Postnatal physiotherapy

After the birth of your baby, we recommend that you follow these 3 steps for the first 1-2 weeks to improve your postnatal recovery:

• Rest: It is vital that you rest following the birth of your baby in order to minimise discomfort and take weight off your pelvic floor and abdominal muscles. You should aim to lie flat for 30 minutes, twice a day.
• Ice: If you have had a vaginal birth or attempted vaginal birth the use of ice or a clean sanitary towel that has been dampened with cool water and placed in the fridge will help to reduce swelling and pain around the perineum. Try and do this over the first 72 hours after the birth to optimise recovery.
• Exercise: Pelvic floor muscle exercises and lower abdominal exercises will assist in your return to your pre-pregnancy shape and will aid with the healing of any skin surrounding any stitches you may have. Providing there is no increase in your pain, these exercises can be started one to two days after your baby is born.

The pelvic floor is a group of muscles that form the base of the pelvis. It consists of a sling of muscles from the pubic bone at the front, to the tailbone (coccyx) at the base of the spine. They close around your back passage (anus), vagina and front passage (urethra). The pelvic floor helps to: tighten the vagina and close the urethra and rectum to help avoid leaking of urine, faeces or wind, support the pelvic organs and abdominal contents and enables sexual activities.

Your pelvic floor is under strain in pregnancy as it has to carry the extra weight of your baby and is also weakened by hormones. During delivery the muscles will be stretched to their capacity. Pelvic floor exercises will help prevent weakness, maintain muscle tone and improve control.

Pelvic floor exercise 1

This exercise helps build the strength and endurance of the muscle.

• Tighten the muscles around your back passage, vagina and front passage as if trying to stop yourself passing wind and urine at the same time.
• Hold this contraction as long as you can.
• Rest for four seconds, then repeat the contraction as many times as you can. Build up to a maximum of 10 seconds and repeat it up to a maximum of 10 times.

Pelvic floor exercise 2

It is important to be able to work your pelvic floor muscles quickly, so they can react to sudden stresses such as coughing, laughing or exercise (which puts pressure on the bladder).

• Tighten the pelvic floor and hold for just one second before releasing the muscles.
• Repeat this, tightening and relaxing steadily as many times as you can up to a maximum of 10 times. Aim for a strong muscle tightening with each contraction.
• Aim to do one set of slow contractions (exercise 1) followed by one set of quick contractions (exercise 2) at least three times each day.
• Practise the exercises when you are lying, sitting and standing. Continue to exercise your pelvic floor muscles for the rest of your life.

NB. Do not stop and start your urine flow when going to the toilet. This is not a safe form of pelvic floor exercise.

Following a caesarean birth it is important to rest. However, during this time you must also do gentle exercises to prevent problems with your chest and circulation:

• Breathing exercises: Hourly, take 3 deep breaths and release whilst resting in bed.
• Circulation Exercises: Move your feet forwards/backwards/in circles 10 times every hour.
• During the first few days if you need to cough or sneeze, lean forward and support your stitches with a pillow or small towel.

Don’t expect too much too soon. During the first 6 weeks you are encouraged to accept all the help that is offered and to avoid any strenuous activity, such as lifting, prolonged standing or vacuuming.

It is important to have healthy bladder and bowel habits, by avoiding constipation and straining whilst on the toilet. To maintain healthy bladder and bowel habits try to do the following;

• Aim to drink up to 2 litres of water a day (especially if you are breastfeeding).
• Eat plenty of fruit, vegetables and fibre but be aware that in helping your bowels to work well you may also experience more wind.
• Don’t ignore urges to go to the toilet.
• Avoid straining and allow plenty of time to empty.

You can try supporting your perineum with your hand when you open your bowels for extra support.

Knee Bends

• Start lying on your back with your knees bent to 90 degrees, feet flat on bed.
• Pull in your lower abdominal muscles and squeeze your buttock muscles.
• Gently flatten your back on the bed and bend your knee up towards your tummy.
• Hold for up to 10 seconds.
• Slowly lower leg back to starting position.
• Repeat with other leg.
• Repeat exercise 3-5 times on each leg.

Knee Rolls

• Start lying on your back with your knees bent to 90 degrees, feet flat on bed.
• Keeping your knees together, slowly lower both knees to the right.
• Gently return knees to starting point and relax.
• Repeat exercise to the left. Repeat exercise 3-5 times on each side.

Pelvic Tilting

In standing, sitting, or lying on your side:

• Pull in your lower abdominal (tummy) muscles and squeeze your buttocks.
• Gently flatten the small of your back.
• Hold for up to 10 seconds breathing normally.
• Relax your muscles gently.
• Repeat up to ten times.
• Do this exercise three times per day. Stop if you experience any discomfort.

Lifting

Avoid heavy lifting during your pregnancy. If you have to lift do it as safely as possible:

• Stand with your feet shoulder width apart, one foot in front of the other
• Bend your hips and knees keeping your back straight
• Pull in your tummy and tighten your pelvic floor
• Hold the load close to your body
• Use the strength in your legs to stand up

Getting in and out of bed

Getting in and out of bed correctly will reduce the strain on your back.

• Sit on the edge of the bed.
• Rest down on to your elbow.
• Put your head on the pillow.
• Swing both legs up onto the bed.

To get out of bed do the same in reverse.

Breast feeding:

Aim to sit upright in your chair with feet raised on a pillow or foot stool. Try not to stoop while feeding; bring baby to you do not bring yourself to your baby. You can also feed lying on your side or sat upright in bed, providing your head and neck and baby are well supported.