Pregnancy Getting Your Body Back on Track After Baby

Abs of Steel?  Not Quite Yet

Our physiotherapists can assess your core and abdominal control and set you safe, graded exercises for you to practice independently at home.  

If you ask for a Core and Floor Appointment, we can use a real time ultrasound machine to help test how you’re going and help you learn faster.

The exercises we set will vary depending on your ability level, keeping in mind your pelvic floor control, and caesar/vaginal delivery precautions.

We also offer Mums & Bubs Pilates Classes for pregnant ladies and postnatally).

Signs that an abdominal exercise is too hard/inappropriate for you:

• you’re holding your breath
• your tummy muscles brace but bulge out
• you can feel your finger/s can dig through your abdominals in the centre line near your belly button (please look at diastasis recti below)
• you feel like you need to pee or fart
• your lower back changes position
• your lower back, hip flexors or neck hurt, ache or fatigue
• you can’t complete 5 repetitions in a row comfortably
• your hips /pelvis wobbles about when you change sides
• you rush through to get to the start or finish position rather than a slow, smooth, controlled movement.

Exercises to Avoid in early Post Natal Recovery

Ab crunches, 2 legs in the air exercises, double tabletop, russian twists, treadmills/mountain climbers, having one or two legs straight in the air, or any exercise working from a full pushup/plank position are BAD exercises to start on (despite what some websites and facebook comments suggest), as these are all quite difficult and place extra strain on the lumbar spine if done without enough abdominal strength.  

(NB. this is not an exhaustive list, just some common ones I cringe at for misinformation for early post natal recovery)  

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Post Caesar - The First Month

Your abdominals have been cut through, so you’ll have to put extra effort into regaining tummy muscles. (But on the plus side, unless you’ve already laboured through to the end of 1st stage, your pelvic floor is likely to be better than after a vaginal birth!)  Having said that, your pelvic floor will still be weakend and stretched simply due to the weight of your baby during your pregnancy, so yes, you must also do pelvic floor exercises!

Circulation

Moving your ankles up and down, and around in circles when you’re lying in bed will help excess fluid return from your ankles (hopefully they haven’t become too much like “cankles”), and also reduce your risk of DVT.

Take enough pain medication initially to allow you to get moving as soon as it’s possible.  Getting in and out of bed, rolling over, laughing or coughing are likely to be your most painful activities initially, but once you’re out of bed, walking is usually surprisingly comfortable (even if you hunch over a bit the first day or two). Once you’re up and walking around, your calves will function as a muscle pump to circulate any excess fluid back up from your ankles.

No Heavy Lifting

Your abdominal muscles normally help support and stabilise your back, so when they are lengthened, weak and cut through, you are at more risk of lower back ache.  So don’t lift heavy things (the baby’s weight should be your maximum, so your baby in their capsule is “too heavy” – very inconvenient, I know!)

The Caesar Smile

Your scar is likely to feel both numb and tender for at least a few weeks, perhaps even several months.  Start by gently massaging along and around the scar as soon as the wound has healed, (even though it’s a bit uncomfortable initially).  If you stimulate the area regularly with massage it promotes healing by increasing blood flow, tissue healing, normalised sensation and less scar tissue formation.  This is something that unfortunately only few women are told.

As it becomes more comfortable, press a bit harder and deeper, and work back and forth across the scar as well.   This reduces the amount of excess scar tissue forming, both on the surface and deeper in. (Excess scar tissue can result in “scar overhang”).  Try using vitamin E cream, cocoa butter, or something similar.  Compression from tight undergarments will also help reduce swelling and excess scar formation.

Tight Undergarments - Look Good By Cheating!

For women with a diastasis recti (split of the linea alba between the 6 pack muscles), this is particularly important!  There are even more supportive abdominal binder options for you in the early stages as well as the options listed below.

Post caesar, you also want a headstart to help your abdominals recover!

Everyone else - why not cheat too if the others are?  :)  

Wear a tight, elasticated waistband around your middle as much as is practical for the first few weeks (especially first 6 weeks).  Options include my favourite, the “Bando” (available at FLEX for $35, it is also great for hiding and warming your tummy whilst breastfeeding in winter!), “SRC Pregnancy Recovery Shorts” (about $250+ from some Chemists or online) or firm control, high waisted undies (Bridget Jones style, $20-35 from Target, Myer etc.).  

My personal hint: really high, (like near your bra) is better to avoid that not-so-pretty-but-totally-unavoidable fat roll appearing over the top.

This has several benefits:

• It holds your tummy muscles in a better position, which will make it easier for you to activate and strengthen them
• Gives you a feeling of support and “core” control, (women often feel wobbly or weak post pregnancy due to weakness in “core muscles”)
• The gentle pressure helps remind you to engage abdominals with everyday tasks such as walking and bending forwards
• Makes you feel less floppy, fat and “pregnant belly” (always a downer when your baby has already arrived, and someone asks you when you’re due!)
• May help the uterus to contract (the jury is still out on this one)
• For women with a “Caesar smile” (scar) the pressure can feel a little uncomfortable for the first few days, but helps with reducing swelling and hypersensitivity of the scar area afterwards
• For women with a diastasis recti (split/tear between the 6 pack muscles), it promotes correctly positioned scar tissue formation, and reduces healing time

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Pelvic Floor - You Won't Regret It!

Start doing some gentle, slow pelvic floor contractions as soon as it’s comfortable (day 1-3 post delivery, depending on the labour).  Start when lying down (easiest position to activate without having to work against gravity).  Once you can do some squeezes well, and feel the difference when you relax you pelvic floor, then progress to more difficult positions: sitting, standing, walking and then bending over/squatting (in that order).

Lying down regularly to take your body weight’s pressure off your pelvic floor will aid comfort and recovery.  Aim to rest lying down for at least 30mins, 3 times a day for the first few weeks, while the bleeding is settling down.

After pregnancy, our pelvic floor muscles have “amnesia”, they lose the “knack” of knowing when to automatically turn on. This is partly due to the weight of the baby during late stage pregnancy, so even women who have a planned Caesar, are likely to exhibit some symptoms of pelvic floor weakness.

This is especially true for vaginal deliveries, particularly if the labour has involved tearing or damage to the pelvic floor, or required the use of forceps, ventouse or episiotomy.

Try to “pre-engage” pelvic floor when you move, especially standing up from a chair, (or sitting down), picking up your baby, bending over (to pick something off floor), walking, go up/down stairs, laughing, coughing or sneezing, or do any movement that feels uncomfortable for your back/groin, or when you are aware you normally “leak a little”. A great regular practice time is when you have finished in the toilet.

Your pelvic floor should return to normal a few months after birth, but this doesn’t naturally happen just with the passage of time.  Strength and endurance, just like with any other muscle, requires training, and weakness or injury can cause symptoms.  Sadly, many women are uncomfortable talking about this, don’t seek help, or don’t realise that it’s possible to return to normal.  

When we say “normal pelvic floor” we mean:

• No “stress incontinence” - leaking of urine (or faeces) when laughing, coughing, sneezing, jumping, running, hopping or playing sport.
• No “urge incontinence” – suddenly needing to go, without much warning
• Pre-pregnancy sexual experience (painfree, normal sensation, and ability to climax as previously)    

Pelvic Floor Info : www.pelvicfloorfirst.org.au has some great info!

Please be wary that some women have issues with an overactive pelvic floor, and difficulty relaxing it.  These women should see a pelvic floor physio for further advice, and not attempt these types of exercises until they have “the go ahead” from their physio.  (Symptoms of PF overactivity include pain with sexual intercourse or during a gynaelogical exam, tailbone pain with sitting, generalised pelvic pain, or pain when doing a poo.)

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Pregnancy & Post Natal Care at FLEX

Physiotherapy

• Our physiotherapists are experienced in manual therapy, exercises and advice for typical pregnancy-related issues such as lower back pain, sacro-iliac, pelvic pain, sciatica, neck & shoulder tension.  
• Core & Floor Appointments - a chance to check how your pelvic floor is going and get the all important pelvic floor and core muscles working well as a foundation before returning to sport or impact exercise.

Mums & Bubs Pilates

• M&B Pilates Classes are modified to be appropriate up to 36 weeks pregnancy, and as soon as 8 weeks post partum where you and your baby are welcome to attend together, and we have a receptionist (also a mother) available for childcare too
• Pilates Screening Sessions 1:1 with a physio before joining classes to allow thorough assessment and exercises to be set safely and appropriately
• Mums & Bubs Pilates Classes have a maximum of 6 participants for personalised attention with a physiotherapist

Massage

• Regular massages during pregnancy to help relieve the ‘tight spots‘ that occur as your body grows and changes.
• Includes belly pillow for comfortable positioning during pregnancy
• Post natally women often get tight from holding, carrying, feeding and burping their baby, as well as sore lower backs until core muscles kick back into gear.  A massage to release this tension is a welcome relief.
• Private health insurance covers remedial massage, so it’s quite affordable!

Braces & Aids

• Sacro-iliac Joint Braces, postural supports, and other physio, pilates and exercise equipment are available from reception and can be fitted for you by a physiotherapist.

Obstetric TENS

• TENS Machine Hire for pain relief during labour. (Any safe pain relief that doesn’t affect your baby at all sounds like a good place to start hey?)

Private Health

• Rebates are available for all physio, massage and pilates appointments (excluding massage gift vouchers), leaving minimal out of pocket expense.

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