At six weeks, it is routine for postpartum women to visit their OB/GYN to assess physical healing and mental well-being after delivery. One of the main milestones around this visit is “exercise clearance”. But what does this mean, and why is six weeks the magic number? In this blog post, we will help define what exercise clearance means, why timeline matters but is not the only consideration, and what to expect at your visit. This is aimed to help you feel more confident in what to expect before, during, and after this appointment, providing some clarity during this beautiful time of being a new mother.  

“EXERCISE CLEARANCE”

The primary outcome most women seek from this visit is to be cleared to exercise as usual. But what does this really mean?  Am I not allowed to do ANY exercise before this? What type of exercise am I cleared for now? How do I start exercising again? 

These are all valid questions that many new moms have; however, concrete answers are hard to come by. One reason for this vagueness is that every pregnancy, delivery, and postpartum experience is SO different. With this much variety, making direct, blanket statements to cover a wide range of possibilities is difficult. 

Generally, the statement regards returning to your pre-pregnancy workout routine and activity. It does not mean light exercise and targeted recovery are off-limits before the six-week mark. Think about it like someone recovering from knee surgery: they cannot go back to running and jumping immediately. They start rehab exercises to promote healing within the first few days after surgery and are taken through a graded progression of rehabilitation exercises gradually over several months. The first six weeks of rehab include very targeted exercises vital to short- and long-term recovery. Postpartum recovery should be approached the same way with a steady, calculated progression to heal the injured tissues and work up to your exercise goals.

WHY SIX WEEKS? 

The six-week time point has been established as a necessary checkpoint based on the timeline of healing properties. By this time, your uterus should have returned to its normal size, internal organs should have shifted back to pre-pregnancy positions, and wounds should have closed completely and be in the final stage of the healing process. This is based on the standard biological time frame of healing. And while time is one important consideration in recovery, it is not the only factor when discussing returning to exercise.   

Continuing with this comparison to knee surgery, just because six weeks have passed does not mean everything is magically back to “normal” again.  We wouldn’t let an athlete back into the game unless they had proved they were fit to play and fully recovered from their injury. In sports rehab, there are sets of physical tests and measures that you have to pass to be cleared to play. The same approach should be taken with postpartum recovery. Rehabilitation after any injury is a journey in which several factors, including time, physical strength and performance, mental readiness, and other wellness factors such as sleep and nutrition, must be considered when discussing returning to exercise. It’s time to start looking at postpartum recovery similarly to any other injury and devoting more to postpartum recovery. 

WHAT TO EXPECT AT YOUR SIX WEEK CHECK-UP 

PHYSICAL EXAM

One of this appointment’s main objectives is to check that all incisions, tears, and injuries you may have endured during delivery are healing appropriately. If so, your doctor will clear you from “pelvic rest.” 

Pelvic rest means you give your vagina a break, and nothing gets inserted into your vagina. This includes tampons and other forms of penetration, including penetrative sexual activities. This also means that you cannot undergo a pelvic internal exam at physical therapy, as this involves inserting a gloved finger into the vaginal canal to examine your pelvic floor muscles. 

This does NOT mean you cannot start pelvic floor physical therapy before six weeks. However, the internal exam assessment of your pelvic floor muscles should only be done once you gain clearance from your OB/GYN. 

EXTERNAL: The physician will check your incision(s) or torn tissue(s) and evaluate tissue healing externally.  Your abdomen and vagina will both be assessed, with further assessment regarding healing depending on if you had a vaginal delivery or C-section. 

INTERNAL: They will check how the vaginal canal and cervix are healing with an internal exam via speculum (that clear device). If you are due for a Pap smear, they may harvest some tissue to get this done. This is NOT a pelvic floor muscle exam. Your OB/GYN is focused on the health and healing of your cervix and uterus, not the state of your musculoskeletal system and its function. To know this, seeking care from an expert in the musculoskeletal system is needed; that’s where pelvic floor physical therapists come in. 

MENTAL EXAM 

Your physician should provide you with a mental health screening tool that assists in assessing for postpartum depression. If you have concerns about your mental health and the changes you've experienced since giving birth, now is the time and place to talk to your doctor. 10-20% of women experience postpartum depression, so you must check in with yourself to get the help and care you need. You are not a “bad mom” or “bad person” if you are experiencing these things; additionally, there is no shame in managing the symptoms that come from the hormonal and lifestyle changes that follow giving birth.  Check in with yourself, and seek help and support early and often.

LAB TESTS

Your provider will perform a glucose tolerance test via a blood draw at this time (especially if you have gestational diabetes). Further testing may be done via blood or urine analysis if you experience other conditions during pregnancy.

FAMILY PLANNING 

This is an excellent opportunity to discuss birth control methods for future planning purposes depending on your unique wants and needs. 

This briefly overviews what to expect at your six-week postpartum checkup. If you have any specific questions or concerns, this is a great time to present them to your doctor. I think it would be a good idea to write them down and be prepared, as these follow-up visits can go rather quickly. This is also a great time to ask your OB/GYN for pelvic floor physical therapist recommendations. If you are curious about progressing with your rehab and want to know more about how to fully recover and get back to feeling stronger than ever, book a free consultation with me at the link in the top right corner. Let’s give your body the recovery it deserves! 

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