Pregnancy comes with a lot of monitoring, at least for people with access to prenatal care. Ultrasounds, genetic screening, glucose tolerance tests, fetal monitoring—the list goes on(1). Once you give birth, chances are you won’t see an OB or midwife until 6-8 weeks afterward, leaving a huge gap in your healthcare. Even then, most people are told at this follow-up appointment that they are “cleared for all activity." What does that even mean? It doesn’t make logical sense that after the seismic shifts of pregnancy, labor, and birth, you can simply pick up where you left off. Maybe you used to enjoy running a few times a week, but most people should NOT start running 6-8 weeks after giving birth(2).
This is where we need to differentiate between medical assessment and functional assessment. Postpartum checkups are focused on medical complications related to pregnancy and childbirth(3). “Cleared for all activity” means that having penetrative sex won’t compromise your physical healing. It means that your uterus has returned to its pre-pregnancy size and location. It doesn’t mean that you feel physically or emotionally ready for sex, or that your body is ready for exercise without an increased risk of injury.
Medical screening during and after pregnancy is undoubtedly important, since growing and birthing a human alters the function of every major organ system in the body(4). And it’s true that many of these changes are reversed within weeks to months after giving birth. But changes to your muscles, joints, and the way they function can persist for years, if not permanently. Consider this: the rib cage expands during pregnancy to make room for the growing baby and may or may not ever return to its prenatal size. This can alter your breathing mechanics, as well as how your abdominal, back, and pelvic floor muscles function. (Trust me: I went from a size 32 to a 36 in bra bands, and 2.5 years postpartum I’m still a 36. RIP, all my old bras.)
This is just one example of why I tell my patients who come to pelvic floor therapy years (or even decades!) following childbirth that postpartum is forever—but it’s never too late to address lingering problems. Pelvic floor therapy addresses pelvic floor issues such as urinary leakage, painful sex, and constipation. But your pelvis is attached to a whole skeleton, and achieving optimal function also means addressing orthopedic issues such as postural changes and loss of core and hip strength that directly impact the pelvic floor.
At Pelvio, we recommend that every postpartum person be evaluated by a pelvic floor PT, even if you are having no overt pelvic floor problems(5). We are experts in assessing whole-body mechanics for childcare tasks and safely returning to exercise.
And please don’t hesitate to reach out for a consultation if you are newly postpartum and are experiencing pain or difficulty performing daily tasks, even in the weeks before your postpartum checkup with your medical provider. There are ways we can help that don’t require internal pelvic floor examination.
If you are pregnant or have ever had a baby and want to learn more, email us at email@example.com or give us a call at 267-570-3603.
Goom T, Donnelly G, Brockwell E. Returning to running postnatal—guideline for medical, health and fitness professionals managing this population. March 2019. DOI:10.13140/RG.2.2.35256.90880/2
ACOG Committee Opinion No. 736. Obstet Gynecol. 2018;131(5):e140-150. Updated guidelines from the American College of Obstetricians and Gynecologists suggest a final postpartum visit at 12 weeks, which is an improvement on the 6-8 week checkup but still does not address persistent functional problems.
Including, but not limited to, the heart, lungs, kidneys, hormones, immune system, gastrointestinal tract, and brain. See Chang J, Streitman D. Physiologic adaptations to pregnancy. Neurol Clin. 2012 Aug;30(3):781-9.
Many European countries offer free access to pelvic floor therapy as the standard of postpartum care. See “Why French Women Don’t Pee Their Pants When They Laugh,” https://www.chatelaine.com/health/lady-bits/pelvic-floor-physiotherapy/