It’s a good idea to start gentle physiotherapy strengthening exercises the second day after your baby’s birth.
Many hospitals offer physiotherapy services or classes before you go home. If you can, take up the offer, as you can find out whether you’re doing the exercises correctly.
If you’ve given birth at home your midwife will help you with the best exercises to get your pelvic floor muscle tone on the right track. Alternatively, ask her about a referral for physical therapy.
Sometimes mothers are given handouts at the hospital, advising where physio classes are available.
When you’re so busy coming to terms with being a mother and learning about childbirth and breastfeeding, it’s understandable that your interest in taking care of your body might wane. But remember, pelvic floor exercises are responsible for good bladder and bowel control!
What is postnatal physiotherapy?
Pregnancy and birth have a significant impact on women’s health. Although some women regain their pre-pregnant body shape quite early, most postpartum women need time to recover. After giving birth, it’s normal for musculoskeletal conditions to take some time to return to their pre-pregnant status.
The pelvic organs, muscles, supporting ligaments and connective tissue have moved significantly during pregnancy, due to your growing baby and uterus. After the birth, they all need to get back to non-pregnant life.
Postnatal physiotherapy is physical therapy specifically for the postnatal period, after many weeks of pregnancy and giving birth.
Postnatal physiotherapy assessment
Regardless of the type of birth women have had, they should have a pelvic floor muscle assessment. In many countries, an appointment with a physical therapist is part of the postnatal care package health services offer. It usually includes assessment and an individualized treatment plan for postnatal rehabilitation.
Postpartum physical therapists specialize in this aspect of women’s health. During the assessment, usually performed by manual techniques, the physical therapist will assess the pelvic floor and muscles and determine the kind of physical therapy the woman might benefit from. If there isn’t any pelvic pain or dysfunction, some strengthening exercises might be necessary. If there is pelvic floor dysfunction, an individualized pelvic floor therapy will be developed. If left unattended, there can be further dysfunctions, such as sexual dysfunction, stress incontinence, bowel problems, and back pain.
The abdomen is also assessed as some women develop what is called diastasis recti (abdominal separation). If not corrected, this can affect the woman’s posture and cause excess weight gain around the waist and back pain.
Do I need physio after C-section?
This is difficult to answer. Whether you have a C-section or a vaginal birth, you should always have a postpartum assessment. Your pelvic and abdominal health might have suffered and might need to be restored.
What exercises should I be doing?
Walking is a great exercise, particularly for the first six weeks after childbirth while your body is recovering. It’s easy and gentle, gets you and baby out in the fresh air, and is excellent for stress reduction. Start your walks slowly and increase the speed and length of your walks as you feel comfortable. If you experience any pain or discomfort, stop and see your doctor.
Swimming is another great exercise following birth; however, you can only do this as long as your blood loss has stopped. Bike riding is okay, as soon as you are comfortable. It’s best to hold off exercise classes or sport until after your 6 week check up, when you have the all clear from your care provider.
Below are some physiotherapy exercises that are great for your after-birth recovery. To make the exercises more enjoyable, set aside some quiet time and put on some music. You could also put your favorite aromatherapy oil in a burner and breathe in the gorgeous smells; it will help you relax as you exercise.
Pelvic floor exercises
The pelvic floor muscles are made up of layers of muscle and other elastic tissues, which stretch from the pubic bone to the tail bone. They support the uterus, bladder, bowel, vagina, anus, and urethra and are some of the most important muscles a woman has. Because they are not visible, however, they are often neglected.
Pregnancy and childbirth can weaken these muscles. Try the kegel exercises below to strengthen your pelvic floor, but don’t overdo them or you’ll end up sore. If that happens, stop doing the exercises for one or two days before starting again.
While lying down, tighten the muscles around the urethra, vagina, and anus, drawing the muscles inside. While doing these exercises, remember not to hold your breath or squeeze your legs and buttocks together. If you can feel your abdominal muscles tighten, this is normal and absolutely okay.
If you are unsure about which muscles you should be feeling, try this: when on the toilet, stop your stream of urine midstream; these are the muscles you should use in the exercise. Another method of checking that you are doing the exercises correctly is by using a mirror. Hold the mirror so you can see the vaginal area; when you squeeze your pelvic floor muscles, you should be able to see the area tighten.
Hold the squeeze for three seconds, then rest. Repeat three times.
Do three quick, hard squeezes in a row hold, then rest between each one.
As you progress, try the exercises in sitting and standing positions. When you cough, lift, sneeze or blow your nose, try squeezing your pelvic floor muscles at the same time. Aim to be doing 3-4 holds for five seconds each and 3-4 faster squeezes by the time you are six weeks post-natal. Increase them to ten if you can.
Daily pelvic floor exercises are beneficial for all women; try to make them a lifelong habit. Do the exercises at traffic lights, in the doctor’s waiting rooms, even right now! No-one will notice that you are exercising your pelvic floor muscles. If you can get yourself into a good routine, you will be less prone later to problems related to poor pelvic floor muscles – for example, incontinence.
At approximately 12 weeks post-natal, you can test your pelvic floor strength. If you want to return to playing high impact sports, you will need to pass this test. A couple of hours after going to the toilet, jump a few times, then star jump. This exercise requires very good muscle strength, so if you don’t have full bladder control, you still need to work on your pelvic floor exercises. It’ also a good idea to speak to your physiotherapist or doctor.
In the early days after the birth, it is good for your pelvic floor, your back, and general well-being to lie flat whenever you can. Lie down to take phone calls, feed baby, and anything else you can think of. Avoid heavy lifting and straining on the toilet, which can weaken the pelvic floor muscles.
Back exercises
These should be performed slowly and should not cause pain. If you feel any pain or unusual discomfort, stop the exercises and consult your doctor or physiotherapist.
Pelvic Rocking
Helps with good posture and relieves wind pains.
Lie flat on the floor with a pillow underneath your head. Put your knees up. Roll your pelvis off the floor, to flatten the small of your back. Tighten your pelvic floor muscles at the same time. Repeat 10 times.
Pelvic Rolling
Roll your knees over to one side. Keep your feet flat on the floor and look to the opposite side. You should feel a gentle stretch in your back. Repeat 5 times on each side.
Abdominal exercises
It is important to exercise the abdominal muscles after having your baby, as they play a very important role in supporting your back and abdominal organs. Doing the following exercises will help you regain your figure as well as strengthen back support. Sit-ups are no longer recommended as a safe or appropriate way to strengthen your abdominal muscles postnatally.
Abdominal Stretch
This exercise will help with good support and posture for your back and tummy.
Go on your hands and knees. Ensure that your back is flat and let your tummy drop. Inhale and, as you exhale, draw the lower part of your stomach up as if you are bringing your belly button towards your back. Hold for a few seconds, then relax. Repeat 5 times. Slowly build yourself up to 10 holds for 10 seconds. Remember not to tilt your pelvis or hold your breath.
Upright Abdominal Stretch
When you have mastered the previous exercise, try this. Kneeling upright, place your hands on your hips, back flat. Inhale and, as you exhale, draw your belly button towards your back, and you will feel the muscles tightening underneath your fingers. Imagine you are doing up your belt one more notch. Build up to 10 holds for 10 seconds each.
The next progression is to do the above exercise in a sitting or standing position. Always aim to have these abdominals working, particularly if you are carrying or lifting.
Tips for taking care of your back
Following the birth of your baby, you are suddenly faced with tasks that you and your body are not used to – for example, carrying baby in a capsule and bathing baby. Here are some tips to avoid injuring your back:
- Baby capsules are heavy and awkward, so avoid carrying them. Opt for leaving the capsule in the car, and choose either a pram or a sling for moving baby
- When purchasing a pram, select one that has an adjustable handle height or is approximately at your waist height
- When bathing your baby, have the bath at waist height. Some laundry sinks are at the right height for this. Keep one hand on baby at all times. If you prefer to use a baby bath, don’t carry a full bath of water; it is likely you will hurt your back or cause a terrible accident if you spill water and slip. Try to fill the bath where you plan to bathe baby, even if you have to use jugs of water
- When changing baby, always have the table at waist height.
Read What Should You Not Do After Giving Birth? for more information.
