Many women are keen to return to exercises as soon as possible after the birth of their baby, but are often unsure where they should start or are simply unaware of the huge impact that pregnancy and childbirth will have on their body and how many of the changes of pregnancy persist into the postnatal period. There is great variability amongst women in the time taken for the body to recover from the effects of pregnancy and childbirth and this will impact on the type of exercise that women should perform in the postnatal period.
The following are important considerations for postpartum exercise:
· The effects of pregnancy hormones persist into the postnatal period meaning that the joints of the spine, pelvis and wrists are particularly vulnerable to stress and strain, especially considering the time in a flexed forward and slouched posture with baby care activities
· The pelvic floor muscles (PFM) are weakened and stretched during pregnancy and vaginal delivery, and it has been reported that one in three women who have had a baby will experience some urinary incontinence. Ideally PFM exercises are performed during pregnancy to maintain strength and control and make it easier to start them working again after the birth. The PFM play an important role in the control of continence and pelvic organ prolapse (POP), so any type of exercise that a woman is undertaking must take into account the state of the PFM. Indeed, performing exercises, particularly high impact or strong abdominal exercises may lead to or worsen the effects of stress incontinence or POP.
· The abdominal muscles also remain stretched for sometime after birth. Many women will experience a rectus abdominis diastasis (RAD) during pregnancy and it is important that this has returned to normal before attempting abdominal crunch-type exercises, along with other strong abdominal exercises such as planks and double leg raises. It is generally agreed that the abdominal muscles are not strong enough to control the pelvis during this type of exercise for at least 8 weeks, and in the majority of women, even longer. Indeed performing crunches, and even getting out of bed incorrectly, may result in the worsening of a RAD.
Learning to correctly work the deeper abdominal muscles with the PFM will assist in:
· Gradually regaining strength in the trunk,
· Reducing a RAD
· Supporting the spine and pelvic regions.
Use of the real time ultrasound machine can be a useful way of assessing how the well the PFM and deeper abdominal muscles are working together in a variety of different positions. This can be particularly helpful further down the track when assessing whether the PFM are strong enough to commence stronger abdominal exercises.
We recommend a post-natal check up with a Physiotherapist with Post-Graduate qualification in Continence and Women’s Health to ensure that the PFM and abdominal muscles are working appropriately, particularly for those women who are concerned that they cannot feel their PFM working or who are experiencing any of the following:
· Leakage of, or difficulties controlling urine, wind or faeces,
· Vaginal or pelvic heaviness or a lump or bulge in the perineal area,
· Internal pelvic pain, for example during sexual intercourse,
· A feeling of bulging or a gap in the abdominal muscles.
Physiotherapy supervised Pilates is a good way of safely regaining strength, while focusing on specific problem areas and ultimately aiming for a total body workout. Hydrotherapy classes are also an ideal low impact cardiovascular exercise option when returning to exercise after having a baby.
Many LifeCare centres have Pilates studios that are run by Pilates Physiotherapists who have completed over 500 hours of specific training in Pilates exercise programming. There are also specific Mother and Baby Pilates classes and Hydrotherapy classesrun at selected LifeCare practices.