"“After having a baby, things will never feel the same again.”
This was a sentiment I heard numerous times while pregnant. Following the experience of childbirth, I didn’t doubt this. After gaining 40ish pounds and pushing out an 8+lb baby, of course, things would be different. And while maybe my body would never be what it once was (hello, lovely stretch marks!) I wanted to do everything I could to help my body heal.
When preparing for childbirth and motherhood, I read as many articles and listened to as many podcasts that I could get my hands on. It was during an episode of the podcast Ali on the Run that I first heard of a Women’s Health Physical Therapist and pelvic floor health. In other countries (France, for example), visiting a women’s health PT is a standard part of postpartum care. In the US not only is this not the case, but it is also rarely even spoken about.
Up until this point, I didn’t know much about my pelvic floor and the important role it played in my overall health. I had never heard of a women’s health PT and was curious about how this could help in the postpartum healing period.
A few reasons women may want to make a PT appointment include Diastasis Recti (DR, separating of the abdominal muscles), bladder and bowel issues, prolapse, painful sex, back or hip pain, and general pregnancy and postpartum recovery. They can also help you ease back into working out in a safe way.
Not knowing which of these issues I might face and knowing I’d want to work out again, I decided I’d ask for a referral no matter how I felt after birth.
As should come as no surprise, I did not feel great after birth. Fast-forward to my six-week appointment, and things still didn’t feel right. I had what some refer to as the “mom pooch,” my pelvic floor felt heavy and weak, and I had other discomforts that were hard to pinpoint. I hoped this wasn’t what everyone was referencing when they said “Things will never feel the same again.” Surely, it must eventually feel better than this!
I asked my midwife for a PT referral and she was happy to provide one. Fortunately, it was covered by my insurance with just a small copay by me.
Source: @themattiejames
My First Appointment
As things go with having a baby, it took me a while to actually get myself to an appointment. At 12 weeks postpartum, I finally got there. While this felt like a long time after childbirth, some women wait years to address postpartum issues (it truly is never too late).
My appointment began with a discussion of how I was feeling and what my goals were. I knew I had DR so a major goal was to heal this and to be able to do a plank again. I also wanted to get back into running, an activity I loved but hadn’t attempted since my first trimester.
Then, we began the exam, first assessing my DR. My PT had me lay on my back with my head slightly lifted. She used her fingers to check the separation between my ab muscles as well as the depth that she could press her fingers in. I had a three-finger separation, though luckily, it was shallow. She explained that the depth was more important than the width. She had me do a couple of crunch-like exercises to see if I could properly engage my core muscles. Being able to properly engage helps with healing.
Next came the internal exam to check my pelvic floor. If you’ve been to a regular PT, this part would seem pretty unexpected, but yes, there is typically an internal portion. The PT put a finger inside my vagina, had me do a kegel, and checked if I could properly engage and relax my muscles. During this part of the exam, she was also checking for prolapse, scar tissue discomfort, tenderness, and seeing if there is one portion of the vaginal wall that is more painful than another area.
Things down there were feeling quite different than they used to, but I wasn’t suffering from any major dysfunction. My PT did recommend I go to back to my midwife to check on some slow healing issues (this turned out to be skin granulation, a not-so-uncommon issue after tearing). I wouldn’t have known to continue to follow up on this without the internal exam.
Next Steps
Based on my goals, my PT gave me a set of exercises to perform four to five times a week to help bring the gap in my abs back together. Since DR can differ widely, the exercises vary from patient to patient. It was too soon to try a plank, but I was given a set of progressions that would eventually get me there. She also gave me a set of exercises to help strengthen my pelvic floor.
Then, we discussed my return to running. The six-week appointment is typically the green light for working out, but my PT recommends that women wait until at least 12 weeks postpartum to begin running. She suggested I start with 60 seconds of running followed by four minutes of walking and to slowly build upon that over time. As someone who has been running since high school and has completed a couple of marathons, she acknowledged how hard it might be for me to start so slow, but this would be key in my healing.
Source: @lauren.michelle.photography
The Slow and Steady Road to Recovery
That slow and steady build is a major aspect of postpartum recovery. I already had the vague advice to start slow, but visiting a PT gave me the necessary tools to safely and effectively go about it.
I asked my PT who should be requesting an appointment like this. She told me that she wished all postpartum patients could have a pelvic health assessment. Every woman will experience changes during pregnancy, and visiting a PT will help you to be the best version of yourself with this new normal.
Even though I didn’t suffer from any major issues following pregnancy and childbirth, my PT visit was well worth it. It taught me the necessary steps in my healing and reassured me that things would get better.
To be fully transparent, with the chaos of new-mom-life, it has been a challenge to fit in my exercises and make it for a follow-up appointment. I do know how important it is to take the time for myself and am still working on this.
Though it may be true that things will never feel the same after having a baby, I do know that healing and regaining my former strength is possible.
Not sure if you should visit a Women’s Health Physical Therapist? Here are a few things to consider:
- It’s never too late: Whether you had your baby eight weeks ago, eight months ago, or eight years ago, now is an OK time to make an appointment. Many women go years without addressing postpartum issues. While it may be better to address the issues sooner rather than later, you can go at any time.
- No problem is too small: After the birth of my daughter, I felt like I was making a big deal out of small issues and discomforts. I thought maybe this is just the way it is, and I’d have to deal with it. I didn’t know anyone else who had visited a PT, so did I really need to? The truth is more women should be having these appointments, and even though they may not be common in the U.S., you don’t need to live with discomfort or pain.
- Your focus is on your baby, but it should also be on you: The weeks and months (and let’s face it, years) following the birth of a baby is challenging. So much of your focus is on your baby, their health, and their development. You also deserve to be healthy. Yes, you’re focused on your child, but don’t forget about you.
- Advocate for yourself: Maybe one day all women in the U.S. will be referred to a PT following childbirth. Right now, that isn’t the case. Don’t wait for your doctor to suggest it because they may never do that. If you think a visit with a PT would be beneficial, ask for it.