Fit for motherhood A guide for new mums Follow us on Twitter @NHSaaa Find us on Facebook at www.facebook.com/nhsaaa Visit our website: www.nhsaaa.net All our publications are available in other formats
This advice is for new mothers following a caesarean or vaginal delivery. Pregnancy and labour places stress and strains on your body, so these exercises are designed to get your body back into shape. It is important to take time to yourself in doing this you can avoid future health problems. Caring for your body Your back is under increased strain for five to six months after your baby is born. During and after pregnancy, your body has increased hormones which can affect your joints, making them more flexible and at risk from damage. Your abdominal and pelvic floor muscles are weaker than normal. Many of the activities involved in caring for your baby, such as carrying, feeding and bathing can put a strain on your body. It is important to take time to rest, when you can, in the early post natal period. You may find these positions useful. 2
Resting postures Lie on your side with pillows between your knees. You may find a pillow under your tummy helpful. You may find sitting on folded towels in a V shape reduces any discomfort in your perineum. See image below. 3
Turning in bed or getting out of bed Suitable for both caesarean and vaginal deliveries. This is very useful for an abdominal wound, painful stitch line or piles. First roll onto your side with your knees bent. up down Keep hands forward. Push up sideways. up down Sit and do not hurry to stand, as you may be light headed. 4
Posture Standing Stand tall. Avoid stooping. If you wish, you can support your section wound with your hand. Sitting or feeding Make yourself comfortable before you start. Your feet should reach the floor. You may find using a footstool or pillows help you achieve a comfortable position. Alternatively, you can lie on your side to breastfeed. Changing or bathing positions. Avoid stooping over a low surface. You can change or bathe your baby on top of a table or chest of drawers. This should ideally be at waist height, or use a baby changing station. Alternatively kneel down in front of a low surface. Take care that any surface used to work with baby is safe and secure. 5
Lifting Engage your deep abdominal muscles (see page 12 abdominal exercise 1) and your pelvic floor muscles (see page 8) before you lift. Get close to whatever you are picking up and bend your knees. Avoid lifting anything heavier than your baby for the first six weeks, where possible. If you are using a sling or a baby carrier be careful as this may place strain on your back and neck. Exercises to help you Circulation Begin this exercise straight away especially if you have puffy legs or ankles or if you have had a caesarean section. You may have been asked to wear TED stockings (support stockings). Briskly circle your ankle for 20-30 seconds. You can also try bending and stretching your ankle for 20-30 seconds. 6
Pelvic Floor Muscles DON T IGNORE YOUR PELVIC FLOOR Strong healthy pelvic floor muscles can: Prevent your bladder and bowel from leaking; Safeguard you against prolapse; Help support your back and pelvis; and Increase pleasure during sexual activity. Exercising them immediately after a vaginal birth can help reduce discomfort and swelling, so don t be afraid to begin as soon as possible after you have your baby. If you have a urinary catheter you should wait until this is removed before you begin your pelvic floor exercises. Where are the pelvic floor muscles? 7
These muscles are at the base of your pelvis, helping with other tissues to form a floor to support your bladder, womb and bowel. The basic pelvic floor exercise Imagine you are trying to prevent yourself from passing wind from the back passage and at the same time trying to stop the flow of urine. The feeling is one of squeeze and lift. This closes and draws up the back and front passages. Avoid Pulling in your tummy excessively; Squeezing your legs together; Tightening your buttocks; and Holding your breath. You may notice your lower tummy draw in slightly. This is okay. Do not stop and start the flow of urine when emptying your bladder. Start gently. You may not notice much happening at first but keep at it. 8
Determine your starting block Tighten your pelvic floor muscles and hold for as many seconds as you can (aiming for 10 seconds). Release and rest for five seconds. Repeat the tighten, hold, release movement as many times as you can (aiming for ten repetitions). For example, if you can hold for two seconds and repeat four times, this is your starting block. Always try to work the pelvic floor muscles until they feel tired. Quick contractions This will help your muscles react when you laugh, cough, sneeze or lift. Tighten your pelvic floor muscles more firmly and then let go immediately. Rest for two or three seconds. Repeat up to ten times. You should try to repeat your starting block and quick contractions four to six times daily for at least the first three months and then maintain these muscles by exercising them one to two times daily for life. Have patience. It can take several months for your pelvic floor muscles to become strong following pregnancy and delivery, including after caesarean section. 9
Remember pelvic floor exercises are for life Tighten your pelvic floor muscles when you feel you might be about to leak. Pull up the muscles before you cough, laugh, sneeze or lift anything. This will also help prevent them from weakening. They can be done anywhere, anytime and in any position. Get into the habit of doing these exercises regularly through the day for example, when feeding your baby. As the strength of your pelvic floor muscles improves you should be able to increase your hold time and the number of times you can do the exercises. Aim eventually for ten holds of ten seconds and ten quick contractions. Try to also practise these exercises while you are standing. 10
Going to the toilet Bladder If you have reduced sensation of needing to empty your bladder ensure you try to pass urine every 3-4 hours. Lean forwards slightly while emptying your bladder. Always sit on the toilet, do not hover. You may find rocking your pelvis backwards and forwards a few times or standing up and sitting back down helps with bladder emptying. Bowel Sit on the toilet with a raise under your feet (see picture). Do not slump. When having a bowel movement, you may find some extra support will make you feel more comfortable; try holding a maternity pad firmly in front of the back passage keeping an even pressure. Breathing out as you move your bowels may help. Do not hold your breath. 11
Abdominal exercises What do they do? The deep abdominal muscles are responsible for supporting the back and pelvis. It is important that these muscles are working effectively before doing any other exercise. This will reduce strain on your back and pelvic floor. The muscles will also help flatten your lower tummy and draw in your waistline. 1. Deep abdominal muscle exercise Lie down as shown above Completely relax your tummy muscles. Breathe in gently. As you breathe out draw in the lower part of your tummy to engage these muscles, and continue to breath normally while you keep the hold. Your back should remain still. You may notice your pelvic floor tightens at the same time. 12
Aim to gradually increase the length of time you are holding to a maximum of ten seconds. To reduce strain on your back and pelvic floor muscles, engage your deep tummy muscles before you lift, for example carrying your baby or doing housework / shopping. 2. Abdominal muscle exercises a) Pelvic tilt Lie in the position pictured above. Engage your deep tummy muscles. Hold these tummy muscles in while you gently flatten your lower back onto the bed, breathing normally throughout. Gently release and then repeat. Build up the time you hold as with exercise one. 13
b) Knee rolling This exercise is useful for the relief of wind and pain. Lie in the position pictured above. Engage your deep tummy muscles. Keeping your knees and ankles together slowly take both knees to the right, just as far as is comfortable, engage your deep tummy muscles as you bring your knees back to the midline. Repeat to the left. Continue with this until you have done this approximately five times to each side. You should repeat these exercises three to four times per day for at least six weeks. General exercise You can return to low impact exercise after a vaginal birth as soon as you feel ready and from 6 weeks after a caesarean section. Begin gently and gradually. Exercise can reduce your chances of developing postnatal 14
depression provided that the exercise reduces your stress. Any sensation of vaginal discomfort, heaviness or discomfort in your section wound may mean you have done too much. Walking is a good activity to begin with and you can set your own pace. Gradually work towards walking briskly. Remember you can do this activity when pushing a pram. Your body s pregnancy changes are still present for approximately five months after you delivered your baby. The hormonal effects mean that you should not begin high impact activities too soon. Swimming you should avoid swimming until you have had one week without experiencing vaginal bleeding or discharge. If you have had a caesarean section you should avoid swimming for six weeks. Remember to engage your deep abdominal muscles as you take part in activities. Do not exercise if you are exhausted. Listen to your body. Different people recover at different rates. If you are used to regular exercises and have done so during your pregnancy, you may find you can return to regular exercise sooner. Do not overdo things. Remember your housework can wait. Give your visitors jobs to do. 15
Caesarean section Extra information You should follow the previous advice but remember your wound will take time to heal and you will have to gradually return to normal activities. Expect to feel tired and listen to your body. Do not expect too much too soon. Ensure you take adequate pain relief. Rest when baby sleeps. When you go home accept help if offered. If you need to cough, sneeze or laugh, lean forwards, bend your knees up and support your wound with your hands, a small towel or pillow. Do not lift anything heavier than your baby for the first six weeks. Remember this includes the baby bath full of water. If you have a toddler encourage them to climb up to you rather than bending down and lifting them. Try to avoid standing for long periods. You can push baby in the pram as long as there is no strain on your body. Take someone with you at first. In the beginning take short walks of about ten minutes. Try to avoid pulling the pram up steps and stairs. Two short walks in the day are better than one long one. 16
Shape up class What better way to get back into exercising, meet other mums and learn the most suitable exercises to do after your baby is born? Come along with or without your baby You can start when your baby is six weeks old for a block of weekly consecutive classes. Venue Parentcraft room, Ayrshire Maternity Unit, University Hospital Crosshouse. Classes run on a Tuesday,Wednesday or Thursday 1.30pm 2.30pm You need to phone to book your place before your baby is six weeks old. Contact 01563 825411 to book your place on an available block. 17
General enquires to Women s Health Physiotherapy Department, Ayrshire Maternity Unit, University Hospital Crosshouse, Kilmarnock, KA2 0BE Telephone 01563 825315 Useful website address and apps www.pogp.csp.org.uk www.tommys.org NHS squeezy app 18
Your notes 19
All of our publications are available in different languages, larger print, braille (English only), audio tape or another format of your choice. Tha gach sgrìobhainn againn rim faotainn ann an diofar chànanan, clò nas motha, Braille (Beurla a-mhàin), teip claistinn no riochd eile a tha sibh airson a thaghadh. 0800 169 1441 Tell us what you think... If you would like to comment on any issues raised by this document, please complete this form and return it to: Communications Department, 28 Lister Street, University Hospital Crosshouse, Crosshouse KA2 0BB. You can also email us at: comms@aaaht.scot.nhs.uk. If you provide your contact details, we will acknowledge your comments and pass them to the appropriate departments for a response. Name Address Comment Last reviewed: January 2019 Leaflet reference: MIS10-318-GD PIL code: PIL18-0173