pregnancy 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 improved readiness for birth, weight management, reduced risk of gestational diabetes (where your blood sugar levels are too high) and preeclampsia (high blood pressure, fluid retention), less back and pelvic pain, improved heart and lung health as well as improved mental wellbeing which includes a lower risk of postnatal depression.

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?

Body changes after pregnancy are inevitable and necessary. Rather than rushing to return to a certain shape or size, instead it is important to focus on recovery and optimising function. During the initial weeks 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. Sufficient rest (especially lying down rest) allows the body to have the opportunity to recover and build the necessary strength for these tasks. Rushing into too much activity too soon can sometimes hinder recovery. Be guided by how you feel and what your energy levels allow. If you are unsure, reach out to your local Women’s health physiotherapist for tailored guidance. 

During the first six weeks after birth, walking is a great exercise to start with along with gentle core and pelvic floor muscle activation exercises. After this, 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. The Pelvic Floor First website is a great resource for safe exercise during and after pregnancy. 

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

The body undergoes many changes during pregnancy and birth. Physiotherapists are best placed to support recovery for every new mother. However, there are certain symptoms that should not be ignored and seeing a Women’s health physiotherapist is even more important. These symptoms include:

• leaking urine, wind or faeces
• problems with emptying your bladder or bowels
• feelings of heaviness or a lump down in your vagina
• pain when you start to have sex again
• 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, advise proper treatment and refer you back to your doctor if necessary.

--How can physiotherapy help me during pregnancy?

Physiotherapists can help you navigate the rapid and unique changes associated with pregnancy. They can guide you with appropriate exercise advice and manage conditions often seen in pregnant people such as:

• pelvic floor dysfunction
  - leaking urine, wind or faeces
  - problems with emptying your bladder or bowels
  - feelings of discomfort, heaviness or a lump down in your vagina
• muscle and joint aches and pains to areas such as
  - low back, hips and pelvis
  - mid back and ribs
  - hands, wrists and forearms
  - neck

Following thorough assessment and diagnosis, depending on your condition, treatment 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 pelvic floor 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?

It is recommended to avoid exercising flat on your back after 16-20 weeks of pregnancy. Gentle stretches can feel nice and help you breathe easier. You can also 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.