Surprised by the transition to an unknown body: quantitative and qualitative aspects of activity limitations and physical changes during the first year post-partum.

Background: Postpartum women require more individualized support from healthcare providers. However, current care may be insufficient, partly due to a limited understanding of how women experience their symptoms and recovery during this period. The aim was to describe experienced activity limitations during the first year post-partum and to explore and describe women's experiences of physical changes and recovery after childbirth.

Method: In an observational prospective cohort study, 504 participants reported activity limitations after childbirth via patient-specific functional scales at 3, 6, and 12 months post-partum (Cohort 1). The participants also reported causes for these limitations in free-text format. To enrich this dataset with narrative insights, an additional group of 14 women (3─12 months post-partum) was recruited for interviews (Cohort 2). The two datasets were analysed via quantitative and qualitative content analysis.

Results: In Cohort 1, 48% of the participants reported limitations in high-impact activities (e.g., running, jumping or ball sports) at 3 months post-partum, whereas 41% reported limitations at 12 months post-partum. Other limited activities in the first six months included exercising, lifting/carrying and brisk walks. The main causes for these limitations were pain, vaginal heaviness and urinary incontinence, sensations of instability, and hesitancy to start exercising. Cohort 2 revealed the theme 'Surprised by the transition to an unknown body,' illustrating women's insecurity about new bodily experiences after childbirth and an experienced need for understanding. The struggle of accepting and adjusting to physical changes contrasts with trust in their bodies' recovery and ability to adapt life to changes. Recovery can be seen as an accomplishment. Unexpected, unfamiliar physical changes can lead to fear of incomplete recovery and sadness about losing the prepregnancy body. The combination of breastfeeding and hormonal changes while recovering from physical changes can be challenging.

Conclusion: Pain, urinary incontinence, and unfamiliar pelvic sensations, such as vaginal heaviness, can limit postpartum activities. Early limitations seem to arise from uncertainty about feelings of weakness and instability, whereas persistent limitations are usually due to pain or leakage. Early reassurance, information, and tailored guidance could support recovery, while persistent symptoms may require targeted treatment to address evolving needs.