Postnatal Recovery

I am currently 16 weeks postnatal on my second baby and have decided to write this blog with fellow mums in mind. I have attended a range of postnatal classes and it concerns me that some fitness classes advertised for mums and babies don’t even seem to check how many weeks postnatal mums are, never mind what type of birth/recovery they have experienced. To me this puts mums at risk of injury while also making them feel they should be able to do exercises that really are not suitable in the early postnatal stages. We all want to get back to our normal shape and the media’s portrayal of the perfect body weeks after birth certainly doesn’t help. I cannot recommend enough going to a postnatal class guided by a trained professional who can support your recovery and set realistic challenges for your body. There is no point having the perfect physique back if every time you laugh or cough you have no control over your pelvic floor to stop leakage (you know what I mean!).

Exercise has many benefits. It can:

· help boost your mood by increasing the levels of feel-good chemicals in your brain (such as


· help you to regain your pre-baby fitness and lose weight

· protect you from aches and pains and give you more energy if you are feeling tired.

· improve physical strength and stamina which will make looking after a newborn baby easier.

There is also some research (although limited) which shows that taking part in regular exercise after the birth of your baby can help alleviate the symptoms of postnatal depression.

The exercises in this article are safe for you if have had either a vaginal birth or a caesarean section. You can still gently exercise your tummy muscles and doing these exercises can help these muscles to recover from the operation. The exercises may pull on your scar, but they should not cause you any pain. If you have had a caesarean you may find that you become more tired because you have had an operation, so be guided by how you feel.

Are there exercises I shouldn't be doing in the first six weeks?

Don't go swimming until you have had seven days without any bleeding or discharge from your vagina (lochia). If you have had stitches or a caesarean section, wait until after you have had your six-week postnatal check and ask your doctor for advice. Don't exercise in a hands-and-knees position for the first six weeks as there is a small risk that a little clot of air can form at the site where your placenta was attached. Wait six weeks before joining an exercise class, unless it is run by a specialist in the field of postnatal exercise and the instructor says that you can attend before six weeks (this is rare). Following a caesarean you will most likely need to wait at least 10 weeks postnatal before starting a class.

How do I get started?

The most important exercises in the first few days after birth are pelvic floor exercises, so start doing them as soon as you can. They may feel like the last thing you want to do, but starting them early will help your perineum and vagina to heal more quickly, improve the circulation to the area and help get rid of swelling and bruising. You won't rip your stitches by doing the exercises. You may find for the first few days or weeks that you can't feel your pelvic floor muscles working or that nothing is happening. Don't worry - this is normal. Keep trying, as the feeling in your pelvic floor will return after a few days and it will be working even if you can't feel it.

As soon as you feel up to it, try to get out and about, ideally walking whilst pushing your baby in the pram. In the first few days, your perineum or pelvic floor may feel uncomfortable, swollen or very heavy. Start with short (10 – 20 minute) walks and increase when things begin to feel more normal. If your lochia becomes redder or heavier, this may be a sign that you are overdoing things, so rest and take things easy.

Listen to your body

When you start exercising after having a baby it's very important that you listen to your body. Don't be tempted to overdo things. If you become tired you'll be more likely to injure yourself. You may feel on a "high" for the first few days and then come down to earth with a crash when the baby blues kick in or you run out of energy. Try to pace yourself with a little bit of exercise followed by some well-earned rest. If you are unsure about what you should be doing or experience pain or any problems with leaking urine (incontinence) when you are exercising, talk to your doctor or midwife who may need to refer you to a physiotherapist.

Exercises for your lower tummy muscles

The lower tummy muscle (called the transversus abdominus) is the most important tummy muscle to exercise after you have had a baby. The transversus abdominus works with your pelvic floor muscles to help support your back and pelvis. Exercising this muscle may help you to lose your 'pregnancy shape' and help to flatten your tummy. Try this exercise either lying on your side or on your back with your knees bent up. (If you have had a caesarean section, you may find it uncomfortable to lie on your side for the first few days, so lie on your back instead). 1. Breathe in and as you breathe out, tighten your pelvic floor muscles. The feeling is one of "squeeze and lift." Imagine that you are trying to stop yourself from passing wind and trying to stop your flow of urine mid-stream, at the same time. Once they are tight, gently pull your belly button in and up so that you feel your lower tummy muscles tighten. 2. Hold this while you count to 10 without holding your breath (this is the hard bit!) and then slowly relax your muscles. Wait at least five seconds and then repeat. Try to avoid moving your back or over-tightening the upper tummy muscles (those above your waist). You may find that you can only hold a squeeze for a second or two in the early days; this is normal. Aim to hold your tummy muscles in for 10 seconds by the time your baby is about six weeks old. You can try lower tummy muscle exercises on an exercise ball once you have mastered them lying on your back or side. 1. Sit on an exercise ball with both feet on the floor, preferably on a carpet to ensure the ball does not slide away from you. 2. Squeeze your pelvic floor and lower tummy muscles and then gently lift one leg off the floor. Remember to breathe! Hold this for up to five seconds, slowly lower your foot and relax your muscles. Repeat up to 5-10 times on both legs.

Pelvic tilting exercise

Pelvic tilts are useful exercises which gently move and stretch your back and also exercise your tummy muscles. They can also help to alleviate back pain. You can do pelvic tilts lying down, sitting or whilst balancing on an exercise ball. Lying down 1. Lie down on the floor or on your bed. Place a pillow under your head. Bend your knees by sliding your feet up towards your bottom. 2. Tighten your pelvic floor and pull in your lower tummy muscles, before squashing the small of your back down into the floor or bed. Hold this for a count to three and then arch your back away from the floor or bed. Repeat this 10 times. Try not to hold your breath! Sitting 1. Sit on a chair or stool with your feet on the floor. 2. Tighten your pelvic floor muscles and pull in your lower tummy muscles before slumping your back and then arching it so you stick your chest and bottom out. Keep the exercise flowing smoothly so you stretch your back one way and then the other. Using an exercise ball 1. Sit on an exercise ball with both feet on the floor, preferably on a carpet to ensure the ball does not slide away from you. 2. Move it backwards and forwards with your bottom, allowing your pelvis to move with it but trying to keep your shoulders still. You can also move the ball from side to side to exercise your waist muscles.

Neck and upper back exercises

It is easy to spend a lot of time sitting in a slumped position while you are caring for a young baby - while breastfeeding for example. Poor posture can give you the appearance of rounded shoulders, saggy breasts and a saggy tummy, as well as neck or upper back pain. Sit upright in a supportive chair to help improve your posture. You can also try these exercises to stretch and move your upper back and neck. Upper back stretches 1. Sit up straight with your arms crossed over your chest. Twist to the left and then to the right. Repeat 10 times each way. 2. Sit and link your hands behind your neck. Twist to the left and then to the right. Repeat 10 times each way. 3. Sit and link both hands together in front of you. Take your arms up in front of you and above your head as far as you can. Hold for 2-3 seconds and then slowly lower your arms down again. Neck exercises 1. Sit and slowly turn your head to the left and then to the right. 2. Slowly, tilt your head so you move your right ear down to the right shoulder and then your left ear down to your left shoulder. 3. Slowly bring your head back to the middle and then bend your neck forwards to your chest and backwards to the ceiling. If you start feeling dizzy while doing these exercises, it could be due to ear problems or neck stiffness. Try to do them more slowly. Miss these exercises out if you still feel dizzy and talk to your doctor. Once you have had baby attend for the postnatal check with the hospital physiotherapist (a good postnatal teacher can also check this in class). They will assess for any evidence of diastasis recti (separation of the abdominal muscles) and provide an appropriate exercise routine. Please do not start doing crunches to rebuild tummy muscles until you have had significant time to recover and the abdominal muscles have knit back together sufficiently as this can cause long term damage.

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