Exercise and Advice after pregnancy

Introduction

This booklet is for women after their pregnancy.

At this time, your own physical recovery may be the last thing on your mind. We hope the information in this booklet will be helpful, either now or later, when the time is right for you. Women often report they found it helpful to start doing some exercises - a little at first, then building up slowly - from early on. The exercises can be done in your own home, or even while you are in hospital.

The following includes a safe and effective set of exercises, and some practical advice to aid your physical recovery including:

• being    comfortable    after    delivery
• moving    easily    (both    on    the    ward    and    at    home)
• exercising    the    abdominal    and    pelvic floor muscles
• starting    to    regain    your    physical    activity    

Your physical recovery will take time, but there is a lot you can do to help get yourself back into shape. Regaining your fitness may help you have more energy - and possibly avoid physical problems later.

The muscles of the abdomen and pelvic floor can become weak during pregnancy, it is therefore important to strengthen them again to avoid problems such as leakage from the bladder or bowels, vaginal heaviness, low back or pelvic girdle pain.

If you need more advice after reading this booklet, please contact your local specialist    physiotherapist    (details    on    inside    back    cover).

Comfort 

To get into bed Stand with the back of your knees against the bed. Support your abdomen with one hand, and put the other hand on the bed behind you. Bend forwards slowly as you sit on the bed. Lower your head and shoulders sideways down on to the pillow, keeping your knees bent and together, and lift your legs up at the same time.

If sitting is uncomfortable, you can get into bed by kneeling on the bed, and then lowering yourself down on to your side.

To turn in bed from lying on your back

Bend both knees one at a time, keeping your feet on the bed. Support the abdomen with your hand, especially if you have had a Caesarean section operation. Make sure that you move your shoulders and knees at the same time as you roll on to your side.

To get our of bed

Bend both kees, keeping your feet on the bed and roll on to your side, moving your shoulders and knees together. Push your body up by pressing down on to the mattress with your upper hand, allowing your feet to go down to the floor. Sit on the side of the bed for a few moments, and then stand by leaning forwards and pushing up with your hands and legs. Try not to stoop; stand tall.

Rest

It is vital to have sufficient rest in the first few weeks. If you feel you want to sleep all the time    and    feel    unable    to    get    out    of    bed    (due    to    feeling    sad,    depressed,    anxious    or    unable    to    cope),    please    seek    help    from    your    GP/health    visitor/midwife/support    network.

Use a method of relaxation, if you have learnt one, and sleep when you can.

• In    the    early    days,    if    you    need    to    cough    or    sneeze,    lean    forwards,    and    support    your    How to exercise your pelvic floor muscles wound - with your hands, a pillow or small towel.
• Try    to    avoid    any    activity    that    causes    strain    for    the    first    6    weeks    (e.g.    prolonged    standing,    housework    and    carrying        heavy    things).
• Don’t    lift    anything    heavy    for    at    least    6    weeks    (e.g.    heavy    shopping    bags,    washing    baskets    and    furniture).

Driving after a Caesarean section operation

• Check    with    your    insurance    company    that    you    are    covered.
• Women    are    normally    advised    to    wait    until    4-6    weeks    after    the    birth.

Also ensure that you:

• are    able    to    concentrate    fully    on    driving    and    the    road    around    you
• can    wear    a    seat    belt    comfortably    -    you    may    be    more    comfortable    with    some    padding    (e.g.    a    folded    towel)    between    your    tummy    and    the    belt
• can    look    over    your    shoulder    and    turn    the    steering    wheel    without    pain    or    discomfort   
• can    perform    an    emergency    stop    without    undue    pain    -    try    it    with    the    engine    off    before    going out for the first time 

Exercises

Pelvic floor muscle exercises

The pelvic floor muscles (PFM)    are    at    the    bottom    of    your pelvis, and support the pelvic organs. 

• If    you    have    a    urinary catheter, wait until it is removed and you are passing urine normally before starting these exercises.

Pelvic floor muscle exercises are needed to:

• improve    muscle    strength    so    that    you    can    control    your    bladder    and    bowel
• support    your    pelvic    organs,    helping    to    prevent    prolapse

Remember to:

• Start    the    pelvic    floor    muscle    exercises    as    soon    as    possible,    after    any    catheter    has    been    removed.
• Do    the    exercises    in    varying    positions,    but    if    you    are    sore    in    the    early    days,    lying    on    your    side might be most comfortable.
• Do    gentle,    rhythmic    tightening    and    relaxing    of    the    muscles,    which    will    help    ease    discomfort, pain and swelling, and will aid healing if you have stitches following an episiotomy or tear, on your perineum.
• Do    not    ‘stop    and    start’    the    flow    of    urine.
• Do    not    get    into    the    habit    of    going    to    the    toilet    ‘just    in    case’.
• Some    women    experience    constipation    -    sitting    in    the    right    position on the toilet helps your muscles to relax, and makes it easier to open your bowels. You can use the position in the diagram on the right  to help you empty your bowels more easily.
• When    having    a    bowel    movement,    you    may    find    some    extra    support will make you more comfortable. Try holding a wad of toilet paper or a sanitary pad firmly in front of the back passage. If you have had a Caesarean section operation, supporting your wound with a folded towel may also help. DO NOT STRAIN  and DO NOT RUSH.
•   Breathing    out    slowly    as    you    move    your    bowels    or    pass    urine    may also help.
• Drink    1.5-2    litres    (3-4    pints)    of    fluids    per    day    to    include    water/squash,    and    eat    plenty    of    roughage.

Abdominal exercises

Finding and exercising your abdominal muscles

The deepest abdominal muscles are called Transverse Abdominals (TA) and they work together with the other abdominal muscles and your pelvic floor muscles to support your back and help with good posture.

It is important to get the basic abdominal contraction right. It is not always easy - always seek    help    if    you    are    finding    it    difficult.    (If    you    are    finding    lying    on    your    back    uncomfortable    this    exercise    can    be    adapted    to    a    side    lying    position.)

1. Lie on your back with knees bent, feet on the floor, relax into the floor.

2. Find neutral spine - neither too tucked nor too arched

3.    Find    your    hip    bones    (see    picture)    and    move    your fingers 2cm down and 2cm inwards - your f ingers    will    now    be    on    your    deep    abdominals    (TA)

4. Breathe in gently allowing your tummy to rise. As you let the breath out, keep your back and ribs relaxed while drawing in your lower tummy at the navel/ belly    button    level    (as    shown    by    the    arrow)    towards    the spine. You will probably feel the muscles under your fingers tense up. Keep the spine in the neutral position and the pelvis still.

5. Keep this contraction in the deep abdominals for 2 or 3 breaths and then relax fully.

Once you are happy with this exercise, you can try using this muscle in a variety of positions.

Regaining your physical well-being

Back care - this is good advice for life

Your pelvic joints will take 3-6 months to return to their original state. You can easily strain your back during this time, so avoid heavy lifting. If you do have to lift:

• bend    your    knees    if    the    weight    is    at    a    low    level
• gently    draw    in    your    abdomen    (use    your    deep    tummy    muscles)
• tighten    your    pelvic    floor    muscles    (see    page    4)
• breathe    out    as    you    lift

Exercise

There are many good reasons to exercise, but start gradually. You should do the exercises given to you in this booklet, or by the physiotherapist while in hospital, and continue them when you return home:

• The    effects    of    the    hormones    can    still    affect    your    joints    for    up    to    6    months,    so    care    should be taken not to start high-impact activity too soon.
• Brisk    walking    is    an    excellent    way    to    exercise.    Be    careful    to    build    up    slowly.    Gradually    increase the time and pace of your walking every day during the first 6 weeks.
• You    can    start    swimming    once    you    have    had    7    consecutive    days    clear    from    vaginal    bleeding/discharge. If you have had a Caesarean section operation, it is sensible to wait    until    you    have    seen    your    GP    at    your    6-week    check-up.
• Always    listen to your body and do not cause pain.
• People    recover    their    physical    fitness    at    different    rates.    If    you    have    exercised    regularly    prior to your pregnancy, you may be able to return more quickly, but avoid impactbased    exercises    until    after    your    GP    check    up. 
• Many    women    feel    extremely    tired,    so    do    not    overdo    it.    Pace    yourself,    accept    offers    of    help, and set aside a regular time to rest.

Sexual intercourse

Many women find it difficult to return to sexual activity, whether due to physical or emotional birth trauma. Some women prefer to wait 6-8 weeks until they have had their GP    check-up,    but    others    want    to    wait    longer.    If    there    are    no    physical    problems,    you    can    resume intercourse when you are ready. Start gently and use lubrication if required.

If you have persistent discomfort, pain or difficulties returning to sexual activity, seek further help from your GP.

If your ability to follow the advice in this booklet is affected by any health problem or disability, contact your local specialist physiotherapist, who will be able to assess you and offer specific alternatives that are suitable for your needs.