There is a lot of focus during pregnancy on being pregnant and preparing for the labour and delivery

of your baby. But what about after? Once you’re a new mum, your role and occupation shifts from

perhaps being deskbound and computer based, to suddenly becoming a night shift manual labourer

with stretched abs that offer little support!

How do we best recover from pregnancy and labour to get on with the job of learning to become a

mum? How do we regain our bodies to be able to enjoy this phase of life and return to exercise?

Of course, everyone is different and will recover at different rates. In many cases it can take up to

one year and this is normal.

The early post partum period should involve gentle pelvic floor exercise and gentle walking.

Sometimes the physios and nurses at the hospital may recommend an early post-natal private

physiotherapy follow up to address abdominal muscle separation and organise muscle retraining

and support for the healing structures.

Sometimes there are pressing issues with the pelvic floor and continence that need attention in the

early days and weeks. And sometimes simply holding the baby for long periods of time while you

both learn to breastfeed and settle creates strain in the back and neck that requires treatment and

a little TLC.

Many women wait until after the six week GP post-natal check-up and then present to

Physiotherapy saying “My abs don’t feel the same. I want to check that I am using them correctly”.

And, “How do I return to exercise safely? When can I lift weights and run?”

The initial post natal physiotherapy assessment involves discussing the labour you experienced and

any impact on the pelvic floor and abdomen (if you had a c-section), current activity and exercise, as

well as your past exercise habits and goals for return to exercise. We discuss and investigate how

your lower abs and pelvic floor are working together to operate as the “core” in order to support

your back while bending and lifting to care for your baby, as well as when you are walking and

exercising.

Our Realtime Ultrasound machine is a great tool for this because we can look through the

abdomen to see if you are correctly engaging the pelvic floor in terms of support for the pelvis and

back, and whether you are lifting in the correct direction (towards the head). It is important to avoid

breath holding and “bearing down” through the pelvic floor. “Bearing down” can cause undue strain

to the muscles and connective tissue in the pelvis and prevent a return to full strength and function.

The Real Time Ultrasound machine also allows us to image the lower abs and help you to understand

how to correctly engage them. Many patients are surprised at the subtly of the action of the core

muscles (the lower abs and pelvic floor working together). Sometimes women who have been

involved in high intensity exercise pre pregnancy need to learn how to relax the upper and outer abs

in order to let the core engage and come back on deck to support the pelvis and back.

The core is a postural muscle, it is meant to engage prior to movement and support through

movement. The amount of effort required to activate the muscle is very low (say 20 % of maximum

effort), but it needs endurance to be able to work all day to support. Just today a new mum was

surprised when we used the ultrasound and she re-learnt how to engage her core. “It’s almost

invisible!” she exclaimed. It is definitely easy to over do it and re-training with guidance makes the

process much easier.

During this session we can also check for rectus abdominus muscle separation. It is important to re

train the core first before launching into sit ups and other exercises designed to exercise the outer

abs. We can help set the abdominal rehabilitation program and progress it specific to your needs

and situation.

You will be asked how your pelvic floor is recovering and whether you are experiencing any issues

with continence in terms of frequency of urination, urgency (rushing to the bathroom) or leakage

with cough or sneezing. If need be this area can be assessed further in order to provide advice and

guidance for specific pelvic floor muscle retraining. Pelvic floor retraining can seem like a bit of a

mystery and women sometimes say that it is hard to “feel” if they are doing the right thing. There is

the opportunity to check whether you are doing your pelvic floor exercises correctly if you are

concerned about technique and would benefit from feedback. Most women are relieved to learn

what is going on and what they can do about it.

Looking after a newborn involves a lot of bending, squatting, baby holding and settling. The initial

physio session will look at how you are managing these tasks and how best to use your core to

support your back.

In terms of exercise progression, the initial step is to learn how to activate the pelvic floor and lower

abs (the “core”) and engage these muscles in daily life. The second step involves basic pilates style

exercises performed lying down, exercises for the abs on all four’s and postural exercises to help

with standing, baby holding and the bending and squatting associated with baby care, as well as

developing endurance in core activation for walking.

The third stage usually involves introducing stationary squats and lunges, longer walks and core

exercises that also involve activation of the outer abs. This is progressed in the fourth stage which

involves adding weights, more load, dynamic movement and may involve sit ups and returning to

interval running and training. It usually takes about three months (at least) to get to this stage. The

connective tissues in the pelvis and the pelvic floor muscles need time to recover before being

subjected to the pressure associated with bouncing, running and harder ab exercises like sit ups and

plank.

So, if you’re pregnant and need guidance or are in pain, call us now to see one of our Women’s

Health Physios. If you have just had your baby, or have had your family but have never been

assessed, feel free to see us and we will guide you every step of the way.

Until next time,

Kath Cowen