Exercise after Child birth

Improving your recovery after birth – physiotherapy advice

Immediately after your baby‘s birth

After you have given birth we recommend that you follow some simple steps which will improve your postnatal recovery.

Rest – lie flat for 30 minutes, twice a day. This will help to minimise discomfort, reduce swelling and take extra weight off your pelvic floor and lower abdominal muscles.

Ice – following a vaginal birth or an attempted vaginal birth, ice helps to reduce pain and swelling around the perineum and is crucial in the first 72 hours after the birth of your baby. Ice should be placed inside your pad for 20 minutes every 2-3 hours and can be continued until pain and swelling cease.

Compression – firm supportive underwear will help support the perineum and lower abdominals and reduce pain and discomfort. This will also help to start the healing process. Control briefs can be purchased from department stores and should be worn for the first six weeks. As a guide, garments should be two sizes bigger than your pre-pregnancy size.

Exercise – pelvic floor and deep abdominal exercises help you return to your pre-pregnancy shape and assist with healing around any stitches you may have. They can be safely started one to two days following the birth of your baby, provided there is no increase in your pain.

Helping you get into and out of bed, while supporting your stomach muscles

The most comfortable, and the best way for you to get into and out of bed is to log roll…

How to log roll:

Bend your knees and roll onto your side. Keep your shoulders and hips in line.

Slide your feet over the side of the bed and push yourself up using both of your hands in front of your body.

Do the same in reverse to get into bed.

After a caesarean birth

While you are resting in bed, it is important to do bed exercises to prevent problems developing in your chest and blood circulation. They include:

Breathing exercises

Take 5 big, deep breaths every hour while you are resting in bed. If you need to cough, support your stitches with your hands or a pillow.

Circulation exercises

Move your feet forwards and back 20 times every hour while you are resting in bed.

Pelvic floor muscle exercises

The pelvic floor muscles are a small but very important group of muscles, particularly in women. They lie deep inside the pelvis and act to support the pelvic organs and control continence. During pregnancy, these muscles become weakened due to the action of pregnancy hormones and the weight of the baby pushing down. It is important that you re-train these muscles during the postnatal period to prevent problems, such as incontinence.

All women should exercise their pelvic floor muscles every day. If you have experienced any urinary leakage or trouble passing urine since the birth of your baby please notify your midwife, physiotherapist or doctor.

There are two exercises that we recommend to re-train your pelvic floor. To begin, lie on your back with your knees bent and your feet supported but apart.

Exercise 1: Long hold

Squeeze around your back passage and your vagina, like you are trying to stop yourself passing wind or urine and try to lift the pelvic floor up. Hold this exercise for 2 to 3 seconds, whilst keeping your abdominal, buttock and thigh muscles relaxed. Continue to breathe normally. Relax for five seconds, then repeat this exercise 3 to 5 more times. Repeat the exercise 4 times a day. As your pelvic floor muscles get stronger, make the exercise more challenging by increasing the number of exercises and the hold time of each exercise to 10×10 seconds. You can also perform these exercises sitting, standing and during activities such as lifting and walking. Always stop exercising when the muscle feels tired.

Exercise 2: Quick squeeze

Tighten the pelvic floor muscles as above this time holding the exercise for only one second. Try to repeat 10 to 20 quick strong squeezes, four times a day.

Functional bracing

Tighten your pelvic floor when you cough, sneeze or laugh and when you are doing things that require effort, like lifting.

The importance of healthy bladder and bowel habits

It is important to avoid constipation and straining when you are on the toilet. Remember to:

Drink between 1.5 and 2 litres of water each day (water is preferable to tea and coffee). Avoid drinking too much caffeine and alcohol. Eat plenty of high fibre foods (e.g. fruits, vegetables). Exercise regularly. Don’t ignore urges to use your bladder or bowel. Avoid straining – take your time when you empty your bladder and bowel to make sure they are completely empty.

The best toilet position to avoid straining:

Sit leaning forward, with your elbows on your knees, allow your tummy to relax. Use a foot stool or lift your heels up off the floor so that your knees are above your hips. Sigh out deeply or make a hissing sound. Don’t hold your breath. Support your stitches with your hand particularly when opening your bowels.

Deep abdominal muscle exercise for all postnatal women

Your deep abdominal muscles help you to maintain good posture and back support. During your pregnancy, as the baby grows, your abdominal muscles stretch and their efficiency is reduced. It is important to exercise these muscles regularly after the birth to prevent back pain and to regain muscular strength.

Exercise 1

To begin, lie on your back with your knees bent and feet supported or kneel on your hands and knees. Breathe in, then breathe out and as you do so gently tighten your lower abdominal muscles by pulling your lower belly in towards your spine. Try to keep your upper abdominal muscles relaxed throughout the exercise. Hold for 3 to 5 seconds, whilst breathing normally. Repeat 6 to 10 times, 4 times a day.

As you get stronger you can gradually increase the time that you hold for up to 60 seconds. You can also make the exercise more challenging by changing your position to sitting or standing. It is important to activate the deep abdominal muscles when you are lifting or walking to provide extra back support.

Exercise 2

During your pregnancy the curve in your low back increases in size. This is sometimes associated with lower back pain. It is important to correct this curvature after the birth of your baby.

To begin, start in the position as above. Tighten your lower tummy muscles and this time flatten your lower back onto the bed or the floor by gently rolling the tail bone and tilting the pelvis towards your ribs. Repeat this exercise as you find comfortable.

Tips for back care and correct lifting technique

Bend your knees, keep your back straight and always tighten your pelvic floor and abdominal muscles as above. Hold the object firmly and close to your body. Do not lift anything heavier than the weight of your baby for the first 6 weeks. Avoid sudden and repetitive bending and twisting movements. Make sure your working surfaces are at waist height (eg. bathing & changing the baby). Create a supportive position for feeding. Place your bottom back in the chair, make sure your feet are supported and use support to help lift the baby up to your breast.

Return to exercise

Commence gentle walking as pain/discomfort allows. Gradually increase your walking distance and speed as you are able. A 30 minute walk each day has been shown to improve your general health and well-being. Avoid other strenuous and high impact exercises during the first 12 weeks (e.g. weights, sit-ups and running).

Before attempting high impact exercises you should check your pelvic floor strength by; coughing with a full bladder or jumping with a full bladder. Only begin if there is no urine leakage. If you have leakage, see a Women’s Health Physiotherapist.

Postnatal physiotherapy class

The Physiotherapy Department runs postnatal classes to help with your recovery after pregnancy and childbirth as well as with your transition home. Please contact the Physiotherapy department if you have been discharged home and would like to attend this class. All mothers and babies are welcome.

Further information

Physiotherapy Department

Royal Women’s Hospital Level 1, Grattan St & Flemington Rd, Parkville VIC 3052 Tel: (03) 8345 3160 Monday to Friday 8.30am – 5.00pm

Tags: Abdomen, Health, Infant, Intestine, Muscle, Pelvic floor, Physical exercise, Urinary incontinence