Essential Care for Every New Mother
Whether you had a vaginal birth or cesarean section, your pelvic floor needs attention and care after childbirth. The pelvic floor is a group of muscles that support your bladder, uterus, and rectum. Pregnancy and childbirth put tremendous strain on these muscles, and proper recovery exercises are essential for every new mother.
Understanding Your Pelvic Floor
The pelvic floor muscles form a hammock-like structure at the base of your pelvis. These muscles:
- Support your bladder, uterus, and bowel
- Control urination and bowel movements
- Play a role in sexual function
- Help stabilize your core
Pregnancy weakens these muscles due to the weight of your growing baby and hormonal changes that relax connective tissue. Vaginal delivery further stretches them, and even cesarean birth affects them due to pregnancy.
Perineal Healing (After Vaginal Birth)
If you had a vaginal delivery, your perineum (the area between your vagina and anus) has been stretched and possibly torn or cut (episiotomy). Healing typically takes 2-6 weeks depending on the degree of tearing.
First-Degree Tears: Small tears in the skin only—heal quickly within 1-2 weeks Second-Degree Tears: Involve muscle—most common, heal in 2-3 weeks Third/Fourth-Degree Tears: Extend to anal muscles—require 6+ weeks and special care
Caring for Perineal Tears:
- Use a peri bottle with warm water to clean after using the toilet (pat dry, don’t wipe)
- Apply cold packs wrapped in cloth for the first 24-48 hours to reduce swelling
- Use witch hazel pads for comfort
- Take warm sitz baths (shallow warm water) 2-3 times daily
- Change pads frequently to keep area dry
- Take prescribed pain medication or stool softeners as needed
- Avoid constipation (straining delays healing)
When to Call Your Doctor:
- Increasing pain rather than improving
- Foul-smelling discharge
- Fever
- Stitches opening or feeling like they’re pulling apart
- Unable to control bowel movements (with 3rd/4th degree tears)
Why Pelvic Floor Exercises Are ESSENTIAL
Many women skip pelvic floor exercises, thinking they’re optional or only for women with problems. This is wrong. Every woman who has been pregnant needs pelvic floor rehabilitation, regardless of delivery method.
Benefits of Pelvic Floor Exercises:
- Prevent urinary incontinence: Stop leaking when you cough, sneeze, laugh, or exercise
- Improve recovery: Increase blood flow to promote healing
- Support pelvic organs: Prevent prolapse (organs dropping down)
- Enhance intimate health: Improve sensation and satisfaction
- Prepare for future pregnancies: Strong pelvic floor withstands subsequent pregnancies better
- Prevent long-term problems: Issues that start small in your 30s can become severe in your 50s and beyond
The truth: One in three women who have had a baby experiences some degree of incontinence. This is common, but it’s NOT normal and NOT something you have to accept. Pelvic floor exercises can prevent or improve this.
Locating Your Pelvic Floor Muscles
Before you can exercise these muscles, you need to find them. Here’s how:
Method 1: Imagine you’re trying to stop yourself from passing urine mid-stream. The muscles you squeeze are your pelvic floor muscles. (Don’t actually practice this while urinating, as it can cause bladder problems—just use it to identify the muscles.)
Method 2: Insert a clean finger into your vagina and try to squeeze around your finger. You should feel a gentle squeeze and lift.
What you should feel: A squeeze and lift sensation, pulling inward and upward. You should NOT:
- Hold your breath
- Tighten your buttocks, thighs, or abdomen
- Bear down or push out
If you’re having trouble locating these muscles, ask your healthcare provider for guidance or request a referral to a pelvic floor physical therapist.
How to Perform Pelvic Floor Exercises (Kegels)
You can do these exercises anywhere, anytime—lying down, sitting, or standing. Most women find it easiest to start while lying down.
Slow Contractions (Endurance Training):
- Squeeze and lift your pelvic floor muscles
- Hold for 10 seconds while breathing normally
- Relax completely for 10 seconds
- Repeat 10 times
If you can’t hold for 10 seconds initially, start with 3-5 seconds and gradually build up over weeks.
Quick Contractions (Strength Training):
- Squeeze and lift your pelvic floor muscles quickly and firmly
- Release immediately
- Repeat 10 times quickly
How Often: Perform BOTH slow and quick contractions, 5-8 times per day. This might sound like a lot, but each set takes only about 2 minutes.
When to Exercise: Link your exercises to daily activities to build a habit:
- While breastfeeding
- At every red light while driving
- During TV commercial breaks
- While waiting for water to boil
- Before getting out of bed
- After using the bathroom
When to Start
Good news: You can begin gentle pelvic floor exercises immediately after birth, even within hours of delivery. Start with just a few contractions and gradually increase. You may not feel much happening initially due to swelling and numbness, but the muscle activation promotes healing.
If you had a severe tear (3rd or 4th degree): Ask your doctor when it’s safe to begin exercises, usually after the first week or two.
Progression and Expectations
Week 1-2: You may feel very little happening. Keep trying—the muscle activation aids healing even if you can’t feel much.
Week 3-6: You’ll start feeling more sensation and control returning. Gradually increase repetitions and hold times.
Week 6+: Once cleared at your postpartum check-up, continue exercises daily. These should become a lifelong habit, not just a postpartum requirement.
Results: Most women see improvement in 6-12 weeks with consistent exercise. Some improvements (like reducing incontinence) can happen within a few weeks.
Additional Pelvic Floor Advice
Avoid Constipation:
- Eat a high-fiber diet with plenty of fruits, vegetables, and whole grains
- Drink 8-10 glasses of water daily
- Never strain during bowel movements (use a stool softener if needed)
- Straining weakens pelvic floor muscles and can worsen tears or hemorrhoids
Don’t Lift Heavy Objects:
- Avoid lifting anything heavier than your baby for at least 6 weeks
- When lifting, engage your pelvic floor first, then lift while breathing out
- Never hold your breath while lifting
Stop Smoking:
- Chronic coughing from smoking puts constant strain on your pelvic floor
- Smoking also impairs healing
- Each cough event increases pressure on weakened muscles
Maintain Healthy Weight:
- Excess weight puts additional pressure on your pelvic floor
- Gradual, healthy weight loss helps long-term pelvic floor health
When to See a Pelvic Floor Physical Therapist
Consider seeing a specialist if you experience:
- Urinary incontinence that doesn’t improve with exercises
- Fecal incontinence or inability to control gas
- Pelvic pain during intercourse
- A feeling of heaviness or bulging in the vagina (possible prolapse)
- Difficulty performing pelvic floor exercises correctly
- Third or fourth-degree tears
Pelvic floor physical therapy is specialized treatment that can make a tremendous difference. A therapist can assess your specific issues and create a personalized treatment plan. Many issues that seem permanent can be significantly improved with proper therapy.
Sexual Activity Resumption
Most healthcare providers recommend waiting until after your 6-week check-up before resuming sexual intercourse. This allows time for:
- Perineal tears or episiotomy to heal
- Cervix to close
- Lochia (bleeding) to stop
- Pelvic floor to begin recovering
When you do resume intimacy:
- Use plenty of water-based lubricant (hormonal changes cause dryness)
- Go slowly and communicate with your partner
- Different positions may be more comfortable
- Pain is not normal—if intercourse is painful, see your doctor
- Pelvic floor exercises actually enhance sexual sensation once healed
Looking Ahead
Strong pelvic floor muscles now will benefit you for decades. Women who neglect pelvic floor exercises after childbirth often face significant incontinence and prolapse problems in their 50s, 60s, and beyond. Just a few minutes daily now can prevent years of problems later.
Make pelvic floor exercises as routine as brushing your teeth. Your future self will thank you.