In the era of celebrity return to fitness and flat tummies within what feels like one day postpartum, there is a lot of pressure for women to feel that that is ‘normal,’ potentially leading to the belief one’s body is less capable if the same does not happen. In truth, it is well documented that the uterus takes a moderate amount of time, up to 8 weeks, to return to its pre-pregnancy size.(1) There are also many other considerations for returning to your pre-pregnancy weight, shape, and activity level. Return to pre-pregnancy size can boil down to genetics, and each woman’s typical response to weight loss efforts. And while I personally wish I had my own nutritionist and personal trainer on hand to address these factors, that is not the case for the majority of women.

Another consideration in postpartum recovery is breastfeeding. Drastic hormone changes occur thru pregnancy and in the postpartum period(2) and are believed to have an effect on the mother up to 6 months after discontinuation of breastfeeding. Breastfeeding, while potentially contributing to difficulty with weight loss in the first three months after birth, contributes to increased fat loss after that time period. It also has a long term protective effect on the mother, reducing her risk for hypertension and diabetes among other things,(3) so while it may be frustrating in the short term, breastfeeding is worthwhile if a mother has the option. There are some women who note significant increase in ease of weight loss after discontinuation of breastfeeding, ultimately confirming that all women are individuals with different contributing factors to retaining weight.

Labor and delivery alone can be major factors when considering return to activity postpartum. Any level of perineal tearing requires a longer time for healing than if tissue injury has not occurred. But if we’re honest, your body experienced major trauma even in the absence of tearing. I like to consider it the pelvic floor’s version of a car accident. After vaginal delivery, it is estimated that the pelvic floor takes two months to recover strength for most women.(4) It is best not to return to jogging or impact activities until urine or feces control is intact.

Every women, and every pregnancy and delivery, is unique and impacts return to pre-pregnancy fitness and shape differently. While this blog post is not all-encompassing (see previous diastasis recti post for another factor), some of the major limiting factors were mentioned. While we all have different healing times, if you continue to have symptoms that were not present prior to pregnancy and childbirth at 6-8 weeks postpartum it is worth consulting a medical provider. Women’s Health Physical Therapists are specifically trained to address postpartum issues, and though we can’t help with genetics and your breastfeeding hormone cascade, we can definitely address many of the factors they affect!

 

References

  1. Paliulyte, V., Drasutiene, G., Ramasauskaite, D., Bartkeviciene, D., Zakareviciene, J., & Kurmanavicius, J. (2017). Physiological Uterine Involution in Primiparous and Multiparous Women: Ultrasound Study. Obstetrics And Gynecology International, 1-10. doi: 10.1155/2017/6739345
  2. Meltzer-Brody, S., Stuebe, A., Dole, N., Savitz, D., Rubinow, D., & Thorp, J. (2011). Elevated Corticotropin Releasing Hormone (CRH) during Pregnancy and Risk of Postpartum Depression (PPD). The Journal Of Clinical Endocrinology & Metabolism, 96(1), E40-E47. doi: 10.1210/jc.2010-0978
  3. Stuebe, A., & Rich-Edwards, J. (2008). The Reset Hypothesis: Lactation and Maternal Metabolism. American Journal Of Perinatology, 26(01), 081-088. doi: 10.1055/s-0028-1103034
  4. Fonti, Y., Giordano, R., Cacciatore, A., Romano, M., La Rosa, R. (2009). Post partum pelvic floor changes. Jornal of Prenatal Medicine, Oct-Dec; 3(4): 57–59.