Postnatal Exercises and Advice

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1 Lancashire Teaching Hospitals NHS Trust If you have had a caesarian section: Rest is more important than exercise for the first few days, but following the advice in this booklet will help you feel better sooner. Deep breaths: Taking a few deep breaths every hour, feeling the ribs expanding at the sides, will encourage your circulation, prevent chest infections, and start the trunk muscles working. Try to do this regularly for the first few days. Coughing: If you need to cough, bend your knees up, and hold on to your lower tummy with both hands. Getting up: Bend your knees up, and roll gently on to your side, then use your elbow and hands to push you up into a sitting position. Going home: Pop a pillow between yourself and the seatbelt for comfort. Driving: Start gradually. CHECK with your insurance company - some will only cover you after 6 weeks. Sex: You may feel a temporary lack of interest - this is normal. Just start when you feel ready. Sport: Avoid strong abdominal exercises and competitive sport for 3-6 months. The exercises in this booklet should keep you going until you feel like doing more. This leaflet was produced by Chartered Physiotherapists at Lancashire Teaching Hospitals NHS Trust. Postnatal Exercises and Advice Essential exercises and helpful advice to get you back into shape after having your baby. With reference to ACPWH (the Association of Chartered Physiotherapists in Women s Health) Date Produced: Dec 2004 Review Date: Dec 2006

2 After you have given birth, you ll understandably want to give your baby lots of attention. Even so, it s important to take a little time for yourself. By regaining your fitness, you ll feel good and have more energy - and you could well avoid health problems in the future. This leaflet offers guidance on safe and effective exercises that will help you get back into shape. This programme should be easy to follow, and needs little effort. You should soon start to feel the benefit. If you have had a CAESARIAN SECTION, these exercises are still ideal. Just remember to start gently and progress slowly, resting more in the first couple of weeks. First things first It is very important that you encourage your circulation, particularly during the first couple of weeks, when you are likely to be resting more, and not using the normal muscle pump. When you are sitting with your feet up on the bed, or a rest in front of your chair, Pump your feet up and down rapidly at the ankles Circle them all the way round at the ankles, first one way, then the other Try to repeat each exercise as often as possible - the more the better Exercising for life Exercise should always be undertaken gradually, particularly if you aren t used to it. Progress at a pace that suits you. Many women choose to go back to sport 2 or 3 months after childbirth, but everyone is different. If you have any questions on what you should or shouldn t be doing, ask your obstetric physiotherapist. You may see a physiotherapist whilst in hospital, but if you don t, feel free to telephone for advice: Preston Chorley The exercises outlined in this leaflet are designed for new mothers - but they are also good for all women. By following them throughout your life, you may help yourself stay healthy. Further advice You should ask your GP for advice if you have any of the problems below. He or she may refer you to a physio who specialises in women s health problems. Persistent pain in your back, pelvis, pubic bone, groin or stomach. A stomach that remains bulging and floppy more than 6 weeks after the birth. Any problems with loss of bladder control - such as wetting, soiling or having to rush to the toilet. Difficulties with sexual intercourse.

3 Changing Whether you sit, stand or kneel to change your baby, remember not to stoop. Lifting, whenever you are lifting, tighten your pelvic floor and deep tummy muscles. Use your legs, bend your knees and get close to whatever you are picking up. This will help to protect your back and pelvic floor. Toning up your pelvic floor muscles The first step Looking after your pelvic floor muscles is essential - following the birth and throughout your life. Initially, exercising them could help reduce discomfort and swelling. Longer term, toning up the muscles may prevent leakage from your bladder or bowel. It can also help safeguard against prolapse, and may improve your sex life. You should start these exercises the day after having your baby. The basic pelvic floor exercise Many women need a little guidance on how to do the basic pelvic floor exercise. Simply get yourself into any comfortable position and follow the instructions below. Imagine you are trying to stop yourself from passing wind, and at the same time trying to stop the flow of urine. The feeling is one of squeeze and lift, closing and drawing up the back and front passages. This is called a Pelvic Floor Contraction. You should start gently and stop if it hurts. Don t pull in your stomach excessively / squeeze your buttocks together / use your legs or hold your breath.

4 The pelvic floor exercise programme Now that you can do the basic pelvic floor exercise, you can use it to gradually tone up your pelvic floor muscles, so that they can work harder and longer. Firstly, though, you need to determine your starting block. Tighten your pelvic floor muscles as previously described, and hold for as many seconds as you can to a maximum of 10 secs. How many seconds can you hold for? Release the contraction and rest for 4 seconds. Now repeat the tighten, hold and release movement as many times as you can. How many times can you repeat this? For example, if you can hold the contraction for 2 seconds and repeat four times, this is your starting block. Now perform the basic pelvic floor exercise - but squeeze and lift more firmly, then let go straight away. This is called a quick contraction and will help your muscles to react quickly when you laugh, cough, sneeze or lift. How many times can you do this? Aim to increase this number, up to 10 times in quick succession, remembering to relax between each lift. You should try to repeat your starting block and quick contractions 4-6 times a day. Caring for your back It is VITAL that you take care of your back after you have had your baby. This part of your body will be vulnerable for 5-6 months after the birth because: Your stomach muscles which normally help to support the back are weak. Your joints are more flexible and at risk from damage, due to the increased hormones in your body. Caring for your baby will involve lifting, carrying, feeding and changing - all activities that will put extra strain on your back. Everyday activities Look after your back by always finding a comfortable, well supported position before carrying out everyday activities. This section will give you valuable tips on good positions to adopt when feeding, changing or lifting your baby. Feeding Try sitting with your feet raised on a footstool or pillow. Place a pillow on your knees and use it to support the arm cradling your baby. You can also breastfeed whilst lying on your side. Ask your midwife or health visitor for advice if necessary.

5 The head lift Perform the pelvic tilt. Lift your head only, hold for a few seconds then slowly relax. Toning up your stomach Exercising your stomach muscles You should start to tone up your stomach muscles as soon as you feel well enough. Work the deep muscles first by following stage one. These muscles are very important as they reduce strain on the back and pelvic floor. Once they are strong, you can then progress to stage two to improve your outer muscles. To progress: Once you feel confident with the head lift, you can progress by: Prolonging the hold, up to a maximum of 10 seconds - keep breathing. Raising your head and shoulders together. Don t forget to squeeze your pelvic floor muscles as you do the exercise. DO NOT CONTINUE if you cannot stop your stomach bulging as you exercise. DO NOT exercise if you feel tired or unwell. It may take several weeks before you reach this stage - this is nothing to worry about! Stage One This stage exercises the deepest muscle in the stomach, which acts like a corset. It stabilises the spine and pelvis, helps flatten your stomach and draws in your waistline. Don t try any strong exercises such as sit-ups or lifting both legs up when lying on your back. These are DANGEROUS. For the first few weeks after giving birth, you should exercise in a comfortable position - perhaps lying on your side as shown below.

6 Let your tummy sag! Breathe in gently. As you breathe out, gently draw in the lower part of your stomach, squeezing in the pelvic floor as well. Let go. Don t move your back at all. You should be able to breathe and talk while you do this exercise. Repeat this movement four or five times, with a few seconds between each one. Aim to build up gradually - holding the muscles in for a maximum of 10 seconds and repeating up to 10 times. After about 6 weeks, you can progress to the position below Stage Two Once you are comfortably achieving the deep stomach exercises, you can move on to stage two. The pelvic tilt Lie in the position shown and perform the deep stomach exercise. Gently squeeze your pelvic floor and buttocks, tilt the pelvis up, and flatten your back on to the floor or bed. Hold this position for a maximum of 10 seconds, then release slowly. Different starting positions to try: Lying face down with a pillow under your stomach Lying on your back with a pillow under your head, your knees bent, and both feet on the floor or bed. Sitting on a supportive chair, or the side of the bed. It is very important to use the deep tummy muscles in everyday activities. Hold them in when carrying your baby, lifting baby equipment and doing housework. You can also add another element to this exercise, by gently rolling your legs from side to side, keeping the knees together. This can be particularly helpful if you suffer from trapped wind, following a caesarian section. Keep your stomach flat. If it bulges out, go back to stage one, and try stage two again in a few days.