What to expect from your postpartum body: Weeks 4-8 

Continuing along in our “What to expect from your postpartum body” series, we will discuss 4-8 postpartum. Below you will find information on how to continue returning to daily activity and exercise safely, what to look for that may warrant a visit to a pelvic floor PT, and what to expect in a typical postpartum therapy session. 

“It’s already been 4 weeks? How has it only been 4 weeks?”

Yes, you read that statement correctly. Once you reach the 4 week postpartum mark, you might feel like your delivery was both a lifetime ago and like it just happened. There may be days where you feel like you know exactly what you are doing and days where you have no idea what you are doing. You and your family are likely still trying to figure out your new “normal”, and that can oftentimes be daunting. To ease your mind a bit and help you figure out what the new “normal” should look like for your body, here are some of the things you should expect in the 4-8 week postpartum phase. 

At this point, if you are still nursing or pumping, it should be a bit easier. Your supply should be leveling out and you should not have a much nipple discomfort as you may have had in the beginning. If you are still struggling with oversupply, undersupply, frequently clogged milk ducts, or cracked/bleeding nipple, you would likely benefit from a consultation with a lactation consultant. (If you have not met with one already). You will also want to make sure you are staying well hydrated and taking in an adequate amount of calories throughout the day. This is one of our favorite water bottles.

On average, most nursing and pumping moms will require anywhere from 300-500 extra calories per day. For some mommas this can be a snack or two,  and for others it can be another small meal. These added calories will be especially important for mommas who are exercising, as they will have a higher energy expenditure. It will also be important to choose nutritionally dense foods that will give you the most bang for your buck. This can include veggies, avocados, nuts and nut butters, fruits, yogurt, plant based smoothies, lean proteins and complex carbohydrates like brown rice, whole grain pastas and breads, or sweet potatoes. This is a great option for a calorie-rich breastfeeding bars. For more information on proper hydration and caloric intake, read more about calories and fluids here.

What’s that? Did you say something about exercise in that last paragraph?

Yes, I said exercise. For some of you that might be the last thing on your mind. But for others, all they can think about is getting back to their prior level of activity.  If you are in the latter group, congratulations! You can gradually start to returning to exercise, with the key word being GRADUALLY. At this point, it is safe to return to low intensity activities like walking and some gentle core/pelvic floor strengthening exercises. These activities will bring good blood flow to the pelvic region and start working those pelvic floor and abdominal muscles again without adding unwanted strain. Activities like the elliptical, yoga/Pilates, and swimming should not be started until around 8 weeks postpartum.  High level activities like running, HIIT classes, rowing, Orange Theory, Powerlifting and Crossfit are still off limits and will remain off limits until at least 12 weeks postpartum. 

These activities are typically not appropriate until 3 months postpartum (at the least), and in many cases up to 6 months postpartum. This is because these higher level activities put a much greater demand on the muscles of our pelvic floor and abdomen, require a high level of trunk and lower extremity coordination, and require the ability to have good load transfer from one limb to another. At this point, not enough healing has occurred for these tissues to properly handle that type of load. So, you will have to wait a couple more months for those activities. The good news is that many of these lower intensity activities can help prepare your muscles for the high level activities. For more info on some of the most recent research on return to running guidelines for postpartum women, click here.

Let’s talk about sex, baby!

Right around the 6 week mark is when most women have their first postpartum OB visit. Many times this appointment is a quick screen to make sure that any perineal tearing or cesarean incision is healing properly, to discuss birth control options, and to be given the “ok” for sex.  However, many women do not feel ready for intercourse at this point, and that is ok. Vaginal dryness from nursing, healing tears, fear of pain, and general vaginal/perineal discomfort can oftentimes limit a woman’s desire to have intercourse or cause discomfort should intercourse be attempted. Although this is very common, pain with intercourse is not normal and is a sign that you would benefit from an evaluation by a pelvic floor PT. In the meantime, here are some tips that can make intercourse more enjoyable once you are ready to try. 

  1. ALL THE LUBE. Nursing hormones can make your vulvar and vaginal tissue dry and this can ultimately make sex uncomfortable. You can use vitamin E oil or coconut oil daily to help hydrate those tissues, and find a water based lubricant to use during intercourse. Slippery stuff lubricant is one we use in the clinic that is water based, has minimal ingredients, and is available on amazon. 

  2. Make sure you have adequate foreplay to stimulate arousal. By stimulating arousal, you will increase blood flow to the vulvar tissue and increase your body’s natural lubrication. Plus, who doesn’t love a bit of foreplay??

  3. If you had any perineal tearing during your delivery, you can do some gentle perineal massage once your incision is completely healed. This can be done on your own, or can be done by your partner. Make sure to be very gentle with your pressure as these tissues are still healing. For info how to perform perineal massage, click here.  

If you attempt intercourse and have pain with initial insertion or deep insertion, you old most likely benefit from an evaluation by a pelvic floor PT. 

“But I’m only 8 weeks postpartum, this is normal.”

Yes, you are only 8 weeks postpartum and still very much in the healing process. However, there are certain things that while common are not normal and will require treatment from a pelvic floor PT.  This includes, but is not limited to, urinary leakage or urgency, continued constipation or excessive straining with bowel movements, pelvic pain with intercourse, hip/low back/ Sacroiliac joint pain, pelvic pressure or the sensation that something is falling out, and excessive vulvar and vaginal dryness. Should you be experiencing any of these symptoms, we recommend that you make an appointment with a pelvic floor PT in your area or contact us for an online consultation.

Other very common, yet abnormal symptoms include depression and anxiety. If you are experiencing these symptoms or other hormonal/mental symptoms, please know that you are not alone. Know that it is ok to seek the guidance and treatment of a mental health professional and may possibly require medication. THIS IS OK! The only way you can truly recover postpartum is to take care of the whole you….the physical, mental and emotional. 

In closing, keep rocking on momma! You’re doing great! 4 weeks down and a wonderful lifetime to go!

Emily McElrath PT, DPT, MTC, CIDN is an orthopedic and pelvic health physical therapist with a passion for helping women achieve optimal sports performance. She is an avid runner and Crossfitter and has personal experience modifying these activities during pregnancy and postpartum. She is certified in manual therapy and dry needling. When not working, Emily enjoys time with her husband and two kids.

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Sara Reardon