If you’re a new mom you have lots of questions about your postpartum body— from identifying common aches and pains, to addressing how and when your body will return to “normal”. And if you were active during pregnancy, you’re anxious to know when you can safely return to exercise AND how to return to your favorite activities. Know that you are not alone! Most doctors don’t have time to cover all these topics during your postpartum checkup. Active Moms’ Club is here to help guide you.
New moms in Active Moms’ Club Postnatal Recovery fitness class had the opportunity to ask our favorite Women’s Health Specialist many hot topic, postpartum questions. The intention of the Q+A session was meant to educate and empower new moms to be champions of their own health. Perhaps you will find the physical therapist’s answers as informative as we did. You may be surprised to hear her answers!
Suzanne Badillo has over 23 years of experience as a physical therapist, and has specialized in women’s health for the majority of that time. She worked as the director of the women’s health program at the Rehabilitation Institute of Chicago (now the Shirley Ryan Ability Lab), then started her own private practice (Link Physical Therapy in Evanston) with a colleague three years ago. She is also the mother of three kids, ages 11, 8 and 7.
Did you have a c-section?
Are you experiencing pelvic pain or digestion issues?
Do you want to return to high-intensity exercise after birth?
If you said yes, to any of the above — you’ll find value in this Q+A.
Q: One of the most common questions that I always hear from moms is about pelvic pain and what is common versus normal. Can you talk about that?
A: There are a lot of things that it could be. It could be coming from their digestive system, the reproductive organs, tissue, muscles, all those things. So the questions that I would ask are what makes it worse? What makes it better? How long has it been happening?
As you know, there is quite a bit of postpartum discomfort that happens that is expected. But if you find that it’s really difficult to care for the baby, stand, bend in a certain way, or it’s hard to sleep or get comfortable, those are reasons to seek help and ask your OB or midwife what you can do about it. Even if it’s somewhat normal and expected, it could still be something that can be addressed and alleviated. As time goes on, all of your symptoms should start to get less and less.
When things are persistent, meaning it just isn’t changing or it’s continuous, even if it’s something you can tolerate (because moms can tolerate a lot of pain), those are things to get help for. It could be pelvic pain, it could be vaginal pain, it could be rectal pain. It could be very specific, like when you have bowel movements it’s really, really painful. Those are very common problems, but warrant some assessment if it seems like it’s just not getting better.
Q: I had a C-section, but I’m eager to get back to the level of fitness I used to be at. I have no pain, but should I be holding myself back because there’s recovery going on that I don’t see or feel?
A: That’s an excellent question. First of all, there are some things about physiological changes that need to happen, in terms of recovery. The uterus itself has to not only come back down to prepregnancy size over time, but also return to its pre-pregnancy location. That by itself takes at least six weeks, which is why we don’t do anything very aggressive before that six week mark, even if a mom is feeling fine.
It doesn’t mean that you shouldn’t move or be active, but avoid a lot of the higher impact, higher exertion activities those first six weeks. With a c-section I would say to wait about eight weeks because of the extent of the surgery. It’s a major abdominal surgery, even though it’s pretty routine, and there’s some healing that has to happen. Generally, as you move and walk around, gauge whether you feel some heaviness or achiness — that’s definitely a sign that you should rest. That doesn’t mean stop doing it, but maybe scale back a little bit. Getting back into things gradually is really the key, even if it feels super, super easy. This isn’t the time to have really aggressive goals to get back to where you were beforehand. It’s really about getting movement and circulation going and starting to move within a functional range with “feel good” exercises that are energizing.
We advise against doing anything with more impact for a prolonged time until at least the six week mark, and that’s across the board for all moms. There are some newer guidelines that just came out in 2019 that named specific guidelines for running and measures that moms should meet before moving on to the next step of physical activity, so that helps to know when it’s warranted to get some evaluation. These guidelines advise to wait until at least 12 weeks to start a gradual running program, because of the high prolonged impact.
Q: Let’s talk about C-section scars. What should a C-section scar feel like?
A: I had three C-sections, so I’m very familiar with the scars. First of all, the pain should be continuously getting better, and each day it gets easier to move. There still could be some prolonged sensitivity in the area for weeks, but if your daily movement is bothering you, that’s a sign that maybe we should do some more direct work on the mobility of the tissue.
As a scar or a wound heals the body starts to lay down fibers to bring the scar together, but it’s haphazard and not nicely aligned at first. That’s why it feels a bit tight initially, but as we start to move it, whether it’s with natural movements or actually massaging it, it starts to glide and slide nice and easily and starts to become more mobile. It doesn’t mean it’s going to look exactly like the rest of the tissue — depending on your genetics and skin color, sometimes the scar is still visible, but it shouldn’t feel tough to move or hurt when you move your arms or other body parts.
What you can do is put your hands on the area, start to breathe, and actually breathe into that space. Do that from day one. It’s not anything too aggressive, and it’s actually really therapeutic in some way to have that connection again with that area. If you’re comfortable with that, then you can start to put lotion on that area too, if you haven’t already. That starts to get circulation going and connect your brain with that part of the body so you can get a sense of what you’re feeling at the moment. It’s important to assess how things change. You want to look at the skin and make sure nothing looks irritated or swollen. Usually it’s after the eight week mark that we start to actually get into massaging the area. By that time the skin is fully healed.
A lot of people don’t even realize that there is an additional scar on the uterine wall, and often times it isn’t in alignment with the scar that you have on the outside. That’s why it’s important to respect that 6-8 week healing time, even if you’re feeling generally good.
Q: Once I’m past the 6-8 week recovery period and feeling good, can I go back to high intensity exercise?
A: It’s really about the pressure within your core and how you regulate that with your breathing, pelvic floor, abdominals, and the way your back is positioned. It’s more about control. If I have someone do an exercise and I can tell they’re holding their breath or pushing down or they’re leaking, or there’s pain, that means there’s something about the forces we need to look at. It might not be the exercise that’s the problem, but it might be more that their form needs to be fine-tuned before they get into high intensity exercise.
That’s why going gradually is important. Start by going through the motion of the exercise and understanding how you breathe and which muscles you activate first. Think about what you are doing functionally and what your pain level is. Once that’s established, pay attention to those things and your mechanics when you start doing higher intensity exercise.
It isn’t that there are certain exercises you can’t do, but more about how to get there safely and build up to that. Lay the foundation. Some people may feel ready to be active 12 weeks after giving birth, but that doesn’t mean that they’re physically ready to be back at the intensity they were pre-pregnancy yet.
Q: Why am I having digestive issues after giving birth?
A: Postpartum digestive issues are pretty common because our system has changed, especially after abdominal surgery. I used to see a therapist for my own digestive issues, and she would say that anything that goes on in your belly can “hijack” your digestive system, meaning it could be overly sensitive once there’s a change in the “topography.” Sometimes some of the scarring you have, even if it’s all normal and healing, can create a tightness that could also upset the digestive system. Pelvic floor issues after birth like pain or muscle spasms can also affect our bowel function. That’s something I would try to assess, and then if it seems like that really isn’t the problem or there might be other things going on, we may refer you to either a GI specialist or a nutritionist, or back to your OB if it seems related to that.
Q: What would a visit to your office look like for a new mom who is proactively seeking physical therapy?
A: First, I would try to gather information about your history and ask questions like, what is your activity and occupational background? What’s your health and birth history? What are your goals? What else should I know about your day-to-day? I would also ask questions about bladder function, bowel function, sexual function, and your activity and fitness level.
Then I would typically do a full musculoskeletal evaluation and check your range of motion, flexibility, strength, and the status of your abdominal muscles. We use ultrasound so you can see your muscles and ensure that you’re using the right muscles during exercises. With your consent, we would do a pelvic floor exam and look at strength, endurance, timing, and soft tissue mobility, not only in the pelvic floor, but also in the abdomen, whether or not you had a C-section.
There are ongoing longitudinal studies looking at women and their outcomes after giving birth over their lifespan. They’re looking specifically at pelvic floor disorders and when they start to come up. What they’re finding is things like stress incontinence and leakage peak at five years postpartum, and then prolapse peaks at 15 years post. So that’s longer than a lot of us realized. What we’re seeing is that problems can happen over time, if not taken care of early. That’s why we need to make sure we catch women early on and give them a good foundation to build on so we can prevent those problems from being inevitable. So knowing your status and knowing how to proceed is really the take home message for women who visit our office.