RETURNING TO EXERCISE AFTER BIRTH

Remember

• This is the "fourth trimester!"

• Pregnancy and childbirth takes an enormous toll on your body.

• Consider the postnatal period a rehabilitation process from the inside out. You need to lay good foundations to achieve your long term goals

How often should I have my pelvic floor checked?

After your 4 week postnatal check - up with your Women's Health Physiotherapist, ongoing check ups every few weeks are recommended to ensure that your pelvic floor is recovering.

This is to progress your exercises safely, and prevent long - term damage that can occur by progressing your exercises too early.

Birth - 12 weeks

The first 3 months post birth is a time for healing and repair both physically and mentally, that is why this period is referred to as the 4th trimester.

Focus on sleep, rest, nutrition and gentle exercise to promote tissue healing. It can be hard for some women to rest, however it is important to listen to your body.

When you start exercise post birth, treat it as if you are completely new to exercise.

Purpose

To know what is 'normal' to you, and being aware of any changes you notice that can be discussed with me at your 4 - week review

When to call your doctor

• Fever of 38°C or higher
• Increasing redness or drainage.
• Bleeding that requires a new sanitary pad every hour
• Severe pain in the abdomen, or pain or urgency with urination
• Foul odour from vaginal discharge
• No bowel movement within 1 week after birth
• Swollen, red, painful area in the leg

Further Info

Read the following handouts in your link:

- DRAM Recovery

- Back & Pelvic Care

After Birth

- Pelvic Floor Exercises

- Healthy Bladder & Bowel Habits - Recovery After Birth

- Returning to Intimacy After Birth

Congratulations on the birth of your baby! Return to exercise should be a very gradual process, regardless of mode of delivery.

There’s a huge amount of change that occurs to your body during and after pregnancy that can leave you feeling disconnected, overwhelmed, exhausted and powerless.

Exercise is known to improve mood, reduce depression and anxiety, maintain cardiovascular fitness and promote weight loss.

However, pushing yourself too hard too soon post-baby, increases the risk of urinary incontinence (which affects 30% of new mums), painful intercouse (which affects 60% of women in the first year post-birth), generalised pain, hernias, separated abdominal muscles, pelvic organ prolapse and musculoskeletal injuries.

If at any stage you experience pain, bladder or bowel leakage or vaginal heaviness or discomfort, stop the exercise and consult your women's health physiotherapist.

The safest way to return to movement and exercise is to consult your women’s health physiotherapist as soon as possible post birth. You will be provided with a thorough assessment to determine what exercises and activities are most appropriate for you and your stage of recovery.

• Wear firm supportive underwear - i.e. compressive or shapewear to provide additional perineal and abdominal support whilst you are awake

• Walking - start 1 to 2 weeks post-birth with 10 minutes of slow walking. Aim to progress to 30 minutes of walking by 6 weeks post-birth. Wear comfortable well cushioned shoes and supportive underwear, avoid hills and put your baby in the pram rather than the baby carrier.

• Pelvic floor and deep abdominal exercises - see Pelvic Floor Exercises and DRAM Recovery handout

• Hold your hand against your perineum - when you laugh, cough and when you get up from a lying or sitting position

Book in with your Women's Health Physiotherapist at 4 weeks for a personalized program to reduce your abdominal muscle separation, progress your pelvic floor recovery, and strengthen your body overall with exercises you can do at home

Remember - the six week check up with your doctor does not mean you are ready to jump back into the same exercise you were doing before you fell pregnant!

It is common for many women to feel the desire to reclaim their body and increase the exercise load too quickly, resulting in pelvic floor symptoms.

All exercise needs to start small and gradually increase as if you are completely new to exercise.

• Cycling - remain seated

• Light strength training - bridges, side lying leg lifts, seated arm exercises, ½ depth squat, light core exercise such as heel slides (as per picture below)

• Walking - progress from 30 minutes - 1 hour up to 4 times per week

• Swimming Water

• Post-natal Pilates or Mums and Bubs

• Pilates Post-natal Yoga

• Aerobics

• Continue pelvic floor muscle exercises - hold for longer and feel a stronger contraction.

Have you passed your Return to High Impact Exercise Assessment with your Women's Health Physiotherapist?

• Strength training - increase weight, repetitions and/ or sets. Standing exercises using body weight and/ or light - medium weights. If you are holding your breath during an exercise it is TOO hard. Post birth modifications are still very important.

• Cycling - increase resistance on the bike, up and down hills, sprints and standing in the saddle

• Jogging - when you have gradually increased your exercise intensity from birth, and you have passed your assessment without urinary/ faecal leakage or bulge sensations - congratulations! Your physiotherapist will give you a graduated return to running program, i.e. start with a 30 second jog and 5 minute walk on a grass surface. If you remain symptom free continue to increase the jogging time and decrease the walking time. Ongoing check ups of your pelvic floor and core recovery will be essential over these months.

• Pilates - increase load by increasing the difficulty of the exercise, e.g. heeltaps and single leg extensions.

From 6 - 12 months

High load exercises are now safe to consider, as long as you have built yourself up to it.Continue to progress your exercises by increasing load and intensity. Examples of high load exercises include jogging, running, boxing, Pilates, Yoga, strength training, exercise classes atthe gym (step, body attack, body pump), netball and basketball.

Remember your 4 - 6 week review with your physiotherapist to asses & monitor your

• Pelvic floor recovery
• C – section incision
• Exercises to close the abdominal separation
• Returning to exercise after birth

Disclaimer

Women are encouraged to discuss their health needs with a health practitioner. If you have concerns about your health, you should seek advice from your health care provider or if you require urgent care you should go to the nearest hospital Emergency Department.

Contact us

Performance Plus Womens Physiotherapy, 40 Lemana Crescent, Mount Waverley

03 9815 2555 (Main rooms)