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introduction

Postnatal recovery time can last for 12 months, and the first six weeks are particularly important. Your pregnancy hormones have caused a lot of changes over nine months, and baby’s delivery (whether vaginal or Caesarean) means your body needs extra care. This booklet can help guide you in your recovery so that you can enjoy this special time with your baby.

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Postnatal Physiotherapy Assessment

A postnatal assessment with a women's health physiotherapist is recommended six weeks post-delivery. This is different from your appointment with your obstetrician, and an important part of postnatal recovery. In this assessment we will screen, assess, and treat you for any bladder, bowel, pelvic floor, abdominal muscle, or musculoskeletal issues.

Please call Southcare Physiotherapy on (08) 9332 2132 or visit www.southcarephysiotherapy.com.au to book your postnatal assessment today.

 

southcare classes

Mother and Baby Pool Classes - The Southcare Murdoch Mum’s and Bub’s hydrotherapy exercise class is offered between 8 weeks and 6 months postnatal, commencing with mother and baby nursery rhymes and introduction to water exercises. Following this, our lovely volunteers come in to look after bub while new mums take part in an aqua-aerobics class. The classes run for approximately 1 hour 30 minutes at the following times.

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Monday - 11.15am
Tuesday - 12.15pm
Wednesday - 11.15am
Thursday - 11.15am

Parent and Baby Pool Class - Parent and Baby classes are for either mum or dad (or both if they are twins) and are on a Saturday morning from 11am to 11.30am. This class is for baby’s 8 weeks to 18 months old and includes nursery rhymes and introduction to water exercises.

 

Clinical Pilates Classes - Clinical Pilates classes are 60 minute sessions run by physiotherapists. Each patient receives a tailored program at every session.

Monday & Wednesday - 7am - 10am / 3pm - 7pm
Tuesday & Thursday - 7am - 11am / 3pm - 7pm
Friday - 7am - 10am
Saturday - 8am - 12pm

 

fitright

FitRight postnatal exercise classes are run by physiotherapists all over Perth, including the area local to St John of God Hospital Murdoch. They are Pilates-style classes run in small groups and aim to optimise your posture, flexibility, core muscles and general strength. They are perfect for anyone with pelvic girdle or back pain, abdominal muscle separation or pelvic floor muscle dysfunction, because the physio instructors can modify all exercise to suit your individual needs.

There are two types of postnatal FitRight classes, all run in 6 week courses throughout the year:

Baby and Me - 

These classes are for babies between 8 weeks and 12 months, and involve 60 minutes of beginner to intermediate level Pilates-style exercise with a physiotherapist. While you exercise, community volunteers look after your baby for you in the same area.

You have the option to do a 90 minute class, where you arrive 30 minutes earlier and do a baby massage and developmental play session with the physiotherapist before you begin the Pilates. This is a lovely option for babies under 6 months old, and helps with digestion, circulation, bonding and gross motor development.

https://www.fitright.physio/mums-and-bubs-fitness-classes/ 

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MumTime - These classes are for Mums to attend in the evenings, for a bit of 'me time' without the kids. They also involve 60 minutes of exercise in a small group setting, but these classes are faster paced with a mix of higher level Pilates, body weight resistance exercise and high intensity interval training. They are usually suitable for Mums who are 6 months to 3-4 years postpartum.

https://www.fitright.physio/mums-only-post-natal-exercise-classes/

Times and locations vary each course. To see class options, visit the website www.fitright.physio, and fill in an online registration form indicating the course/s of your choice. Waitlists are often in place so it is recommended to register early. Private health rebates apply. Pre-assessment with a physiotherapist is essential, all the information is on the website.

https://www.fitright.physio/fitright-initial-assessments/

Follow FitRight on social media for regular tips on women's health, fitness, pregnancy and post-birth rehabilitation:

www.facebook.com/fitrightphysio

@fitrightphysio

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Perineal Care

The perineum is the skin and muscle between the vagina and the anus, and is under stretch when baby is born. Some women who have a vaginal delivery will need stitches to repair their perineum after childbirth, either from a tear or an episiotomy.

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How do you take care of your stitches?

·      Showering daily and after bowel motions

·      Patting (rather than wiping) dry, with a towel after showering or toilet paper after emptying your bladder

·      Changing your maternity pads every 2-3 hours

·      Support your stitches by wrapping your hand in toilet paper and applying pressure to your perineum during bowel motions

What should you avoid in the first six weeks?

·      Direct soap, cream or powder onto the stitches

·      Baths

·      Tampons

·      Sexual intercourse

 

How can you manage the pain and swelling from stitches?

·      Rest: Lie flat on your back or side every few hours and avoid sitting for long periods

·      Ice: Freeze a maternity pad with water and place between two pairs of underwear for 10 minutes. You can repeat this every two hours

·      Compression: Wear a double pad and firm fitting underwear

·      Pain relief: Take paracetamol tablets as directed

·      Pelvic floor: Regular, gentle pelvic floor squeezes (not holds) can help to resolve swelling through the muscle pump mechanism

What should you watch for?

·      An increase in pain after pain has improved

·      An increase in bleeding

·      Smelly discharge

·      Bladder discomfort or burning when emptying your bladder

·      Report to your midwife or obstetrician if you notice any of these

·      It is useful to use a hand mirror to check your stitches so that you can notice any changes in their healing. This can also make you feel more comfortable with the healing process

Your perineum usually heals in two to three weeks and can be checked by your obstetrician at your six week check if you have any concerns.

Book an appointment with your Southcare Women's Health Physiotherapist for ultrasound treatment, which will help to decrease pain and swelling, and laser treatment (pain free light therapy), to improve the healing process. 

To review this information about wound care after a vaginal birth, see the FitRight video 'Vaginal Birth Specific Rehab': 
https://www.fitright.physio/educational-online-videos/

 

Caesarean Care

A Caesarean is major abdominal surgery and it may take your body 6-12 weeks to heal completely.

What should you do in hospital?

  • Deep Breathing
    • Deep breathing helps to reduce the side effects of anaesthesia
    • Sit upright in bed, knees bent, feet on the bed. Place one hand on your abdomen above the navel
    • Breathe out gently, then take a slow deep breath getting in as much air as possible. Relax and gently breathe out
    • Aim for 5 deep breaths per waking hour
       
  • Ankle pumps
    • Ankle pumps help to improve circulation
    • Move feet up, down and in circular motions briskly at the ankles at least ten times per hour
       
  • Huff
    • Coughing places more stress on your abdomen and pelvic floor muscles so it is better to huff to clear phlegm from your chest
    • Take a medium breath in and then force the air out through a rounded mouth as if you are fogging up a mirror
       
  • Supported Cough
    • If you need to cough, sneeze or laugh hold your abdomen gently with a hand or place a rolled up towel gently over the area.  

What should you avoid in the first six weeks?

  • Heavy lifting
    • Try not to lift anything heavier than baby
    • Be particularly careful with prams, capsules, loads of washing, and food shopping
       
  • Strenuous activity
    • This includes mopping and vacuuming as this strains the abdominals
       
  • Driving
    • You are required to avoid driving until you have medical clearance from your obstetrician. If you have an accident before this time you may not be covered by your insurance company

How should you get out of bed in the first six weeks?

  • Bend your knees up and roll onto your side. Keep your knees together and pulled up towards your chest
  • As you push up with your hands to a sitting position, swing your legs down over the side of the bed
  • A hand or rolled up towel can be gently held against the incision
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Your women’s health physiotherapist can check your Caesarean scar at your postnatal assessment, and give you advice to help decrease scar tissue.

 To review this information about recovery from a Caesarean Section, see the FitRight video 'Caesarean Specific Rehab': 

https://www.fitright.physio/educational-online-videos/

 

breast care

Milk in your breast is carried from your mammary glands to the nipple by breast ducts. Poor emptying of the ducts or pressure on the ducts can cause the duct to become blocked. A lump will form as the milk builds up behind the blocked duct, your breast may feel hard and sore in one area, and may look red. If you develop fever or flu-like symptoms you may have mastitis, an inflammation of the breast tissue that may progress to infection.

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It is very important that you see a GP as soon as possible if you believe you have mastitis, as you may need antibiotics.

What can you do to prevent blocked ducts and mastitis?

  • Ensure correct attachment with your lactation consultant
  • Avoid missing or putting off feeds, and breastfeed your baby as often as they want to feed
  • If your breast becomes uncomfortably full and your baby is not interested in feeding, express a small amount of milk for comfort.
  • Avoid tight tops or bras, or anything that compresses your breasts
  • Alternate which breast you begin each feed with to ensure they both get drained regularly

What can you do to treat blocked ducts and mastitis?

  • Rest as much as possible
  • Feed from the sore breast first, when your baby's sucking is stronger
  • Change feeding positions to help empty the breast completely
  • Gently massage the breast during feeds and in a hot shower
  • Apply a cool pack after the feed for pain relief

Book an appointment with your Southcare Women's Health Physiotherapist for ultrasound treatment, which will help to clear the blocked duct. If you have fever or flu-like symptoms you must be on antibiotics for 12-24 hours prior to commencing treatment.

 

nipple care

It is expected that your nipples will feel sensitive or tender in the first few weeks of breastfeeding, however sore, painful, grazed or cracked nipples are not normal, and breastfeeding should not hurt.

What can you do to improve nipple pain?

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  • Before feeds:
    • Look for early feeding cues (e.g. hands to mouth, open mouth, sticking tongue out) to offer a feed before your baby starts crying
    • Offer the less sore side first
    • To ensure your baby will be gentler on your nipples, start your milk flowing by gently massaging your breasts and applying warmth. To lubricate the nipple and soften the areola, express a small amount of milk before feeding
       
  • During feeds:
    • Ensure correct attachment with your lactation consultant
    • Before removing your baby from your breast, insert a clean finger into the corner of baby's mouth to gently break suction
       
  • After feeds:
    • Express a small amount of breast milk and apply to nipple
    • Allow your nipples to dry before closing your bra
    • Change nursing pads frequently, use washable nursing pads if disposable pads cause chaffing
    • To stop clothes rubbing, use breast shells or nipple protectors
    • Avoid products or materials that will dry or damage your nipple skin (e.g. soap, shampoo, rough towels)

It is important to identify the cause of grazed or cracked nipples so that it can be fixed, as they will usually improve quickly. Causes may include: poor positioning or attachment, skin infection or dermatitis, tongue-tie in your baby, and incorrect use of breast pumps.

Book an appointment with your Southcare Women's Health Physiotherapist for laser treatment, a pain free light therapy which will speed up the healing process.

 

pelvic floor muscles

What are the pelvic floor muscles?

The pelvic floor is made up of layers of muscle and tissue. The muscles attach at the front of the pelvis at the pubic bone and finish at the back at the tail bone, making a hammock or sling.

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What do they do?


The pelvic floor muscles have four main functions:

  • Support of the pelvic organs (the bladder, uterus and bowel)
  • Control of the bladder and bowel
  • Improve vaginal tone to help with sexual enjoyment
  • Support the back by working with the abdominal muscles

 

What makes the pelvic floor muscles weak?

  • Inactivity of the pelvic floor
  • Pregnancy
  • Constipation
  • Heavy lifting
  • Chronic coughing
  • Ageing

 

What are the signs of a weak pelvic floor?

  • Accidentally leaking urine when you exercise, laugh, cough or sneeze
  • Not making it to the toilet in time
  • Difficulty controlling wind
  • Prolapse symptoms (this may be felt as bulging into the vagina, heaviness or discomfort, or a feeling of pulling, dragging or dropping down)
  • Lack of sexual sensation

 

What are the signs of a tight pelvic floor?

  • It is important to relax your pelvic floor muscles when they are not under load, they should not be held tight all day
  • You should not have any pain with sexual intercourse or vaginal examinations (this may indicate your pelvic floor is not relaxing)

 

What can happen when the pelvic floor muscles are weak?

Urinary Incontinence

Urinary incontinence or leakage can occur when the pelvic floor muscles are weak. The two most common types are stress incontinence and urge incontinence. Stress incontinence is the leaking of small amounts of urine during activities that increase pressure inside the abdomen and push down on the bladder (examples: coughing, laughing, and sneezing). Urge incontinence is a sudden and strong need to urinate that stops you making it to the toilet.

Prolapse

Feelings of heaviness or dragging are common after vaginal delivery and indicate your pelvic floor is still recovering. It is important to give your body lots of rest when these symptoms occur by lying down throughout the day.

 

When to start pelvic floor muscle exercises?

Begin your pelvic floor exercises within 24 hours after delivery even if you have stitches and/or swelling. The gentle muscle pumping action will improve the circulation and reduces the swelling which helps with healing. If you have a catheter in, then you should wait until your catheter has been removed to start pelvic floor exercises. 

 

How do you do pelvic floor muscle exercises?

  • Squeeze and lift the muscles around your back passage, vagina and front passage and then fully relax the muscles
  • Quick and short for strength and coordination:
    • Squeeze and lift as strong as possible
    • Aim is to perform 10 repetitions
  • Slow and sustained for endurance:
    • Squeeze and lift for as long as able
    • When you can feel a definite relax at the end of the hold then you should try to increase the hold time in each set by 1-2 seconds. Your aim is to eventually complete 10 repetitions of a 10sec hold.
  • Complete these exercises 3 times per day

Your women’s health physiotherapist will check your pelvic floor at your postnatal assessment with our real time ultrasound machine and provide a specific exercise program. A vaginal examination may be recommended by your women’s health physiotherapist.

 

 

 

bladder and bowel

Good Bladder Habits:

  • Drink at least 2L of fluid a day, ensuring your urine is a light straw colour (this is a sign of adequate hydration)
  • Caffeine, alcohol, soft drinks and artificially sweetened drinks should be minimal (only one third of your fluid intake) 
  • Go to the toilet when your bladder feels full, not “just in case”
  • Normal frequency for urinating is 4-8 times in 24 hours with a volume of 250-400ml during the day and 400-600ml at night

 

Good Bowel Habits:

  • Normal frequency is from 3 times a day, to once every 3 days
  • Never defer a bowel motion, if you feel the urge to go respond immediately or as soon as possible.
  • Do not strain to empty your bowel
  • Passing a stool should not be painful, it should be a well formed stool, a smooth and cohesive paste that is easy to pass
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Your women’s health physiotherapist will screen you for bladder and bowel problems at your postnatal assessment.

To review this information about pelvic floor muscle rehabilitation and good bladder and bowel habits, see the FitRight video
'Postnatal Rehabilitation - The First Six Weeks: 
https://www.fitright.physio/educational-online-videos/

 

Rectus Abdominis Diastasis 

What is it?

Rectus Abdominis Diastasis (RAD) is the stretching of the linea alba ligament causing the separation of the two rectus abdominis muscle bellies. It is a common condition that develops during pregnancy due to the growing baby.

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How do you look after you abdominal muscles?

Natural resolution of the RAD generally will occur in the first 8 weeks after delivery. To aid in the natural resolution it is advised to avoid over-using the abdominal muscles (sits ups, leg lowers, planks) and to avoid heavy lifting. If it is still present after 8 weeks, specific exercises are required to assist with resolution of your RAD.

Getting in and out of bed:

  • Roll onto your side and push up onto your elbow
  • Slowly lower your legs to the ground while pushing up on hand

Lower abdominal (transverse abdominis) contraction:

  • You can co-contract your transverse abdominis with your pelvic floor. Try to do your lower abdominal contractions when performing your pelvic floor exercises.
  • As you contract your pelvic floor, gently contract your lower abdomen as if you are trying to draw your hip bones together
  • Your upper abdominals should stay relaxed, with no rib movement

Your women’s health physiotherapist will check your RAD at your postnatal assessment, and can provide exercises to assist with resolution.

To learn more about RAD and how to perform and progress these deep abdominal muscle exercises, see the FitRight video
'Postnatal Rehabilitation - The First Six Weeks': 

https://www.fitright.physio/educational-online-videos/

 

caring for your body

The postnatal period is a time that can be challenging for the body, as it involves new movements (e.g. feeding, carrying lifting) that are repeated multiple times per day with the added weight of your baby. Most musculoskeletal issues do not go away by themselves and will need the correct assessment, diagnosis, and advice on management.

Common areas of postnatal pain that can be helped with physiotherapy:

  • Neck pain
  • Upper back, rib and shoulder pain
  • Lower back and hip/pelvis pain
  • Wrist pain

Before baby, such issues are easily managed as you are able to rest from most tasks for recovery. Postnatally, your baby needs you to take care of them, even if the tasks are those that are causing problems. That’s why it is important to have these issues managed as soon as possible.

Common tasks that contribute to postnatal pain:

  • Feeding (whether breast feeding or bottle feeding)
  • Carrying and settling baby
  • Lifting baby from capsules, car seats, prams, change tables, cots, and bassinets
  • Bathing baby

What can you do to prevent postnatal pain?

  • Good posture is the position that puts the least load on your body, not necessarily sitting or standing straight
  • When settling baby, a variety of movements and positions will help to distribute the load. This might include carrying, baby wearing, and bouncing on a fit ball
  • Ensure your back, feet, and arms are always supported during feeding. You should be able to relax and maintain good posture
  • When lifting, keep neutral spine, use your legs as much as possible, and keep baby as close to your body as you can

 Your women’s health physiotherapist can assess you for musculoskeletal problems at your postnatal check, and provide treatment, exercises, and advice.

 For video demonstrations of optimal feeding posture, lifting techniques, stretching ideas and more, see the video
'Postnatal Rehabilitation - The First Six Weeks':
 https://www.fitright.physio/educational-online-videos/

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Exercises for Spinal Mobility

Animal stretches on hands and knees: Hold each stretch for 20 seconds.

Cat – Arch your back so that your bottom tucks towards the floor, then come back to neutral

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