, and gentle pelvic floor exercises.

Once you reach 4 weeks, you may feel ready to start more functional movements such as squatting and hinging, and some upper body strengthening exercises. I highly recommend seeing your pelvic floor therapist so they can assess you and prescribe specific exercises based on your activity level, current strength, and goals. I am also working on a program for what to do in the first 6 weeks postpartum, you can join the interest list for my prenatal prep courses here and get information on when this course will be available.

Please keep in mind that the advice in this blog post is for educational purposes only. I am a pelvic floor therapist, but not YOUR pelvic floor therapist. Every pregnancy, labor and delivery, and postpartum journey is unique. If your OB or midwife has recommended you wait longer to exercise or you have specific restrictions, please follow them and discuss with your pelvic floor therapist how to proceed.

If you’re interested in learning more about what I teach my prenatal and postpartum clients, join the interest list for my upcoming prenatal prep course here. Those on the interest list will get first access to the course and special discounts.

Blog post written by Dr. Alexis Hutchison, PT, DPT, OCS