Updated: Apr 9, 2020
This pic is a throwback to my 6 week postpartum checkup. Can you believe what a little squish this guy was? I can’t believe how much has changed in a few short months. But, I digress… What I really want to talk about is what happened at that appointment.
At that appointment, my midwife checked my tear and my stitches. She checked my cervix, confirmed bleeding had stopped and my organs were in the right places. She screened me for postpartum mood disorders. We discussed birth control. Surprisingly, she evaluated me for a diastasis recti (this isn't standard at the 6 week checkup, but it was a welcome surprise!). 𝐀𝐧𝐝 𝐬𝐡𝐞 𝐜𝐥𝐞𝐚𝐫𝐞𝐝 𝐦𝐞 𝐟𝐨𝐫 𝐞𝐱𝐞𝐫𝐜𝐢𝐬𝐞. And friends, two things: One, this is a normal run down for a 6 week checkup (minus the diastasis check, that was a pleasant surprise!). Two, I SHOULD NOT HAVE BEEN CLEARED TO EXERCISE. Not with my pelvic floor. But here’s the thing, she didn't know. Midwives and OB-GYNs, even ones that are very good at their jobs, are not trained to evaluate pelvic floor function and dysfunction. They aren’t experts in rehabilitation or exercise prescription. In short, they shouldn’t be clearing people for exercise. In fact, I would argue 𝐢𝐭 𝐢𝐬 𝐎𝐔𝐓 𝐎𝐅 𝐒𝐂𝐎𝐏𝐄 𝐟𝐨𝐫 𝐭𝐡𝐞𝐬𝐞 𝐩𝐫𝐢𝐦𝐚𝐫𝐲 𝐜𝐚𝐫𝐞 𝐩𝐫𝐨𝐯𝐢𝐝𝐞𝐫𝐬 𝐭𝐨 𝐛𝐞 𝐠𝐢𝐯𝐢𝐧𝐠 𝐩𝐨𝐬𝐭𝐩𝐚𝐫𝐭𝐮𝐦 𝐩𝐞𝐨𝐩𝐥𝐞 𝐚𝐧 𝐚𝐥𝐥-𝐜𝐥𝐞𝐚𝐫 𝐭𝐨 𝐞𝐱𝐞𝐫𝐜𝐢𝐬𝐞 unless they’ve had additional training. What should they be doing? Working within their (valuable) expertise- and then referring people to pelvic health physical therapy for evaluation of readiness for exercise. Not only was I on the receiving end of a bunk “all-clear”, but I frequently talk to new parents who have the same experience. They’re “cleared” and then they find out the hard way, they weren’t really ready. At best this results in a setback, at worst an injury. Something needs to change. No provider can be everything to everyone. Postpartum care requires a team approach. And we need a revolution in the way we care for birthing people so that we can get appropriate care. In the mean time, understand that the 6 week checkup is limited in scope, be your own advocate and ask for a referral to pelvic floor physical therapy if you are interested in an evaluation of readiness to return to exercise.