A new baby in the family is a time of great change, especially if it is your first. It is a steep learning curve for most, as families adapt to the new addition; sleep is interrupted, there are nappies to be changed, extra washing to be done, all whilst getting to know your little bundle.
Looking after a baby is very demanding, both physically and psychologically. Mothers with new babies spend a lot of time in a flexed forward and slouched posture while they are feeding, changing, bathing and carrying their baby. Unfortunately at this time the joints of the spine and pelvis are particularly vulnerable to stress and strain due to the effects of pregnancy hormones, which may persist into the postnatal period. Many women may also notice troubles with their wrists, due to the extra strain on them with various babycare activities. Weakness and lengthening of the trunk muscles will contribute to a lack of muscular support of the spine and pelvis, also making it difficult to maintain ideal body posture.
The pelvic floor muscles (PFM) and abdominal muscles are two groups of muscles which are affected by pregnancy and childbirth and will require particular attention postnatally.
The PFM are weakened and stretched during pregnancy and vaginal delivery. Ideally PFM exercises are performed during pregnancy to maintain strength and control and make it easier to start them working again after the birth. Generally PFM exercises can be started within the first 48 hours after the birth. Initially it may be difficult to feel the muscles working, so it is best to aim for gentle contractions held for a short time. Begin practising while lying on your bed on your back or on your side with knees bent. Focus on tightening and gently lifting around your front and back passages, as if trying to prevent passing urine or wind, holding briefly and then relax the muscles. This will help to reduce swelling and bruising. Women who have had a caesarean birth should also practice their PFM exercises regularly.
As well as combining with the deeper abdominal muscles and deep back muscles to help support the trunk, somewhat like an in-built corset, the PFM play an important role in the control of continence and pelvic organ prolapse. If you are concerned that you cannot feel your PFM working or if you 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,
It is recommended that you seek advice from a Physiotherapist with Post-Graduate qualifications in Continence and Women’s Health for a more detailed assessment of this region and a specific PFM exercise programme.
The abdominal muscles 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. 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 may result in worsening the diastasis.
Learning to correctly work the deeper abdominal muscles with the PFM will assist in:
· Gradually regaining strength in the trunk,
· Reducing a diastasis
· Supporting your spine and pelvic regions.
Use of the real time ultrasound machine can be a useful way of assessing how the well the PFM and lower abdominal muscles are working together in a variety of different positions. This can be particularly helpful further down the track when assessing whether your PFM are strong enough for you to commence any upper abdominal sit-up type exercises.
There is great variability in how women recover their strength and control of this area. Women who have spinal pain or pelvic girdle pain may need to see a Physiotherapist for specific treatment, whereas those women who may be experiencing a more internal pelvic pain, for example during intercourse, are recommended to consult a Physiotherapist with Post-Graduate qualifications in Continence and Women’s Health.
A Post-natal check up with a Physiotherapist with Post-Graduate qualification in Continence and Women’s Health is recommended to make sure that you are on track with your PFM and abdominal rehabilitation. Physiotherapy supervised Pilates is a good way of regaining your strength safely, while focusing on your specific problem areas and ultimately aiming for a total body workout.
FOR FURTHER INFORMATION contact your local Women's Health and Continence Physiotherapist