Helping your body get back to normal Introduction Congratulations on the birth of your baby! We hope you are a recovering well and hope this booklet gives you some practical advice and exercises to strengthenn you as well as some information about the services you can access a postnatally. If you have a third degree tear t or a separation of your recti abdominus (tummy) muscles your midwife, consultant or GP will refer you to the physiotherapy department for treatment. If you develop any back pain orr pelvic pain within the month after giving birth you may well be referred to physiotherapy. Once referred we can assess your problem and treat as appropriatea e through individual appointments or in a class setting. We have a team of experienced and dedicated staff who will treat and monitor your problem, teach exercises and offer advice to ensure you recover as quickly as possible. Once we have received your referral we will contact you by b telephone or letterr to make an appointment which is convenient for you. We will explain our services and answer any questions you may have during this call. Your appointment will be made 1-2 weeks of the referral date, however if you do not hear fromm us within three weeks please contact us on 01206 742550. Your midwife willl tell you that they aree referring you to ourr service and why. Below is an outline of the services we offer postnatally:- Postnatal classes A six weekk exercise circuit class aimed at patients with a separation of the tummy muscles and decreased muscle tonee around the t stomach. Womens Health Physiotherapyy Individual assessments for patients who have sustained a 3rd degree tear after childbirth orr who havee pelvic floor weaknesss and incontinence problems. All assessments are carried out in a private room with w an experienced physiotherapist. Individual postnatal appointments If you are experiencing low back pain or pelvic pain following the birth of your baby you will be individually assessed and treated by the obstetric team. Page 1 of 6 Leaflet namee Leaflet number Created Reviewed Next review Helpingg your body get back 751n8 10 Julyy 2007 September 2016 September 2018
All of our obstetric and womens health staff are female and are very happy to answer your sensitive questions and will try to make you feel at ease. Whether or not you have been referred to physiotherapy you are advised to start the following exercises which are safe to do following the delivery of your baby. These are very important to prevent problems with prolapse and incontinence and for you to regain your strength after your baby. You are also able to do these exercises straight after a Caesarean section as pain allows. Pelvic floor muscle exercises why do you do them? The pelvic floor muscles form a sling or hammock surrounding the back passage, vagina and urinary passage. Pregnancy puts strain on these muscles. We need to keep them as elastic as possible enabling them to support the abdominal and pelvic organs and to control any leaks of urine which can occur when running and coughing etc. It is important for you to safeguard your tummy muscles after the birth of your baby as they may have separated during pregnancy to allow your baby to grow. This gap should close up spontaneously, however you will need to be careful not to put too much strain on your tummy muscles too soon. If you find that your tummy domes when moving about or lifting then you are putting strain on your tummy muscles so If this happens stop the activity and ask to be referred to a Physiotherapist. You may be given a tummy support to protect against strain but also some appropriate exercises to strengthen your muscles. If you have not been referred to a physiotherapist but are worried about straining your muscles you could try wearing some support knickers after your birth. Physiotherapist but are worried about straining your muscles you could try wearing some support knickers after your birth. They help to reduce discomfort and swelling after giving birth. The best way of keeping these muscles strong is by exercising them regularly. Carrying out your pelvic floor exercises If you have a catheter, wait until this has been removed before starting this exercise. Pelvic floor exercises can be done while lying or sitting: tighten the muscles around your back passage, vagina and front passage and lift up and squeeze inside as if you are trying to stop passing wind and urine at the same time you need to concentrate on using the correct muscles, so don't squeeze your legs together or tighten your buttocks gently tighten/hollow the lower abdominal muscles before and throughout each pelvic floor exercise, to make each grip more effective it is most important not to hold your breath, just breath normally during the exercises. Page 2 of 6 Leaflet name Helping your body get back Leaflet number 751n8 Created 10 July 2007 Reviewed September 2016 Next review September 2018
Exercise 1 squeeze and lift your pelvic floor muscles in a sloww and controlled way,, holding for 5-10 seconds, thenn letting go and resting for 4-100 seconds between each muscle contraction build up your strength, by repeating each held contraction 5-10 times. It is important to be able to work these muscless quickly too help themm react to sudden stresses from coughing, laughing or exercise that put pressure on the bladder. You also need to practice some quick contractions. Exercise 2 draw in the pelvic floor and hold for just one second before letting go repeat in a steady manner, aiming for a strong muscle, tightening with each contraction up to a maximum of 10 times. Do your exercises carefully. The quality is important. Fewer good exercises will be more beneficial than many half-hearted ones. Abdominal muscles why do you do them? These muscles form an elastic corsett helping to hold the abdominall organs in their correct place and support your back, so helping you to maintain a good posture. These muscles have become weak during your pregnancy. Deep abdominal exercisee lie on your side or on your back with a pillow underr your head, knees bent up and feet flat on the bed. place your hand below your belly button and as you breathe out draw your tummy away from your hand, squeezing your pelvic floor as well. You are aiming for a 10 second hold, 10 times. Page 3 of 6 Leaflet namee Leaflet number Created Reviewed Next review Helpingg your body get back 751n8 10 Julyy 2007 September 2016 September 2018
The pelvic tilt lie on your back with your knees bent up and feet flat f on the bed pull in your tummy and tilt your pelvis up flattening your lower back against the bed hold this position forr a 2-3 seconds and then release gently. Repeat 10 times. Knee rolling lying on your back with your knees bent up and arms by yourr side gently lower both knees to thee right as far as is comfortable bring them back to the middle and lower to the left repeat this three times to eachh side. Divarication exercise lie on your back with your knees bent up and feet flat f on the floor cross your hands over your abdomen, firmly holding each side take a deep breath in and as you breathee out, slowly raise your head (chin to chest) and pull your hands together. If you notice thatt your tummy bulges as you are exercising, you are quickly. progressing too Page 4 of 6 Leaflet namee Leaflet number Created Reviewed Next review Helpingg your body get back 751n8 10 Julyy 2007 September 2016 September 2018
General advice following a Caesarean section When you get home look after yourself and gratefully accept any help offered. Use your common sense where lifting is concerned. If it hurts don't do it! We would recommend that you don't lift anything heavier than your baby for six weeks. When carrying loads try and keep them close to your body and not at arms length. If you drive don t assume you can just get in a car and drive. If you have had a general anaesthetic (GA), please check with your insurance policy. Some policies state that you are not covered for 6 weeks after a general anaesthetic. From our point of view, you should be safe to drive after 2 weeks. Check that you can tolerate the seat belt, do an emergency stop, change gear and check you can look over your shoulder and are alert enough not to be a danger on the road. Sometimes problems may arise at a later date, if this happens you should ask your GP, midwife or consultant to make a referral to us. Once we have received your referral we will make contact with you to arrange an appointment. Problems we can help with include:- persistent pain in your back, pelvis, pubic bone, groin or stomach an abdomen that domes on activity after more than six weeks any problems with loss of bladder or bowel control such as bed wetting, soiling or having to rush to the toilet difficulties with sexual intercourse. Further information If you have any further queries or concerns please do not hesitate to contact the Obstetric Physiotherapy Department on 01206 742550. Your NHS number When you attend hospital you will be asked for your NHS number and other information such as your address. Please be patient with this procedure. It is to ensure our records are kept up to date and to protect your safety. However, if you do not know your NHS number, please do not worry you will still receive care! Concerns or complaints If you have any concerns or worries about your care, please contact the department responsible. However, if you are unable to resolve your concerns or wish to make a formal complaint, please contact the Integrated PALS (Patient Advice and Liaison Service), Complaints and Litigation Service on 01206 745926 or ask any member of staff for a leaflet, which will describe how you may make a complaint. Page 5 of 6 Leaflet name Helping your body get back Leaflet number 751n8 Created 10 July 2007 Reviewed September 2016 Next review September 2018
Your views If you or a family member has recently been in either Colchester General Hospital or Essex County Hospital for any reason, you can tell us about your experience by visiting the www.nhs.uk website and clicking on the "Comments" section, writing to the address on the front of this leaflet, emailing your comments to info@colchesterhospital.nhs.uk or filling in a questionnaire at the hospital telling us if you would recommend our service to a friend or family member. Obstetric Physiotherapy Department Gainsborough Wing Colchester General Hospital Turner Road Colchester CO4 5JL Tel: 01206 742550 Page 6 of 6 Leaflet name Helping your body get back Leaflet number 751n8 Created 10 July 2007 Reviewed September 2016 Next review September 2018