The six-week GP check – where you are pronounced ‘back to normal’, right? The 6-week check is an interesting experiment because it rarely scratches the surface in terms of what women need postnatally. And therefore, assuming that this check signs us off for ‘normal’ activities, whatever that is – is doing our long term physical and mental health a disservice. How many women jump eagerly back to running/start Postnatal Boot Camp Body Shred having been ‘cleared for exercise’ after a GP check where exercise wasn’t actually even specifically mentioned? How many women begin running having been cleared for exercise, only to then experience a vaginal prolapse because their pelvic floor muscles haven’t been rehabbed effectively before attempting high impact exercise (the answer is that I don’t completely know, as pelvic floor stats are possibly only showing part of the story as a LOT of women suffer in silence with pelvic floor dysfunction, or are unaware of what symptoms to be aware of). But the GP said it was ok…? Did the GP actually verbalise this, or do we assume?
We prioritise losing the baby weight, looking back to normal, without even a glance at how your body is reorganising its strength and power inside.
One of my clients has had three babies, all vaginal births, with intervention i.e. with episiotomy (surgery) or tearing of the pelvic floor muscles. She has had three postnatal 6-week checks. And she has never had her pelvic floor examined internally or heard of women’s health physio. For 10 years she has been putting up with pelvic floor dysfunction – light incontinence, just enough to feel crap about it but not feeling it’s ‘serious enough’ to go to the GP – and pelvic pain, in silence. These experiences are sadly all too common. Women need to know that we need to advocate for ourselves, to ask for guidance and for the care that we need and deserve. Injured muscle doesn’t repair itself without proper care. If a professional footballer tore her hamstring, she would have physio for weeks before being sent back onto the pitch – we know through decades of medical research that injured muscle does not repair itself without focused rehabilitation. So, why therefore do we turn a blind eye to pelvic floor injury through pregnancy and birth?
In some surgeries the GP check isn’t even viewed as a necessary check any more and you have to request it. If this is the case for your local surgery, please don’t skip it, it’s really important to check in on your physical recovery and access a forum for asking questions about your healing. This check is not, and never has been, meant to be a ‘clearance for exercise’, yet for some reason that’s what it’s understood as being. It generally covers a discussion about contraception (although you may feel like this has never felt lessrelevant) and your mental health in this early period. It rarely comprehensively checks your physical healing. Only a full physio check at this point would truly ‘clear you for exercise’. Please speak up if you don’t feel that you are being given more than a cursory glance-over. Make sure you ask your GP about:
Pelvic floor – ask to be checked internally if that feels appropriate and safe for you. Ask for specific guidance about pelvic floor exercise and describe the pain/discomfort you’re experiencing if you’re worried. Don’t suggest that everything is fine if it’s not. Now’s the time to speak up. If you ask to be referred to a women’s health physio now, it may be that due to waiting lists you wouldn’t get an appointment for a few weeks/months anyway, so bear this in mind if the doctor suggests it’s ‘too soon’ to see a physio and tells you to come back in a few weeks. Ask to be referred now. It’s too easy to postpone this and just hope things will get better in time. Tending to your new baby, it can feel like this actually isn’t that important, but it is. You are important too. Pelvic floor issues don’t magically get better on their own.
Diastasis recti – ask to have your abdominals checked. In my experience, it may not be mentioned unless you bring it up, and even then your GP may look nonplussed if they are not specifically trained in women’s health. If your GP dismisses you, or doesn’t seem to know what you’re asking, don’t be deterred. Don’t allow anyone to suggest that this is ‘just’ a mum issue that is ‘normal’ and you have to put up with. Ask to be referred to a women’s health physio, or get yourself independently to one, or to a postnatal-qualified Pilates trainer so they can check you. Do not be fobbed off. This is so important and sadly not something that GPs yet have enough awareness of or time to promote robustly in an immensely pressurised (and wonderful) NHS.
It takes six weeks just for your uterus to settle and the blood supply to regulate back to pre-birth levels. Your body will only just have started to assemble itself into its pre-baby organisation at a cellular level. Your connective tissue needs to reconnect. It can take months and months for your hormones to balance to pre-pregnancy levels. If you’ve had a Caesarean or a birth with intervention, there will be multiple layers of invisible tissue healing going on, which require lengthy rehabilitation and ample rest. Giving birth is a huge event. Don’t belittle it by assuming that after six weeks you are ‘back to normal’.
What was your experience of a 6-week check? Useful or not? Were you referred to physio? I’d love to hear…..
Pilates for Pregnancy by Anya Hayes