Why we have to rebuild from the inside out after having a baby

By Fit Right

It’s common practice to go and see a health professional at approximately six weeks after giving birth, usually an obstetrician, a midwife or a GP. The purpose of this consult is generally to ensure you’re medically well, and to get the ‘all clear’ for return to normal activity – be it lifting toddlers, driving, sex, sport or all of the above!

It is time that the word got out there - being medically well at 6 weeks postnatal is great, but this check up does not necessarily mean that your body is ready for the vigour of high-end exercise like kettle bells and burpees.

It is very important to have a check up with a Women's Health & Continence (WH&C) Physiotherapist after having a baby. This would be ideal at 6 weeks postnatal, when you have your medical check up, but if that time is too hectic, then it can be later. Just make sure it is before you get back into higher level physical exercise, or before you get pregnant again. As your physiotherapist in hospital (if you're lucky enough to have access to one) should tell you, physical activity in the first 6 weeks or so should be only pelvic floor exercises, gentle stretches and gradual return to half an hour of low impact cardio exercise - like walking.

At a postnatal WH&C Physiotherapist appointment, a physiotherapist will go through a number of questions about your pregnancy and birth, your medical history, your bladder and bowel functioning, your muscle and joint functioning, your exercise history and what sort of exercise aims you have to get back to.

The physiotherapist will then assess your pelvic floor muscles, which is important even if you have had a caesarean section delivery. This may be off-putting to some people – “you’re going to put what, where…?!” – but it doesn’t necessarily have to be done via a vaginal examination. A screening test can be done with an ultrasound through your lower tummy, which shows the physiotherapist how well you can elevate and relax those muscles – and you, the patient, can see this on the screen too, which is great for feedback and learning. A vaginal examination may be recommended as well if you report issues that suggest pelvic floor dysfunction, and of course if you agree to it! Some of the added benefits of an internal exam are that muscle strength, tone, pain and the presence of a prolapse can be assessed.

Then your abdominal muscles will be assessed. The presence of a Rectus Abdominis Diastasis (RAD) will be determined, which means whether or not your ‘six-pack muscles’ have come back to where they should be after they were stretched in pregnancy. This stretching of the connective tissue between the muscles occurs in almost everyone who carries a baby to full term. But did you know that natural healing only occurs in the first 8 weeks? If a gap is present after that, you will need to do specific exercises to rectify it.

It will also be assessed whether you can activate your deeper ‘core’ abdominal muscles, and your gluteal muscles, which together with your pelvic floor help to support your lower back and pelvis. You posture will be assessed, as will any specific joint or muscle dysfunction.

Then a plan of attack will be put in place as to the best way to achieve your exercise goals. In this way, it is a very individual approach to postnatal exercise – there is no ‘recipe’ that you should be able to achieve a certain level of activity at a certain number of months postnatal. I can’t tell you how many times I hear something along the lines of ‘but I waited until 3 months before I did sit ups, so I should have been fine!’ We can never assume that one woman’s muscle activation, hormonal changes in connective tissues, and birth trauma are the same as the next woman.

Think of return to exercise like building a house, and if you don’t firstly build strong foundations, you will always have issues building your house on top of it! Therefore, spend the first weeks or months preparing your ‘foundations’ or your ‘core’ – this is what a Women’s Health Physiotherapist specializes in and can help guide you along the way. Then when your joints, muscles and organs are all in tip top shape, and you get the ‘all clear’ from the Women’s Health Physiotherapist, then you can go to higher level exercise like boot camp.

This may be anywhere between 2 months and 12 months + after childbirth, depending on how you present at that initial assessment and how quickly you progress. Even at this stage though, it is still so important for all women to incorporate pelvic floor and deep abdominal exercises into their exercise routines – keep your foundations strong!

There is nothing that makes me sadder than when a woman comes to see me at 6 months, or 1 year postnatal, suffering with worsening urinary incontinence, back pain, or who has been diagnosed with a vaginal prolapse, and when I ask them about their return to exercise, in retrospect they have gone too hard, too soon, without ever getting the right information. It happens more often than you would think!

Don’t be one of these women – get your postnatal assessment done with a Women’s Health Physiotherapist first, and build on strong foundations.

Note: The views and advice expressed on this blog post are those of the author and are not representative of the Pregnancy Babies & Children's Expo.

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