Your body’s recovery after childbirth

We talked to physiotherapist Tove Jendman, who specialises in obstetrics, gynaecology and urology. She’s an expert when it comes to Kegels, urine leakage, swollen genitals and other things that happen with the female body during pregnancy, birth, and the first few weeks and months afterwards. Together, we’ll try to unpack some of the most common questions about the body’s recovery process, whether the birth was vaginal or a C-section.

Tove, can you tell us about what parts of the body are actually affected by pregnancy and childbirth?

Actually, pregnancy affects most of the body. Already from day one of pregnancy, the body starts to produce more relaxin. It makes all of our internal organs, tendons, ligaments and muscles softer and more flexible. The body becomes more sensitive in general, for example, your immune system might be slightly suppressed and your skin will be more sensitive.

The body also makes more plasma and blood, which is necessary to supply both the baby and mother. In turn, this affects the lungs and it will be easier to feel breathless. Loads of things are underway inside the belly, of course: the uterus, which has never been used before a first pregnancy, has grown and all the surrounding ligaments become stretched out and tense. The organs become crowded and so do the intestines, and as a result you may experience a looser stool or constipation. Your feet are particularly vulnerable, because your body weight and the increased elasticity cause them to widen and lengthen. It’s not unusual to go up a shoe size. Throughout the last trimester, the body is carrying a load constantly, whether seated or standing. All of this concludes with the marathon known as childbirth. So there are plenty of explanations for why the body doesn’t feel as it usually does afterwards, and you will be recovering throughout the first year after giving birth.

The belly doesn’t disappear right after childbirth, even though the baby has come out. Why?

Once the baby is out, the body has excess skin, fat and weak abdominal muscles. The extra kilos gained during pregnancy are often located around the belly. That means the belly will still be quite round for a good while after giving birth.

Is it true that the abdominal muscles separate?

We have four layers of muscles inside the stomach; only the two muscles that run down the middle of the stomach separate, which often happens around week 20 of pregnancy. The other three layers will be stretched out and weak, and are often fairly inactive during pregnancy. This means that after each pregnancy, you will have to find and begin to use your abdominal muscles. According to one new study, it is normal for abdominal muscle separation (diastasis recti) to be 2.4 cm at the naval three months after giving birth. The amount of time it takes for separated abdominals to return to normal varies. And they may not always come back together completely; you can live perfectly well with diastasis recti, even of a few centimetres. Some people will have symptoms, and others will not. Symptoms can include pain or instability. It is important to strength-train the other three abdominal muscles, the hips and the back muscles, which all help create stability in the trunk. To help these muscles work in a better way, try to relax the spinal curve you had while pregnant and find a more neutral spine, and don’t sit still too much. Even daily activity at home is beneficial for the body’s recovery.

This feeling when you’re on the toilet, like everything is just falling out – when will it feel normal again?

During the first six weeks after childbirth, the uterus and ovaries return to their normal size and the swelling goes down. After that, the sensation that everything is falling out will go away, too. The pelvic floor contains a lot of connective tissue and it will continue to tighten back up for many months to come, so the stability will keep getting better.

Do you have any tips on handling your bladder after childbirth?

After giving birth, your bladder might feel a little numb and it may be hard to get everything out. Try to sit for an extra moment and lean forward to ensure you’ve emptied your bladder completely. It’s also a good idea to not pee for preventative purposes; only go when you really have to go. As much as you can, try to return to your pre-pregnancy pee habits.

Many people experience constipation after giving birth. Why does that happen what can be done about it?

There are several possible explanations here. You might become constipated because, for natural reasons, you don’t move around much after giving birth. In addition, the reorganisation of your intestines can take some time. Pelvic floor pain and that feeling that everything is falling out might have you feeling a little scared and anxious about going to the toilet, which can produce constipation.

Just remember to eat well, drink plenty of water, and pay attention to signs from your body indicating that it’s time to empty your bowels. It’s also a good idea to get up and move around, since this gets your bowels moving. High toilet seats are so bad for the body; we just weren’t made to sit like that. A simple solution is to place a stool under your feet. Your knees need to come higher than your hips, which will open the sphincter/anal opening and make it easier to empty your bowels. After that, there’s a lot to be said for taking deep breaths and relaxing. Inhaling deeply, so that you can feel it low in your belly, promotes intestinal movement and is a necessary part of continuing to transport food further along the large intestine. You can also try rocking back and forth a little bit while sitting on the toilet. But don’t strain or push, which could lead to prolapse later on.

Sometimes, injuries from childbirth make it difficult to empty your bowels. If you had a tear, going to the toilet can be much worse, of course. In this case, it’s important that you don’t hold it; you should use the toilet when your body needs to. Don’t push; instead, breathe deeply, rock gently, and use a toilet stool! Deep breathing doesn’t only help get your bowels moving – it’s also an effective form of pain relief. Childbirth can sometimes cause the back wall of the vagina to protrude more than it should, which can cause the perineum, which should be providing support, to become thin and weak. For a temporary solution, place your thumb inside your vagina to help support the perineum in order to empty your bowels more easily.

How common is urine leakage after giving birth and what can be done about it?

Your pelvic floor has been impacted by hormones and by months of downward pressure from the baby, so urinary incontinence is common, whether you gave birth vaginally or via C-section.
Abundant evidence supports the efficacy of pelvic floor training, and you can begin to find and strengthen your pelvic floor already during pregnancy. But don’t go around squeezing all the time; that won’t make any muscles stronger. Some studies indicate that low and medium-intensity exercise in general can reduce incontinence. It’s especially important to strengthen the muscles of the trunk, i.e. the abdominals and back.

When you cough or sneeze, it increases pressure on the abdomen, so offset that by squeezing your pelvic floor. The activities that lead to especially high pressure on the pelvic floor include jumping on a trampoline, intense interval training, heavy lifting and running for a long time. So be gentle on yourself. Remember that it will be a year before your body is fully recovered, so try to stick to activities at a level that your body can manage – not the level your brain wants. But don’t normalise urine leakage; it should gradually improve. Ultimately, it shouldn’t be an obstacle in your daily life, and most exercise should be okay. A gynaecologist/urology therapist or physiotherapist specialised in women’s health can check your musculature and help teach you how to work with your pelvic floor. There are also devices that can support your urethra, such as an incontinence pessary. Sometimes a menstrual cup can also provide sufficient temporary support for the urethra. Surgery could potentially be a last resort.

How long and how often should you do Kegel exercises after giving birth?

This is a sticky question and there are a lot of opinions when it comes to Kegels. It’s important to let go of the idea of a standard regimen. As with all exercise, some people will need more and others will find pelvic floor exercises very easy. New mums often hear that they should do their Kegels a few times a day, and keep on doing them for the rest of their life. But the problem is that many new mothers are terrified of leakage and prolapse, which causes them to squeeze all the time. And instead, that could lead to pain, tense muscles and fatigue in the pelvic floor region. A tense pelvic floor is unfortunately just the tip of the iceberg.

To unpack this a little, I want to talk about the function of the pelvic floor. The pelvic floor makes sure that we don’t accidentally pee or pass stool. It supports our internal organs and it is the base of the trunk. If you breathe calmly, you can feel your breath all the way down into your pelvic floor, as it should be. If your pelvic floor muscle is tense, then the major breathing muscle (the diaphragm) can’t work as it should and your breathing will be shallow, landing high up in your chest. This can lead to a state of tension that can cause pain and reduced intestinal functioning. So if you aren’t having any issues with pain or urine/poo leakage, then your pelvic floor is working as it should. After pregnancy and giving birth (vaginally and via C-section), the pelvic floor is stretched out; it is good to find and activate these muscles by gently squeezing and holding for two seconds, then releasing for two seconds. We’re all different, so it’s tough to say how long you should keep going as a general rule. If you continue doing pelvic floor exercises, then be mindful to relax completely afterwards. Take a few deep breaths and let your pelvic floor rest. In its resting state, it has its own active muscle tension, called tone, which is an important part of continence, i.e. not peeing yourself. Tone is always there, for example when we sleep, and it doesn’t require that we do anything for it to work.

What do I do if Kegel exercises are not helping?

If you’re still having issues with urine leakage, step one is to consider when you are leaking and if you might be asking too much of your body at these times. Stress incontinence is the most common problem after giving birth. There is evidence that light to moderate exercise for your whole body can build up the pelvic floor musculature and make it thicker and stronger. The body’s muscles are connected and work together in long chains, which means that arm exercises improve abdominal strength, which in turn benefits the pelvic floor. So remember that Kegel exercises aren’t the only thing you can do for incontinence. But if you’re still having trouble with urine leakage and it isn’t gradually improving and becoming less pronounced, then do seek help.

About how long will it take my body to heal? When can I expect to be back to normal?

During the first six weeks, the swelling in your genitals and organs will go down and they will return to their normal size. The pelvic floor muscle will begin to recover, along with your hormone levels and metabolism. After three months, levels of the hormone relaxin will be back to normal. In another 6–12 months, the connective tissue, which supports, protects and holds various parts of the body together, will return to normal levels of support and stability. How long it takes will vary from one person to the next; we’re born with different kinds of connective tissue and that isn’t something you can control. However, your muscles can and should be strengthened back up, and there are some muscle groups that are particularly vulnerable after pregnancy. This includes your abdominals, which have been stretched out and inactive, as well as your glutes. If you’ve lost a lot of muscle tone during pregnancy, just remember that it will take some time to regain. Conditioning is also something to build back up gradually. After about a year, you should be able to recognise your body again. Being ‘back’ depends on where you started, of course. Some people feel they have loads of time for exercise, while others feel like they have no time to themselves at all. Prioritising your recovery and exercise is so important for feeling good as a parent. Taking care of yourself is as important as taking care of your baby. Lying on the floor and doing a few exercises beside your baby is being a present parent and caring about your own health. You don’t have to get a gym membership.

Lastly, do you have any more tips on how to take care of your body after giving birth?

Try to keep your wrists straight: place the baby’s bottom on your forearm instead of holding it with your hand. Sigh, take lots of deep breaths throughout the day, relax your shoulders and let go of any tension in your shoulders, jaw and hands. The body is amazing at healing and recovering after injury, pregnancy and exertion, but remember that exercise after pregnancy and childbirth should be stepped up gradually. Listen to your body and learn to understand what it needs. Your body and spirit are connected. If your body is tired, then it needs rest. If it’s restless, then it needs to move. Try to work with your body instead of forcing it.

Please note that all information above is based on Swedish recommendations.