WHAT is Postpartum Rehab, and WHY should EVERY mother have it?

By Sheri DeSchaaf, PT, DPT


Most women are familiar with the common postnatal recommendation of “no exercise for 6 weeks,” or until she is seen for her postpartum check up. But is doing nothing really the BEST way to restore a woman’s body and prepare her to care for a growing child, and all the responsibilities that come with it?

After any physical trauma, minimizing strain on healing tissues is crucial to allow the body to heal and recover, and the same applies to childbirth. After any comparable athletic trauma, rehabilitation (physical therapy) would be a standard part of the plan of care – helping the patient to regain mobility and strength, and educating them on what not to do to avoid reinjury, as well as what TO do to restore injured muscles, fascia, tendons and ligaments, and regain strength and stability. After any significant surgery, such as a rotator cuff repair or knee arthroscopy, patients are immediately referred to 6-16 weeks of structured rehabilition from a qualified physical therapist. I think we would ALL classify a C-Section as significant surgery, and yet no such referral is made – mothers are simply instructed to go home and “rest” for 8 weeks, then go back to doing “whatever feels good”.

You may be surprised to discover that there actually IS specialized phsyical therapy for women to repair their bodies after childbirth. However unlike in France, where every new mother is referred for 6-8 weeks of postpartum therapy, American doctors almost never refer to PT, leaving women to sort out the myths and somehow make it back to fitness on their own.

Women in American society often feel far too much pressure to get their pre-baby body back within months of childbearing. And while we must encourage women to REST during the early postpartum phase, we should also consider that:

  1. Women HAVE to use their bodies the minute the baby is born and every minute after that – to roll over, stand up, lift and carry a 6-10lb newborn, breastfeed for long periods in various positions, and often care for older children and tend to their normal daily duties, whether or not they are “exercising”.
    The deep core muscles that have been overstretched, overloaded, strained and torn during pregnancy and childbirth often do not simply resume their perfect pre-pregnancy function and coordination. They often require careful, intentional retraining to function normally again. This does not magically happen at the 6 week time point.
  2. Every move we make as a human body requires a functional deep core system. Even something as simple as rolling over in bed requires the effective coordination and activation of more than 10 different muscles, including the diaphragm, transverse abdominis, pelvic floor, multifidi, and more superficial spinal and abdominal muscles. We need these muscles to turn back on or get stronger after pregnancy (babies get bigger, helpers go home or back to work, older children forget you just had a baby…). The key is, how do you progress appropriately in this delicate healing period, to restore normal core function and begin strengthening while promoting tissue healing and preventing injury. This is where postpartum PT comes in.

After any injury, the first task is to assess the muscles that are most impacted and restore their normal mobility, tone, and activation. Pelvic PT helps women manage and navigate pain, identify any red flags, ensure that the pelvic floor, abdominals, and other core muscles are functioning well, and that mothers are educated on proper body mechanics, posture and breathing for postpartum tasks like breastfeeding and carrying baby. After the trauma of childbirth (with about 25% currently ending in surgery), pelvic floor therapists assist mothers in careful retraining of the muscles most impacted by pregnancy and birth – the pelvic floor, transverse abdominis, superficial abdominals, and diaphragm. They help restore proper posture and breath patterns to allow a woman’s body to function in optimal alignment, avoid injury, and prepare for return to “real exercise” like running, weightlifting, HIIT training etc.

If a woman goes home from her birth experience and does nothing to strengthen her deep core muscles, retrain her pelvic floor, restore normal posture and mechanics, then the likelihood she will NOT be ready to resume exercise at the 6 week mark is pretty high. On the flip side, if she goes home and gets antsy and frustrated and starts up with her “normal” core exercises again at week 3 or 4, she is likely to hurt herself and further damage the healing soft tissues of the pelvis and abdomen. There is a safe, intentional way to restore the core and return to exercise, and it is imperative that women who want to return to rigorous exercise after their 6 week clearance take the necessary interim steps to rebuild the pelvic floor and core muscles, retrain the appropriate postural responses and breath patterns, and learn how to move optimally prior to resuming impact exercise, heavy lifting, or aggressive abdominal exercise.

There are a few things that most women will find beneficial to begin as soon as you are physically comfortable doing them, as they are natural ways to promote initial retraining of the deep core. The first one is walking. As soon as you are physically able, start walking a little more each day, focusing on good posture and deep breathing. (If you have any increased bleeding or pain, stop the activity and consult your doctor/midwife.) Second, mind your posture and breathing. When you sit, sit up straight. When you stand, stand up tall. And at all times remember to breathe evenly, never holding your breath. As you practice your posture and breathing, focus in the gentle expansion of the abdomen and ribcage with inhale, and the gentle contraction of the abdomen and pelvic floor with exhale. This focused awareness will help you get back in touch with these muscle groups while also focusing on restoring normal posture and alignment to your body.

If you’d like to learn more about safe and effective return to fitness after pregnancy and childbirth, please join us June 16th with Dr. Sheri DeSchaaf, DPT for Bellies, Bladders and Beyond.