Postpartum physical recovery

Pregnancy can be a woman’s most transformative experience—physically, mentally, and emotionally. 

“Even with the smoothest of births, it's normal to experience some changes postpartum,” says Dr. Jennifer Lincoln, an obstetrician-gynecologist.

While most changes fall within a wide range of “normal,” many women experience physical conditions and complications that may warrant immediate attention. Knowing what to expect, and being in touch with your body, will help you adjust and adapt to the changes you’re going through in the postpartum period. 

Here’s a look at the most common conditions and how to care for yourself.

Your body goes through many changes during pregnancy, ranging from pressure on your bladder to belly expansion to hormonal shifts that can leave you feeling moody, achy, bloated, or nauseated. 

As your baby grows inside you, you may spend a lot of time thinking about and discussing the mode of delivery and immediate complications of childbirth, from pain and the risk of bleeding to the return to normal activities. Yet you may be unaware of some of the leading postpartum complications. These challenges include pelvic-floor disorders such as urinary and fecal incontinence, pelvic-organ prolapse, and sexual dysfunction. 

Pelvic-floor conditions may take decades to develop and are impacted by other factors such as body mass index, diet, constipation, smoking, and high-impact activities. Being aware of these potential long-term delivery impacts, as well as their risk factors, can help you manage them more effectively.

How your body changes during pregnancy

During your pregnancy, your uterus expands to accommodate your growing baby, and with this change comes a change in your center of gravity.

“To help keep you from tipping forward, your posture adjusts,” explains Ashley Rawlins, a Dallas-based pelvic-floor therapist at Origin Physical Therapy. “At the same time, the muscles in the back have to work harder, and the muscles in the front (your abs) are further elongated and weakened.”

Hormonal changes contribute to pelvic ligaments and joints being looser and stretchier, all of which can contribute to weakening of the pelvic floor, notes Jenny Archer, a pelvic-floor therapist.

Impact of delivery on the pelvic floor 

During a typical birth, your baby’s head comes down into the pelvis and presses against the muscles that line it. As you push, the baby’s head presses against the muscles with such great force that the normal blood flow to these muscles is temporarily cut off. Between each push, fresh blood comes in, and the muscles have time to recover. However, with prolonged pushing, these muscles and nerves can become more stressed, leading to short- and long-term damage. 

Two nerves, the pudendal and pelvic nerves, lie on either side of the birth canal and are especially vulnerable to the pressures of labor. The pudendal and pelvic nerves carry the signals from the brain to the muscles that hold the bladder and rectum in place¹. If these nerves are injured, the signals meant for the muscles around the bladder, vagina, and rectum may not be properly transmitted, which can result in a weakening of the pelvic floor.

Furthermore, research has shown that certain factors, such as a large baby, prolonged labor, a baby being in a challenging birthing position (such as “sunny-side up” or “breech”) during labor, or vaginal delivery assisted by a medical device such as forceps or a vacuum, all increase the risk of pelvic-floor disorders down the road².

Because planned C-sections avoid the stretching and tearing of the muscles and nerves that occurs as the baby's head comes through the pelvis, it is not surprising that women who have a C-section have a lower risk of a pelvic-floor disorder, such as urinary incontinence, anal incontinence, or prolapse³.

That said, a C-section doesn’t eliminate these risks, as many pelvic-floor disorders are related to pregnancy rather than labor.

“Not all women with vaginal deliveries have pelvic-floor issues, and cesarean section does come with its own set of risks,” says Dr. Michele Torosis, an obstetrician-gynecologist. “I am certainly not suggesting electing for a cesarean section with the sole intention of avoiding risk for pelvic-floor disorders.”

What happens to the pelvic floor after birth?

How your pelvic floor is affected by birth often depends on the circumstances of your pregnancy, labor, and delivery. Studies have shown that nearly 24 percent of women in the United States have at least one pelvic-floor disorder⁴. A woman’s lifetime risk for surgery for a pelvic-floor disorder is 20 percent⁵. These common conditions are seldom discussed in the postpartum period because most disorders present many years after childbirth or are brushed off as a normal part of recovery.

Three out of four women experience vaginal-bulge symptoms at eight weeks postpartum, and the bulge symptoms typically resolve within a year⁶. Issues with incontinence are more likely to manifest in the first five years after childbirth, while pelvic-organ prolapse typically takes 10 or more years after delivery to become an issue. 

Postpartum pelvic-floor recovery

Once your baby arrives, it takes a minimum of six weeks to heal from the experiences of childbirth. It can take the pelvic floor, organs, and pelvic joints as long as a full year to return to a pre-pregnancy state. 

“Depending on how the baby was born, most patients feel ‘back to normal’ within three to four months, with continued healing for up to a year postpartum,” Archer says. “Rest and nutrition play a big role here, with improved healing rates in people who are able to get more rest and eat more nutritious foods postpartum.” 

Pelvic-floor exercises can also help facilitate your pelvic and abdominal recovery, regardless of how challenging your pregnancy or birthing experiences may have been.

Pelvic-floor exercises, which include stretches and breathing methods, can help support improved bladder, bowel, and sexual functions.

"When restoring a happy and healthy pelvic floor, we should focus on so much more than just strength; we want balance,” Rawlins says. 

“To best support bowel, bladder, and sexual function—as well as all of your normal daily activities—we need muscles that have appropriate endurance, coordination, flexibility, and even speed (think: the quick reaction that is needed for those unexpected sneezes!),” Rawlins adds. “This is especially true in the postpartum period, when your body and your muscles have been put through the ultimate test.”

Risk factors and mitigators for postpartum incontinence

Vaginal deliveries—particularly with a first child—are largely unpredictable and uncontrollable. No two moms have the exact same experience, and physicians may deem certain procedures necessary in certain childbirth situations. That said, certain childbirth events have a reputation for increasing your risk of developing postpartum incontinence, and there are certain things that can minimize these particular risks when in labor. These events (and mitigators):

What to do about a weak pelvic floor

If you’re experiencing any of these symptoms, or just don’t feel right in your pelvic region, contact your health care provider, or bring your symptoms up during one of your postpartum visits. There are many solutions to remedy a weak pelvic floor, including Kegels, or pelvic-floor muscle resistance training, as well as working with a pelvic-floor physical therapist who can create a specific plan for you. 

How to find a pelvic-floor physical therapist

Finding a pelvic-floor therapist might not be as easy as it seems, especially if you live in a rural part of the country. Your doctor might recommend one that is affiliated with your hospital or medical network, or you can work with a PT at Origin, which has five physical locations in Los Angeles and also offers virtual visits that you can do from the comfort of your home (something that definitely comes in handy during those first few years with a little one).

Your pregnancy-oriented doctor visits don’t end with giving birth. You can expect to have two important postpartum appointments—about two and six weeks after delivery, respectively. Whether you’re looking forward to them, or they seem like extraneous items on your overloaded to-do list, these are key opportunities to talk to your doctor. Do not blow them off.

Going to the doctor might be the last thing on your mind or seem unnecessary, especially if you feel pretty good, or don’t feel that you have any extenuating healing circumstances or medical issues that need immediate attention. However, the American College of Obstetrics and Gynecology recommends seeing your obstetrics provider in the first three weeks after delivery, and most OBs increasingly recommend an in-office follow-up two weeks postpartum. 

At your postpartum visits, your doctor or midwife will check on your physical, mental, and emotional health, but you’ll also have a chance to ask questions about your labor and delivery, as well as your recovery. From breastfeeding to sleep (or lack thereof) to parenting methods to what is (and isn’t) normal with your physical or mental recovery, anything is fair game.

While there isn’t much you need to do before your postpartum visits, there are ways to prepare for them.

“It's a great idea to have your top questions written down so you don't forget them,” says Dr. Jennifer Lincoln, an obstetrician-gynecologist. “Between sleep deprivation and ‘mom brain,’ it can be hard to keep it all straight!”

Dr. Michele Torosis, a female pelvic medicine and reconstructive surgery fellow at UCLA Health, shares her answers to the common questions that come up with her patients at these checkups. 

Postpartum appointment guides

These visits are important opportunities to address your challenges and concerns, from managing pain to planning for a future pregnancy. Here are some questions to come prepared with—and a preview of responses your provider might have for you.

Here’s what you can expect from your postpartum visits and how to optimize the time spent with your provider. 

Physical exam

One of the most fundamental purposes of the postpartum visits is to assess how you’re physically recovering. Your doctor will perform a pelvic exam to make sure that any vaginal lacerations are healing—and that your uterus is shrinking back to its pre-baby size, which will happen whether you delivered vaginally or via C-section. 

You might be wondering about your uterus—or maybe your body’s shape in general. Don’t worry if you still feel about six months pregnant. According to Dr. Lincoln, it usually takes about six weeks after childbirth for your uterus to return to its normal size (about the size of an apple). 

After your doctor or midwife finishes the physical exam, it’s a good time to ask questions about any symptoms you’ve been experiencing, such as bleeding, blood clots, constipation, hemorrhoids, or urinary incontinence. Most of these symptoms are par for the course, when it comes to recovery, but it still may be comforting to hear that from your doctor. 

Contraception

Your doctor will likely broach the subject of contraception, if not at your second-week postpartum visit, then at your sixth-week postpartum visit. While getting pregnant again might not be the first (second, or tenth!) thing on your mind, it’s important to discuss the possibility. In fact, the American College of Gynecology (ACOG) warns against women getting pregnant in intervals shorter than 6 months¹. Not to be too alarmist, but there are risks to be aware of.

“Pregnancies that are conceived in this short interval are at slightly higher risks for complications like preterm birth and, if you've birthed by cesarean, for uterine rupture as the scar has not had time to fully heal,” says Dr. Lincoln.

There are a few things to consider regarding contraception, however. “If you are exclusively breastfeeding, lactational amenorrhea may be a form of birth control for you, but review this with your provider to ensure you meet the criteria for it to work best,” says Dr. Lincoln. And believe it or not, your period may return as early as your sixth postpartum week, so depending on your situation, contraception may be your best bet to prevent a pregnancy so soon².

Dr. Lincoln tells her patients “estrogen should be avoided in breastfeeding until milk is well established, and even then can potentially interfere.”³ Never fear, though. Plenty of birth control methods are safe after pregnancy. These include:

If you’re breastfeeding, your provider can discuss methods that won’t interfere with your milk supply.

Mental health

A big portion of your postpartum visit should be dedicated to discussing how you’re feeling, mentally and emotionally. Having a baby is a giant life transition, and it’s going to be at least a little bumpy. It’s incredibly normal to experience what’s called the baby blues, or feelings of sadness that accompany the postpartum period. In fact, 70 percent to 80 percent of moms experience this very thing⁴.

Baby blues might feel like mood swings: One moment you’re elated that you’re finally holding your sweet baby, while the next you may feel tearful for seemingly no reason. Don’t worry—this fluctuating state of emotions often subsides after a few weeks, but mention it to your doctor if it doesn’t, or if it gets worse. It’s possible that your baby blues might fall into the category of a perinatal mood and anxiety disorder (PMAD), often collectively referred to as postpartum depression or anxiety. PMADs are more serious than baby blues, persist beyond the first few postpartum weeks, and typically require medical treatment.