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Pregnancy brings constant physical change and giving birth brings about even more. Not only are you now looking after your baby, but your body is trying to adapt yet again to change. After birth a lot of focus is on your new baby, but it is important to make sure you also take the time to focus on yourself and your own recovery.
Immediately after delivery – “RICE”:
Rest – in a horizontal position:
Lie in bed or on the couch, on your back or side. This is especially important the days in hospital post-delivery as this helps to take stress off the pelvic floor and allows it to recover more quickly. Aim for 2 hours for the first 2 weeks and 1 hour for the next 6 weeks (in addition to sleep).
Ice – your pelvic floor:
This helps to reduce swelling and pain through the pelvic floor. Apply for 15-20 mins every 3 hours for the first 48 – 72hours.
Compression – shorts or leggings:
Wearing compression garments helps to support the pelvic floor after pregnancy and delivery. (e.g., SRC shorts – these can be fitted by a physiotherapist from 36 weeks onwards).
Elevate – your pelvic floor:
Lying down to help take stress off the pelvic floor, this also helps to reduce pain and speeds up your recovery
First 6 weeks After Delivery:
While return to traditional exercise isn’t encouraged in the first 6 weeks after birth it is important to start to get your body moving. Basic stretches such as cat camel, seated rotations, neck stretches, and lower back knee rocks are a great way to keep your body moving and slowly start to reintroduce exercise (See image below). When you are ready you can also start slow short walks on flat and even paths. You can gradually increase your walking distance over the 6 weeks. Always make sure that you are listening to your body and rest when required.
How and when to restart your pelvic floor exercises?
Recovery of your pelvic floor muscles and regaining normal function following delivery is essential. If pain allows aim to start your pelvic floor exercises 24-72 hours after birth.
Start with small squeezes, focusing on lifting your pelvic floor upwards and tightening around the anus, vagina and urethra (exit of the bladder). Make sure your buttocks, legs and upper tummy muscles are relaxed when your contract and lift.
Aim to start with 1 sec on and off contractions, with the goal to complete 10 contractions initially (this is one set). Aim to complete this one set 4 times per day. Make sure you rest between reps (same rest time as the hold time – e.g., 1 sec hold, one sec rest)
Aim to increase the hold time by one second each week (e.g. 2 weeks after delivery = 2 sec hold x 10 reps, week 3 = 3 sec holds). Aim to build to 10 sec holds by 10 weeks after delivery.
It is also important to start your exercises lying on your back as this is an easier position to start reactivating the pelvic floor. As this position gets easier you can move into a sitting position.
Everyone’s recovery after pregnancy is different and everyone’s ability to contract the pelvic floor after delivery is different. Remember to take it slow and listen to your body. If you are not ready to increase your hold time, keep working and progress when you are ready. The speed of your recovery and the ability for your muscles to contract (the hold time and number of contractions) will vary depending on your pelvic floor strength prior to your pregnancy, exercise completed during your pregnancy, your delivery (vaginal vs caesarean) and natural differences. If you are unsure at any stage, get in contact with your Women’s Health Physiotherapist.
How to return to exercise and start using your abdominal muscles again?
Your abdominal muscles stretch and weaken during your pregnancy as they naturally make room for your growing baby. You may have heard this called DRAM (Diastasis Rectus Abdominus Muscle Separation), which is the increased distance between the muscle bellies of the rectus abdominus to allow for the growing uterus during pregnancy.
Your abdominal (core) muscles normally act to support your back, pelvis and abdominal organs. It is therefore important to get these muscles working again after delivery to help prevent the onset of lower back pain and get you back to doing what you love. It will also help you to look after your new baby as you will be required to perform lifting, pushing and pulling movements every day.
Initially your stomach muscles will not be strong enough for you to move from lying on your back to sitting up. So, for the first 6 weeks after delivery continue to roll onto your side (log roll) when getting out of bed and use your arms to push up into sitting. When sitting on the couch, also think about using your arms to bring yourself up into a sitting position if moving from a resting position (leaning back into the couch).
It’s best to perform you core exercises while lying on your back or side initially. Focus on pulling your lower abdominal muscles in towards your spine (think about pulling you lower tummy in as though you were doing up the zipper on your favourite pair of jeans).
Aim to start with 5x5sec holds (with 5 seconds rest in between each activation). Aim to build to 10x5sec holds and then 10x10sec holds over the first 6 weeks. Ideally aim to complete these exercises two times per day in the first 6 weeks.
It is also important that you think about activating your abdominal muscles when you are changing positions (e.g., getting off the couch), bending or lifting (e.g., lifting baby out of the bassinet or car seat). As this helps the body relearn to automatically activate the core muscles and helps to protect your back.
6 Weeks after delivery and beyond:
At the 6-week mark this is when it is ideal to book in with a women’s health physiotherapist to have your abdominal muscles assessed (strength of contractions, distance of abdominal separation) and discuss the next steps required to get you back to feeling yourself and to doing what you love (walking, gym, running etc.)
Exercise after giving birth is important as it allows you to start to rebuild your fitness, helps with sleep and mental state, but most importantly gets you back to feeling like yourself.
It’s important that your return to exercise is gradual. You can do this by starting a physiotherapist guided class after you have been cleared to return to exercise by your pelvic floor physiotherapist (approximately 6 weeks after birth). These classes are designed to gradually increase the difficulty of your exercises to allow your body to slowly adapt. Your physiotherapist can also ensure that your exercises a specific to you, starting at the correct intensity but also working towards your individual goal (important if you wish to return to high intensity activities or more strenuous sports).
It is important to note that it is encouraged to wait 12 weeks until you return to running if this is your goal. When you are ready to get running it is important to start very slowly (small jogs between blocks of walking). You need to monitor your pelvic floor for a feeling of heaviness and or signs of urinary incontinence. A return to jumping based movements (e.g., sports such as basketball/netball or bootcamps/ aerobics style classes) are also not encouraged until at least 12 weeks after birth.
If you are unsure if you’re ready to get back to the sport you love or not sure how to return to running, book to see a Women’s Health Physiotherapist.
Remember, urinary incontinence is not a symptom that you just have to live with after pregnancy.
Helpful Hints and Tips:
Protect your pelvic floor: Always think about tightening your pelvic floor muscles before you cough, sneeze or lift (important during pregnancy and after birth)
Get your pelvic floor active early: Try and find a convenient time to complete your pelvic floor exercises (e.g., when feeding your baby) (Note: don’t practice while using the toilet – e.g., stopping the flow of urine)
Avoid straining when using your bowels:
- Have step under feet (knees should be above hips) and lean forward resting your elbows on your knees. Relax your lower abdominal muscles and keep your back straight
- You can use toilet paper to support the pelvic floor muscles when using your bowels to reduce pain and stress on the muscles
- Avoid constipation – drinking 2-2.5L of water each day and include fibre in your diet (e.g., lentils, apples, brown rice, whole grain breads and cereals)
Think about your posture:
- When standing – think stand tall, chest open/ shoulder back, pull belly button to spine (activate your core)
- When sitting – place pillow or rolled towel in the small of your back and make sure your feet are supported on the floor
- If breastfeeding – use pillows to help support your baby and bring them up to you, rather than arching through your back to bring yourself down to their level
Monitor your breasts:
Engorgement, blocked milk ducts or development of mastitis (inflammation of the duct due to blockage) can cause redness, lumps and pain. If you start to notice these symptoms book in with you women’s health therapist to quickly treat the condition.
Unsure – Don’t be afraid to ask questions: Unsure of pelvic floor activation or have any other questions after birth– book in with a Women’s health Physiotherapist to assess for correct technique or ask any questions (We are here to help)
If at any stage in your postpartum recovery you are unsure or don’t know how to progress your recovery, book in with your Women’s Health Physiotherapist to discuss your concerns or questions.
If you are suffering from low back or pelvic girdle pain, or if you’re wanting to find out more about our Clinical Pilates during pregnancy, you can make a booking to see our titled Women’s Health Physiotherapist & Pilates instructor, Nicole Symons, HERE.
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