Postpartum mom doing tummy time with baby

I recently ran into one of those articles, “{x} things no one tells you about your postpartum body.” And it was par for the course with respect to these types of click-bait-y, sensational stories. Namely, it was poorly researched, fear mongering, and full of half-truths based on a single person’s experience and second-hand hearsay.

Here’s the thing. First hand accounts ARE important. It’s important for us to share and connect and normalize the childbearing experience. But can we be frank about changes and challenges of the postpartum body while also being real and offering hope? I feel like that’s not such a stretch. Knowledge is power and the more you know about what is possible, what is common, and what is normal postpartum, the better you will be able to advocate for your own health care.

Your body undergoes some seriously heroic shit to produce a baby. And real talk: sometimes it involves muscles that separate, organs that droop, and things that tear. But there is an upshot: Female bodies are remarkable and resilient and they are capable of amazing transformation and healing. Two things that will help you capitalize on your body’s innate ability to heal after childbirth are 1) a little knowledge of what’s really going on and 2) who to call for help. So friends, here are a few very real, mostly encouraging, highly actionable things I think you should know about your body after baby.

1. Let’s start with the one everyone always wants to talk about: Diastasis recti.

During pregnancy, your abdominal muscles stretched to accommodate a growing fetus. Can you imagine what might happen if they didn’t??! This is a completely normal and expected mechanism by which your body makes space to accommodate a growing baby. Some studies have found that up to 100% of pregnant people (that’s everyone, folks!) have a gap of at least 2.2 cm or greater by the end of their pregnancy.

These days, you can read a lot online about “Diastasis Recti”. It gets blamed for “mummy tummy” or “mommy pooch” and associated with the change in appearance of a postpartum belly. But remember, abdominal separation during pregnancy is a totally normal phenomenon that enables your body to carry a baby. And as I’ll talk about in a bit, it’s not the only reason your belly might look a little different.

Diastasis recti in postpartum belly

Healing an abdominal separation has a lot to do with the tension of the tissue in that gap and just a little with the width of the gap itself. In MOST cases, the gap will decrease and gain tension by 6-8 weeks postpartum. It fact, it only becomes a “problem” if the gap remains greater than 2.2 cm (and fails to generate specific types of tension) after 6-8 weeks or so postpartum. If that occurs, in MOST cases, there are effective conservative (e.g. non-surgical) treatments to speed the healing along. Conservative treatment of Diastasis Recti consists of physical therapy prescribed from a pelvic floor physical therapist (sometimes called a women’s health physical therapist). Physical therapy and appropriate exercise are the first-line treatments, NOT surgery, as many popular articles would have you believe.

It is important to understand that even if the gap in your abdominal wall has “healed”, you might still not have a flat tummy because 1) stretched muscles take time to return to their optimal length 2) muscle tone is likely lower than pre-pregnancy 3) extra fat tissue, a totally normal part of the pregnancy and postpartum experience, will impact the look of your belly. Please give your body, and that postpartum belly in particular, the grace it deserves and the time it needs to heal after carrying your sweet babe.

Click here to read more and access additional resources related to Diastasis Recti.

2. You might feel like something is falling out of your vagina.

Your pelvic floor works with the rest of your core muscles to support your pelvic organs. After 9 months of working hard to support a growing uterus and fetus and stretching to up to 3.5 times their length to birth a baby, these muscles need time to rest and recover. It’s pretty common for pelvic organs to sit lower during the very early postpartum than they will later on. That means, if during the very early postpartum period (first six weeks or so) you feel symptoms like a tampon is falling out or if you feel heaviness or sagging in your pelvic floor, don’t get too excited. Give your body a chance to recoup.

If your symptoms persist, see a pelvic floor physical therapist. About half of women who have given birth experience pelvic organ prolapse. A prolapse occurs when the connective tissue that supports the pelvic organs becomes damaged and is insufficient to provide proper support and either the bladder, uterus or rectum descend into the vagina. Prolapse is not a condition that is typically “healed”, but there is a lot that can be done to manage it.

Pelvic organ prolapse is typically treated conservatively (i.e. non-surgically) with physical therapy and/or pessaries. With physical therapy, the degree of organ descent and the intensity of symptoms can typically be improved. Pelvic floor physical therapists can help you learn to manage your intra-abdominal pressure (a fancy term for the pressure generated in your abdomen whenever you do ANYTHING) to minimize your symptoms. Specialized providers (typically specially-trained OBs, Nurse Practitioners and Urogynecologists) can fit devices called “pessaries” to help support your organs and reduce symptoms. Pessaries are like an orthotic for your vagina and no more difficult to use than a tampon.

Prolapse may sound like a scary thing, and granted, it’s not something you’d go try and score on purpose. But receiving a pelvic organ prolapse diagnosis is NOT a death-sentence for your fitness routine, your daily routine, your sex life or anything else. There is typically a period of adjustment where one comes to terms with a diagnosis and then learns to manage it, but I want to assure you that it is something you can manage.

3. If you gave birth by C-section, incurred an episiotomy or experienced a severe vaginal tear, you’ll need to give your scar some love.

It’s a damn amazing thing that all of these mechanisms exist to help safely deliver your new baby. And it is equally remarkable that our bodies have so much potential to heal from such significant physical traumas. In some cases, scars will heal nicely on their own. In many cases, you’ll want to get a little bit of assistance from a pelvic floor physical therapist to work on scar mobility through massage. If your scar burns, itches, generates pain, or is otherwise uncomfortable, make sure you seek out medical assistance.

Click here for a great resource on c-section massage that you can perform on your own scar.

4. After you give birth, your bladder might seem like it has a mind of its own.

But friend, I guarantee you that your bladder is firmly under the control of your brain and your pelvic floor. Often times, after giving birth, the pelvic floor can remain weak or it can become overly-tight. Either condition can lead to unwanted drips (or floods). If you are having any kind of leaking, consult a pelvic health physical therapist. Mommy sneeze-pee jokes aside, incontinence is a common (but not normal) symptom after you have a baby and it is not one that you have to live with. If you are trying to workout while you are healing your leaking, a postnatal fitness coach can also help by teaching you strategies to stay dry while you workout.

5. You’ve forgotten how to breathe.

No joke. Most newly postpartum people will breath into their shoulders rather than their rib cage. This has implications for stress management, healing of the pelvic floor and abdominal wall and all kinds of common postpartum aches and pains (like a sore or tense upper back and shoulders).

Quick and dirty tip: Make sure when you inhale, you feel your chest and tummy expand. Your shoulders should not rise and your tummy should not draw in. If they do, consciously focus on letting your ribs expand your bra line during each inhale and contract on exhale. If you’ve read this far, you might not be surprised to hear that the best people to help you restore your breathing mechanics are pelvic health physical therapists or appropriately trained postnatal fitness specialists.

A lot of the changes that characterize postpartum bodies are perfectly predictable adaptations to having a baby. In fact, it is an exception rather than the rule when someone goes through the trials of pregnancy and childbirth and has nothing but a baby to show for it! It can take a lot of time (sometimes, years!) for our bodies to return to something that feels “normal” but please do not assume that you’ll need to live with abdominal separation, symptomatic prolapse, burny scars, urinary leaking or any other postpartum ailment long-term. If you are experiencing any of the symptoms or conditions discussed in this post, book an appointment with a pelvic health physical therapist. Click here for resources to help you locate a pelvic floor physical therapist or contact me if you need help locating one.

Keep Reading!

Breathing Strategies in Pregnancy and Postpartum: the Connection Breath

10 Ways to Modify Your Exercises to Manage Pelvic Pain, Pressure or Leaking

An Introduction to Your Pelvic Floor

Take a deep dive into HOW to dial in your breathing strategy to feel stronger and more supported in your exercise, kick-start your postpartum recovery and manage pelvic health symptoms. Download a copy of The No B.S. Guide to a Stronger, Drier Pregnancy and Postpartum.

Redmond, WA-based Seattle birth doula Laura Jawad, headshot

My mission is to make sure that having a baby is not a reason why you can’t do all the things.

Contact me if you have questions about exercise or pelvic health pertaining to pregnancy or postpartum. I work with people locally (Seattle’s Eastside: Redmond, Bellevue, Kirkland and surrounding areas) and online to develop personalized pregnancy and postpartum personal training plans. I also offer labor support (birth doula services) within the greater Seattle-Metro Area.