Post natal exercises and advice for new mothers

• Begin the exercises in this leaflet as soon as you feel well enough.
• They are suitable if you have had a vaginal delivery or caesarean section.
• These exercises should not cause you pain.
• They should be done slowly and carefully.
• If you are unsure about any exercise, consult your Community Midwife or Women’s Health Physiotherapist.

Looking after your pelvic floor muscles is essential – following pregnancy and childbirth and throughout your life. Starting the exercises soon after a vaginal delivery could help reduce discomfort and swelling. However, you should still do pelvic floor muscle exercises following a caesarean. The exercises may prevent bladder and bowel problems, prevent prolapses and improve your sex life

Before you begin please note:

• Do not do pelvic floor muscle exercises with a catheter in place.
• Do not stop and start your flow of urine.
• Stop when your muscles are tired.

Begin in a position you find comfortable

• Imagine that you are trying to stop yourself from passing wind and, at the same time, imagine that you are trying to stop your flow of urine. The feeling is one of ‘squeezing’ and ‘lifting’, closing and drawing-up the vagina (birth canal). This is the basic contraction.

• Start gently and stop if it hurts

• Try to avoid pulling in your tummy excessively, clenching your buttocks or holding your breath

There are different ways to progress this basic exercise once you feel ready to try:

1. Aim to improve how long you can hold each contraction for – how many seconds can you ‘hold’?……….Let the muscles relax for the same amount of time.

How many repetitions can you do?…………

Your goal is 10 repeats of a 10 second ‘hold’, 3-4 times every day. It may take several weeks of practice to achieve a 10 second hold so don’t give up! This exercise helps to improve the strength, stamina and support of your pelvic floor muscles.

2. Make each contraction very quick and very powerful, then release it immediately: squeeze, release, squeeze, release and so on. How many quick contractions can you do?.…….

Repeat up to 10 times, 3-4 times every day.

You will need this brisk reaction from your muscles particularly when you cough or sneeze, run or jump, to prevent leakage of urine, faeces or wind.

3. To make your muscles work harder, change the position in which you practice your exercises – they are easier to do lying down and harder to do standing up. Once recovered you will be spending a good part of each day on your feet so your pelvic floor must be able to cope with the strain.

4. Gently tighten your pelvic floor muscles and hold your lower tummy in at the same time as you go about your normal daily activities.

Use a regular activity, like feeding your baby, to remind you to exercise.

The deep stomach muscles are very important as they reduce strain on your back and pelvic floor. They act like a corset, stabilising the spine and pelvis, flatten your stomach and draw in the waistline. Start as soon as you feel well enough.

Exercise 1: Deep Stomach Exercise

• Lie on your side, or face down with a pillow under your stomach, or on your back with a pillow under your head, your knees bent and feet flat on the floor or bed.
• Let your tummy ‘sag’ and breathe in normally.  As you breathe out, gently draw the lower part of your tummy in, as though you are pulling your ‘belly-button’ towards your spine. Squeeze up your pelvic floor muscles at the same time.
• Hold for a few seconds, then relax.
• Try to breathe normally throughout the exercise – don’t hold your breath.
• Repeat 5 times, with a few seconds’ rest between each contraction.
• Build up gradually – hold the muscles for a maximum of 10 seconds and repeat 10 times.
• Keep your back still. You should be able to breathe and talk while you exercise.
  

Exercise 2: The Pelvic Tilt

• Lie in the position shown above and perform the deep stomach exercise. At the same time, gently squeeze your pelvic floor and buttocks, tilt your pelvis up and flatten your back on to the floor or bed.
• Hold this position for a few seconds, then relax.
• Gradually build up to 10 second holds, repeated 10 times.
• Remember to keep your stomach flat. If it bulges out down the middle of your abdomen, go back to Exercise 1, and try this one again in a few days’ time.
  

Exercise 3: The Head Lift

• Perform the Pelvic Tilt (Exercise 2).
• Squeeze your pelvic floor muscles.
• Lift your head only and hold for a few seconds.
• Release gently and rest for a few seconds. Remember to keep your stomach flat. If it bulges out down the middle of your abdomen, go back to Exercise 2 and try this one again in a few days.
• Once you feel confident, you can progress by:
• Prolonging the hold, up to a maximum of 5 seconds (keep breathing).
• Increasing the number of repititons.
• Raising your head and shoulders.

It is vital that you take care of your back after you have had your baby; it may be vulnerable for some months after the birth.

When caring for your new baby, take care of your back by:

1. Standing ‘tall’ with your tummy muscles pulled in and your bottom tucked under.
2. Sitting in a comfortable chair with good back support particularly when feeding your baby.
3. Lifting correctly by bending your knees, keeping your back straight, tightening your stomach and pelvic floor muscles and holding any load firmly and close to your body.
4. Making sure that your working surfaces are at waist/hip height.

Also:

•  Alternate sitting and standing jobs.
• Avoiding sudden and repetitive bending and twisting movements.

Exercising for life: Exercise should always be undertaken gradually, particularly if you are not used to it.  Progress at a pace that suits you. Many women choose to go back to sport 2-3 months after childbirth, but every woman is different.

You should contact your GP for advice if you have any of the following problems, as he/she may refer you to a specialist physiotherapist:

• Persistent pain in your back, pelvis, pubic bone, groin or stomach;
• Any problems with loss of bladder or bowel control, such as leaking, soiling or having to rush to the toilet;
• Difficulties with sexual intercourse.