The three things you need to know about your rehab after birth…

 

Even in ‘normal’ times, it is an unfortunate reality that many women give birth and then enter the world of new motherhood with little or no guidance as to when and how to reintroduce movement and exercise. 

 

Now, in this world of social distancing and isolation, new mothers are potentially less likely to see a physiotherapist after birth and get advice on things like pelvic floor recovery, abdominal muscle rehabilitation, regaining your fitness and returning to exercise without causing yourself future issues. 

 

Here are the top things that I would suggest to all brand new Mums with regards to their physical recovery:

 

1️⃣  Start pelvic floor exercises early

The pelvic floor muscles are the muscles that form a sling at the bottom of the pelvis, and they are responsible for keeping our bladder and bowel from leaking, holding in our pelvic organs, supporting our lower back and pelvis, and maintaining optimal sexual function. Pretty important roles, it’s not a muscle group you want to neglect!

If you’ve had a vaginal birth, the pelvic floor muscles have had to stretch up to two and a half times their normal length to allow the baby to be born. The muscles may have torn or been cut, but even if they are intact, they have still undergone the equivalent of a significant sporting injury and need adequate rest and rehabilitation.

If you’ve had a caesarean birth – I’m sorry to say you’re not completely in the clear! Research has shown that long term, it’s the pregnancy that is the main risk factor for pelvic floor muscle dysfunction, due to the weight of the growing uterus directly down on the muscles and the hormonal changes that occur. 

You can start regularly activating your pelvic floor muscles right from the first few days. If it is painful at all, or if it’s difficult to feel the connection to these muscles, don’t worry. Just keep trying each day without working through pain, and understand that by training those nerve pathways from your brain to your muscles, you will be helping recovery. 

There is no ‘recipe’ way to activate these muscles, and it is very important to realise that many women are not contracting their pelvic floor contraction correctly with verbal instruction only. Wherever possible, I recommend getting your pelvic floor checked with an ultrasound or vaginal exam with a Women’s Health Physio. 

But in the meantime, check out this video that I have created regarding awareness of the pelvic floor – this is a great place to start!

 

2️⃣ Stretching and good posture are key to preventing pain

Right from the early days, incorporate stretching into your daily routine. 

This is especially important if you’ve had a caesarean section, as the new scar will have better long term outcomes if it is regularly moved (within pain limits) in the early weeks, rather than kept in a shortened state during the healing phase. 

Some examples include: 

  • Sit down on the mat when your baby is having a play or doing tummy time, and stretch out your hamstrings and your back. 
  • Stand up straight and take deep breaths regularly
  • When your baby is latched at the breast, take the opportunity to lower your shoulders and turn your neck in all directions
  • Place your hands on the edge of the cot and drop your chest down low, keeping your legs straight, for a modified version of downward dog that gives a lovely stretch to your legs and back
  • Twist your spine as often as you can – when sitting, or standing, or lying down.

Have a good think about your posture during tasks that you’re doing regularly. Catch yourself if you are spending large amounts of time holding your baby in a forward hunched position, and see if you can vary this with more upright postures. 

Think about your most common postures while you are feeding your baby. Is there any way to adjust this so that you are sitting upright more often, with your elbows, lower back and feet supported?

 

3️⃣ A gradual return to cardio fitness in the early weeks will set you up for an easier return to exercise

The way that everyone feels in the early weeks after giving birth will be different. Some people will have more pain, and some will have less energy, and there is no recipe way to approach return to exercise. 

However, for the majority of new Mums, a gentle walking regime is a great place to start. 

Have a go at a five-minute walk around the block within the first week or so and see how you feel. Use caesarean scar pain (which means that the scar is not ready for that level of activity) or vaginal heaviness (which usually means that the pelvic floor and the tissues that support the pelvic organs are not ready for that amount of load) as indicators of whether you’ve done too much.

Using these indicators, gradually build up time, distance, intensity and whether or not there are any inclines. Perhaps start without the pram or baby carrier and build up to that if possible. 

By 6 weeks post-birth, most women should be able to have worked up to 30-45 minutes of brisk walking on most days (where sleep deprivation and energy levels allow it!). 

 

Good luck with your early return to exercise and activity!

And remember – the team at FitRight have a huge amount of online resources available to assist you, including:

Just because our world has suddenly gone online, doesn’t mean that you can’t get the gold standard in pre and postnatal physiotherapy care!