When Megan Roup, pre and postpartum fitness trainer and founder of The Sculpt Society, gave birth to her first child, she was surprised by how quickly her doctor cleared her to go back to "normal activities" (i.e. things like exercise and sex) when she felt anything but normal. "When I went in, the appointment felt very rushed. They did a quick exam and [the doctor] basically said, 'You're good to go,'" Roup tells TZR. An underwhelming and brief six-week postpartum appointment is something that she says is all too typical (at least in the United States). "I wasn't completely caught off-guard because I had talked to other women about their experiences. So I was really curious about how mine would go and how that would feel," she says.
Roup knew she couldn't dive back into her workouts — or regular routine, for that matter — 100% like before she was pregnant and gave birth. She also knew a thing or two about modifying exercises post-baby, and other important factors like making sure she didn't have diastasis recti (abdominal muscle separation) and the importance of rehabbing the pelvic floor.
But for many women without the training and resources Roup had, she saw huge discrepancies in the information and support available. "In that moment, I just felt really angry and frustrated for 99.9% of women who trust their doctors and are looking for information about what the next steps [for exercising and getting back to workouts] should look like," she says.
Beyond The 6-Week Check-In
"In reality, [going back to normal activities at six weeks] is just so far from the truth, and for a true recovery, true healing process, there are other steps that are vital for women," says Roup. Dr. Stacy Henigsman, OB-GYN at Allara, seconds this notion, explaining that after delivery, women’s bodies need ample time to fully heal. "If you exercise too quickly after a cesarean section then this healing can’t occur,” says Henigsman. “And exercising too soon after a vaginal delivery also carries risks.”
She explains that for the former delivery process several abdominal layers are cut. “One of the most important layers is the fascia,” says Henigsman. “Fascia is a thin layer of connective tissue that surrounds and supports all organs in your body, including your intestines. If you exercise too soon after a cesarean section, your fascia may not heal completely, and this predisposes you to an incisional hernia.” Other risks include incisional infection and excess vaginal bleeding. As for those who give birth vaginally, the medical professional explains that some two-thirds have a vaginal tear or experience an episiotomy. “This type of trauma to the vagina needs time to heal,” says Henigsman. “Exercising too soon can disrupt your vaginal stitches.” This can lead to severe bleeding, possible re-stitching, or even potential infection.
And then there’s the common issue of the aforementioned diastasis recti. "Almost 50% of women experience diastasis recti during and after pregnancy,” says Henigsman. “This condition occurs when the two large rectus muscles that meet in the middle of the abdomen become separated by an abnormal distance. Doing improper exercises after delivery can make diastasis recti worse. This will cause back pain, pelvic pain, damage to your posture, pelvic floor dysfunction, and hernia, in extreme cases.”
Vigorous exercise too soon after delivery can also put excess strain on a woman’s joints and ligaments, which were relaxed during pregnancy by the hormone relaxin. Premature stress can cause excessive back pain and pelvic floor dysfunction, and it can predispose a woman to severe ligament and joint injury, explains Henigsman.
Pelvic floor rehab, where a specialist like a physical therapist helps to rehab and strengthen the muscles (which is the norm in postpartum care and covered by insurance in some countries, like France), is something Roup says was vital for her recovery process. "Pelvic floor therapy or programming was not even mentioned in my prenatal appointments and in my [post-natal] checkup; to me [that] was just mind-blowing,” says Roup. “That's a part of your body that's just been through [so much] trauma. It's so important that we take steps that are vital in the recovery process for women. And it's so important that we take time to tap back into our pelvic floor and do the work so that we can eventually go back to our regular activities in a safe way.”
Filling In The Gaps In Postpartum Fitness Recovery
Roup says she sees the six-week "all clear" as a marker for starting a slow, rehab-focused program instead of diving back into regular workouts right away. Her own experience spurred her to create a specific program (TSS Mama) for women who are cleared to work out and want to slowly and safely build up their strength again. The program includes pelvic floor and 360 breathing exercises that can be done alongside the pre/postnatal workouts. The pelvic floor exercises involve doing slow, controlled movements in which you focus on breathing and connecting to the pelvic floor muscles (read: feeling and engaging the muscles more). There's also a Postpartum Pelvic Floor + Core Recovery Program that new moms can do before starting the postnatal workout program that focuses on recovery and strength building.
"My entire postpartum program is a much slower and more specific way of moving for the next six weeks,” Roup says. “I believe those next really vulnerable six weeks [should be spent] slowly layering on strength within the core work and within regular exercises. So that when you're around 12 to 14 weeks, you can feel much more confident in going back into a ‘normal’ core workout and knowing how to really do those exercises correctly so that you're not causing any harm.”
Roup also encourages being patient and loving with yourself during this time, which can be difficult in today’s social media-driven society, which has cultivated a culture of perfectionism and imposter syndrome. "I think it was really important to me to show those vulnerable moments of like 'I just didn't work out and I felt really weak,' and looking at my body in the mirror and not recognizing it," says Roup. "I was very transparent on social because I felt like unfortunately, so many women on Instagram look ‘perfect’ like a week later after giving birth. And that's just not the reality. I knew it would be powerful for other women to see someone even like me, who's in the fitness industry, struggling to feel strong in that fourth trimester. "