RETURNING TO FITNESS AFTER BIRTH

VAGINAL DELIVERIES AND CAESAREAN SECTIONS

WESTERN SUSSEX HOSPITALS TRUST

Women’s Health Physiotherapy Department, Worthing Hospital, Worthing Tel: 01903 285014

Women’s Health Physiotherapy Department,

St Richard’s Hospital, Chichester Tel: 01243 831712

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This leaflet offers guidance on safe and effective exercises that will help you get back into shape following the birth of your baby. The exercises are also suitable for Caesarean deliveries. They are easy to do and can fit into your daily routine. They will help tone up your stomach and pelvic floor muscles and help your posture return to your pre-pregnant condition. By regaining your fitness you will feel better and have more energy. You could also avoid health problems in the future. If you have had a Caesarean section then your return to fitness will be a few weeks slower, so don’t expect too much too soon. POSTURE Your posture has changed to accommodate the growing baby. Some muscles have lengthened and stretched whilst others have tightened and shortened. It is common for your tummy muscles to separate slightly during pregnancy. However, if you are concerned about the amount of separation following birth then see the ward physiotherapist or your GP. Do not do sit ups for a few months following birth.

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Regaining good posture after your baby’s birth is very important and can help prevent back pain. Strengthening your deep stomach muscles will help maintain good posture and support your back. Try to keep a small ‘natural’ curve in your lower back, stand up tall and hold in your stomach muscles. If you have had a Caesarean section then avoid walking with a stooped posture and try to stand tall immediately. This will not harm your wound. In the early days support your scar if you need to cough, sneeze or laugh. PELVIC FLOOR EXERCISES

Your pelvic floor muscles are supportive muscles attached to the walls of your pelvis, which stretch like a sling from your pubic bone at the front to the coccyx at the back. They help support your bladder, womb and bowel and also close the bladder outlet and back passage. They are weakened by pregnancy and also stretched if your baby is born vaginally. Exercises will help to strengthen them.

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If they remain weak then you may experience the following: Lack of control of urine, wind or bowel motions

Leaking a small amount of urine with exercise or when you cough, sneeze or laugh

Increased risk of prolapse

Diminished sexual enjoyment When to start exercising them: You can start from day one. If you have a catheter in place do not do pelvic floor exercises until it has been removed and you have passed urine. You can do the exercises in any position. Sitting with your legs slightly apart may be a good position to start, but also try other positions ie: lying, standing, lying on your side. Even if you have stitches, bruising or haemorrhoids (piles) you can start the exercises, since gentle rhythmic tightening and relaxing of the muscles can help ease pain and swelling. How to do your Pelvic Floor Exercises

1. Draw up and tighten the muscles around your back passage without squeezing your buttock or thigh muscles as if trying to stop yourself passing wind, and hold.

2. At the same time take this feeling forward and tighten the muscles around the front passage, as if trying to stop yourself passing urine. Lift up through the vagina. Hold the squeeze for as long as you can (build up to 10 seconds) then release and lower with

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control. Try not to overwork your tummy. Don’t hold your breath.

3. Also try some ‘quick’ contractions of the pelvic floor. Tighten and lift in one quick contraction and let go immediately. This helps your muscles react quickly when you cough, sneeze, lift etc.

4. Aim to do one set of slow holds and one set of quick lifts a minimum of three times a day. Work to a level you are comfortable with. During each set aim for a maximum of 10 second hold, for a maximum of 10 times, followed by five to 10 quick lifts.

NB: In the first few weeks you may feel nothing – do not panic! Keep practising and try to do the exercises often every day for the first three months to help the muscles regain their strength. Then aim for three sets a day for life. Tightening these muscles before you cough, sneeze or lift will help protect from bladder leakage. Do not do your exercises by trying to stop midstream when you are on the toilet as it is not good for the bladder. Further hints

If you are having trouble controlling your bladder and/or passing urine as normal, please ask to see a the physiotherapist or mention it to your midwife.

Avoid standing for long periods as this may increase swelling and discomfort in your perineum, particularly if you have stitches. If you find sitting uncomfortable try resting on your side.

Supporting your perineum/stitches with your hand or toilet paper or pad will ease discomfort when you have your bowels open. If you have had a

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Caesarean section you may also find it useful to support your scar when you are opening your bowels.

Avoid constipation. Drinking at least three to four pints(approximately two litres) per day and eating plenty of fresh fruit and vegetables will help to keep you regular.

If you are having difficulties passing a motion then getting your feet up onto a foot stool or a box may help when you are sitting on the toilet. Try not to strain by holding your breath and pushing hard; instead do three or four short sharp pushes on an exhalation.

Some women find having a short warm bath with a few drops of tea tree or lavender oil helps, as it soothes the perineum and acts as a mild antiseptic.

Pain relief – as well as your normal painkillers ice can be helpful if you are suffering from a painful swollen perineum after labour. Wrap it in a damp cloth and place the ice pack between you and the pad. Remove after 10 to 20 minutes. This can be done as often as you need.

STOMACH EXERCISES Your stomach muscles have been greatly weakened and stretched during pregnancy, and it is important to start toning them up as soon as possible. Work the deep muscles first (exercises one and two) as these important muscles help reduce strain on your back and pelvic floor by acting as a natural corset. They also help flatten your stomach. NB: Do not try strong exercises such as full sit-ups or lifting both legs up straight when lying on your back – these may be harmful.

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Try to do these exercises at least once a day. Exercise 1 – deep stomach exercise In any comfortable position, gently pull in the lower part of your stomach below your belly button whilst breathing normally. Make sure your back remains still. Hold your tummy in, for 10 seconds, then gently let go. Try to repeat five to 10 times. Gradually increase the hold time. As you improve, pull in your pelvic floor muscles at the same time. Also try this exercise during day to day activities. Exercise 2 – deep stomach exercise This is similar to Exercise 1, but it is a little harder as the muscles are working against gravity. Try at first in a kneeling forward or supported leaning forward position. When you are comfortable progress to all fours, as in the picture (right). Hands under shoulders and knees under hips, keeping your back straight pull your lower abdominal muscles up towards your spine as you breathe out. If you have a large separation of your tummy muscles, seek advice from your physiotherapist before trying this exercise.

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Exercise 3 – pelvic tilt In a lying position with your knees bent and feet on the floor, draw in your abdomen and tilt your pelvis so that the small of your back flattens onto the floor. Hold for up to 10 seconds and release gently. Repeat five to 10 times. This exercise may help ease wind and low back pain. General Advice Returning to your normal fitness level after birth is good for general wellbeing. Many women feel extremely tired after childbirth, so pace your activities and get plenty of rest. Accept offers of help and try to have a regular rest.

1. Circulation – avoid prolonged standing after delivery and if your ankles are swollen, put your feet up with your knees supported and move your ankles regularly.

2. Walking is a good safe exercise for most people and can help build up general fitness. Gradually increase the speed and distance of your walk.

3. Swimming – it is recommended that you start this after your six week post-natal check.

4. Returning to sports – do not attempt this until you feel ready. For low impact exercise resume gently from six to12 weeks. For high impact exercise resume gently from about three to four months.

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LOOKING AFTER YOUR BACK Your back and pelvic joints are vulnerable for up to three to six months after the birth due to muscle and postural changes during pregnancy, and the increase in the number of activities that put strain on your back postnatally (i.e. lifting, carrying, feeding and changing your new baby). It is vital that you take care of your back. Ensure your pram or buggy handles are at the appropriate height, to avoid stooping. Getting out of bed

Roll over onto your side leading with your upper

body. Swing your legs over the edge of the bed and sit up by pushing with your arms.

This will help protect your back and abdomen while your muscles remain weak.

Do not do a sit-up to get out of bed. Feeding Ensure you have a good sitting position every time you feed. Put a cushion in the small of your back and the baby on a pillow to bring him/her closer to you. Putting your feet on a small stool may help. You can also feed the baby lying on your side – especially at night.

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Changing Avoid stooping during nappy changes. Change the baby at a sensible height eg: Standing at a changing table, kneeling by the bed. Lifting When you lift, tighten your pelvic floor and deep abdominal muscles (exercise 1). Use your legs and not your back to take the strain. Bend your knees and keep what you are lifting close to you.

Carrying the baby in the car seat is not advised

Avoid activities that may cause strain until you’ve had your six week check. Don’t lift anything heavier than your new baby ie: small children, heavy shopping, baskets of washing. Have help with vacuuming and jobs involving prolonged standing. Try sitting when attending to other children. This is especially important if you have had a Caesarean section.

Driving

Bear in mind disrupted sleep may impact on your ability to drive comfortably, but after a normal delivery there is no time limit on driving.

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If you have a Caesarean section check with your insurance company for any guidelines. Generally it may take four to six weeks before you are ready. Check you can look over your shoulder, wear a seatbelt and do an emergency stop. Take another driver with you on your first journey.

Sex

Resume sexual intercourse when you are comfortable. Start gently and use lubrication if required. If you’ve had stitches or a Caesarean section you may want to wait for at least six weeks whilst tissue healing occurs. Some positions may be more comfortable than others.

Six week check

At your six week check mention any concerns to your GP.

We are committed to making our publications as accessible as possible. If you need this document in an alternative format, for example, large print, Braille or a language other than English please contact the communications office by telephoning 01903 205111 ext 4038. The Trust is keen to know if this document/leaflet gives you the information you need in a way that is easy to understand. Please tell us if you think we can improve it by calling the team details below. Women’s Health Physiotherapy Team, Western Sussex Hospitals NHS Trust

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www.westernsussexhospitals.nhs.uk Tel: Worthing 01903 285014 / Chichester 01243 831712 Leaflet produced April 2012 Reviewed April 2014