While women are accustomed to weekly check-ups towards the end of their pregnancy, once they actually deliver their baby the focus of care shifts from the woman to the newborn child--and while in the hospital they're provided with an overwhelming amount of information for caring for their new addition, guidelines for caring for themselves aren't so clear. Simply telling a woman to abstain from sex and asking them to schedule a six-week check-up doesn't provide them with the guidance they need as they heal, regardless of whether they've delivered vaginally or by a cesarean section, sending them down a Google-driven rabbit hole with a bevy of questions which all relate back to the same thing: the pelvic floor. Urine incontinence, back pain, and even painful intercourse all have one thing in common--they're all caused by a weakened pelvic floor.
We spoke to Marianne Ryan, PT, OCS, and author of Baby Bod: Turn Flab to Fab in 12 Weeks Flat, who discussed the importance of educating and treating women after they've delivered a child. "If the pelvic floor muscles aren't working properly, your whole stability system is off," she explained.
Not only are your muscles weaker from pregnancy, labor, and delivery, but pregnancy hormones in your system can continue to affect connective tissue for up to three months after childbirth--and even longer if you're breastfeeding. "Six weeks allows for just the initial stage of recovery. That might be enough time for any soft tissue injuries to heal, but it's not enough time for the muscles to recover, and certainly not enough time for the connective tissue to completely firm up," Ryan explains in her book.
While you may be eager to quickly jump back into a workout routine you need to first assess the current state of your stability system--or else you could wind up doing more harm than good, completely setting your recovery time back and even making your "Mommy Tummy" look worse.
Ryan offered up two tests you can do at home to assess the stability of your core and pelvic floor: the straight-leg test and the jumping test. You can first try the straight-let test as early as 48 hours after giving birth if you had a complication-free vaginal delivery. In her book, Ryan recommends doing the test on a weekly basis to monitor progress. If you've had a C-section, episiotomy or endured a 3rd or 4th-degree tear, however, you should wait until after your six-week postpartum check-up to try this self-test.
"To do the straight leg raise test you would lie on your back and raise a straight leg about 10-12 inches and then you do the same with the other leg and look for wobbling in the pelvis," she explained. "Pelvic pain either in the pubic area or the abductors of the thighs or one leg feeling heavier than the other just means that you're not totally activating your stability system."
The second test will determine if you're ready to resume more advanced exercises, like running, jumping, or lifting heavy weights: the jumping test. "With a full bladder, you stand with your feet hip-width apart, jump up and down 20 times, cough 4 times and if you don't leak, if you don't have a fullness feeling in the pelvic floor region, you're good to go and you can start doing more vigorous exercises safely."
Although many think a weakened pelvic floor is only a concern for women who give birth vaginally, the truth is that even if you had a cesarean section your organs have probably been compromised in some way. "They've been carrying a huge baby and all of the ligaments holding up all of the organs get stretched out, which can make the pelvic floor weaker," she explained. "The type of cut can throw off the whole mechanics of the core stabilization and as time goes on scar tissue develops and grows and develops restrictions of movements in the organs," Ryan explained.
A full-term pregnancy typically lasts 40 weeks so expecting to bounce back immediately after having a baby simply isn't realistic--and if you try to push yourself too hard you can actually wind up hurting yourself. What you can do, however, is ensure you're taking the right steps towards recovery, be patient, and know when to consult an expert. If you're still leaking urine months after giving birth, you're still enduring back pain and the thought of intercourse makes you shudder, it's probably time to seek out a professional. "Go for a check-up with a women's health specialist who has advanced training," Ryan said.