From a PT: What to Know About the Early Postpartum Phase

As a pelvic floor physical therapist who works with many pregnancy and postpartum clients, I get sent a lot of questions during the first few weeks after birth. There are such huge physical and emotional transitions happening, and most people don’t really know what to expect. Coupled with the fact that every individual has a different experience, it’s hard to know what “normal” might be. So I’m going to tell you what I end up telling a lot of my clients.

Basic tissue healing takes at least 6-8 weeks

Whether you had a vaginal delivery with some perineal tearing or a C section, your body will need at least 6-8 weeks for your tissues to heal. This doesn’t mean that everything feels normal after this time frame, but that it takes at least this long for tears and incisions to close. It may take longer if you have any complications, like an infection. During this first 6-8 weeks prioritizing rest and recovery will best support this healing process. Taking care of your baby and figuring out how to do this is work enough for your body, so no need to push for a lot of activity.

This also means that it’s very hard to know yet if there are lingering postpartum problems like prolapse. Inflammation is a natural part of the healing cycle, but it can also produce swelling and discomfort early on. Feeling of pain or pressure may only be temporary. Signs of infection like fever, excessive redness, or oozing from a wound should be brought to the attention of your doctor immediately, but low level discomfort and pressure will likely resolve as your complete the healing process. After 6-8 weeks, of healing your doctor and/or a pelvic floor PT will be able to better assess any lingering issues.

It Can be normal to experience some urinary leakage in early postpartum

If you had a vaginal delivery, your pelvic floor muscles stretched immensely during birth. These muscles may struggle to function optimally right away. Muscles work best when they operate at a certain length. Muscles that are too shortened don’t work well and muscles that are too stretched out don’t work well. Your pelvic floor often needs time after birth to slowly return to a more normal length. As this happens, the muscles often start to function better all on their own and control over urinary leakage returns. And if you had any perineal tearing, then there’s also some healing that needs to happen. Muscles work best when they don’t have an inflammatory healing process happening nearby. So if you’re experiencing some urinary leakage in the first 6-12 weeks postpartum, it may resolve on it’s own. If you’re still experiencing leakage after this time frame, then your muscles may need a little retraining and you should see a pelvic floor PT.

Bellies can take quite a lot of time to shrink and settle

Many people are shocked at how they can still look pregnant for a while after they have given birth. But this can be very normal. In the first few weeks postpartum your uterus is still shrinking, so this may keep your belly enlarged temporarily. Next, consider how stretched your abdominals have been. Pregnancy keeps your abdominals lengthened for a quite a while, sometimes half of your pregnancy depending on when your belly really popped. Just like I discussed above, those muscles will take time to return to a more normal length. They may hang looser and respond less to attempts to tighten them in the first 6-12 weeks. The same can be true for skin that was stretched.

What your stomach looks and feels like in the first few months postpartum is unlikely to be what it will look like a year or more later. It can be uncomfortable to see such a striking visual reminder of how much your body may have changed, but it will keep changing as you continue your postpartum process. Everyone will progress at their own pace, and it will be different for everyone.

Postpartum Recovery Can be different for Everyone

Your postpartum recovery is unique to you. Though there are common things that many people experience, the process is ultimately very individual. You may experience completely different things than your friends, and may work through your recovery at a very different rate. Try not to compare yourself to anyone else, especially if those people are on social media. There can be wonderful information and points of connection on social media, but also glossy facades that emphasize the good without showing you the challenges. Try to tune in to what you really need, and let yourself go at your own pace.

There is help out there for you if you need it

I think a lot of people can feel anxious and unsure about what they’re experiencing in early postpartum partly because there isn’t always an obvious way to know if they need help or where to get it. But there are many perinatal practitioners out there who can help navigate this. If you’ve gone through 6-8 weeks of healing and still have issues like urinary leakage, pelvic pressure, pelvic pain, or concern for abdominal separation (read more about this HERE) then you can see a pelvic floor PT like me for help with any of these. Read more about what to expect from pelvic floor physical therapy HERE. If you’re struggling mentally or have concerns about postpartum anxiety or depression, you can see a mental health therapist who specializes in the perinatal period. If there are issues with breastfeeding you can see a lactation consultant. If you’re local to Los Angeles, I have recommendations for all of these and more! Don’t hesitate to get in touch if you need some guidance.