Postnatal Advice and Exercises

 

You can try to start gentle exercises after the second or third day of the birth of your baby.

Follow the advice of your midwife regarding the timing of this.

What exercises should I be doing?

  • Walking is a great and gentle exercise, particularly for the first six weeks while your body is recovering. It’s very easy, gets you and baby into the fresh air, and is excellent for relaxing your mind and body.

Start your walks slowly, approximately 10 to 15 minutes for the first two to three weeks and increase the speed, time and distance of your walks as you feel comfortable.

Try to go for a walk with someone else pushing the baby stroller; this means that you will walk rhythmically and upright.

If you experience any pain or discomfort, stop, and discuss this with your midwife or with a physiotherapist. It is best to avoid steep hills or lots of steps for the first four to six weeks if you can. Flat even surfaces are best and then you can walk reasonably fast.

  • Swimming is another great exercise following birth; however you can only do this as long as your blood loss has stopped. Avoid public pools because of the risk of infection. Natural areas such as sea or lake are ideal.
  • Bike riding is okay, as soon as you are comfortable. If you have had stitches or perineal bruising avoid cycling for eight weeks. Be sure you have a wide comfortable bike seat.
  • Treadmill or cross trainer work is fine to do starting on low speeds and no incline.
  • Exercise classes or sporting activities are best to defer until your 6 week postnatal check up, so you can get the all clear from your doctor, midwife or obstetrician.

Tip:

Wear good supportive clothing, bra and underwear, and good supportive foot wear

  • When you resume sports and exercise it is wise to avoid any HIGH IMPACT exercise for the length of time you are breast feeding. This sounds like a very long time, but your soft tissue and ligaments are very vulnerable to stretching during the months after birth (including your uterine ligaments, vaginal walls and breast tissue) The biggest risk of jogging, running, jumping etc. is prolapse of your pelvic organs. Once this happens, no amount of exercise can repair the damage. Often the symptoms of this (which can be bowel/bladder problems) do not occur until you are older, but the damage is already done. If you notice any unusual bulge/lump in your vagina see you health professional immediately.

General Advice

In the early days after the birth, it is good for your pelvic floor, back and wellbeing to lie down flat whenever you can.

It is especially good for your back and uterus to lie on your tummy for about 20 minutes twice a day. Put a pillow under your tummy to prevent discomfort to your breasts.

Take phone calls lying down, feed baby lying down and anything else you can think of.

Avoid heavy lifting.

Below are tips on how you can avoid injuring your back/pelvis.

  • Baby capsules are heavy and awkward, so avoid carrying them for any length of time. Opt for leaving the capsule in the car, and choose either a pram or a sling for taking baby with you.
  • When purchasing a pram, select one that either has an adjustable handle height, or one that is approximately at your waist height.
  • When bathing your baby, try to have the bath at waist height. Some laundry sinks are at the right height for doing this, and you can even use the washing machine as a change table afterwards!. If you prefer to use the baby bath, do not carry a full bath of water as you could hurt your back, or could cause a terrible accident if you spill water and slip. Try and have the bath filled where you plan to bathe baby, even if you have to fill the bath with jugs of water.
  • When changing baby, again, you should have the table at waist height or use a nice comfortable changing mat on the floor.
  • Avoid straining on the toilet, which can weaken the pelvic floor muscles and cause haemorrhoids. Use a small stool under your feet when having a bowel motion to prevent straining and to help to empty completely

Below,  I have given you some 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 favourite aromatherapy oil in a burner and breathe in the gorgeous smells, helping you to relax as you exercise.

 

How is your pelvic floor?

The pelvic floor muscles are made up of layers of both muscle and other tissues (ligaments, fascia and tendons) some elastic and some not, which stretch from the pubic bone to the tail bone and connect with other muscles and ligaments.

They support the uterus, bladder, bowel, vagina, anus and urethra. They also contribute to spinal and abdominal strength and function.

They help to close off the bladder and bowel outlets to help prevent leakage.

 When they relax the bladder and bowel can empty effectively.

A functional pelvic floor can contribute to sexual response and sensation

The pelvic floor muscles are some of the most important muscles a woman has, yet because they are not visible, they are often neglected until there are problems!. Pelvic floor muscles weaken for similar reasons to other muscles in our body: natural ageing and inactivity, hormonal changes, being overweight, ongoing constipation, chronic cough and pelvic surgery.

Pregnancy and childbirth will also alter the strength and ability of your pelvic floor.

You will have heard about them during pregnancy and now it is time to restore their function after baby.

Research has shown that regular exercise can strengthen and re-activate the pelvic floor muscles. It is possible for women of any age to reduce or completely overcome symptoms of weak pelvic floor muscles.

Start by lying down on your back with your knees bent and feet flat on the bed, tighten the muscles around the urethra, vagina and anus; see if you can feel the muscles closing, tightening and drawing forward towards your front pelvic bone. Try to hold this contraction and then release; you should have a definite feeling of letting go.

PLEASE do not be hard on yourself!! You may not feel anything for a few weeks until the muscles recover from stretching. Just keep doing this movement and imagining it happening as the brain can help the muscles relearn quickly.

Some other ideas to help you to visualise this:

  • Think of a sea anemone closing shut and pulling within itself

  • When standing think of the muscles of your pelvic floor making a figure of eight around your vagina and anus. Squeeze and draw up the centre between the circles.

  • Think of a little dog curling the tip of his tail between his legs.

When doing pelvic floor 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.

Hold the squeeze for as long as you can. Then rest. Repeat this three times to start with. Once this is easy, you can add on more contractions until you are doing ten. Do not overdo it, the muscles will tire easily.

If you are unsure of what muscles you should be feeling, you can use a mirror. Hold the mirror so you can see the vaginal area and when you squeeze your pelvic floor muscles, you should be able to see the area tighten and draw in.

Another method of checking that you are doing the exercises correctly is, when you are on the toilet, stop your stream of urine when midstream and you should be able to identify the muscles.  (Do not make a habit of doing this as it can affect your bladder’s ability to empty completely) It may take weeks to be able to do this.

 

To finish the exercise programme, do three quick, hard squeezes in a row, then rest and do three more.

You can do this easy programme every time after you have been to the toilet. We all go to the toilet at least four to five times a day, so this is a good regular time to start exercising your pelvic floor muscles.

Remember one good quality contraction is better than lots of little ineffective ones and good results take time and effort.

 
 

 

 

 

 

 

 

 

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. Continue to increase up to ten if you can do so.

Pelvic floor exercises are very beneficial – you should try to make it a lifelong habit. Do the exercises at a regular time each day. If you can get yourself into a good routine, you will be less prone to problems which result from weak pelvic floor muscles later, for example, poor bladder control and urinary 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 did not have bladder control, then you still need to work on your pelvic floor exercises. Remember your pelvic floor recovery will take longer while you are breastfeeding.

It would be a good idea to speak to your physiotherapist or doctor if you are noticing problems.

 

 

Back exercises

These exercises should be performed slowly and should not cause pain. Do them on a firm bed or a blanket or towel on the floor.

You can do them every day if you have time, but three times a week will be enough to help. If you do feel any pain or unusual discomfort, please stop doing the exercises and consult your physiotherapist or doctor.

Tip: Ask a friend or family member to give you a gentle massage for your neck, shoulders or even your feet.

 

Pelvic Rocking

Helps with good posture and relieves wind pains.


Lie flat on the floor with a pillow underneath your head. Bring your knees up with feet flat on floor. Roll your pelvis/tailbone off the floor, to flatten the small of your back. (Tighten your pelvic floor muscles at the same time if you can). Try not to hold your breath. Repeat 10 times.

 

Flexible bridge

Lie on your back with knees bent and feet flat on the floor. Draw in your lower tummy, gently, and breathing out, lift your bottom off the floor until your body is in a straight line like a bridge. Now imagine a soft wind is blowing the bridge from side to side. Do these movements gently five to six times. Remember not to hold your breath.

Wind screen wipers

Do this in the same position as the last exercise but have your arms out to each side away from your body and palms facing upwards. Imagine your legs are like windscreen wipers, gently moving from side to side.  Roll your knees over to one side. Keep your feet on the floor and look to the opposite side. A gentle stretch should be felt in your back. Repeat 5 times on each side.

Elegant Cat


Come onto your hands and knees. Draw in your lower tummy and breathing out bring your right knee towards your chin by tucking your head down. Now lift your right leg out behind you straightening your knee and lift your head up to look forward.

Hold for three seconds, remembering to breathe gently. Keep your head in line with your spine, try not to let it drop.Lower your leg slowly. Do this 10 times. 

Rest and then repeat with your left leg.

Once you feel that you can do this exercise easily, you can try to lift your right leg and your left arm together and hold as above. Then try this with your left leg and your right arm.

 

Swiss/gym ball work

A gym ball is great addition to have at home for sitting on and for exercise. Use it if you are at the computer for a while, or even to watch TV.

Try these suggestions:

·Sit in a relaxed open position and do some gentle bouncing up and down. Do some fast bouncing and then some slow bounces. Try drawing up your pelvic floor muscles as you bounce.

·Sit on the ball and rock your pelvis back and forwards, keep your upper body still.

·Now try rocking your pelvis from side to side.

·Now try some gentle rhythmical circles with your pelvis. Remember to go both clockwise and anti-clockwise.

Five to seven minutes is a good amount of time to spend doing these movements.

 

 

Abdominal exercises

It is important to restore and remind the abdominal muscles of their job, after having your baby, as they play a very important role in supporting your back and abdominal and pelvic organs. It will help you regain your sense of self, as well as strengthen back support, by doing these exercises.

  • Work on strengthening the deep tummy muscles called transverse abdominus and the waist muscles called the obliques.
  • Ask your midwife or physiotherapist to check the gap between your vertical tummy muscles (rectus abdominus) If this is wider than 2 cm you will need advice and abdominal support to ensure optimal healing (see the page on Rectus Abdominus Diastasis).
  • Try drawing your lower tummy, below your tummy button in a little bit. Stand and walk tall with shoulders soft and wide. Start by holding in for 2 to 3 seconds (continue to breathe in and out) Aim to eventually hold your lower tummy in gently during movement (e.g. lifting, bending, changing position). This happened naturally before your muscles were stretched during pregnancy.
  • You can help during the first few weeks by wearing firm under wear or even a light abdominal binder (or cycle pants) This helps you to be aware of your muscles and keep them shortened so that they remember their job and you can use them more effectively.
  • A good time to work these deep muscles is when you are out walking or pushing a pram.

Please note that sit-ups are not recommended as a safe or appropriate way to strengthen your abdominal muscles post-natally.

 

The Tummy Tuck In

This exercise will help with good support and posture for your back and tummy.

You will need to be on your hands and knees. Try to let your lower back curve down a little, and let your tummy drop.

Breathe in, and as you breath out, draw the lower part of your stomach up towards your spine from below your tummy button (as if you are trying to draw your skin away from a tight pair of pants). Hold for five seconds if you can. It may take a week or so to get to five seconds.

Repeat 5 times. Slowly build yourself up to 10 holds for 10 seconds. Once you feel strong enough you can do this whenever you remember during the day. Remember not to tilt your pelvis or hold your breath! You may also notice your pelvic floor muscles working when you draw in your tummy. This is good because these muscles work together as a team.

Upright Tummy Tuck In

When you have mastered exercise number 1, try this! Kneeling upright, place your hands on your hips. Breath in, and as you breath out, 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. Aim to always have these muscles gently working, particularly if you are carrying or lifting.

 

Another Tummy Tuck In:


Lie on your back with both knees bent and feet flat on the floor.

Put your hands on both hips and check that you are keeping your pelvis still and horizontal.

Draw in your lower tummy and then let your right knee slowly fall out to the side, still keeping your pelvis and hips still and in line. If you feel your pelvis tilting to the right then bring your knee back up. Hold for three seconds. Repeat with left leg. Do this five times for each leg.

 

Bottom and hips:


Side lifts:


Lie on your left side. Draw in your lower tummy, below your tummy button and, keeping your hips and shoulders in line, breathe out and lift your right leg away from your left leg. Hold for 5 seconds and try to keep your hips and your shoulders still. Remember to breathe gently.

 

Slowly lower your leg. Repeat 10 times.

Turn onto your right side and repeat this with your left leg.

 

Elegant Cat


Come onto your hands and knees. Draw in your lower tummy and breathing out bring your right knee towards your chin by tucking your head down. Now lift your right leg out behind you straightening your knee and lift your head up to look forward.

Hold for three seconds, remembering to breathe gently. Keep your head in line with your spine, try not to let it drop.

Lower your leg slowly. Do this 10 times.

 

Rest and then repeat with your left leg.

Once you feel that you can do this exercise easily, you can try to lift your right leg and your left arm together and hold as above. Then try this with your left leg and your right arm.

 


 

Dog Leg Lift

Still on your hands and knees, draw in your lower tummy and with your left leg bent at hip and knee, lift out to the side like a dog by a power pole!

Do this with the right leg. Repeat with each leg ten times.

 

 

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References and helpful resources:

Lewis S “Back in Shape”, Hamlyn Pub 2000

NZ Continence Association leaflet “One in three women who ever had a baby wet themselves” 2011, www.continence.org.nz

Post pregnancy DVD, NZ physio and fitness trainer: “The core and the floor”. www.filifit.com

Tupler J “Lose your mummy tummy” 2005, Perseus books

Whiteford B, Polden M “Postnatal Exercises” Century Pub 1984

Winsor M “The Pilates Pregnancy” Random House 2002