Postpartum Healing Beyond 6 Weeks
Mothers in the U.S. are taught one thing about postpartum healing:
It takes 6 weeks.
The truth, of course, is much more complicated than that.
Not only can your healing begin before 6 weeks, but it’s a process that often continues for weeks, months, and years after giving birth. There’s simply no clear-cut timeline for healing that we can follow.
I had years of experience working with postnatal clients and even with all I knew going into pregnancy and birth, I wasn’t prepared for my own postpartum journey.
Though everyone’s journey is different, I wanted to give you a glimpse into mine to help break the toxic myth of a magical 6-week healing.
At birth:
One day shy of 42 weeks, I pushed for 4 hours and birthed an 8lb 15oz baby boy vaginally at home with a midwife, doula, birth assistant, and my husband by my side. I did not tear and therefore did not require stitches.
Immediately postpartum:
I had difficulty walking from muscle soreness after spending the majority of my 12-hour active labor on hands and knees. I also could not engage abdominals or pelvic floor at ALL even though I did Pilates my entire pregnancy.
3 weeks postpartum:
I texted my pelvic floor physical therapist friend/colleague in a panic because I felt incredibly weak in my pelvic floor. I still couldn’t engage pelvic floor muscles, felt a heaviness that I assumed was a prolapse, and was having a hard time holding my pee, poop, and farts.
4 weeks postpartum:
I developed severe back pain because I wasn’t able to engage abdominals and was caring for a 9lb baby.
5 weeks postpartum:
I returned to my Pilates practice with one of my studio instructors. My perineum was still sore and I couldn’t sit upright without a cushion underneath. Pilates helped me coordinate my abdominal muscles and pelvic floor, and brought even more relief for my back than the massage I’d gotten that same week. My instructor had me do all the exercises on my back or standing so I didn’t have to sit up or go on hands and knees, as my wrists were very sore from holding my babe.
6 weeks postpartum:
My midwife had an appointment with me to check on my healing. This is usually called a “clearance,” but I loved that my midwife presented it more as a check-in on how I was healing. There was no way I was near any sort of ending when it came to my postnatal physical healing. I was still extremely sore in my perineum and vaginal area, and was still bleeding lightly, which was not alarming. The perineal tissue is JUST starting to heal on a very superficial level at 6 weeks.
My midwife also let me know that she trusted me to check my own abdominal diastasis because I know more about it than she does. (I love sharing this because it highlights how we each have our expertise as practitioners. I can’t catch babies, but I can definitely check you for an abdominal diastasis and help you heal.)
8 weeks postpartum:
When I checked myself for abdominal separation, I felt a 2.5-finger toward the top of my rectus abdominus, a 2-finger close to my navel, and a 1-finger diastasis below my navel. I continued with weekly Pilates.
4 months postpartum:
I still had a lot of pain around my vulva opening. My husband and I tried to have penetrative sex twice, and I found it incredibly painful. Sex was also emotional for me, which I wasn’t expecting. We had to go slow and I had to be extremely gentle with myself. I imagined I’d be having sex after 6 weeks, especially because a lot of sexual desire dulled during pregnancy had actually returned. However, I wasn’t physically ready to try until 4 months and still had more physical and emotional healing to do.
My experience with sex prompted me to finally make an appointment with my pelvic floor PT friend/colleague. She confirmed what I assumed: I had what appeared to be a bladder prolapse. It wasn’t severe enough for an official diagnosis, and she gave me exercises to continue strengthening my vaginal walls. I was using the words “it feels like my vaginal walls are collapsed.” She assured me I was simply healing. She also noticed there was some skin that hadn’t fully healed, which was why sex was extra painful. I made an appointment with my midwife so she could use silver nitrate on what she identified to be some small lacerations.
6 months postpartum:
Sex finally started to feel fun and pleasurable, but we still had to be careful with positioning.
10 months postpartum:
I was having trouble holding in pee and felt a lot of instability when my legs were wider than my hips. I realized I was sucking in my abdomen so that I could hide my baby weight when I was with clients, causing unneeded pressure on my pelvic floor, and therefore causing weakness and an inability to engage my pelvic floor in a functional way. I did the inner work of accepting my body as-is and then worked on diaphragmatic breathing. This helped rebalance my core system and strengthen my pelvic floor.
Note: If I’d focused on ONLY isolating kegels instead of rebalancing my breath and dynamic core system, I feel confident I would’ve encouraged more dysfunction instead of pelvic floor healing.
11 months postpartum:
For a month, I focused on allowing my low abs to eccentrically contract (expand) on the inhale, and concentrically contract (pull in) on the exhale. This was a very different experience than just sucking in my abs, and it was a lesson on practicing what I preach/teach. I saw results not just in my pelvic floor stability but in my abdominal muscle strength and function.
1 year postpartum:
I took my first ballet class. My baby stopped breastfeeding at one year, but I know I need to consider my body a breastfeeding body for another 3 to 6 months as far as being careful not to overstretch or overwork my joints. I’m careful in ballet class and don’t push myself beyond limits. Sex is pleasurable, and I’m not feeling much discomfort. I plan to see a pelvic floor physical therapist as a year postpartum follow-up.
