“Alright, everything looks good. You can have sex, work out, return to life as usual.”
These were the words from my OB at my 6-week check up. I felt anything BUT ready to jump back into bed with my partner, and I really didn’t like the grin that was on his face when he heard those words.
We have to normalize a check up for every postpartum body by a pelvic health physical therapist, and let me tell you why.
The standard 6-week mark for a postpartum OB exam is scheduled at this point in part because it takes the collagen in our tissues 6 weeks to turn over into “new” collagen. So, that magic 6-week mark is based on the idea that the tissue that tore, over stretched, or was injured during childbirth has had time to create new tissue and is now “okay.”
This does NOT mean that your hormones have necessarily re-balanced, your muscles have recovered from the impact of pregnancy or birth, your pelvic bones have re-aligned after 9 months of pregnancy, or that you are emotionally ready to partake in what can be a somewhat rigorous activity such as sex.
A pelvic physical therapy session includes a full assessment for postpartum bodies. We check posture to see if your body is still standing in a pregnancy stance. We check rib alignment and pelvic alignment, since oftentimes we find our bones still flared and open after pregnancy. Just bringing these down and back in line with each other impacts whether or not we can effectively turn on our pelvic floor and use our diaphragm with breathing and with going from sit to stand or walking up stairs, etc.
A postpartum session can include a pelvic exam that assesses the pelvic floor muscles and tissues around them. We also treat and release scar tissue from a C-Section, perineal tear, or episiotomy so that the muscles can move and stretch without pulling on scar tissue. This helps that first experience with postpartum sex go a LOT smoother. You will reconnect to your body in your session and KNOW what you are capable of and safe to participate in with your partner.
After assessing how the muscles are doing, we then retrain them to work effectively and safely. Kegels are NOT always the answer, and oftentimes can do more harm than good if we do not first see what your body is doing before beginning a pelvic floor strengthening exercise program. For many women, the pelvic floor muscles are found to be “on” more than at rest, almost like a “constant Kegel” or a Charlie horse in your vagina – ow! This can actually cause pain with intercourse, because you can’t relax the muscles enough. It may even cause incontinence because you can’t engage them when you need them, like with a sneeze or with jumping jacks (You should not be leaking during those activities. This isn’t something you just have to live with now that you’ve had a baby.) Your muscles are exhausted from this constant workout they’re stuck in. We see this more often than we actually see “weak” pelvic floor muscles.
All of this assessment and treatment is specially formulated for YOU. We spend time with you, for you, and because you literally deserve this care. If you can get started right after birth using your body the CORRECT way, you will be less likely to injure yourself, have pain or numbness with intimacy, feel defeated when you go for that first run, or set yourself up for issues down the road. It is so important to help the pelvic floor recover not only from birth, but also from being pregnant and the changes that occur over those months. This is why it doesn’t matter if you deliver vaginally or via C-Section, your body can still benefit from postpartum care to assist your healing.
And the good news is, it’s never too late! We believe once postpartum, always postpartum, and we see improvements and healing occur years later, when babies are in middle school, high school, or having babies of their own.
In France and some other countries, this care is standardized for every postpartum woman. Until the US catches on to this, we will keep telling you all that this is available, this is life-changing, and that you deserve to be taken care of since you, as a mother, are literally bringing humans into the world, one uterus at a time. Thank you for this. Let us take care of you now.