The 6 Week "All-Clear" Postpartum

The 6 Week Postpartum Check: What Does “all clear” really mean?

The 6-week checkup with your OB or midwife is largely agreed upon as the point where you are medically cleared to return to all normal activities. Checking in at this point is incredibly important when it comes to catching any concerning symptoms related to your pregnancy - including changes in your metabolic health (think, thyroid, blood sugar, cardiovascular system), as well as mood and mental health. There will be a check for how healing is progressing if you had any tearing or stitches with a vaginal birth or your scar is healing after a cesarean. An assessment of pelvic floor and core function is not typically part of this 6 week check - even though birth (both vaginally and by cesarean) has massive impacts on the musculoskeletal system. The all-clear for both sexual activity and exercise at six weeks postpartum can leave many postpartum women feeling lost or even nervous with regards what they can or should do - especially those who who still feel symptoms of heaviness, pressure, pain or urinary leakage. 

What happens to the pelvic floor in pregnancy

Throughout pregnancy, your body adapts to grow your baby - we gain weight, our ligaments become more lax to accommodate baby growth, posture and centre of gravity changes, all of which require a shift in our strength, endurance and postural control. By the end of pregnancy, the abdominal muscles are stretched to 115% of their resting length.

In labour and birth, the pelvic floor muscles are able to stretch 250-300% of their resting length. Recovery of these muscles and their connective tissues is thought to take atleast 4-6 months to be fully recovered. More than 6 weeks, certainly! The mobility of the part of our bladder that connects with our urethra - our bladder neck - also tends to remain higher than it was in pregnancy. This is especially true in those who had a vaginal birth, making the need for more muscular strength to support this and prevent incontinence even higher. 

What about a cesarean birth?

With a cesarean, the scar on the uterus takes time to heal and is usually still quite thick by the 6 week check in. We know that remodelling and healing continues far beyond this time. The pelvic floor is also impacted in a cesarean! Even if we don’t have a vaginal birth, a baby was still grown and supported for many months. Many people are also labouring for many hours - and even pushing - before their cesarean. Pelvic floor weakness or challenges with coordination can still be happening, even without the vaginal birth. 

How common is pelvic floor dysfunction?

Pelvic floor dysfunction in women may be as high as ¼. We know that pregnancy and vaginal birth are risk factors for dysfunction including urinary incontinence, urgency, overactive bladder, and pelvic organ prolapse etc. If incontinence is present in pregnancy, it is more likely to continue into the postpartum period.  We know that, when done appropriately, exercises that work on coordination and strength of the pelvic floor in early pregnancy tend to result in fewer pelvic floor (especially incontinence) symptoms later in pregnancy or in postpartum. Symptoms of pelvic floor dysfunction don’t always manifest right away. They can sometimes go months before becoming a concern for people and at that point we may stop associating them with birth, making it more challenging to patients to seek care or get support.

So what do we do?

The timeline for returning to activities in postpartum is going to be individual! For many women, it’s beneficial to start moving your body before that six week mark - usually this involves regaining control and coordination between our brain and body. If we worked on this in pregnancy, this is often easier to come back to in postpartum. Your symptoms, personal history with exercise and the amount of social support you have will impact what you can do. In any case, the ramp up back to regular exercise will be gradual. Getting started early seems to improve outcomes and being sedentary is actually more risky than gentle movement.

Having an assessment of your pelvic floor muscles, once you’ve had the six week all-clear, can have an impact on your confidence with movement going forwards. Many patients I see are worrried something might be wrong because they feel different. Reducing some of the fear and building a strategy around return to movement can be helpful. Addressing the health, coordination and strength of these muscles can guide your next steps in exercise. We want to make sure the core and pelvic floor are working in synchrony and not causing you symptoms.

What about returning to sexual activity?

This is often a big topic in my office. Some folks are ready right at six weeks, other’s need more time. This is so individual. Six weeks “all-clear” doesn’t mean you have to be ready. Fatigue, discomfort, mental health, feeling overstimulated with touch, being nervous etc. are all reasons why you may delay. This is valid! If you are experiencing pain due to a scar or feeling of tension, this is worthwhile bringing up to me or your pelvic floor physiotherapist. The postpartum period, especially if you are breastfeeding, can also come with vaginal dryness. Increases in prolactin cause estrogen to dip - leading to dryness and changes to vaginal tissue. Lubrication is your best friend! If this isn’t providing enough relief, hormonal options are also available. It’s worthwhile chatting with your care provider about this to get the support you need. Sex shouldn’t be/doesn’t need to be painful in any phase of life.

Your return to activities is unique to you - there’s no perfect timeline

Having a goal to return to more intense exercise is helpful for mood, overall health and even sleep, postpartum. This can be daunting for many new moms. Getting support along this journey (including having an assessment) can be so helpful. Light movement can be started early and we will want to the progression to moderate/vigorous activity to be more gradual and individualized. Your experience and recovery from birth matter, as do your preferences for getting back to exercise and/or sex. Remember to be kind to yourself - you are on your own timeline, no one else’s.

If you would like support on next steps, either while waiting for your 6 week check-up, or in the confusion after you’ve been cleared - I’m here for you. You are welcome to book a complimentary meet and greet appointment to discuss how I might support you in this new phase of your life.