Postnatal Period

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. 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.

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 with various baby-care activities.
  • The pelvic floor muscles are weakened and stretched during pregnancyand vaginal delivery, and it has been reported that one in three women who have had a baby will experience some urinary incontinence. Ideally pelvic floor muscle exercises are performed during pregnancy to maintain strength and control and make it easier to start them working again after the birth. The pelvic floor muscles play an important role in the control of continence and pelvic organ prolapse so any type of exercise that a woman is undertaking must take into account the state of the pelvic floor muscles. Indeed, performing exercises, particularly high impact or strong abdominal exercises may lead to or worsen the effects of stress urinary incontinence or pelvic organ prolapse.
  • Generally pelvic floor muscle 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 pelvic floor muscle exercises regularly.
  • The abdominal muscles also remain stretched for some-time after birth. Many women will experience a rectus abdominis diastasis during pregnancy and abdominal exercises prescribed should take into account the state of the abdominal wall. Performing heavily loaded abdominal exercises, such as double leg raises, may result in the worsening of a diastasis. In the early postnatal period, women may need to take care with the way that they get up out of bed and when they move from sitting to standing, especially while carrying their baby.

We recommend a post-natal assessment at six weeks postpartum with a Physiotherapist with post-graduate qualification in Women’s Health and Continence to ensure that the pelvic floor muscles and abdominal muscles are working appropriately, particularly for those women who are concerned that they cannot feel their pelvic floor muscles working or who may be experiencing any of the following:

  • Leakage of, or difficulties controlling urine, wind or faeces. This is termed incontinence,
  • Internal pelvic pain, for example during sexual intercourse
  • A feeling or dragging or pressure in the vaginal or perineal region, which is a common symptom of pelvic organ prolapse,
  • Rectus abdominis diastasis

As well as their role in continence and support of the pelvic and abdominal organs, the pelvic floor muscles work in combination with the deeper abdominal muscles and deep back muscles to help support the trunk, somewhat like an in-built corset. Learning to correctly work these muscles appropriately will assist in:

  • Gradually regaining strength in the trunk,
  • Resolution of a diastasis
  • Supporting the spine and pelvic regions.

Use of the real time ultrasound machine can be a useful way of assessing how the well the pelvic floor muscles and deeper abdominal muscles are working together in a variety of different positions, particularly further down the track when stronger abdominal exercises maybe commenced.

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. See our fact sheet titled Pilates. Will it Help Me? for further information on Pilates

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.

Selected LifeCare practices run specific Mother and Baby Pilates classes and Hydrotherapy classes

For more information talk to a specialist at a Lifecare clinic near you.

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