Now we get to the 6 week check up. This seems to be the holy grail of postpartum fitness milestones. I hate to break it to you but IT IS NOT.
The 6 week check up is basically that; a check up. The doctor will see if you and your baby are healthy and you have stopped bleeding. If you have a good doctor, he or she will also check on your stitches and see how you are healing; that the stitches are not infected and the tearing hasn't gotten worse for any reason. When the doctor sees that you have stopped bleeding, you are cleared for exercise officially, and deem in the western medical system as “recovered” from pregnancy and childbirth.
Do you notice what is missing? Probably not.
The 6 week check up is basically that; a check up. The doctor will see if you and your baby are healthy and you have stopped bleeding.
The doctor doesn't check you for prolapse. This is a shame because this is where 90% of most postpartum injuries and issues come from. The fact is, your OB/GYN typically isn’t even trained to check for this in the check up. Even if you mention symptoms of a prolapse, your typical doctor might miss it. Unless your uterus coming out of your cervix, you will be sent on your way and declared fully capable of exercise.
This is a shame because prolapse is where 90% of most postpartum injuries and issues come from.
After your 6 week check up, it is VERY crucial for you to see a pelvic floor physiotherapist. In fact, I don’t train with postpartum client unless they see one. Because there are three types of prolapse and four stages for each type, it is important that a licensed professional take a look at you.
Knowing if you have a prolapse will dictate the next steps in your training program. Every prolapse is workable within a training program, that is, if you have an experienced postpartum trainer or if you see a good pelvic floor physiotherapist.
But let's assume you are healthy.
Your program will be fairly simple within the first 16 weeks after birth. When coming back to sport, be it running, weightlifting or even MMA and zumba, you will always work from the core and out to the extremities. Most women want to focus on losing weight, slimming through the hips or getting their abs back but this is just not the way to jump on the wagon.
Within all programs, start first with the connection breath, syncing the pelvic floor to the diaphragm, and then work on bracing. Bracing, bracing, bracing. We brace and do a glute bridge, brace and have one leg up in the air, brace and do banded pull aparts, brace and breathe.
When coming back to sport, be it running, weightlifting or even MMA and zumba, you will always work from the core and out to the extremities.
The main goal is to bring awareness and function to the deep core. We are increasing the tonus of the transverse abdominis, internal obliques and pelvic floor. There are not sexy muscles by any means. You can’t see them in a bikini. They are hard to activate without cues from a professional or a very high kinaesthetic awareness. The good news is these bracing techniques will be a solid foundation to healthy movement patterns.
More good news: all this bracing leads to strengthening and straightening the rectus abdominis, which is the muscle affected in diastasis recti. In fact is you are having issues with Diastasis Recti, this is your protocol.
After a couple weeks of bracing and mild pelvic floor activating exercises, you will start to work on more complicated movements. You still have to be very cautious in these workouts.
Start to reintroduce squats, hip hinge movements, step ups and upper body lifting, focusing on just pulling. Keep the weight in the moderate to medium range. The weight must feel like a challenge but not overly taxing. Step ups are a great introduction because you are developing single leg strength and working on good landing mechanics. This will be important when you start jumping and running again.
Stay away from heavy weight that falls in the less than 10 rep range. We are going for easy movements that allow you to focus completely on specific muscles moving and technique. At this time, you will also be avoiding jumping.
Knowing if you have a prolapse will dictate the next steps in your training program. Every prolapse is workable within a training program, that is, if you have an experienced postpartum trainer or if you see a good pelvic floor physiotherapist.
Avoid heavy downward pressure on the pelvic floor. This means avoid heavy presses, back squats and front squats. For the most part, you will be doing no pressing. Goblet squats will be your savior. The hug and press on the goblet position actually activate the TA and the PF in a way that is very good for rehabilitation. Also the front loaded squat is great for strengthening the spine.
Stay away from front planks for a while. Side plank exercises are a good bet but avoid any front plank movements until further into the recovery process.
More good news: all this bracing leads to strengthening and straightening the rectus abdominis, which is the muscle affected in diastasis recti.
Do deadlifts and good mornings. This will allow you to practice the proper lifting technique for picking up you baby and, well... everything else you pick up from the floor.
It's a slow and steady roll back to a string body after birth. Not everyone follows this timeline. Some move faster and are ok and some move slower and are not ok. But i can tell you that you should be moving slower and more cautiously than taking a risk and moving quickly. The risk on injuring yourself is much to great and the price is to high.
For the most part, you will be doing no pressing for 16 weeks. Goblet squats will be your savior.
So here is a quick recap. Every women and body is different. Also you timeline will be different depending on how fit you were or were not before and during pregnancy. Women who have had a C-section will also experience different recovery process.
0 weeks to +/- 6 weeks = Connection breaths + walking
+/- 4 weeks to +/-8 weeks = Bracing, stretching and mild PF exercises
+/- 6 weeks to +/-16 weeks = Core/PF centered training
+ 16 weeks = Cautious and tailored training based on progress
Pregnant women need to work harder and postpartum women need to work smarter.
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