Physiotherapy Advice for After the Birth of Your Baby

1. Keep your baby as your heaviest lift for the first 4-6 weeks. Make a lifelong habit of tightening your pelvic floor muscles and bracing your lower tummy before lifting.
2. Do sets of pelvic floor muscle exercises with daytime feeds - gradually increase the length of the squeezes and the number in your set.
3. Do pelvic tilt exercises throughout the day to flatten your tummy.
4. Brace your lower tummy muscles often each day and gradually increase the length of the hold to strengthen and flatten your tummy.
5. Go for a walk every day.....gradually build up the length and speed of your walk over time.

Stitches and swelling/bruising

Stitches in the perineum (between the vagina and the anus) can be uncomfortable. Your stitches will begin to dissolve and fall out after around 7 days and your wound should be well healed after 2 - 4 weeks (depending on the size of the wound). Even if you don't have stitches, there may be internal swelling and bruising around the perineum that can be uncomfortable. It is important to keep this area clean and dry while it is healing, and change your maternity pads regularly.

Regular pain relief in the first few days is important for your comfort. Please follow the P.R.I.C.E regime below to help with your healing:

• Protect your stitches when opening your bowel (passing a bowel motion - poo). Wrap some toilet paper (or a clean maternity pad) around your hand and give firm upward support to your stitches to help you to relax.
• Rest flat (on your back or side) regularly while you are in hospital and continue this every day once you have gone home until your stitches are healed. Try to not spend too long sitting, standing and/or walking in the first few days after your baby is born.
• Ice packs can be applied to the perineum every 1 - 2 hours - only leave the icepacks on for 10 - 15 minutes at a time. This can be useful for the first 24 - 48 hours for swelling and bruising, and as a 'natural' pain reliever at anytime in your recovery period.
• Compression from your pad(s) or rolled towel placed between the legs when sitting helps reduce swelling and bruising and also gives gentle support to the perineum. Always try and sit up as tall as you can, rather than slumping in your chair or in the bed. Starting gentle pelvic floor muscle exercises can also provide some compression to this area.
• Elevate the perineum area regularly during the day by lying on your tummy for at least 15 - 20 minutes, with a pillow or two underneath the hips. You may also like a pillow under your chest if your breasts are tender.

There are a few simple exercises and tips that can help make you more comfortable for the first 24 - 48 hours after your delivery. This will help prevent some of the common complications associated with abdominal surgery (of any kind).

Wound support and breathing

• Support your wound with your hands or a pillow if you need to cough, sneeze, laugh or go to the toilet to open your bowels.
• Relaxed abdominal breathing (feeling the tummy gently rise and fall with deep breaths in through the nose and out through the mouth, up to 5 breaths at a time) can help to relieve the discomfort of wind pain and after birth pains.

Circulation

• It is important to get out of bed and moving early after your delivery to promote circulation.
• Simple leg exercises should be performed until you are comfortably up and about to increase circulation and reduce the risk of blood clots. Bend and stretch your ankles and legs alternately 10 times every hour.

Getting in and out of bed

• When rolling over or getting in and out of bed, it is important to support your wound using your abdominal muscles.
• Don't try sitting straight up from lying on your back. You need to roll onto your side with knees bent while bracing with your abdominal muscles. Then push yourself up into a sitting position using your underneath elbow.
• While in hospital, this is made easier by having the head of the bed raised up - you can do this using the remote control next to your bedside.

We encourage adequate fluids (aim for 1 1/2 – 2 1/2 litres per day then drink to your thirst) and regular pain relief, as this will help your bladder and bowel function and help you to move around more easily whether you have had a vaginal delivery or caesarean section.

• You will be asked to measure at least the first two wees that you do – please pass urine into the grey pot in the toilet and ask the midwife to record the volume of urine in the pot.
• If there are any concerns about your bladder function eg. pain or difficulty passing your urine, please discuss this with your midwife or physiotherapist.

Your bowels can take a few days to return to normal – the most important thing is to not strain when opening your bowels.

• Eating a high fibre diet (fruits, vegetables, wholegrain foods) and going for short regular walks will help with your bowels.
• Sit correctly when opening your bowels with your bottom to the back of the toilet seat, legs apart, up on toes (or feet flat on a footstool), keeping a straight back and then leaning forwards with your tummy and pelvic floor muscles relaxed. Do not hold your breath.
• Your doctor may prescribe you stool softeners to help open your bowels comfortably.
• If you are troubled by haemorrhoids, please try applying ice packs regularly to the area. Haemorrhoid creams are available – please speak to your doctor or midwife.

Women's Physiotherapy recommend the following exercises for helping you get back in shape following the birth of your baby. These exercises should be done slowly, without pain or strain. If you need help with your exercises, please speak with your physiotherapist.

Pelvic Floor Muscles

• Your pelvic floor muscles stretch like a trampoline across the floor of the pelvis, running from the coccyx (tailbone) at the back through to the pubic bone at the front, and sideways to the sitting bones.
• In a woman, the pelvic floor muscles help to support the bladder, the uterus (womb) and the bowel. The urethra (front passage), the vagina (birth canal) and the rectum (back passage) all pass through the pelvic floor muscles.
• The pelvic floor muscles play a large part in bladder and bowel control, as well as sexual function. These muscles are normally firm and thick. During pregnancy, the pregnancy hormones and the growing weight of the baby has a weakening effect on the pelvic floor.
• All women are encouraged to exercise their pelvic floor muscles regularly throughout life.

Pelvic Floor Muscle Exercises:

• Tighten your pelvic floor muscles by squeezing around the birth canal, vagina and back passage all at once, lifting up and towards your pubic bone ('squeeze and lift!'). Hold each contraction for 2-3 seconds and then release and relax - you feel a definite 'letting go' of the muscles. Repeat ('squeeze and lift!') and relax, resting for about 5 seconds between each contraction. Repeat this as many times as you can, up to a maximum of 8-10 squeezes.
• If you cannot hold the squeeze for 3 seconds, don't worry - do your best and hold for as long as you feel comfortable. We are looking for quality contractions – not quantity! As you practice and your muscles get stronger, you should be able to hold each contraction for longer – aim for 5-6 seconds by six weeks postnatal.
• It is important to continue to breathe normally through the exercise and keep the muscles in your legs, buttocks and tummy relaxed. Keep your back still.
• These exercises can be done when lying down, sitting or standing. It is useful to combine these exercises with everyday activities such as feeding your baby or brushing your teeth to help you to remember to do them often in your day.
• Tighten your pelvic floor muscles every time you lift your baby, cough, sneeze or laugh to protect your pelvic floor and help prevent leakage of urine or wind.

Pelvic floor muscle exercises are exercises for life!

Abdominal Muscles

• Stretching of the tummy muscles during pregnancy may mean that they are unable to effectively protect your back from injury and maintain good posture.
• Exercise your tummy muscles regularly after the birth of your baby to regain strength and your pre-pregnancy shape. Your physiotherapist will check your tummy muscles when you attend the Postnatal Physiotherapy Education class.
• Sit up exercises (or 'crunches') are not recommended for the first 6 – 8 weeks postnatally.

Pelvic Tilt Exercises

• With knees bent and feet flat, gently flatten the curve of your lower back by tilting your pelvis/hips backwards. Relax your buttock muscles, these should not tighten at all. It is important to keep breathing naturally and normally while doing your exercises.
• Hold for 3 – 5 seconds, if possible. Aim to repeat 5 – 10 times. Do this exercise regularly during the day when lying, standing or sitting. Nappy changes are a good time to remember this exercise.
• Remember to relax your buttock muscles - these should not tighten at all. It is important to keep breathing naturally and normally while doing your exercises.
• This exercise can also help to relieve back pain when it is performed as a gentle stretch (pelvic rocking), as well as wind pain in the first few days after Caesarean Section.

Abdominal Bracing Exercises

• Abdominal bracing uses your deep tummy muscles to help protect your back and pelvis from pain and injury.
• Let your tummy muscles soften and relax and then gently draw your lower tummy at the level of the bikini line back towards your spine.
• Keep breathing normally. Do this often during the day and gradually increase the length of hold, up to 5 – 10 seconds. Rest and then repeat this exercise 5 – 10 times. You can practice this exercise when lying down, on hands and knees, sitting or standing.
  
• Every time you lift your baby, push/pull or change your position (eg rolling over in bed or going from sitting to standing), remember to first tighten your pelvic floor muscles and then brace your low tummy muscles.

Take care of your back by:

• Stand "tall". Imagine you have a piece of string pulling the centre of your head towards the ceiling.
• Change nappies, dress and bath baby at waist height. If you need to get lower, bend your knees and hips and keep your back straight.
• If sitting to feed your baby or expressing, sit in a comfortable chair with good back support. Consider using a footstool and/or pillow(s) to find the best position for you. Relax the muscles in your neck and shoulders when holding and feeding your baby.
• Avoid lifting anything heavier than your baby for the first 6 weeks. If you have a toddler, squat, kneel down or let your toddler climb onto your lap if they need comforting, rather than lifting.
• Whenever you are lifting, remember to bend your knees, keeping your back straight, brace your pelvic floor muscles and low tummy muscles, and hold the object you are lifting close to your body. Avoid lifting and twisting - move your feet to turn instead.
• When carrying your baby, avoid carrying on one hip as this increases strain on your back.

Gradually regain your general fitness after the birth of your baby. You may like to start a walking program or join a Postnatal Exercise class, run by a physiotherapist, close to home. Once you are more than 6 weeks postnatal, you may like to start gentle bike riding or swimming but please wait until your stitches (tummy or perineum) have healed. Yoga or Pilates may also be useful but please speak with your instructor before starting your first session.

We recommend avoiding high impact exercise (eg running, aerobics), contact sports (eg netball) or heavy weights for at least 3 - 4 months after the birth of your baby. A gradual return to these activities is also suggested. You must be confident that your tummy and pelvic floor muscles have returned to normal strength, and you are not experiencing any back pain, before resuming these high impact activities.