The magic that occurs 6 weeks after having your baby… or does it?!

“I’ve had my 6 week check… I’m good to go”

Many women are eager to exercise after having a baby. Is your driver the headspace that exercise gives you? Perhaps you are an athlete and you normally pursue exercise at a high level? Is it to help shift baby weight? Perhaps you have been comparing yourself to other mums? Scrolling through Instagram and seeing yummy mummies with amazing bodies doesn’t help with this…

Whatever your motivation to get back to exercise, more and more women are wanting to exercise soon as they can after childbirth. And do you know what, I completely get it. I have been there 3 times myself after each of my boys were born. For me, the major drivers were getting ‘me time’ back and getting that endorphin release.

Just last year, guidelines were published offering guidance on returning to running after having a baby. The guidelines were welcomed by a lot of people – me, other Women’s Health Physiotherapists, fitness professionals as well as mums themselves! I use these guidelines as a framework which very much underpins my practice.

One thing I can say is that it is impossible to give a timeframe for return to exercise that suits ALL women – we are all different, we have all been on a different journey, we all have different bodies, and we will all have different exercise goals. As a Specialist Women’s Health Physiotherapist, I have been assessing, treating and advising postnatal women for many years. I get asked these questions time and time again:

“When can I exercise again?”

“How should I build up my exercise up?”

“What exercises or movement should I avoid, if any?”

“Can I now do sit ups?”

“Am I allowed to do impact exercise?

“Can I do weight-lifting?”

If a post-natal mum asks me a question like this, I cannot answer it accurately unless I fully assess her. Without an assessment, it is impossible to give clear individualised advice. One size DOES NOT fit all!

Physiotherapy Assessment

So, if a woman wanting to return to exercise comes to clinic, what happens in order for me to give her the individualised advice that she needs? I carry out a ‘subjective assessment’ where I ask a series of questions:

  • What kind of exercise do you want to do?
  • Have you previously exercised?
  • What level do you want to get to with your exercise?
  • What was the mode of delivery – vaginal delivery / caesarean section?
  • Give me your birth story…
  • Were there any complications? If so, what were these?
  • Are you breastfeeding?
  • How are you feeling since having the baby? Are you having any problems?
  • Are you having any urgency or leaking from your bladder or bowel? Do you have any heaviness down below?
  • Do you have any other health problems / concerns?

These are just some of the questions I will ask. I use her answers to build a clear picture of the person sat in front of me.

Clearly all women will have a different story and will have different answers. Following on, I would carry out a thorough physical examination (‘objective assessment’). This would include assessing:

  • Posture and action of the diaphragm
  • Relevant functional movements and sport specific tasks for that woman
  • Strength and flexibility in the muscles around the hip, back and pelvis
  • Function of the abdominal muscles, including diastases recti
  • Pelvic floor muscles – including contraction, relaxation, co-ordination, endurance AND strength
  • For possible pelvic organ prolapse
  • The attachments of the pelvic floor (during some vaginal deliveries the pelvic floor muscles can lose some of their attachment to the bones of the pelvis)
  • The size of the opening in the pelvic floor (the medical term for this is gh+pb)

It takes around 90 minutes to complete an initial assessment. Most women then require treatment and rehabilitation over several appointments to ensure a safe return to post-natal exercise.

The risks of an early return to exercise…

So, what are the risks of a return to exercise too early? Pelvic organ prolapse, bladder problems, bowel problems, pain, worsening diastasis recti – just to name a few…

The ‘6 Week Rule’

Most women follow the standard ‘6 week rule’ and resume after their post-natal GP check. Sadly, few women actually receive a thorough assessment of their body at their GP check and are often just told that they can resume exercise.

I believe the ‘6 week rule’ can be harmful. It puts all women into the same bracket. It assumes that your body has healed, that you know how to build up / adapt / change / return to your exercise of choice. It also assumes that that all deliveries and recoveries are the same, that all women’s bodies the same and that all women are returning to the same activities.

Let’s think about a runner who has broken her ankle. Typically, her leg will have been placed in a cast, she will have been told to use crutches and will have probably been told not to weight bear on it for 6 weeks. She sees her doctor at 6 weeks and the cast is removed because her bone has heeled back together. Does she at that point start running right away? Of course not! She will follow a progressive rehabilitation programme to get back to running. This is often under the guidance of a physiotherapist. The physiotherapist will treat, guide and direct the athlete working on flexibility, strength and function. After a period of time (typically 3-6 months after the initial injury), she will be able to safely get back to running knowing that she has the strength and flexibility to do it.

So why is pregnancy and childbirth any different? No matter how ‘simple’ the birth is; there is major trauma to the pelvis, pelvic floor and abdominal muscles. Why are women not given the same attention and rehabilitation as an athlete with an ankle injury. This completely baffles me!

Finally…

In summary, there is no magic that happens at 6 weeks. Each and every post-natal woman (especially one wanting to resume exercise!) needs to have a thorough individualised assessment with a Specialist Women’s Health Physiotherapist. This assessment needs to take account of her exercise goals, her body and her birth journey in order to guide her back to exercise safely.

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