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
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
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
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,