Postpartum Pelvic Floor Considerations

Original Editor - Jess Bell based on the course by Ibukun Afolabi
Top Contributors - Jess Bell, Kim Jackson and Carin Hunter

This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (18/01/2022)

Introduction

The postpartum period has been divided into three phases:

• The initial / acute period which covers the first 6 to 12 hours after birth
• The subacute period which lasts between two and six weeks
• The delayed postpartum period, which can last for six months

The effects of birth are usually felt most during the first 12 weeks postpartum - the time also known as the fourth trimester. However, in reality, childbirth can impact a mother’s pelvic health for much longer than just the fourth trimester. Thus, pelvic health should be a key focus during the postpartum period as the pelvic health foundations established during this period can have a long-term impact women.

The Fourth Trimester

During the fourth trimester, tissues are still healing and the body is "finding its new self".

Specifically during the first two to six weeks, the body experiences significant changes in terms of:

• Haemodynamics
• Genito-urinary recovery
• Metabolism
• Emotional state

Changes in the later postpartum period tender to be very gradual and pathology is not common. Because of these changes, it is important not to overstrain or exert the tissues. Instead, the focus should be on:

• Rest
• Recovery
• Replenishment
• Restorative practices

Expectations for Recovery

It may be necessary to discuss recovery expectations with women. Savage suggests having a wellness action plan can help expectant mothers and their families to be proactive and prepare for their physical and emotional needs after the birth of their baby. However, it is important to note that many women in the fourth trimester will have to plan:

• Their return to work
• Childcare
• Getting strong enough to manage everything on their own etc

Discharge from Obstetric Care

Many women will be discharged from the care of their midwife or obstetrician after their six-week follow-up unless there is a specific medical concern. These time-frames / standards may vary in different countries.

At the point of discharge, not all women will be given a comprehensive examination of their pelvic floor. However, when it is safe and appropriate, a women's pelvic health physiotherapist can provide this evaluation as needed. This is often around the five to six-week mark once bleeding has stopped. It is also possible to teach clients how to perform a self-examination of their vulva and perineal region with a mirror.

The rest of this page will discuss six specific areas that pelvic health physiotherapists can review with their clients prior to the six-week assessment to enhance their pelvic health.

Normal and Abnormal Experiences

According to Finlayson et al., many women do not feel prepared for the physical and psychological impact of childbirth nor the recovery period in the postpartum period.

The following can occur:

• Body may still be in “birthing” mode (ie. open, soft ligaments, etc)
• Connective tissue / soft tissue healing takes at least six weeks
• The stability system (i.e. inner core) is often compromised and needs retraining
• The vulva / vagina will likely look and feel different after a vaginal birth

• Clients may express that they feel like their bottom is falling out
• Pelvic heaviness or pressure
• Discomfort or pain in hips, low back, pelvis, perineum
• A jiggly / jelly-like belly
• Doming or tenting in the abdomen when trying to sit up or lift things
• A sense that it is challenging to control the loss of urine, stool or gas
• Dryness or sensitivity in vaginal tissues (this can persist due to hormonal changes)
• A sense of living in an unknown / different body

After six to eight weeks and by 12 weeks, these sensations will usually have self-resolved.