Sorting out postnatal problems: from pelvic floor to tummy

As a West London-based personal trainer and pre-/postnatal specialist, I have trained many mums with varying postnatal issues. Each pregnancy, delivery and recovery is unique and the education I’ve been provided by my clients over the last couple of years has been as beneficial to me as the safe and effective training sessions I’ve provided for them.

Having a baby is a life-changing experience, where suddenly this little person becomes the priority in your world, and mum comes second. With all the added responsibilities that come with becoming a mum, it can be a daunting process trying to get your own life back on track.

When it comes to training, it’s important to me to help you find what type of exercise you enjoy whilst addressing any physical issues you may be experiencing (whether that be existing, or developed during your pregnancy or after birth). Every exercise is chosen with your needs in mind so that you get the results you are after. But remember—if it takes nine months to grow a baby, then the body needs up to a year post-birth to really allow it to heal fully whilst ensuring you are strengthening your body to function optimally, feeling good inside and out.

Physical recovery post-delivery is varied depending on your labour and birth type so the exercise you do needs to reflect your personal needs and goals. Below I highlight the most common issues my clients face post-birth, and what you can do to help resolve these.

Caesarean-Section Recovery

There are different reasons for having a c-section and this will form part of your own personal birth story. Sometimes it’s not important why but rather how you can start the healing process now that your body has gone through this major surgery. Everyone heals at different rates so listen to your body and respect its limits.

Ask for help. In the early stages, everyday tasks may feel impossible. Start with gentle movement that you can do in bed such as leg slides, ankle circles and deep breathing or meditation. Build up your walking slowly to encourage blood supply but rest when you feel any discomfort. As the days and weeks go by you will find that your strength starts to increase and you can move more freely.

Nutrition is key to aid recovery. After trauma, the body needs extra calories, protein, vitamin A, Bs, C, E, zinc and iron to support recovery. The body uses protein to heal wounds, so if you aren’t eating enough it will break down body tissues to access the amino acids it requires. Fats are important to make up the membranes of new cells. They also provide energy. Carbohydrates such as vegetables and whole grains provide energy in the form of glucose for the cell-building and wound-healing processes. Keeping your fluid and fibre intake high (e.g., with fruit and vegetables) will also help to soften stools and avoid constipation.

Once you have had the all-clear from your GP, you may feel unsure of what you should or shouldn’t do when returning to exercise. For c-section the recovery period is 12 weeks before you begin exercising again (6 weeks for a natural birth), and even at this stage it’s important to build things up gradually to ensure the incision continues to heal well, internally and externally. If the intensity is too high, the force caused to the abdomen area may cause pain and discomfort. Initially it’s all about reconnecting with your body and switching muscles back on using safe and effective exercises to enable you to handle everyday tasks. As your body progresses so will the exercises, increasing strength and mobility.

Abdominal Separation

In order to allow room for a growing baby the abdominal muscles need to stretch and expand. Diastasis recti is where the rectus abdominus, often known as the ‘six pack’ muscles, come apart as the linea alba (soft connective tissue that keeps these muscles together) relaxes to facilitate this process. This will happen to varying degrees in every pregnancy.

Once the baby is born these muscles are often felt and you may notice a gap. Many women feel that they need to close this gap in order to get their tummy muscles back to how they were before. However, more emphasis should be placed on strengthening the connective tissue and other abdominal muscles, including the core and pelvic floor, that will help restore both function and in most cases appearance.

The restoration phase is different for every woman, and there is no definitive time whereby your abdominals will have healed, but with the right exercises, over time you should feel improvement to the strength of the abdominal muscles. I often hear from my clients that GPs do not provide a diastasis recti check as part of the post-birth check-up, which is where a postnatal personal trainer or a women’s health physiotherapist can be beneficial.

Pelvic Floor Function

Whether you’ve had a natural delivery or a caesarean, during pregnancy the pelvic floor would have been placed under additional pressure that can cause a degree of weakness. If you endured a tough labour, a forceps delivery, an episiotomy or a tear, regaining pelvic-floor function will be key to living a life full of pee-free laughs and sneezes!

When we breathe, our pelvic floor naturally pushes down on an inhale and lifts on an exhale. If you were to focus on your breathing and emphasise your out-breath, you would feel a greater awareness of the pelvic floor lifting and contracting. Do this focused breathing a few times a day as soon as you’ve had your baby. Be sure to allow your pelvic floor to relax as well as contract to ensure the muscles take full advantage of contracting and de-contracting.

If at your six-week check you don’t feel like the pelvic floor is functioning as it should, ask for a referral to a women’s health physiotherapist (NHS or private if you can afford it). They can give you a detailed assessment of your pelvic floor and provide you with some exercises.

Once you are ready for exercise, ensure you are keeping impact to a minimum. If you could imagine your pelvic floor like a trampoline and a few springs were loose, you wouldn’t want anyone jumping on it. So launching into running or other intensive cardiovascular work is a no-no! Start with exercise that allows you to engage your pelvic floor, such as performing a lunge or a squat and add some resistance using bands to increase the pelvic floor and core activation. Use your breath to create a deeper core reaction by emphasising the exhale on effort.

Next week I’ll talk about the healthy way to lose the pregnancy weight, including some exercises time-pressed mums can do at home.

Yasmine Say
Yasmine Say is a West London-based personal trainer with a background in design, branding and sports marketing, most notably for the London 2012 Games. Her aim is to help change lifestyle habits, as opposed to just seeking the quick fixes, and each of her fitness plans are developed and tailored to each client with the long-term view in mind. She believes we all have a right to fitness and without question it can improve our health, our confidence and our well-being. Her website is at sayfitnesspt.com.

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