Postnatal Bodycare and Advice Useful tips and helpful advice

Transcription

1 Postnatal Bodycare and Advice Useful tips and helpful advice Produced for Healthcare Professionals to give to mums-to-be

2 Caring for your body Now you ve had your baby, there are four important ways in which you can care for your body 3 4 Most of your body s pregnancy changes return to normal automatically (your uterus will have reduced in size by 6-8 weeks and your ligaments will have tightened up by around 5 months after your baby s birth). But, some aftereffects of pregnancy and labour will need your time and effort before there is a return to full strength and function. Your abdominal and pelvic floor muscles are stretched and weak and it is particularly important for your future health and comfort that they recover properly. The right kind of exercise, starting gently and gradually becoming stronger, is essential. Some of the things you do with and for your baby can lead or add to back pain if done awkwardly or incorrectly. Using your back properly will help to reduce strain. Having a new baby can be very stressful and tiring. A short spell of relaxation every day is a must; it can be a lifesaver! Although most new mums make an excellent recovery after childbirth, some problems can linger on; back and joint pain, stress incontinence (a bladder which leaks when you cough, sneeze, run or jump) and abdominal and pelvic floor muscles that remain weak and flabby. Don t just put up with these discomforts or feel that nothing can be done to help. Women s Health Physiotherapists are specially trained to deal with these and other postnatal problems. The exercises in this leaflet will give you a good start towards improving your abdominal and pelvic floor muscle strength. There are several books and videos available on this subject which may be helpful to you. One such video/dvd is Pilates in Pregnancy. This is endorsed by The Association of Chartered Physiotherapists in Women s Health. You may contact your Midwife, Public Health Nurse, GP or Women s Health Physiotherapist for details of this video/dvd and other currently recommended material. Your pelvic floor muscles The pelvic floor muscles form a basin inside your pelvis and help to keep your bowel, uterus and bladder in place. They also help control your bladder and bowels so that you don t leak urine, wind or faeces. Basic pelvic floor exercises Squeeze shut your back passage (as if holding back wind), your vagina (as if gripping a tampon) and your urethra (as if stopping your urine flow), and draw your pelvic floor muscles inwards and upwards, hold whilst breathing. Then relax and let your pelvic floor lower again. Always rest for a few seconds before trying again. clitoris To find your local Women s Health Physiotherapist: Contact the Secretary, c/o The Irish Society of Chartered Physiotherapists (ISCP), Royal College of Surgeons Ireland, St Stephen s Green, Dublin. Tel: urethra perineal area vagina perineal area Note: If you had pelvic, leg or back pain during pregnancy or straight after delivery, or have any difficulty with any of the exercises within this leaflet, speak to your Midwife, Public Health Nurse, GP or Women s Health Physiotherapist.

3 Your pelvic floor excercises How to check if you are doing the exercises properly 3 4 Try and stop or slow down your urine flow towards the end of your stream - then relax and finish emptying your bladder. This is a test and not an exercise - only do it to find your pelvic floor initially. Hold a mirror so that you can see your back passage and your vagina. You should see a lifting movement. Put your fingers on your perineum (the area between your back passage and vagina) - feel the upward movement as you squeeze. You can also put two fingers in your vagina and try and feel the muscles contract from the back, sides and front. When you resume intercourse, try squeezing around your partner s penis. When to do your pelvic floor exercises You can exercise your pelvic floor muscles whatever you are doing! Lying (on your back, side or tummy), sitting (while you feed your baby, or when in the car, or when chatting on your mobile phone) and standing up (ironing or in queues). Your abdominal muscles As your abdomen enlarges in pregnancy, the muscles stretch and lengthen and often separate down the centre leaving a gap after birth. To check the width of this gap, lie on the floor with your knees bent up towards you, with the middle fingers of one hand, press down into and across your abdomen finger widths above your umbilicus (tummy button). Squeeze your pelvic floor muscles then lift your head and shoulders, breathing out as you reach for your toes with your other hand. You should feel a space that narrows as you lift your head and shoulders higher. If you have a very wide gap you may need the guidance of a Women s Health Physiotherapist to teach you how to safely progress your exercises to ensure the gap closes. 5 Sometimes it is very difficult to know if you are doing a pelvic floor contraction properly. Ask your GP at your 6 week postnatal check to help you learn how to re-train the muscles or refer you to a Women s Health Physiotherapist. How to do the pelvic floor exercise as your muscles get stronger If your pelvic floor area is very sore or swollen immediately after your baby is born, gentle rhythmical squeezes will help relieve the pain if done frequently, for 30 seconds at a time. Before After Early on Only hold each squeeze for as long as you can - maybe 3-4 seconds. Remember not to clench your buttocks too. Pause for a few seconds between each squeeze. Repeat 4-5 times. Later Try to contract your pelvic floor more strongly and hold for longer (5-0 seconds). Add some quick strong squeezes - remember to let go after each one. Try to do the quick squeeze as you cough or sneeze. Stronger still Hold each squeeze for 0 seconds. Repeat this exercise 0 times, if possible, with a 4 second break in between. Remember not to hold your breath or clench your buttocks. Keep practising the quick squeezes too.

4 Early abdominal exercises The deep abdominal muscles 3 This exercise will help to close the gap between all the abdominal muscles and will shorten your elongated muscles and encourage them to lie side by side again. Lie on your side comfortably. Let your tummy relax! Breathe in. As you breathe out, gently draw your lower abdomen in towards your spine - hold for a few seconds, breathing normally, then relax. Be careful not to move your back or pelvis. Repeat 4-5 times, resting in between. Aim to build up to a 0-second hold repeated 0 times. Begin this exercise immediately after delivery; vaginally or by Caesarean section. Try squeezing your pelvic floor at the same time, if you can. Repeat 4-5 times, resting in between. Aim to build up to a 0-second hold repeated 0 times. Try these exercises both sitting and standing. When the bleeding stops and as the above exercise becomes easier try this, kneeling down on all fours with your back straight and still. Eventually, try to draw the deep abdominal muscles in, along with a pelvic floor squeeze whenever you lift your baby or shopping. The basic pelvic tilt Begin this exercise straight after delivery. It continues to restore your muscles to their normal length. Lie on your back with both knees bent. Breathe in. As you breathe out, draw in your abdominal muscles as in the previous exercise and tilt your pelvis so that your back flattens into the mattress. Hold the position for 5 seconds, breathing out and then relax. Repeat this exercise 4-5 times. Aim to build up to a 0-second hold repeated 0 times. You can also do this excercise standing against a wall. Head lift Later abdominal exercises Try this excercise to 3 days after delivery. Lie on your back and breathe in. As you breathe out, prepare with a deep abdominal contraction, a pelvic floor squeeze and pelvic tilt, then gently lift just your head breathing normally. Then rest back for a few seconds before repeating. Try 3-4 times and aim to build up to 0 repetitions. If you feel your tummy pushes out into your hand STOP! Go back to the earlier exercises - you may need to contact a Women s Health Physiotherapist for help. The head and shoulder lift When your gap is almost closed, and providing your tummy stays pulled in throughout this exercise, you can progress by: Lifting your head for longer - up to 0 seconds maximum. Always rest between each lift. Lifting your head and shoulders and reach for your knees, checking that your tummy stays pulled in. Note: Always squeeze your pelvic floor muscles with this exercise as increased pressure is put on the pelvic floor, which can weaken it. Make sure you use your tummy muscles by drawing in if your neck hurts.

5 Caring for your back as you care for your baby Feeding Sitting If you misuse your back at any time in your life you risk injuring it and getting backache. After your baby is born your spine is particularly vulnerable and because so much baby care involves bending and lifting, it is easy to cause problems if you are not careful. Even sitting feeding your baby can give you back pain if done incorrectly. Place a small roll in the curve behind your waist and one pillow on your lap and at least one other under your arm. Sit well back in your chair. Have your knees level with your hips. Changing and Bathing Don t bend and stoop over your baby! Change and bath your baby on a surface that is the right height for you, and safe for the baby. Note: Never leave your baby unattended on a high surface. Lifting Always put the cot side down. Bend your knees, keep your back straight and hold your baby close to you when you pick up. Posture Standing correctly protects your back, flattens your abdomen and improves your shape. Stand and walk tall, pelvis over feet, tummy drawn in and pelvic floor lifted up slightly. Be tall, slim and firm. Lying on your side Lying on your side is a particularly comfortable way to breastfeed if your back aches. Try your pelvic floor and deep abdominal exercises while you feed (in either position). Good posture Bad posture

6 Getting back into shape Returning to sport and more vigorous general exercises Remember - it is normal for the body to store some fat in pregnancy. The most sensible way to lose the excess weight you may have gained in pregnancy is to quickly settle into a routine of healthy eating and frequent moderate exercise. It is important especially if you are breastfeeding to eat well. The first six weeks after baby is born is not the time to go onto a strict diet. Your body needs nutrients to recover from the physical stresses of pregnancy, labour and delivery. To establish breastfeeding you will need to ensure you keep up the calories and the fluids and have a daily rest by lying down to make up for the loss of sleep. Continuous daily activity will use up essential calories for breastfeeding. Exercise will help tone your body and provide you with a sense of wellbeing. Taking your baby for a walk in the pram at least once a day will be beneficial for both of you. As your baby gets older, and if you feel energetic, you can start a more vigorous schedule of exercise. Just remember your body will need to warm up before you begin and cool down when you finish. After the 6 to 8 week postnatal check, many women join a gym or exercise class. These help with self discipline and will provide you with a social outlet. Make sure your instructor has a recognised qualification. Start slow and remember to keep up a healthy well balanced diet and rest if you have a bad night s sleep. Recommended Exercise If you choose to lose weight, avoid ALL fad-type diets. The most effective diets are those that provide a reduced calorie intake and a balance of nutrients three times a day, in combination with regular moderate exercise. Remember to ask your Midwife, Public Health Nurse, GP or Women s Health Physiotherapist for advice about diet and exercise and for details of local postnatal exercise classes. Resting and relaxation You should aim to have some time everyday when you switch off - even if it is only for 5-0 minutes. Lie down, sit on a chair or sofa with your feet up, or just rest your head on your hands on the kitchen table. Concentrate on your shoulders, hands and jaws. Release tension in your shoulders by pulling them down - stop pulling them down and enjoy the new comfortable position. Spread your fingers out and then let them rest - long and supported. With your lips together drag your lower jaw down - stop dragging it down and notice the new pleasant feeling with your two sets of teeth apart. Now focus on your breathing say to yourself let go with every outward breath. Pause slightly between finishing a breath out and breathing in again - this is very calming. Try to focus on this soothing breathing and relax your shoulders and jaw whenever you are coping with stressful moments. Take your time and enjoy being a mum. Swimming Cycling Walking Tennis Jogging This can be started once all vaginal bleeding ceases and the abdominal gap has closed. A good form of aerobic exercise for your whole body - although it won t specifically strengthen your abdominal or pelvic floor muscles. Is the cheapest and easiest, and you can do it with your baby. Begin gently, gradually increasing the time. Start brisk walking after your 6 to 8 week postnatal check for 0-0 minutes daily. Begin when your abdominal muscles can support your back and the ligaments have started to strengthen around 3 to 5 months. By then your pelvic floor muscles should be able to support your bladder so you don t leak urine when stretching or on impact. You can begin gently jogging after your ligaments have regained their normal strength after 5 months, or wait longer if still breastfeeding. Important Notice: Breastfeeding is best for your baby, as it is perfectly suited to nourish infants and protect them from illnesses such as ear infections, stomach upsets, diabetes, eczema and obesity. It is important that, in preparation for and during breastfeeding, you eat a healthy, balanced diet. Combined breast and bottlefeeding in the first weeks of life may reduce the supply of your own breastmilk, and reversing the decision not to breastfeed is difficult. The social and financial implications of using an infant milk should be considered. Improper use of an infant milk or inappropriate foods or feeding methods may present a health hazard. If you use an infant milk, you should follow manufacturer s instructions for use carefully failure to follow the instructions may make your baby ill. Always consult your doctor, midwife or public health nurse for advice about feeding your baby.

7 Produced in association with Liz Laverick, MCSP, Clinical Specialist in Women s Health and Continence (Physiotherapy) Manager and Marie Gallie, BSc MCSP, Women s Health Physiotherapist. NM