Pre and post natal

--What are some common changes I can expect to happen to my body when I am pregnant?

As the baby grows inside your tummy, your hormones, posture and balance change and 50 per cent of women experience low back pain. As the baby grows and gets heavier, the pressure inside your tummy and down onto your pelvic floor increases. This pressure means your pelvic floor muscles need to stay strong to support the weight from above. Up to 67 per cent of women will leak urine (incontinence) when they laugh, sneeze, cough or exercise during pregnancy but those with stronger pelvic floor muscles are less likely to leak during pregnancy and after the baby is born.

By the third trimester 66-100 per cent of women will experience widening of their abdominal muscles, noticing a gap down the centre of their tummy when they do things like get up from lying down. This widening is normal to make room for the growing baby and usually goes away 8 weeks after the baby is born.

--How can I prepare for my pregnancy?

One of the best ways to prepare for pregnancy, physically and mentally, is to become or remain physically active and healthy prior to, during and after pregnancy. The benefits of regular physical activity are weight management, reduced risk of gestational diabetes (where your blood sugar levels are too high) and preeclampsia (high blood pressure, fluid retention), heart and lung health and mental wellbeing.

Women with uncomplicated pregnancies are advised to do aerobic as well as strength training exercises, working towards 20-30 minutes per day, most days of the week at moderate intensities (you should still be able to talk while you exercise).

--What can I do after I give birth to get back into shape quickly?

The effect of the pregnancy and birth on the structures that support the pelvic organs including the pelvic floor and abdominal muscles, will determine how soon you can get back to activities. In the first month after having your baby, your body is recovering and working out how to be strong just for normal daily tasks such as getting up from a chair, picking up the baby, having a shower and feeding your baby. Usually by 6 weeks you should be feeling stronger, but be aware that you still have a couple more months of recovery.

Walking is a great exercise to start with but be sure to also rest, even 5-10 minutes lying on your side a few times during the day. You may be able to start light exercises, however these are best done with guidance from your physiotherapist trained in this area. Allow your body to gradually get stronger and hold off on high impact activities such as running and sport for at least 3-6 months. Take time to read the pelvic floor first guidelines for safe exercise after birth www.pelvicfloorfirst.org.au

--What complications can arise during pregnancy?

Discussing common complications in pregnancy can be scary but it is important to be aware. Problems such as gestational diabetes and putting on too much weight can lead to serious issues if not addressed. These could include early and complicated delivery due to a larger baby and high blood pressure. It’s important to speak with your midwife, GP or obstetrician if you have any health concerns. Following a healthy lifestyle with proper nutrition and exercise can help to prevent or control other issues such as tiredness, nausea, vomiting, depression, gaining too much weight and constipation. If something doesn’t feel right, speak to your doctor.

--How do I know if I need physiotherapy or other medical attention after pregnancy?

Many bodily functions and activities can feel strange in the first month after having a baby, but they should start to improve within the first 4-8 weeks. If you worsen in that time, or are still having, or start to have, any of the following issues such as: leaking urine, wind or faeces, problems with emptying your bladder or bowels, feelings of heaviness or a lump down in your vagina, pain that doesn’t go away when you start to have sex again, or other aches and pains elsewhere in the body like your hands, neck or back, a physiotherapist trained in this area will be able to diagnose the problem. They can advise proper treatment and refer you back to your doctor if necessary.

--How can physiotherapy help me during pregnancy?

Common muscle and joint aches and pains in pregnancy, such as pain in the low back, hips, pelvis, hands, and neck can be relieved by physiotherapy treatments. These may include:

• educating you on what is wrong and why
• advice on your posture
• assessment and exercises to help strengthen and coordinate your abdominal and pelvic floor muscles
• using certain belts or compression pants
• treatment  such as massage or ultrasound
• advice on using heat and ice
• activities and positions you should avoid to help decrease your pain.

--How can physiotherapy help me after having a baby?

After having a baby, there are a variety of other issues you may be suffering from. Physiotherapists can help by:

• giving you a thorough assessment on your abdominal and pelvic floor changes that have occurred as a result of pregnancy, labour and delivery
• examining your bladder or bowel issues
• educating you about your problem and what treatment will be best to help you
• giving you exercises to improve posture, pelvic floor muscle function and coordination, and helping you return safely back to your sport or favourite exercise
• giving you breastfeeding support and treatment for mastitis and blocked ducts
• supplying supportive braces or devices

--How effective is physiotherapy for my recovery pre and post childbirth?

Research shows that pregnant women doing an intensive, supervised pelvic floor muscle exercise program were 56 per cent less likely to leak urine in pregnancy and 30 per cent less likely to leak up to 6 months after giving birth. More importantly, up to 10 per cent of women after having babies will leak faeces. Women who did pelvic floor exercises were half as likely to report this.

--What can I do at home during pregnancy?

Gentle stretches can feel nice and help you breathe easier. Try the following:

• Spinal twist – lying on your side with legs slightly bent and both arms reaching out in front of you, slowly take a big breath in while you reach the top arm behind you. Make sure to follow with your head and chest. You can hold it there and take another breath, or slowly breathe out and return back to the start. Try 5 times on each side.
• Cat/Cow – on your hands and knees, slowly take a breath in, allow your tummy to drop towards the ground and lift your chest upwards while you stick your bottom out. As you breathe out, tuck your bottom under, round out your lower back towards the sky and drop your head. Try 5-10.
• Pelvic floor muscle contraction and relaxation – in any position you are comfortable, imagine slowly trying to hold onto wee and wind (squeezing and lifting the pelvic floor muscles below) then slowly relax them (as if you are dropping and allowing opening from your vagina). Be aware of the sensation of both contracting and relaxing. Try changing how you breathe by breathing in to relax, then breathing out to contract. Or holding a gentle contraction for 3-5 seconds before relaxing. Try 5-10 of those.
• The knack – get into the habit of quickly squeezing and lifting your pelvic floor muscles before you blow your nose, cough, sneeze, lift a toddler up, get up from a chair.

--What can I do at home after childbirth?

The pelvic floor and knack activities in pregnancy above are safe to do at home after having a baby as long as you feel okay. Be very aware of how you are standing, sitting and holding your baby.

• Use props and pillows in sitting to take the weight of the baby so you don’t have to hold them to you whilst feeding. This also gives your neck a break.
• Try to keep more weight towards your heels in standing so your hips are not held in front of you trying to support the baby

Take frequent rest breaks lying on your side, even if it’s for 5 minutes.