How long should a “normal” postnatal recovery be?

How long should a “normal” postnatal recovery be?

How long did it take you to “recover” after you had your babies? Was it six weeks? Six months? A year? When we talk about “post-natal recovery” there’s an awful lot we need to consider.

I read with interest this article from the Daily Mail in UK, which suggested that post-natal recovery timeframes are actually closer to 12 months, a lot more than generic 6 week time frame that is so often bandied about.

I think the issue here is with the definition of “post-natal recovery” – because in my opinion, there’s a lot more to it than simply waiting for your episiotomy wound to heal.

Of course, there’s the “physical recovery” – pelvic floor function and rehab, repairing any abdominal separation (diastasis recti), regaining your core strength and returning your body to a better posture and alignment, addressing any back, neck and shoulder complaints you may have from pregnancy or constantly lifting and carrying your baby, plus whatever other physical issues may have cropped up for you. This is all really important if we want our bodies to be functional for the next 60 odd years, and to not be reliant on incontinence pads in our 40s.

When did you feel "back to normal"?

When did you feel “back to normal”?


Then there’s the “emotional recovery” – adjusting to the role of motherhood and all the feelings that come along with it: fear, anxiety, bewilderment, helplessness, overwhelm, concern, failure, confusion, anger, loss, and guilt that can go along with this. Not to say that all our emotions are negative. There’s also love, joy, passion, gratitude, purpose, connection, fulfilment, and so much more. But you know what – these emotions can be overwhelming too – and it can take us a while to settle into these new feelings and emotions as well.

And what about the “social recovery” which I think is often forgotten, but which can be really challenging for so many women. Adjusting to changed relationships – with your husband or partner, your friends, your own mother. Adjusting to no longer being a worker or bringing in an income. Navigating the maze of postnatal and baby services and making new friends. Redefining who you “really are” now that your a Mum. Feeling like you’ve lost your own identity. Feeling trapped or unable to escape. There’s a lot that happens in the social front – these are all challenges and women often need support to adjust to these changes.

So bearing all of that in mind – how long would you expect it to take to “recover” from childbirth? It’s an intensely personal experience, and it’s about so much more than whether or not you’re “all healed down there”. Some women bounce back from childbirth straight away – both physically and emotionally. Others may take longer to sort through the emotional challenges, others may not notice the physical challenges until after they have their second baby. Some might not notice issues until they decide to go back to work, or until their children start school.

It’s not a precise science, and there’s a lot of factors to consider. But for the majority of women, their postnatal “recovery” continues much longer than their 6 week post baby check up!

Here’s my top five tips for supporting your postnatal recovery:

1) Realise that postnatal recovery involves a LOT of different factors

It’s so much more than just losing the baby bump. I mentioned all the factors above that have an impact on how well we “bounce back” after birth. Take a few minutes to review those areas of your life, and then give yourself a little credit for ALL the adjustments you’re currently dealing with. There’s always more happening than meets the eye – wellbeing involves a lot of different factors.

2) Give yourself time – aka: Please, please, please don’t set yourself deadlines.

I posted on facebook recently about this US Runner who was back training for Olympic trials five weeks after childbirth, despite having a significant abdominal separation and lots of incontinence issues. As a professional athlete, this woman makes her living through running, she’s on a tight timeline when it comes to Olympic trials, and she also has a huge team of health professionals supporting her in her rehab. I’m hopeful she’ll make a full recovery at some point. But I wonder how much faster she might have healed her abdominal separation and pelvic floor issues if she’d had the time to recover properly – without loading her body up with a heavy running schedule while simultaneously trying to rehab. Most of us aren’t professional athletes, so there’s no hard and fast timeline for us to have to recover from.

3) Know what’s “normal” and what’s just common in the postnatal period

There’s a big difference between “common” – as in it happens to lots of new mothers, and what’s “normal” as in what’s the way something “should” be. Some postnatal concerns can be uncomfortable or embarrassing – such as incontinence. And in the rush to make women feel better about these embarrassing conditions we’re quick to reassure them it’s “totally normal, nothing to worry about!” But this does women a huge disservice. Labeling something as “normal”, when it actually isn’t, means that women may think these things are what “should” happen to new mothers, and therefore not seek help to address it. Let’s recognise that issues such as postnatal incontinence, abdominal separation and back pain are “common”, very, very common in fact – but they’re not normal – it’s not how the human body is designed to be. And we can work to address these issues – we just need to be aware that we CAN. #commonnotnormal

4) Get the right professional support

One of my clients last week told me she was considering changing her personal trainer. She’s not 100 percent happy with his level of knowledge on what is and isn’t suitable for postnatal and pregnant women, and after having a few back pain twinges recently, so she’s reconsidering whether he’s the right fit for her. Working with pregnant and postnatal clients requires a detailed understanding of female anatomy, and an excellent knowledge of what is and isn’t appropriate for this group. Make sure you find health professionals (whether it be your physio, personal trainer, or group fitness instructor) who has additional training in pregnancy and postnatal care. Even the best trainer in the world can unintentionally cause damage if they don’t have training in this field.

5) Do the work!

Okay, I admit it. Postnatal rehab can be boooooring! There’s a lot of breathing, a lot of checking your posture and alignment, a lot of repeating the same several exercises with perfect form. I know it can be boring. But it’s effective. It does the job – if you do yours! Rehab only works when the rehabber puts in the yards to do what their therapist asks them. This is true for postnatal women, professional footballers or injured workers. People who follow their rehab programs properly will always recover better than those who don’t. Rehab may not have the same level of exhilaration as an early morning run, or a Body Attack class with your bestie, but those things will always be there. In six weeks, or 12 months, they will still be there. But if you don’t do the work now – if you don’t take the time to make rehab a priority, what might also be there in 12 months is incontinence or abdominal separation – and the long term implications aren’t that much fun. Do the work. It will be worth it, I promise.

What has been your experience? I’m always keen to hear from my readers, so shoot me an email to sarah@bloomwellbeing.com.au if you have any queries or comments.

Until next time, keep well and take the time to rehab properly!

Cheers, Sarah

ps. If you’d like to know more about rehab for motherhood, make sure to check out my Core Floor Restore five week online program. It’s chock full of information about abdominal separation, pelvic floor dysfunction, posture and alignment, back and neck pain, and it’s been specifically created for Mums to support their own understanding of their recovery and wellbeing. Click here to check out the Core Floor Restore program details and pricing.

What Spiderman can teach us about C-section scars.

What Spiderman can teach us about C-section scars.

Last week I posted a facebook update about C-section scars and asked how many of you had been advised to undertake scar massage following your surgery and healing. I was utterly surprised that not one of you had been given this information. Just as none of the amazing ladies I had spoken with at a presentation recently had either.

So I’ve decided to write a post on the subject. Because I get the feeling this is an issue which is affecting many, many women unknowingly. If you’ve ever had a C-section (or any other type of abdominal/pelvic surgery), if you had a severe perineal tear during birth or if you’ve had gynaecological surgical procedures, such as for endometriosis – then read on!

First post on the subject: What’s an “adhesion”?

This series is all about scar tissue and adhesions, and the impact they can have on your insides! But I’m going to start by talking about hands. Bear with me, it’ll all make sense soon….

I first came across the issue of scar tissue and “adhesions” when I was working in hand therapy. At this time a fair percentage of my clients were angry young men who had punched walls or windows instead of people in acts of displace rage, and had sustained significant traumatic injuries to their hands – a far cry from my current role as a Women’s Health OT! My job back then, as an OT/Hand Therapist was to custom build a thermoplastic hand splint for my client and to develop a rehabilitation program to promote healing, repair, motion, flexibility and strengthening of their hand structures. Part of this was to advise them how to prevent adhesions. In hand therapy adhesions are a big bad. We want to avoid them at all costs, because they can seriously interfere with the functioning of your wrist, hand and fingers. As anyone with opposable thumbs will tell you – that’s pretty important.

Whenever we cut or tear a body tissue, as in a surgical cut or an accidental gash or puncture wound, the body will immediately start to repair itself through the inflammation process and the formation of scar tissue. Now, trust me when I say that scar tissue is a pretty awesome invention – I’m not bad-mouthing it at all. It’s a totally necessary function of our amazing bodies which allows us to repair and put back together parts of our body which have been cut open. Quite important really.

So the primary goal of scar tissue is to close over wounds in the fastest way possible – but left unchecked it will just shoot this scar tissue out everywhere forming messy webs, instead of the nice neat bonds which adhere only to the structures we want them to adhere to.

Do you remember the scene in Spiderman when Tobey MacGuire first realised he could shoot spiderwebs out of his wrists? (Which, btw, is totally gross!) Anyway, he goes a bit cray-cray, shooting webs here, there and everywhere in the privacy of his bedroom – which ends up with spiderwebs soaring all across the room haphazardly, sticking everything together in one big interconnected webby mess.

Yeah. Good one Spidey.

Now, I couldn’t find a screenshot of the scene I’m talking about, so here’s a gratuitous pic of Tobey Maguire without his shirt on instead. You’re welcome.

This is kind of like what scar tissue does inside your body when it’s left to its own devices.

Basically, it goes all Spiderman-in-training on you and shoots little scar tissue tendrils out everywhere. So the scar tissue that is forming within your skin layer might start shooting tendrils down to your underlying muscles – which bonds the skin to the muscles, or it might go further and send tendrils down which attach the muscles to your internal organs – such as your bowel or bladder. This is what we call an “adhesion” when two structures which aren’t supposed to be joined, end up stuck together. This is bad news, because it means that one or more of those structures might not work the way it’s supposed to work from that point on.

Here’s a little activity for you to try. Make a fist a few times with your right hand. See how far tightly you can close that right fist. Now, with your left hand, pinch the skin on the back of the right hand and try to close the right hand into a fist. Notice how you can’t close it as far. Now let go of the skin and see how you can close that fist even further.

This is kind of like what an adhesion does. It attaches the skin to the muscle, which means that we can’t move that muscle through its full range of motion anymore. See why we’re pretty hot on it in hand therapy?

Yeah, yeah Sarah – but what has this got to do with C-section scars??

Clearly, the impact of adhesions is quite obviously demonstrated on our hands, which are designed to move through a wide range of intricate movements. But it’s not so easily demonstrated on our bellies. Which don’t require the same dexterity as our hands. Which is why this so often goes untreated for so many women.

But the fact is, that this very same scar tissue process is happening in our bodies after we have a C-section. And the thing with a C-section is that there are several layers of skin, muscle, organs and fascia involved. All of which are cut and which need to be sewn up separately following the delivery – which is why the stitching up phase is much longer than the incision phase.

So knowing that we have several layers of body tissue all healing and all producing scar tissue at the same time, there’s a very real possibility of abdominal adhesions here. So there you go. Hand therapy to C-sections in quick flick of a surgeon’s scalpel.

Stay tuned for the next instalment, where we’ll talk about the impact scar tissue and adhesions can have on our internal abdominal and pelvic structures, how we can go about prevention adhesion formation and what we can do to reverse any which may have already formed.

Until next time,

Be well.

Sarah xx

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Postnatal injury. Common, not normal.

Postnatal injury. Common, not normal.

Did you know that up to  65 percent of post-natal women will experience lower back pain in the 18 months after giving birth?

Or that 45 percent of all post-natal women will experience incontinence within seven years of pregnancy?

What about the fact that 10 percent of women who experience pelvic girdle pain during pregnancy will continue to have persistent pain for two years or more following delivery?

What do these stats tell us? That post-natal injury is normal, right?

No – it just tells us that it’s common. But common does not necessarily mean normal.

What I’m talking about here is not just an issue of semantics. It’s more an issue of acceptance, attitudes and belief.

The post-natal period is an extremely vulnerable one for many women – both emotionally and physically. During this time our bodies are recovering from the enormous strain which has been placed on them over the past 40 weeks or so.  I’m not just referring to the struggle to get our flat tummy back (mine was never flat to start with!). What I’m talking about is restoring our posture and alignment after several months of having a changed centre of gravity. Allowing our joints, muscles, tendons and ligaments to return to their pre-natal state after being stretched, pulled and pressurised in so many different ways to accommodate our growing baby and our changing body structure. Allowing our hormonal balance to be restored.

This all takes time (did you know it can take up to 500 days for some tissues to fully heal?), and often the body can’t do it on its own. This is when we have the potential to develop what appears to be a chronic injury.

Because it happens so often, society just accepts it as “normal”.

“Oh you’ve got back pain – yeah, that’s just normal after having a baby.”

No.

I say don’t use the word “normal”.

My mission through my private practice and this blog is to encourage women to challenge this notion that postnatal injuries are “normal”. By giving them this label, we are subconsciously telling women that they should just expect these injuries to occur – “It happens to everyone, just get used to it and get on with life.”

Back pain is common - but that doesn't mean you have to accept it as normal!

Back pain is common – but that doesn’t mean you have to accept it as normal!

Last year during my post-graduate studies I completed a literature review on the incidence of soft tissue injuries among post-natal women. One of the more concerning themes that emerged in my research was the often dismissive nature regarding these injuries – both from the women themselves and also from their treating health professionals. Issues such as back pain, pelvic pain and diastasis recti (abdominal separation) were often considered to be “normal” post-pregnancy states which would eventually improve spontaneously given time – therefore they sometimes weren’t given proper consideration or treatment early in the pre-natal period. This belief is a concern to me. It tells me that health professionals need to be proactive in the physical rehabilitation of post-natal women. Not only to provide early-intervention treatment or referral to other practitioners, but also to educate women on the difference between “common” and “normal” post-natal injury and recovery.

For the vast majority of situations, these injuries can be addressed, overcome and even prevented – with the right support, treatment and advice.

So please, if you are struggling with one of these conditions and have been told – “don’t worry, it’s just normal, it’ll go away eventually”. Don’t accept that. Demand a treatment option. Seek a different practitioner. Find a qualified Women’s Health Occupational Therapist, Women’s Health Physiotherapist, or Women’s Health trained Pilates Instructor.

If you want to work with me here in Adelaide, you can undertake my one to one OT Core Restore program,

Or if you’re from anywhere else around the globe, you can join my five week online Core Floor Restore postnatal wellbeing program.

Addressing injuries early and appropriately will speed up your healing and recovery time. And that will mean you can get back to “normal” much sooner.

Until next time,

Sarah x

ps. Just in case you want the references:

Gustafsson, J. & Nilsson-Wikmar, L. (2007). Influence of specific muscle training on pain, activity limitation and kinesiophobia in women with back pain post-partum – A ‘Single subject research design’. Physiotherapy Research International, 13(1), 18-30. doi: 10.1002/pri.379

Lee, D.G., Lee, L.J. & McLaughlin, L. (2008). Stability, continence and breathing: the role of fascia following pregnancy and delivery. Journal of Bodywork & Movement Therapies, 12(4), 333-348.

Vermani, E., Mittal, R. & Weeks, A. (2009). Pelvic Girdle Pain and Low Back Pain in Pregnancy: A Review. Pain Practice, 10(1), 60-71.