3 - 6 Months Postpartum

Recovery Progress
X Months Out of 18 Down! 3%

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Overview

Congratulations! You’ve made it this far! By this time, nighttime sleep is likely getting a little more predictable though daytime sleep may still vary. This hopefully helps increase energy during the day, but it may still be challenging to do things like shower solo with an unpredictable nap schedule. 

If you had a c-section, your scar should not be too much of a bother. If it is, this is something to bring up with your doctor.* We’ll touch on that later in the core section.

While it’s completely normal not to feel like your totally old self, hopefully you’re feeling more like a human at this stage. You should be feeling a little bit stronger physically as well. 

During the 3-6 month phase, it’s important to focus on building a good foundation of strength and practicing habits and behaviors that will help propel you into the later phases of postpartum recovery. For example, building a foundation of pelvic floor and core strength will allow your return to things like running easier down the line.

Core

Your core is…probably a lot of things at this point. Keep in mind that it was stretched for 9+ months to allow for a HUMAN CHILD to grow in your womb. So please don’t discount everything your body has done. 

Your core may not look or work quite the way you remember it, even at 3-6 months postpartum. However, hopefully you’re noticing some improvements in your strength and overall appearance if that is important for you. The good news, if you’re not totally in love with your core right now, is that your body is still healing and you can continue to build strength for weeks, months, and years to come!

Diastasis Rectus Abdominis

Diastasis rectus abdominis (DRA) is probably the most common core issue. This is a separation of the 6 pack ab muscles. By the 6 month mark, the gap between the muscles has likely closed as much as it will on its own without extra support.

How to Support C-section Scar Healing

If you had a cesarean section, you may be experiencing scar pains weeks and months afterwards. Initially, incisional (scar)  pain is likely from the immediate swelling and healing that is happening. As it heals, there may be discomfort for a variety of reasons. Scar tissue can develop causing the scar to be tighter in some areas than others. Additionally, as the nerves heal, you may experience pain or discomfort. It’s normal to have pins and needles- type sensations but sharp stabbing pains that do not ease are not normal and should be addressed with your healthcare provider, especially if symptoms don’t improve with normal over-the-counter pain relief. Pain related to nerve healing should improve over time.

You can start with scar desensitization early on but it can also help if you’re getting started further down the recovery road. Scar desensitization  means you’re trying to help the nerves and tissues heal so they are not as sensitive as time goes on. Start with touching around (not directly on) your incision a couple of times per day if you haven’t started yet. As this feels better and you notice you can tolerate more sensation, you can begin scar massage since your incision should be fully healed at this stage.

Pelvic Floor

By this phase of your postpartum journey, any incisions or tearing should be healed. However, while you may be past the soreness that came with childbirth, you may be noticing new issues. While not everyone will deal with pelvic floor issues after baby, they are relatively common. The following are common (but not normal!) pelvic floor issues that you may notice during this phase:

  • Pelvic Pressure/ Heaviness/ Dragging
  • Pain with Intercourse
  • Leakage
  • Nerve Injuries (typically numbness/ tingling in the pelvic area)

If you’re not finding that you’re experiencing any specific pelvic floor issues or symptoms, it’s still important to consider the pelvic floor as you return to normal activities and exercise. Practicing pelvic floor strengthening exercises and relaxation is important so that as you return to things like jumping and running, your pelvic floor can work with you instead of against you. Regardless of the way your baby was delivered or any symptoms, or lack thereof, your pelvic floor went through a lot for 9+ months and is still recovering! 

Pelvic Floor Exercises: It's More than Kegels!

Incorporating a combination of strengthening and relaxation/ stretching will help maintain a healthy pelvic floor. Try these exercises:

  • Pelvic Floor Strengthening (Kegel): On an exhale squeeze your pelvic floor up and in as if you are trying to stop the flow of urine. Relax these muscles when you inhale. Start with holding for as long as you exhale and work up to 10 second holds. 
    • Start with as many repetitions as you’re able to do without using other muscles like your inner thighs or glut muscles and work up to 10 repetitions
  • Pelvic Floor “Quick Flicks”: Squeeze and lift the pelvic floor muscles for about 2 seconds and relax, repeat these quick squeezes 10 times. It’s important to avoid holding your breath here.
  • Pelvic Floor Relaxation: Practice in a comfortable position. As you inhale imagine opening up or bulging the pelvic floor as if you’re gently trying to have a bowel movement. On an exhale return to baseline. Repeat the expanding and opening on an inhale. Practice for a couple of minutes

Yoga and general stress management and stretching are all good strategies to help the pelvic floor muscles from becoming too tight.

Risk Factors for Pelvic Floor Issues

While it’s not entirely possible to predict whether a pelvic floor issue could arrive after baby, there are some risk factors during pregnancy and even postpartum that could increase your risk. Those risk factors for developing pelvic floor issues include:

  • Age
  • Having had more than one child
  • History of constipation
  • Urinary leakage during pregnancy
  • Head size of baby

Symptoms of Pelvic Floor Dysfunction

Sometimes you may be experiencing issues or problems that you can’t quite pinpoint but don’t seem like your “normal.” The following are common symptoms or signs that you may be experiencing pelvic floor dysfunction. Pelvic floor dysfunction could be a sign of muscles that are either too weak, too tight, or not working or coordinating the way that they should be.

  • Pain in the pelvic, vaginal area
  • Pain in the lower abdomen
  • Heaviness, pressure, dragging in the vaginal area
  • Leakage of pee or poop
  • Not being able to control passing gas
  • Having trouble making it to the bathroom on time
  • Peeing frequently (more than 6-8 times in one day)
  • Pain with sex
  • Constipation, straining with bowel movements
  • Numbness or tingling the the pelvic or vaginal area

Diagnosis of Pelvic Floor Dysfunction

When it comes to diagnosing pelvic floor dysfunction, the symptoms you are experiencing are important in figuring out what may be going on. These are important symptoms to bring up with your healthcare provider. You can also seek care from a pelvic floor therapist who can help by listening to your symptoms and perform further assessment to determine the root cause of your issue. 

When it comes to a pelvic floor assessment, there are a few things to expect at your appointment:

  1. A thorough discussion about your symptoms
    • This will include questions about pain, peeing, pooping, labor and delivery, and questions about your general health
  2. Assessment of your overall posture, strength, mobility/ flexibility
  3. A pelvic floor assessment
    • This is what is the most different from a typical physical therapy visit. A pelvic floor assessment can be internal or external and your therapist will go over in detail what to expect.
    • Your therapist will be looking at how your muscles are coordinating, their endurance, strength, and ability to relax
  4. Development of a treatment plan for your issue

By asking questions and doing a thorough assessment, a pelvic floor therapist can play a crucial role in helping get to the bottom of your issues.

Treatment for Pelvic Floor Dysfunction

If you find or believe you might be experiencing pelvic floor dysfunction or issues with your pelvic floor, the treatment for this is vast and varies depending on what the issue is.

If you’re experiencing issues like pain or constipation, it’s very possible your pelvic floor muscles may be too tight or overactive. Typically, those types of issues are best addressed with treatment focused on relaxation and stretching. 

360 Breathing and diaphragmatic breathing are a good place to start to promote pelvic floor relaxation. 

In addition, learning to bulge or relax the pelvic floor muscles can also be helpful.

If you’re experiencing issues such as leakage or pressure, it’s possible that there is weakness in the pelvic floor. In this case, treatment will likely be focused on coordination and strengthening of the pelvic floor muscles. 

To learn more about what to expect with pelvic floor physical therapy, check out these resources:

Adjusting to Motherhood

As you and your baby leave the fourth trimester, you may be feeling more like yourself and gaining some confidence in your ability to tackle the challenges of motherhood. It’s also common to feel overwhelmed by new challenges ahead. Parenting is like riding waves in the ocean, sometimes you are treading water and sometimes you are surfing! You learn to surf waves that you were only treading at first.

You have likely overcome the early waves of womb and scar healing, newborn feeding, and surviving on minimal sleep. Maybe you are even riding some of the highs of hearing your baby’s coos and interactions with you. Hopefully these can help propel you forward as you tackle new waves like adjusting to life as a working mom or staying home with your kiddos, chronically disrupted sleep, and a struggle for a daytime schedule. This hard work will pay off and you will keep learning to surf as your baby continues to explore their environment and grow in their independence.

Feeling Less like yourself?

If the challenges of motherhood have you feeling:

  • overwhelming sadness
  • feelings of hopelessness
  • excessive worry and rumination
  • feelings of being overwhelmed
  • extreme changes in appetite
  • sleep and concentration”,

You may be experiencing a perinatal mood disorder (“Postpartum Depression Symptoms”, 2020). You can learn more about postpartum mood disorders here or see our Maternal Mental Health Resources for additional support. It is hard to believe when you are struggling with these symptoms, but there is help out there mama. 

Returning to work (or not)

Have you heard the term ‘mom guilt’? Feeling like you are constantly failing at something is a common theme for moms, especially new moms. If you are returning to work, many moms feel like they are failing on all fronts. If you are staying at home with your baby, you may be feeling internal and possibly external pressure to keep up with all of the things at home on top of the demands from your baby. Returning to work and staying home both come with their challenges, so we have included a few helpful tips below.

Returning to Work

While many unfortunately have to return before the 3 month mark, most new moms will likely be headed back to work around this time (unless you’re outside of the US!). This can be an interesting time. Not only are you getting another human ready in the morning, but you likely have more to prepare and think about as you return to work. Betterup has a great article about going back to work with some tips to consider. 

Don’t Compare: Let Your Values Guide Your Priorities

Whether you are working or staying home, it’s important to continue to evaluate whether your expectations are realistic by talking with veteran moms and letting your values guide your priorities. One of the biggest challenges for me (Alex) is not to compare myself to other moms. Some moms may value a clean house, while others value exercise, time with their partner, or something else. None of these are wrong unless they are wrong for you, but you can’t prioritize everything or you are setting yourself up for failure.

A Schedule for Mom (When Your Baby Won’t Follow the Schedule)

Your baby may be sleeping for longer stretches at night (Pacheco, 2022). If you are like me and just want baby to be on a regular schedule, hang in there mama! Unfortunately, in my (Alex’s) experience, daytime sleep isn’t always predictable until 6 months. But just because your baby doesn’t necessarily have the same exact schedule everyday doesn’t mean that you will never be able to plan anything in your day. 

  • Quick Tip: If you like structure, consider the flexibility that a block schedule allows.
    • Block Schedules: Essentially, block scheduling allows you to prioritize certain activities in blocks of time rather than exact set times during the day. You could divide your day into loose blocks based around approximate sleep/wake/feed cycles.

      • How to Block Schedule:

        • Pick a realistic number of tasks you want to accomplish each day based on your priorities
          • Start with 1-2 non-essential tasks per block and grow from there
        • Fit those tasks into your baby’s approximate sleep/wake/feed cycle blocks
          • Sometimes you will have to move things as the day goes on and that is normal
          • Most of the time, you may not get to all of your tasks if you are a time-maximizer, overachiever like me (Alex) and that is also ok!
      • Here’s a video that helps break down Block schedules. Thanks to my veteran mom sister who originally shared this with me.

While we covered the newest struggles you may be facing during this timeframe, if sleep or nutrition are bigger challenges to you, check out the links below for some resources we have covered in the past:

Common Struggles

As you move through your recovery journey, you may still have things you struggle with even as you get towards the 6 month mark. These are common struggles we’ve heard from other moms, ourselves, and from what research tells us. As you read through this section, keep in mind that while these are all very common issues, there are many resources to help walk you through these. We don’t want you to live years with something that there is help for.

Urine Leakage

We may sound like broken records, but urine leakage is relatively common at any point postpartum. However, please remember it is not normal. It’s possible that you did not notice any leakage until this point. The cause for that may be that you’re starting to do more activity or exercise. As you ask your body and your pelvic floor muscles to do more work, they may not be able to function properly without leakage if they are not strong enough. 

Pro Tip: Check your bladder habits first. Are you getting enough water throughout the day? Are you fully emptying your bladder when you urinate? Consider keeping a bladder diary to track symptoms and see if there are any leakage triggers. If you find that your bladder habits are generally good (avoiding irritating foods and beverages and peeing at normal lengths of time), starting with pelvic floor strengthening may be the next step.

Discomfort with Intercourse

Pain with intercourse is a common struggle for many new moms at various stages of postpartum recovery. There are a variety of factors that influence pain with sex. Hormones, libido, stress, fatigue, muscle tension and healing are all things that can contribute to intercourse not feeling the same as it did before childbirth. 

Research has shown that almost 50% of women 6-12 months postpartum report a lack of interest in sexual activity, 43% experienced a lack of lubrication during intercourse, and 37.5% had pain with sex 6 months after birth (O’Malley et al, 2018). There are a few things that put women at higher risk of experiencing pain with intercourse, or dyspareunia:

  • vacuum- assisted birth
  • 2nd and 3rd degree perineal tears
  • Episiotomies
  • Breastfeeding in combination with other factors
  • Dissatisfaction with body image 

Pro Tip: Being aware of the fact that you are having an issue with intercourse is the first step to overcoming this common struggle. Recognize that pain with sex is not normal and can change. Communicate with your partner and consider working with a pelvic floor physical therapist. Additionally, using lubrication to avoid increasing pelvic floor discomfort due to hormonal factors. 

Weight Loss

Weight loss is typically a large focus of the postpartum journey on social media and in the news. While there are health reasons to work towards returning to pre-pregnancy weight or close to it, it is important to remember that the pregnancy weight gain happened over a period of months and the same should happen with postpartum weight loss. There are factors that can contribute to weight retention postpartum:

  • A decline in healthy diet
  • Unhealthy lifestyle behaviors
  • Irregular sleep and meal times
  • Physical activity levels that are low
  • Watching >2 hours of television per day
  • Psychosocial factors such as depression and anxiety


Pro Tip: While it’s important to take time to rest and bond with baby, returning to physical activity and a healthy diet will put you on your way to postpartum weight loss (Makama et al, 2021). Additionally, most research suggests that breastfeeding moms also have slightly higher rates of postpartum weight loss than those who are not breastfeeding. While it’s important to feed your baby in the best way for both of you, that can be useful information for some.

Hair Loss

Most new moms will notice a surprising effect of the postpartum period, and that is hair loss. This hair loss is normal, according to the American Academy of Dermatology, and it’s not true hair loss. The shedding of hair is caused by decreasing estrogen levels and will return to normal by 12 months postpartum. According to the American Academy of Dermatology Association, there are some things that can help:

  • Use volumizing shampoo
  • Avoid “conditioning” shampoo
  • Use a conditioner for fine hair and primarily on the ends
  • Avoid “intensive conditioners”

Exercises for 3 - 6 Months Postpartum

At this stage of your postpartum recovery, it’s likely safe to engage in exercise without any immediate issues or concerns. However, you may find that it’s not incredibly easy to return to your normal level of activity. You may notice leakage with running or pressure with weight-lifting. We always recommend reaching out to a provider to determine the cause of any issues you’re experiencing. But sometimes those issues can be prevented or alleviated with a gradual return to exercise. 

How to Tell If You are Overdoing It

As you return to exercise, there are some signs and symptoms that you want to watch for to help determine if you’re doing too much too quickly. These signs can also be helpful in identifying pelvic floor or core issues:

  • Pelvic pressure
  • Pelvic dragging or heaviness
  • Doming or coning in the middle of the abdomen
  • Pain
  • Soreness that lasts more than 24-48 hours
  • Continue to increase intensity or distance, no more than 10% per week
  • Don’t increase intensity and volume in the same week (i.e. if you’re going to add more weight to your squats, don’t also increase how many repetitions you’re doing)
  • Start with 2 sets of an exercise and work up to 3 or 4, after that gets easier, increase weight
  • Remember: just because you CAN do something does not mean you always SHOULD do something

Exercises

Exercises in this phase of recovery are focused on starting to build on the foundation of strength you’ve started to build. For many, by the 3 month mark you may start to feel ready to return to your normal workout routine but be surprised when it doesn’t feel quite like you remembered. These exercises can help you continue to build core, pelvic floor, and general strength. 

Low impact exercise is recommended for the first 3 months (i.e. limiting jumping, running) and then using a return to running or high impact exercise protocol for months 3-6  (Groom et al, 2019). With that being said, if you experience any of the following symptoms at this point, it’s important to see a pelvic health provider before returning to running:

  • Heaviness/ dragging in the pelvic area
  • Leaking urine or not being able to control bowel movements
  • Doming or gap in the abdomen
  • Pelvic or lower back pain
  • Blood loss after 8 weeks that is not a menstrual cycle  (Groom et al, 2019)
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Pro Tip: To get started with a well-rounded workout, it’s important to work on all areas that need attention. To start, pick one exercise from each below to create your own workout for this stage. For more guidance and tailored workouts, we have partnered with Expecting and Empowered to bring you a $20 discount on their annual workout membership or $5 off a monthly subscription with code PRT

Core Exercise

Dead Bug

Planks

Side Plank (option for modified)

Sidelying Breathing

Pelvic Floor Exercises

Child’s pose + Kegel

Kegel + Squat to Stand

Deep Core + Straight Leg Lift

Squat + Kegel

General Strengthening

The following are general strengthening exercise ideas that would be excellent to work into a workout routine.

Deadlift

Fly

Bicep Curl to Overhead Press

Dumbbell Lunge

Lateral Walks with Band

Clamshells

A great option with postpartum recovery is a guided workout program. Expecting and Empowered created a workout app that will guide you through the first 33 weeks after delivery. Their workouts are separated into a c-section recovery and vaginal recovery. Modifications are available for all exercises. Head over to app.expectingandempowered.com and use Code PRT for $20 off an annual subscription or $5 off a monthly subscription. 

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    CREDITS

    Sources

    Fonti Y, Giordano R, Cacciatore A, Romano M, La Rosa B. Post partum pelvic floor changes. J Prenat Med. 2009 Oct;3(4):57-9. PMID: 22439048; PMCID: PMC3279110.

    Fu, W., Yuan, H., Ye, X., Shou, D., & Zhu, W. (2021). Prediction of postpartum pelvic floor dysfunction with a nomogram model based on big data collected during pregnancy. Annals Of Palliative Medicine, 10(2), 2143-2151. doi:10.21037/apm-21-166

    Makama M, Skouteris H, Moran LJ, Lim S. Reducing Postpartum Weight Retention: A Review of the Implementation Challenges of Postpartum Lifestyle Interventions. J Clin Med. 2021 Apr 27;10(9):1891. doi: 10.3390/jcm10091891. PMID: 33925502; PMCID: PMC8123857.

    O’Malley D, Higgins A, Begley C, Daly D, Smith V. Prevalence of and risk factors associated with sexual health issues in primiparous women at 6 and 12 months postpartum; a longitudinal prospective cohort study (the MAMMI study). BMC Pregnancy Childbirth. 2018 May 31;18(1):196. doi: 10.1186/s12884-018-1838-6. PMID: 29855357; PMCID: PMC5984394.

    Pacheco, D. (2022, June 10). Babies and sleep: What to expect & tips. Sleep Foundation. Retrieved September 11, 2022, from https://www.sleepfoundation.org/baby-sleep 

    Postpartum depression symptoms & definition: Perinatal mood disorders. Postpartum Depression Alliance of Illinois. (2020, June 23). Retrieved August 27, 2022, from https://ppdil.org/symptoms-of-ppmds/

    Woodley SJ, Boyle R, Cody JD, Mørkved S, Hay-Smith EJC. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2017 Dec 22;12(12):CD007471. doi: 10.1002/14651858.CD007471.pub3. Update in: Cochrane Database Syst Rev. 2020 May 6;5:CD007471. PMID: 29271473; PMCID: PMC6486304.

    *Note: We provide information on postpartum recovery not healthcare advice. We encourage you to discuss any content with your healthcare provider – we value their role in your recovery and this site is not a replacement for healthcare services like obstetricians, gynecologists, midwives, primary care providers, physical and occupational therapists, and mental health providers. See our Terms & Disclaimer and our Resources for more information.