Pregnancy results in gradual changes in the body, which do not return immediately to normal, but guidance in this leaflet and regular exercise will help mothers regain strength.
It is common to develop lower back pain, shoulder and upper spine tenderness and stiffness during and after pregnancy. This may be due to changing body shape, weakness of muscles, and increased demands placed on the body with the new arrival.
It can take up to five months for the ligaments to fully tighten up after the infant’s delivery, so adherence to good posture in all activities of daily living is vital. To help encourage correct muscle activation and reduced joint strain, try advising the practice of some of the following techniques:
When feeding the infant, it is advised to sit tall, preferably on an armchair, with arms and shoulders relaxed. A small footstool under the mothers feet, and a small roll at the small of their back, will ensure their back is well-supported.
When getting out of bed, they should bend both knees, press them together and roll over onto their side before sitting up. Reverse to lie down.
Avoid any unnecessary lifting and take smaller loads.
Avoid bending forward postures when caring for the infant as repeatedly doing this will cause wear and tear on the back. When lifting, always use your leg muscles to do the work.
Following childbirth, leakages can sometimes occur from the front and/or back passage. This may resolve after a short time. Exercises can help but if the problem persists beyond twelve weeks post-natally, women are advised to contact your Chartered Physiotherapist in Women’s Health, Public Health Nurse or GP.
The pelvic floor forms a broad sling of muscle, lying across the bottom of the pelvis, through which pass the openings from the bowel, vagina (birth passage) and the urethra (passage from the bladder).
They are the main support for the pelvic organs and give control of the three passages.
It is important to make them strong again as weakness of the pelvic floor can cause symptoms such as leakage of urine when coughing, urgent or frequent need to pass urine, leakage of wind and/or stool from the back passage, or decreased satisfaction during intercourse.
Postnatal women may have stitches in or near their vagina. The muscles may feel weak and sore, but this exercise will ease the pain and start to strengthen them. Try to start gently within a few hours of the birth.
Tell mothers to imagine that they are trying to stop themselves from passing wind and at the same time trying to stop their flow of urine mid-stream. The feeling is one of ‘squeeze and lift’, closing and drawing up the back and front passages.
Gentle rhythmical squeezes, in the first 48 hours after childbirth will help ease pain and reduce swelling. These should be done frequently, for 30 seconds at a time.
This routine should be practised as often as possible. Mothers should feel their lower tummy (below your tummy button) tightening gently as they do this. However, it is very important to do this exercise without pulling in the whole tummy, squeezing the legs together, tightening the buttocks or holding their breath.
Add some quick strong squeezes to the 10-second hold, remembering to relax completely after each exercise.
Quickly lift and squeeze the pelvic floor muscles prior to laughing, coughing, sneezing or lifting; this will protect the pelvic floor and prevent undue pressure on the muscles. This technique is known as “the knack”. Mothers should get into the habit of using “the knack” in all situations where extra pressure is coming on the pelvic floor, including each time they stand up, or lift their infant.
How to know if you are doing your exercises correctly:
If you have had a Caesarean section or had limited mobility during pregnancy, please contact your GP or Midwife before resuming activities. All return to exercise should be on a gradual pain-free basis. Walking is a terrific exercise, so when you feel able, start with a slow pain-free 10 minute walk. As you regain strength, you can increase the length, frequency and speed of the walks. Taking your pelvic floor to the third floor and holding for 20 seconds as you walk is a great way to exercise your pelvic floor. However, remember to fully relax it between exercises as failure to release the muscle fully between contractions can lead to dysfunction of the muscle.
You may start the following exercises within days of the birth as long as they are pain-free and do not cause strain. Aim to do the exercises twice a day.
Lie on your back with your knees bent:
This exercise can also be done while sitting and standing, once you have mastered it in lying.
With your head on a pillow, lie on your back with knees bent and feet flat on the bed:
Once you have mastered this exercise, it can be practised in any position, side-lying, sitting or standing.
Lying on side with knees bent:
Initially after having a baby your tummy muscles remain stretched and lengthened down the centre of your abdomen leaving a gap in the middle which may take some weeks to close. Before progressing with the exercises, you need to ensure that there isn’t a gap or hollow in your tummy muscles. This can be done as follows:
Increase the number of repetitions as you feel able
If you need advice about increasing activity or to determine if you are ready to resume sporting activities, please ask your GP, or contact your Chartered Physiotherapist in Women’s Health.
Above all, enjoy being a mum!
Some important things to know about your baby
The World Health Organisation Guidelines recommend that babies should be placed on their backs for sleep to reduce the risk of cot death. It is very important to follow this advice. However, it is important that babies spend some time on their tummies every day.
Babies should be placed on their tummies from day 1, for just a few minutes three times daily initially, gradually building up the length of time. Initially, you can place your baby on your chest, facing you. This is a great way to play with your baby, and to make eye contact with him, which is one of the first steps in communication with your baby. Your baby may not like being on his tummy initially, so start slowly, but persevere! The benefits to your baby are worth the effort.
Your baby should NEVER BE LEFT ALONE while on his tummy.
Too much time on their backs can cause a delay in babies acquiring movement skills, and can also cause flattening of the side of their head. To avoid this, alternate which end of the cot you place the baby’s head at night; babies will naturally turn towards the light or coloured objects in the room which will change the area of pressure on the baby’s head.
The best piece of equipment you can invest in for your baby is a colourful mat to place on the floor, so that he can enjoy his tummy time on it while exploring his environment in your company!
It is very important to engage with your baby by using eye contact. With your baby lying on a flat surface, or on your tummy as in the image above, encourage your baby to make eye contact with you in midline (ie. when your baby’s nose is in line with your baby’s belly button).
Encourage your baby to follow your face from side to side and up and down, coming back to midline after each movement. This is the start of communication and head control.
Floor time: The floor is the best place for your baby to spend his awake time. This may be difficult if you have young toddlers, but a playpen can overcome this difficulty. Your baby needs time on the floor, completely unsupported and with as little clothes on as possible to become familiar with their bodies and their ever developing movements. Between the ages of 0 and 2, if your baby is not asleep, he should be moving. This is how he develops and begins to learn.
Enjoy getting to know your new little member of your family!
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