Pelvic floor rehabilitation after birth: when, how many sessions, with whom?

In France, pelvic floor rehabilitation is decided at the postnatal check, six to eight weeks after the birth. It is done with a midwife or a physiotherapist, often over about ten sessions, and is covered by national health insurance when prescribed. It matters most if you have leaks or a feeling of heaviness.

You hear about it from pregnancy onwards, often without really knowing what it involves. Do you need it, even without leaks? When should you start, with whom, how many sessions, with or without a probe? Here are the answers, and what the French guidelines say, with pointers for the UK.

What is pelvic floor rehabilitation?

It is guidance from a professional to learn to feel your pelvic floor, contract it and relax it at the right time. The pelvic floor is the group of muscles that close the base of the pelvis and support the bladder, womb and rectum. Pregnancy and birth stretch it: rehabilitation helps it regain strength, reflexes and coordination.

It is not just about "strengthening". It also teaches you to brace your pelvic floor before an effort, to breathe better and to regain confidence in your body. To understand what happens in the weeks before, read our guide to the perineum after birth.

When should you start pelvic floor rehabilitation?

After the postnatal check, six to eight weeks after the birth. Before that, tissues are still healing and the lochia is ending: French guidelines do not advise supervised rehabilitation in the first two months. If you have significant leaks or pain in the first weeks, mention it straight away: an assessment can be brought forward.

Meanwhile, you can already get into the habit of gently tightening your pelvic floor before coughing, sneezing or lifting your baby, if it does not hurt; in the UK, the NHS encourages gentle pelvic floor exercises from the first days. Avoid classic sit-ups, heavy lifting and high-impact sports.

Is pelvic floor rehabilitation compulsory?

No. It is not compulsory, but it is strongly recommended if urinary leaks persist beyond three months, if you leak wind or stools, or have a feeling of heaviness or pain. For women with no symptoms, the French college of obstetricians (CNGOF) does not consider it necessary as prevention. The postnatal check lets you decide together.

In practice, in France, many midwives offer it widely, because an assessment over a few sessions is reassuring, picks up what goes unnoticed and prepares a return to sport. If you notice anything unusual and it has not been offered, ask for it: you do not have to wait for things to get worse.

How many pelvic floor rehabilitation sessions?

Most often about ten, but the number depends on your assessment and prescription. Some women need only three to five sessions to learn the right movements, others more. For urinary incontinence, guidelines advise at least three supervised sessions, combined with exercises at home. The prescription can be renewed if needed.

A session usually lasts about half an hour, once or twice a week. The work you do at home between sessions counts as much as the sessions themselves.

Question	Usual landmark in France
When to start	After the postnatal check, six to eight weeks after the birth
Who prescribes	The midwife or doctor who does the postnatal check
Who provides it	A midwife or a physiotherapist
Number of sessions	Often about ten, depending on the assessment
Frequency	One or two sessions a week, about half an hour each
Cost	Covered by national health insurance on prescription, under maternity cover
After a caesarean	Same rules, depending on the assessment

Midwife or physiotherapist: who should you see?

Both are trained for it, and in France the cover is the same. Choose by distance, availability and trust: you will be talking about an intimate part of your body, so it matters that you feel at ease. Some physiotherapists specialise in pelvic health. A midwife can also carry on with your postnatal follow-up.

If you do not get on, you can change professional along the way. It is not a matter of politeness, it is your care.

What happens in a pelvic floor rehabilitation session?

The first session is an assessment: questions about the birth, leaks and sensations, then an examination, usually with one finger in the vagina, to assess the contraction. The following sessions combine, as needed, manual work, guided exercises and sometimes a probe. Every step is explained to you, and you can always say no or ask for a break.

• Manual work. The professional guides the contraction with a finger and helps you feel the right muscles.
• Biofeedback. A probe connected to a screen shows the strength of the contraction: you see what you are doing.
• Electrical stimulation. A gentle current makes the muscle contract, useful when you can barely feel it at first.
• Exercises at home. They extend the sessions and build the right reflexes.

Is the probe compulsory?

No. The probe is one tool among others, not a required step. Many rehabilitation programmes use manual work only. If a probe is suggested, it is personal: in France it is prescribed, bought at the pharmacy and then reimbursed. If the idea bothers you, say so: other methods exist, and your consent is asked every time.

Do you need pelvic floor rehabilitation after a caesarean?

Often, yes. Even without a vaginal birth, the pelvic floor carried the weight of the pregnancy for months, under hormones that soften it. Leaks or a feeling of heaviness are possible after a caesarean. The rules are the same: assessment at the postnatal check, then sessions if needed. Scar massage can be covered at the same time.

For recovery as a whole, read our guide to recovering after a caesarean, and for scar care, our article on the caesarean scar.

Which exercises can you do at home?

The ones your midwife or physiotherapist taught you, because every pelvic floor has its own needs. The principle: tighten the pelvic floor as if holding in wind and the urge to pee, hold for a few seconds while breathing normally, then relax completely, several times a day. Do not hold your breath and do not squeeze your buttocks or tummy.

One precaution: do not deliberately stop your flow of urine to practise. This "stop test" can interfere with emptying the bladder. It is sometimes used once, to find the muscles, but not as an exercise.

And sit-ups, and sport?

Abdominal work comes after the pelvic floor. You start with the deep tummy muscles, with exercises that do not push the organs downwards, then go back to high-impact sports such as running, often not before three to four months. Crunches and sit-ups wait. Walking, on the other hand, is welcome from the first days.

For the short answer, see also our question on

• when to start pelvic floor rehabilitation

When should you seek advice about your pelvic floor?

Frequently asked questions

When should you start pelvic floor rehabilitation after birth?

After the postnatal check, six to eight weeks after the birth. Earlier, tissues are still healing. If you have significant leaks or pain, mention it before.

How many pelvic floor rehabilitation sessions do you need?

Often about ten, depending on the assessment. Some women need fewer, others more. Exercises at home count as much as the sessions.

Is pelvic floor rehabilitation reimbursed?

In France, yes. Prescribed after the birth, it is covered by national health insurance under maternity cover, whether done by a midwife or a physiotherapist.

Does pelvic floor rehabilitation hurt?

No, it should not hurt. There can be some discomfort at first, especially after a tear or an episiotomy. Say so: the professional adapts the approach.

Can you do rehabilitation without a probe?

Yes. Manual work and guided exercises are often enough. The probe is an option, never an obligation.

Is it normal to leak urine after giving birth?

Small leaks are common in the first weeks and often lessen on their own. If they persist beyond three months, rehabilitation is recommended: it works.

Can you go back to sport before rehabilitation is finished?

Walking, and gentle swimming once the lochia has ended, yes. Running, jumping and classic sit-ups wait until rehabilitation is complete and the professional following you agrees.

A muscle you learn to know

Pelvic floor rehabilitation is not an exam to pass. It is time for you, to understand a muscle rarely talked about that works very hard. To get to know it better, read again our guide to the perineum after birth.