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Postpartum Recovery: Is rest really best?


Parent lies on back holding infant on knees

Five days in bed. Five days on the bed. Five days near the bed. Birth professionals have used this 5-5-5 rule to guide their client's postpartum recovery period for many years. The idea is that rest promotes healing so by implementing complete rest and increasing activity very slowly over two weeks a parent will heal faster.


But is this true? While we know rest is necessary for healing, we also know that immobility increases the risk of blood clots, or thromboembolism, which accounts for 9% of pregnancy-related deaths in the United States. We don't need to increase that risk so I started digging to find out what the research really says.


Background

I could not find the true origins of the 5-5-5 rule. In her memoir, Call the Midwife, Jennifer Worth says that it was common practice in the 1950s to "lie in"for 10-14 days after birth. This sounds very similar to the 5-5-5 rule. The recommendation seems to have been around in one form or another for at least 70 years. In fact, for centuries many cultures around the world have observed lying-in periods of up to 90 days. Within these cultures, fewer modern parents are observing this custom but it is often still the expectation.


When I can't find the evidence behind a recommendation, I get extra suspicious. So I began to look into recent research on optimal postpartum healing. As with much of postpartum, there is not a significant amount of research on the topic but there is enough to form a guideline.


Medical Evidence

Extensive research has been done on the benefits of exercise in pregnancy and also the

Woman pushing stroller on beach

need to reduce activity through pregnancy depending on the needs of the body. The American College of Obstetrics and Gynecology (ACOG) recommends returning to exercise gradually during postpartum. They make it clear that each person's physical journey will be different and that some people may begin an exercise routine within days of delivery. To be clear: this initial exercise routine should be gentle. Move Your Way, a program run by the U.S. Department of Health, suggests that even simple tasks around the house count as exercise. The point is to move. What that looks like is up to each individual person's recovery.


Of note, ACOG found no research to suggest that returning to exercise increases the risk of health complications. In fact, one study found that postpartum movement decreased the risk of excessive bleeding. Parents are often told that returning to exercise too rapidly will increase their bleeding but research shows this may not be the case. Parents should monitor their symptoms after any new movement or exercise and talk to their provider about anything that concerns them.


Physical Recovery

Knowing that postpartum parents are safe from medical complications is key information, but I also wonder about physical complications. The pelvic floor goes through a tremendous amount of stress during pregnancy and birth. Recovery has been shown to take at least six months and can be hampered by doing the wrong sorts of activities too early, something I can personally confirm.


Rate of Perceived Exertion Chart

So, what do physical therapists have to say about ideal postpartum recovery? It turns out that gentle movement is encouraged in the immediate postpartum period. This should begin with walking around the house and can increase gradually as comfort increases. Comfort should be assessed by using the Rate of Perceived Effort. In the immediate postpartum, movement should fall within the 0-2 RPE range.


When walking around the house feels comfortable, parents can begin walking for longer periods of less than 10-15 minutes. Parents should monitor symptoms for 24-48 hours after increasing their activity to make sure there aren't any adverse side effects. If they're unsure, parents should see a physical therapist. Some symptoms may be signs of pelvic floor problems and others may be normal signs of the muscles regaining their strength. In my opinion, parents should see a physical therapist even if they aren't seeing adverse side effects. Some symptoms begin very quietly. (Again, ask me how I know.)


Mental Health

Okay, so medically and physically postpartum movement is okay, but what about mentally? Jennifer Worth posits that the benefit of a laying-in period is for moms to have a chance to rest while someone else does the household work for them. I can't help but agree that this is a huge benefit. New parents should be able to focus on their baby and new family, not scrubbing the bathroom. Does rest help reduce stress for new parents?


Surprisingly, the evidence suggests that movement is what reduces symptoms of depression in postpartum women. One study looked at women's emotional responses after exercising with and without their babies. They found that whether mothers exercised alone or with their babies, their mood was significantly improved and their anxiety was reduced after exercising.


Another study looked at anxiety and depression scores before and after 60 minutes of

Parent in downward dog with toddler crawling underneath

exercise followed by 60 minutes of rest in postpartum women. They found that the moms' moods were significantly improved after exercise and rest. This tells us that in the postpartum period, movement and rest are important, not exclusively rest. It is important to note that the movement itself should be relaxing in order to see these benefits. If parents jump back in too quickly or exercise out of a sense of guilt instead of a devotion to their own health they may not see the same benefits.


The Bottom Line

While rest is crucial for healing, movement is equally as important. Perhaps in the past when laundry had to be washed by hand and preparing meals took hours it was important for postpartum parents to have complete rest in order to avoid these strenuous activities. However, in the modern era, when our day-to-day lives involve very little physical exertion, these guidelines are no longer ideal. Instead, parents should begin gentle movement as soon as possible and continue to increase within a range of 0-2 RPE. Rest is important between periods of movement. Talk to your provider about your own personal recovery and ask for a referral to a pelvic floor physical therapist. Everyone's recovery is individualized. The key to optimal healing is to stay tuned in with your body.


What About Cultural Traditions?

I am not here to tell any culture-- or any person, for that matter-- how to handle postpartum recovery. That decision is up to each person individually. If your culture values postpartum rest and it's important to you to follow that custom, by all means, do it! The risk in a complete rest period isn't so significant that I would say you're putting yourself at major harm by resting. I'm glad you're here reading this so that you can make an informed decision. As always, trust your instincts!


Cheers,

Script reads Elizabeth






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