After months of anticipation you finally have your new baby in your arms. Nothing can prepare you for the absolute craze of the first 6 weeks. Your whole world seems to revolve around attending to your baby’s every need... so it is important that at this point we stop and remind you it is essential to find time to look after the other most important person in the house…. you!
In the first 6 weeks your body is trying to recover from the gruelling toll that pregnancy and childbirth (by whichever means) takes on your body. No matter how good you might feel, it is important to be aware of how to best optimise your recovery - as this early window is a crucial time for connective tissue healing.
Read on for our essential tips to aid your recovery after birth!
You might have heard the ‘RICE’ recovery principles applied in the context of sporting injuries and they are equally applicable to soft tissue healing after childbirth (either vaginal tearing, episiotomy or c-section scar). Here’s how to apply these principles after your delivery:
Rest: At least 1-2 hours a day spent lying horizontally gives your abdominal and pelvic floor muscles some anti-gravity time to rest and restore.
Ice: Ice has a brilliant anti-inflammatory effect and can be used on the perineum (the area between your vagina and your back passage) straight after birth. After a vaginal birth, we suggest placing an ice pack inside your pad (just rip your pad on the side and place an ice pack in the pad) for 15-20mins every 2-3 hours. Ice should be continued for a minimum of 72 hours but recommended for as long as you have discomfort. The BodyIce re-usable perineum packs are perfectly designed for ongoing home use .
Compression: Support around the lower abdominals and perineum can not only feel great but may also help to limit strain through these areas. When in use should feel supported and comfortable- garments should never be too tight. There are a range of compression wear garments on the market - our pick is Solidea (you can try them on in the clinic).
Exercise: Hopefully you have seen a Pelvic Floor Physiotherapist during your pregnancy to ensure you are activating your pelvic floor muscles correctly. The time spent working on muscles in pregnancy is essential to build up your muscle strength. It is also important to maximise your familiarisation with the muscles which makes it much easier to get started with post natal program when your muscles can feel quite different after birth.
Aim to start your pelvic floor exercises 1-2 days after giving birth, as long as your catheter (if you had one) has been removed and your bladder is emptying normally.
The focus in the early days (week 1-2) is maintaining and restoring the connection between your brain and your pelvic floor muscles . Try and turn the muscle on and off regularly throughout the day. No set dosage is required at this stage - repeat a series of short gentle holds (perhaps 1-2 sec on and off) every 1-2 hours . We recommend starting your exercises in lying or sitting (as standing is usually very difficult).
As your awareness improves over the coming days see if you can sustain the contraction for a few more seconds. You should feel the pelvic floor muscles tighten and then relax. Once you can feel the muscle hold for a short time 2-3 sec, then try and do this 8-10 times in a row. Repeat around 3-4 times a day.
Every few days try to increase the length of your holds if you can. Remember to tighten as strongly as you can (as long as you are able to still talk and breathe).
Once you can hold a strong contraction for 10 seconds with ease, you can try to progress your program by repeating the exercise in a standing position. Continue to build on your hold length and repetitions until you can achieve 10 x 10second holds upright. It may then be time to consider a functional assessment with a pelvic floor physio to progress your exercise towards your specific goals.
(Side note: C-section mums -hope you didn’t skip this part!! Pregnancy itself (regardless of delivery type) stretches and weakens the pelvic floor muscles - so the instructions above still apply.)
Bladder and Bowel function after birth
There may be no bigger fear than the thought of having your first bowel motion after birth! Keep your fluids and fibre up and ask your midwife for a stool softener or consider having some Movicol on hand to keep things soft. A clean hand (covered with tissue/pad) over the perineum or on the abdominal scar can help to provide a bit more comfort and less apprehension. It’s also a good idea to continue to up the fibre (or softeners) over the first 6 weeks to keep things moving - straining with recovering perineal stitches or an abdominal wound is bad news.
Bladder function is equally important as the bladder can sometimes malfunction after both C Section and Vaginal births. Check that you have noticed regular urges to pass urine, can pass your bladder contents with ease and feel completely empty after going. If things don’t feel normal (this includes big gushes of urine onto the floor when you stand up), flag this with you midwife immediately or call us! If you can’t empty your bladder at all, this is something to go straight to the emergency department about (this risk of this kind of ‘retention’ is small and tends to occur only in the first 24-48 hours post birth).
Caring for Your Back and Neck with a newborn
Prevention is the best cure. Our number 1 tip for back care is to be mindful of your posture. You may often find yourself bending and hunching forward repetitively which can lead to aches and pains in any region of the spine. Whenever you remember, start some shoulder rolls to straighten up your upper back, tuck your chin in gently and lift your head up tall. Sit in a supportive chair, particularly when you are feeding, ideally with a firm but comfortable base and arm rests (to offload the shoulder and neck muscles). No matter how much your love looking at your baby please remember to move your neck and look around often when you are feeding - or you are likely to wind up with a very stiff and sore neck.
Follow the links below for our favourite exercises to loosen up your back and neck and keep your posture aligned:
Abdominal Muscle Separation
Abdominal muscle separation (which may also be called diastasis or the rectus abdominis or ‘DRAM’) is an extremely common in most women during pregnancy as the body must adjust its shape to accommodate the growing baby. You should notice this separation naturally starts to decrease over the first few weeks after delivery.
We recommend avoiding repeated or prolonged bending through the trunk, heavy lifting and straining on the toilet to enable smooth and fast recovery of the abdominal wall. You can also use post-partum compression garments to help provide support to the abdominal wall in the early days.Starting some gentle Core activation and Pelvic tilt exercises is another way you can help with the healing process. (Click above to see our videos for examples).
If you have ongoing concerns about your tummy muscles or require further rehabilitation (e.g. still have a noticeable gap, bulge or weakness which persists beyond 3 months) a Women’s Health Physiotherapist can provide a specialised assessment and targeted exercises and advice to assist in ongoing recovery.
Returning to Exercise after birth
Starting your pelvic floor exercises, basic core exercises and gradually increasing walking distance within the first 6 weeks is a great starting point and is usually all that we recommend up until this point.
It is not useful to overload the body in this early window - as it may hinder the natural recovery or soft tissues and connective structures that is occurring below the surface. Furthermore, women often don’t realise how de-conditioned (i.e. unfit!) you may be after pregnancy and/or the toll that labour and delivery has taken. A good aim is to slowly build up to completing a 45min walk by 6 weeks post birth.
So where to from 6 weeks...well this is usually the time we would recommend an assessment with a women’s health physio to check your abdominal wall and pelvic floor recovery, as well as address any musculoskeletal aches and pains. After this check-up we can give you more specific and individualised advice about returning to other activities as everyone is highly variable. High impact exercise (running, jumping etc) is not recommended before 12 weeks (see our blog on these guidelines here). The 6-12 week window is an ideal time to work on building strength, endurance and restoring posture and often postnatal specific exercise classes are designed target theses areas.
As always, if you feel your body isn’t recovering as you expected or have any specific concerns, please get in contact with us. We are all extremely passionate about ensuring you can enjoy every precious moment that this truly amazing time has to offer, and that you can do so feeling confident your physical self is being taken care of.
Special thanks to Anna Coney for her contribution to this blog. Anna is a Women’s Health Physio who works on the postnatal wards at The Women’s and also consults from East Keilor on Mondays.