The Postpartum Experience No One Wants to Read About but Should
I’ve been writing this post for almost 4 months now and as each week of being in pain and not running has passed, the content and tone have changed. My baby is 6 months old and I have not had a single day without pain in my hip and/or pelvic region. I have not run a single pain-free step with confidence. Every day I wake up and wonder if today will be a day with lots of pain and minimal movement, or a day of minimal main and some movement. Last week I was able to do a 6 mile hike (and even a few little running steps) with my husband with no pain during or after and today it feels like someone is trying to pull my pelvis apart. My story is not inspiring or hopeful and I do not overcome the odds to become a stronger runner after having a baby. My body was destroyed by childbirth and along with my pelvic floor, my athletic dreams have been shredded. Why am I sharing this? Because despite expanding my expectations for my postpartum return to running – because let’s be honest, it is pretty much impossible to actually let go of all expectations – I was in no way prepared for my current reality and if my story helps one woman feel less alone, or be better prepared, then sharing my pain is worth it.
At this point, I don’t have a clear diagnosis or plan of action that has yielded significant results. My pain moves around from my right groin / adductor across the pubic bone and sometimes in my left hip. Activities like rolling over in bed and standing on one leg to put on pants have been painful since my third trimester and while I have some days with pretty minimal pain, there has not been consistent progress. The pelvic region is seemingly a blank void in medical care – and I have heard anecdotes that in some orthopedic educational materials, it is a literal blank void – and despite working with an orthopedic sports doc, a pelvic PT and a “regular” PT, no one can seem to figure out the underlying issue. As I have been going through this, I find myself looking for answers in other women’s postpartum journeys and craving the details of their experiences, only to find most accounts lacking. And I get it: postpartum is a highly personal experience but I also strongly believe that it is important to diversify the narrative about postpartum return to running. My situation is on the extreme side of things, but most women do not just effortlessly return to their pre-baby mileage within weeks of giving birth or set records within months, despite what the majority of stories we see in sports media would have us believe. This article does a good job summarizing the current landscape in women’s postpartum care for anyone who wants to read more.
It goes without saying but I will say it anyway: Each experience with pregnancy, childbirth and postpartum is unique. There are plenty of women who recover fairly quickly and do not experience complications or extreme challenges returning to high levels of exercise. That being said, by sharing my experience on social media, I have heard from countless women who have had similar, or even more severe difficulties. I want to normalize a slow return to running in the hopes that I can prevent other women from the feelings of shame, inadequacy, and frustration that have been cycling through over the past 6 months. I am not a doctor or physical therapist but I do want to share the information I have learned through my experience. As always, you should check with your doctor, and ideally a physical therapist who specializes in women’s health / the pelvis.
Just like racing, you can prepare all you want for giving birth but on the day, there are so many factors that are totally our of your control. My situation is unique, but not uncommon. I had a very fast labor – less than 90 minutes from my water breaking to my daughter joining this world. And while many women have expressed envy over this, I think I would prefer more time for my body to prepare to pass a human head through my pelvis. Just like in running; the shorter the event, the more intense it is and while I didn’t have to endure hours of painful labor, I think my body was totally wrecked by the concentrated intensity. I was prepared for the long, slow build of a 50 miler and ended up with the speed and intensity of the 800m in the Olympic finals and had no choice but to perform.
When I started making inhuman noises and screaming that I had to push about 15 minutes after my water broke, the nurses didn’t believe me and thought I was just over-reacting to standard contractions. Thankfully my husband kept his cool and convinced them to check, which they did begrudgingly. The doctor put her hand inside basically while rolling her eyes and the second she reached my cervix her face went blank and her tone became serious: “Um she’s 9 cm dilated, 0 drop and 100% effaced”. In other words, it’s go time. I was literally wheeled through the labor and delivery unit screaming on a gurney ER style (or Grey’s Anatomy style for the younger folks reading). There was no time to discuss my delivery plan or get our bags from the car. I wasn’t planning on using pain medication, but there was no time for that either. My delivery time should have been about 20 minutes of actual pushing, and I heard “your daughter will be born on the next contraction” at least 5 times – which is like saying “only 1 more mile to go” when the finish line is actually 10K away. In the end, I pushed for about 45 minutes and required an episiotomy because she got stuck and her heart rate started to slow. She eventually came out and the doctors assessed the damage: I had a grade 2 tear and for those who don’t know and episiotomy is when they cut through skin and muscle to make more space for the baby to come out. I also had abdominal separation, but not an extreme case. I was unable to rest in the days immediately following childbirth because my baby was in the NICU – turns out she did not react well to the super fast delivery either. If there is any doubt, I love my daughter more than anything, and while having her pretty much destroyed my body, I don’t regret it one bit.
Initial Postpartum Recovery
When training for a race, all of the focus is on the event itself. Preparations are made to achieve the best outcome possible on race day: Long runs to build endurance, workouts to build strength, studying the course, planning fuel, etc. are all part of the process. Even on race day itself, the goal is usually to get to the finish line with nothing left in the tank, knowing a full effort was given. I assumed the most demanding part of having a baby was actually having a baby and that much like after a race, I would simply rest and recovery would happen on its own. All the moms, and probably most of the dads, reading this are laughing because the reality is that the birth of the baby is just the beginning.
The guidance from my OB was to not do any exercise, even walking, until I stopped bleeding which can be anywhere from 2 days to many weeks depending on the particulars of each birth. I spent the first 3 days walking back and forth between my room in the recovery wing and the NICU every 2-3 hours to feed Aila, so I started off on the literal wrong foot. Once we got home, I did not leave my house for 10 days and started with basic breathing and core exercises about 2 weeks after giving birth. I thought I could stitch together my own recovery plan from resources like this article in Women’s Running. We were in the middle of a pandemic and the thought of getting my shit together enough to leave my house multiple times a week to see a pelvic PT was overwhelming. I was an elite athlete after all, my body should be primed to recover and build strength, and I was no stranger to hard work.
I suppressed all my urges and natural tendencies to push hard for a fast return and thought I was being very conservative with how I progressed exercises. In hindsight, I wish I had seen a pelvic PT in the first few weeks after birth so I could have had a more detailed understanding of my injuries and thus a more informed rehab plan. Below, I share a couple of the key things I Have learned in my journey thus far.
Breastfeeding Can Make It Difficult to Return to “Normal” Running
I’m not saying this to deter people from breastfeeding, and I am sure there are women who disagree, but numerous women reached out on social media to tell me that they were unable to build strength or run at full effort until after they stopped breastfeeding. Like I said, I’m not a doctor, so I can’t explain the science in detail, but breastfeeding can impact a woman’s return to running in ways I had no idea about until very recently. The hormone relaxin is released during pregnancy to, you guessed it, soften and relax a woman’s body, especially the ligaments and tendons in her pelvis, to prepare for childbirth. One not so pleasant side effect experienced by some women is pelvic instability and pain in the pubis symphysis. I have had strength imbalances in my hips for years and so it was not entirely surprising that I developed groin pain in the later weeks of pregnancy which ultimately sidelined me from running after about week 34. I had assumed that after giving birth, my hormones would settle down and I would be able to build core and hip strength back relatively easily. Well it turns out that a woman’s body continues to pump relaxin throughout her body while she is breastfeeding, which can make it difficult to regain strength and for me means that I am still experiencing pubis symphysis and groin pain which is what is preventing me from running. Until I knew that it was completely normal and common to experience difficulty building strength while breastfeeding, I was driving myself crazy with frustration at my lack of progress despite doing rehab exercises 6 days a week.
Tears Experienced During Childbirth are not Dissimilar to Other Muscle Injuries and Should be Treated as Such
I am lucky enough to have some incredible people in my life who shared some great information about seeking a women’s health focused PT and this helpful infographic outlining the recommended protocol for a safe return to postpartum running. The paper is “Returning to running postnatal – guidelines for medical, health and fitness professionals managing this population”(Goom, Donnelly & Brockwell 2019). You can check out the full guideline here.
I knew I needed to rest and let my body heal before starting to run, despite being “cleared” for running by my OB at my video check-up 3 weeks postpartum (IE with no physical exam). Despite going in with what felt like a wealth of information, I had never really thought of the injuries I sustained to my pelvic floor muscles in the same way I thought of other muscle injuries until I saw this post on Instagram from Dr. Christine Pieton, DPT, MBA . It identifies recovery and rehab protocols for pelvic floor tears by comparing them to hamstring injuries by grade. Based on my grade 2 tear, my body could need 6 months to regain strength and load tolerance, but my episiotomy is a surgical procedure and probably required closer to 16 weeks of tissue healing time alone.
I did not know this until it was too late. I started with some very short running intervals (5 intervals of 30 seconds) every 2 or 3 days around week 10. I thought I had gone through the appropriate graduated steps, and even though I knew I had strength to build, I thought folding in this very small amount of basically running drills would help build that strength without over-taxing anything. If I had gone into postpartum with a better understanding of the trauma that my body sustained, and the recovery and rehab time, I probably would be much closer to running than I am right now.
Some Final Thoughts
I realize my general tone is pretty negative, but every time I have tried to put a positive spin on how I recount my story, it sounds fake. Most days, I don’t feel very positive, so I will not try to sugar coat it. I feel betrayed by my body. I feel frustrated at the lack of progress or clear diagnosis. I feel overlooked by the medical system despite some very well-intentioned individuals. I feel totally unmoored by the constant yo-yoing of my emotions. The list goes on and I’m ashamed to admit that I feel envy and bitterness towards women who have had a straightforward return to running after having a baby. At the same time, I hope no one has to experience the physical pain and uncertainty of a difficult postpartum recovery. If you take anything away from this post, I hope it is that you advocate for yourself during pregnancy and in postpartum to get the advice and support you need. Be proactive about your pelvic health: see a pelvic specialist physical therapist during pregnancy and soon after having your baby if you can afford it (because no, it is almost never covered by insurance, but sometimes is so you should definitely check!). Be kind to yourself and your body: growing and birthing a human is a huge fucking deal and you are not inferior for needing time to recover. Finally, to all those women who did get back to healthy running quickly and have achieved totally badass things in the months after childbirth: you rock! I’m not trying to detract from your accomplishments, but rather provide a different perspective to give all the women who have struggled in postpartum a voice.
I feel very fortunate to have had the support of my sponsor throughout this challenging time. Salomon, Equator Coffees, Mt. Tam Sport and Spine and Insidetracker have been there for me and it’s truly appreciated.