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Your “All Clear” Postpartum Checkup and the Return to Exercise, Part 1

Hey Baby, Hey Baby, Hey!

Channeling No Doubt with a fun fact coming at you! If you’ve noticed a lot of birth announcements recently, you’re not imagining things. According to a recent study, the most common birth month is September, specifically September 9, followed closely by the months of August and July. (1) This means lots of new moms will be or have just recently had their postpartum checkup, commonly referred to by many as the “6 week all clear” visit to resume normal activities and exercise.

Postpartum fitness

Photo used with permission from Madison Cleckler of Madison’s Mommas www.madisonsmommas.com

But what does this actually mean and what are your next steps?

(Check out this fun study to see the data and where your birth date ranks!)

Postpartum checkup – what is it?

First things first, what is a postpartum checkup and why is it important?

The postpartum checkup is commonly used to asses the vagina and cervix, and to confirm that the uterus has returned to normal. Your vitals will be checked, and doctors will inquire about a litany of topics, including emotional changes or postpartum depression, breastfeeding, the return to sex and birth-control options, and maybe bowel movements or healing from perineal tears or c-sections.

This visit is a chance to make sure that the body is healing and on the right road to recovery. If everything appears okay, many women are given the green light to resume normal physical activities. For many of us, that means returning to our favorite form of exercise.

Yay!

It can be exciting to hear the all clear, and we may want to jump right back in to where we left off, excited to regain freedom within our own bodies again. But, here’s where I may become a buzzkill:

I’m asking you to think of this as a yellow light – a first step in the postpartum recovery. To understand why, here are some considerations as you navigate your postpartum return to fitness.

New guidelines for postpartum care

The American College of Obstetricians and Gynecologists (ACOG) released new guidelines earlier this year, calling for changes to improve postpartum care. The old guidelines referenced only 1 postpartum visit, to occur 6 weeks after birth. Currently, as many as 40% of women do not attend a postpartum visit. (2) The goal is to have an increase of attendance of postpartum visits. YES!!

According to the new guidelines, ACOG states that postpartum care should be ongoing, rather than one follow-up visit, and that all women should have contact with their OB/GYNs or care providers within the first 3 weeks postpartum as well. 

Alison Stuebe, author of the ACOG Committee Opinion, says,

“New mothers need ongoing care during the ‘fourth trimester.’ We want to replace the one-off checkup at six weeks with a period of sustained, holistic support for growing families. Our goal is for every new family to have a comprehensive care plan and a care team that supports mother’s strengths and addresses her multiple, intersecting needs following birth.” (3)

These changes make my heart sing! This is a step in the right direction for better care to moms, which we desperately need. The United States has one of the highest maternal death rates among all developed nations, and according to studies the rate is rising while it declines elsewhere around the world. (4)

STANDARD PRACTICES MUST CHANGE, and they are, with the new ACOG guidelines working to create more support during the 4th trimester. In looking at the postpartum toolkit for providers, the amount of information that OB/GYNs are expected to provide is quite comprehensive. The list of information to potentially review with a patient, to me, is overwhelming. You can review the toolkit here.

Still more to discuss

However, ALL of this – and more information – matters.

The WHOLE conversation is so needed for all women, not just a handout referencing Kegels or a pamphlet educating about weight management (which is what many women are given as they leave the exam room).

Perhaps some offices already provide information sheets with potential postpartum considerations and local resources for women, but I do know this is not the case for all.

I’m hopeful that we can find a solution to connect all women with specific resources located in our communities through these postpartum visits (or annual visits), to help truly provide a comprehensive postpartum-care plan. 

The green light to exercise

In my opinion, considerations for the return to exercise could still be better defined. For many women, exercise is an important part of their identity and something they cannot wait to return to. This means CrossFit, HIIT, boot camps, marathons, triathlons, boxing – whatever it is that makes your soul happy!

When women receive the all clear, many of us take that to mean a return to play and picking up where we left off. Although these conversations will be different for each woman, having a more in-depth conversation or better resources available regarding return to exercise and general considerations to be aware of needs to be addressed.

Many women are given few or no suggestions at this visit, and we are left to determine what the “all clear” means for us. I think we could all appreciate a more direct starting point. 

Resuming “normal” activity

Ok, what does resuming normal activities or exercise mean? The ACOG states that if a healthy pregnancy and “normal” vaginal delivery were had, you should be able to start exercising again after the baby is born – sometimes within days. (5)

I challenge that the word “exercise” needs to be better defined at the postpartum visit. It can be too broad a word to use; each one of us is biased as to what exercise means based on our individual fitness level, lifestyle, goals, etc.

When we hear the word “exercise,” we don’t always think of moderate-intensity exercise, such as walking or breathing and pelvic-floor exercises. When we hear the word “exercise,” we think sweat, heart pounding, challenging. At least that’s what I used to think, and what I suspect many other moms think as well.

Without a doubt, exercise is beneficial for most everyone. The Center for Disease Control and Prevention recommends at least 150 minutes of moderate-intensity aerobic exercise, like walking, in time frames of at least 10 minutes, spread throughout the week. (6) Hundreds of studies can show the benefits of exercise, including heart and lung health as well as mental health and a variety of other important benefits.

However, after giving birth women are returning to what they know and doing what they’d always done pre-birth, not realizing how their bodies are still healing structurally, hormonally, and emotionally, potentially leaving them open for injury.

We have a right to know more.

Movement, during this time of our lives, the 4th trimester (period of time considered to be 12 weeks post birth), should be supportive of restoring our long term function and strength.

Why is this important?

If you’ve read my other blogs, you may know that I took my 7-week all clear to mean that I was good to jump back into high-intensity and heavy strength training. My only goal was to get as fit as possible as quickly as possible so that I could feel like who I used to be. In my case, I may have done too much too soon, which may have contributed to my incontinence, hip/low back pain, and diastasis recti.

I was chasing who I used to be, not embracing who I was at that moment or acknowledging
the fact that my body underwent a massive change over the duration of 9 (plus) months! 

I’m not writing this to scare anyone, but to bring awareness about the how and why we need to have more considerations in our return to exercise. Pelvic floor and pain issues don’t happen to everyone, however shouldn’t we at least be aware that they exist?

I believe this conversation should also be a part of the comprehensive care plan given to women postpartum.

I know from friends, clients, and social media stories that it’s all too common for newly postpartum moms to get back to lifting weights, rowing 2k’s, and back out hitting the pavement in as little as a few days post delivery, to even running half marathons 8 weeks post c-section. Unfortunately, some women end up with pelvic-floor issues, due to an array of reasons, some of which may be attributed to doing too much too soon.

If you do have experience with pelvic-floor issues (even a small amount of leaking), there is help!

Deserving more

How can women make an informed decision about what activity they return to without further education, the guidance of a progressive 4th trimester exercise plan, or a local list of resources they can reach out to?

These resources are becoming more commonplace for breastfeeding, mental health, and other postnatal issues, but not many, if any, resources are given in regard to return to exercise or the health of our pelvic floor.

Photo by Kate Johnson

Integrating movement back in a way that meets women where they are based on their unique goals and supporting long-term function and strength, all while honoring the incredible changes our bodies have been through, needs to be a part of the overall conversation at the postpartum checkup. Moms are athletes after all, carrying, squatting, lifting, twisting all day long, and we need support in how to restore function and strength!

I know the discussion about return to exercise isn’t a black and white answer, which may be why there’s not more conversation at postpartum appointments. Ultimately what this discussion sounds like will depend on each individual, her goals, and her previous/current level of fitness.

What’s right for one woman won’t always be right for another, but there can be general guidance and support. This is why I’m writing some general thoughts on how to transition from the early postpartum check-up back to your lifestyle and fitness routine.

Stay tuned for Part 2 of this article, featuring 4 general considerations for your return back to exercise!

1. Data: U.S. National Center for Health Statistics (1994-2003); U.S. Social Security Administration (2004-2014).

2.  Optimizing postpartum care. ACOG Committee Opinion No. 736. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018;131:e140–50.

3. https://www.acog.org/About-ACOG/News-Room/News-Releases/2018/ACOG-Redesigns-Postpartum-Care

4. https://www.npr.org/2017/05/12/527806002/focus-on-infants-during-childbirth-leaves-u-s-moms-in-danger

5. https://www.acog.org/Patients/FAQs/Exercise-After-Pregnancy

6. https://www.cdc.gov/cancer/dcpc/prevention/policies_practices/physical_activity/guidelines.htm

The content provided here is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions or concerns you may have regarding your health or body.

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