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Realistic Timelines For Postpartum Recovery And Return to Exercise

by | Jun 10, 2024

This wonderful and informative post was guest-written by Austin pelvic floor physical therapist Dr. Rebecca Maidansky, PT, DPT.


Imagine if you were told that you’d be fully recovered and back to running 6 weeks after your ACL repair, a recovery known to take about a year. If those were the expectations set but at 6 weeks you were just starting to feel confident walking and maybe doing some bodyweight squats, you’d be pretty distraught about your lack of progress. You’d worry about what’s wrong with your knee, what went wrong with your procedure, if you did something to cause this abnormally slow progress, when in reality the only problem was the expectation set in the first place.

That’s the position we’re putting birthing people in leading into their postpartum recovery. Conventional guidelines are notoriously aggressive, setting so many postpartum people up to feel like something is wrong and their body is failing them.

Understanding realistic timelines for postpartum recovery is one way we can reduce the pain and suffering folks experience during their early postpartum weeks and months. In this blog post, we’ll discuss how conventional timelines set you up to feel like you’re failing, factors that play into recovery, and a more realistic timeline for recovery. Then we’ll end with some recommendations you can follow to help you reach your recovery goals.

Conventional Timelines Set You Up to Feel Like You’re Failing

Conventional timelines shared by birth workers can easily set you up to believe you’ll be “cleared” for sex and exercise at your 6-week postpartum visit, and voila, back to your previous lives you go.

Many are telling people who just spent around 9 months changing their lifestyle, posture, diet, sleep schedule, workout routine and so much more that after months of change, they should expect to feel themselves 6 weeks after birth. This fails to factor in the significance of those many months of change. But this timeline also doesn’t account for the variation between birth experiences and the incredibly personal factors that play into postpartum recovery.

This conventional expectation of 6 weeks to return to sex, exercise and generally feeling like yourself is setting you up to fail. It’s setting you up to feel like you’re behind schedule when at 5 weeks postpartum you’re still bleeding, at 7 postpartum weeks still having scar pain, or at 5 months postpartum still leaking urine when you try to run.

When someone expects to feel like themselves at 6 weeks postpartum and they don’t, they’re left to wonder what went wrong for them, when in fact the only thing that was wrong was the expectation set in the first place.

Factors That Play Into Postpartum Recovery 

To understand why this timeline of 6 weeks for postpartum recovery is unrealistic and what a more realistic timeline may look like, let’s dive into all the factors that play into an individual’s postpartum recovery. There’s a wide range of normal when it comes to postpartum recovery as a result of the wide range of factors that play into pregnancy, birth, and recovery itself.

Here are just some of the factors we need to consider when setting realistic recovery expectations:

Pregnancy complications

How you felt through pregnancy and your prenatal health status has a massive impact on postpartum recovery. Someone who had pubic symphysis pain that was so debilitating they could barely walk will likely have a different recovery than someone who was able to keep up with their workouts throughout their entire pregnancy. 

Someone who was placed on bed rest will have a different recovery than someone who was able to continue working until the day they went into labor. Health status throughout and prior to pregnancy will have a massive impact on postpartum recovery.

Mode of birth

Did you have a vaginal birth? Did you push for a long time or have a precipitous (very fast) birth? Did you have a planned c-section? Or did you have an emergency c-section? The method of birth and the specifics around the birth will impact recovery.

Birth injury

Related to mode of birth, birth injury can play a major role in recovery timelines. If you have a vaginal birth with no tearing as compared to a vaginal birth with a grade III tear and a coccyx (tailbone) injury, recovery may look very different. 

Vulvar tearing occurs in up to 85% of vaginal births. Injury to the coccyx, pelvic nerves, and hip labrum are less common but possible during vaginal birth. The presence and severity of any of these injuries can massively impact the postpartum recovery timeline.

In the case of a cesarean, there’s also variability in recovery. A planned cesarean versus an emergency cesarean can result in different levels of tissue trauma due to the pace of the procedure. Additionally, someone who pushed for hours but ended with a cesarean versus someone who had a planned cesarean will also have different tissue considerations during recovery.

Parity

How many births have you previously had? It’s not uncommon for folks to come into our clinic and tell us that their second or third recovery is totally different than their first. This makes sense, people recover differently from a first injury versus a repeat offense. For others, the second recovery is significantly easier than the first. Either way, previous birth experiences influence recovery. 

Lactation

For as long as you produce milk, your body will remain low on estrogen. Estrogen is necessary for healthy vulvar tissue. This is why many folks are prescribed topical estrogen during the postpartum period. Low estrogen can contribute to symptoms like urethral pain, urinary urgency, and frequency and pain with penetration.

If you’re producing milk, your body has not returned to its pre-pregnancy state. Folks will often report needing to modulate their diet and exercise plan to avoid impacting milk supply. All of these factors can influence recovery.

Postpartum support

Do you have family in the area or are you on your own island? Are your friends bringing you nutritious meals or are you eating goldfish for dinner? Are you able to afford a postpartum doula to give you extra rest or are you handling all the responsibilities on your own? Do you have a partner and do they have parental leave? Do you have parental leave?

The amount of support someone has postpartum massively impacts recovery. A lack of social support has been linked to increased levels of postpartum anxiety and depression and a lack of physical support can lead to higher levels of activity than your body is ready for, extending recovery timelines.

A More Realistic Timeline For Postpartum Recovery and Return to Exercise

So what’s a more realistic timeline for postpartum recovery? Accounting for all the factors above as well as the personal differences in what makes an individual feel like they have “recovered”, a more realistic timeline for postpartum recovery is 3 to 18 months, not 6 weeks.

For some, recovery means being able to sit comfortably at work and go for a walk with their little one without pain. For others, recovery means a return to competitive running or weightlifting. “Recovery” is defined by the individual who is doing the recovering. 

No matter what recovery means to you, it’s important to acknowledge that your body will be different following pregnancy and childbirth. 

Recovery doesn’t mean going back to your pre-pregnancy body. 

We can’t expect our bodies to experience something as monumental as pregnancy and childbirth and continue to look and act exactly the same as they did when we were teenagers. But we can work towards regaining strength and confidence in our ability to do whatever we want to do while addressing any existing symptoms that arise during this time.

More realistic guidelines for returning to exercise and activity after childbirth in a way that supports a healing body

  • For the first three weeks after childbirth, prioritize rest when possible. Increase walking timelines by 5 minutes per week for the first 6 weeks. Week one postpartum, limit walking increments to 5 minutes when possible. Week two, limit increments to 10 minutes. Week three, limit to 15 minute walks and so on.
  • If you experience increased bleeding, leakage, heaviness in the pelvis or pain at any point during or following activity, consider this as your sign to modify activity the following day.
  • In most cases, folks can typically begin exercises in a gravity neutral position between weeks 3-6. This includes exercises performed while laying on a mat. Weeks 3-6 can be used to work on glute, core and postural muscles. Think exercises like bridges, side lying leg lifts, bird dog. 
  • Around 6 weeks, assuming any symptoms you’re experiencing are improving and you’re feeling relatively comfortable moving, you can continue increasing your walks by 5-10 minute increments each week and begin bodyweight strengthening exercises to work on strength, balance and coordination. This can include exercises like squats, lunges and step ups.
  • After 2-3 weeks of bodyweight exercise, assuming you’re continuing to feel relatively well and exercise doesn’t exacerbate any existing symptoms, it’s typically appropriate to begin light resistance training. This can mean banded workouts, dumbbells, kettlebells at lower intensity.
  • Around 10-12 weeks postpartum and after 4-6 weeks of bodyweight and resistance training, it may be appropriate to add in impact training. This can include exercises like jump squats, box jumps, jump rope and other exercises that prepare your body for things like returning to running and higher intensity exercise.

Research on return to sport after pregnancy and childbirth remains limited. The timelines above are a combination of existing research and years of clinical practice as a perinatal pelvic health specialist.

This timeline covers the first three postpartum months and assumes someone is having minimal to no pelvic floor symptoms. It also assumes that any existing symptoms are not exacerbated with exercise. If at any point exercise begins to exacerbate symptoms, this timeline needs to be personalized and extended. 

This outline is the fastest recommended that the average individual progresses after childbirth. For many, the timeline outlined above is far too aggressive. Depending on the factors listed above and many more not listed, this timeline may feel fast or slow. It’s important to acknowledge that no matter where you are on the spectrum, your recovery is part of the bell curve of normal. There’s massive variation in recovery timelines from person to person. No two bodies or experiences are the same. No recovery is the same, either.

There is no one timeline that will fit all people, but 6 weeks will fit very few. 

What Can You Do If You’re Not Reaching Your Recovery Goals? 

While it’s true that whatever symptoms you’re feeling in the first few weeks following childbirth will likely improve with time, time is not enough to address many of the common postpartum symptoms folks experience. If you’re experiencing urinary incontinence, pain with sex, pain in or around the pelvis, heaviness in the vagina or any other pelvic health symptoms, your body may need a little more support.

If your symptoms aren’t progressing as you’d like after you give birth, it may be time to call your local pelvic floor physical therapist. While OBs and midwives specialize in keeping you and baby healthy and safe throughout pregnancy and early postpartum days, pelvic floor physical therapists specialize in restoring optimal coordination, tissue health and muscular function. We’re the ones who help get people back to moving throughout life pain-free and getting back into the gym or sports without symptoms. 

Whatever symptom you’re experiencing after childbirth does not need to be your forever. Pelvic floor physical therapy can help.


This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. 

Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal health services. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.

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A non-diet and weight-inclusive dietitian, intuitive eating coach, and body image healer. Here on the blog, I focuses on exploring intuitive eating, gentle nutrition, the complex arena of body image and feminism, anti-oppression, and all the ways these things intersect. I want us all to be free to own our appetites, and our desires, and eat really, really well. 

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