After birth - advice from a physiotherapist

Our physiotherapist shares her best postpartum tips and advice:

Pelvic floor exercises—Kegel exercises

Pelvic floor muscles soften during pregnancy and stretch out during childbirth. Your best chance of finding these muscles is to start doing your Kegel exercises immediately after childbirth.

Pelvic floor exercises are important even for women who have had a cesarean section.

How to do your exercises

Lie on your back with your knees bent and slightly apart, or lie on your side. Place one hand on your stomach and ensure that your abdominal muscles are relaxed. Try to also relax your back, buttocks and legs.

Clench the muscles around the rectum. Continue clenching around the vagina and the urethra, as if you needed to urinate but cannot. Imagine closing a zipper from the back and forward. Lift up the entire section of your pelvic floor. It should feel like you are pulling something up toward your navel.

Use just a little force when you clench, hold for 2 seconds, rest for 2 seconds. Continue this rhythmic clenching as long as you can, ideally 5 to 10 clenches twice or three times a day. Concentrate so that you locate the right muscles. You can check that you are using the correct muscles by inserting a finger into your vagina and clenching the muscles around your finger.

Once you have located the right muscles, you can start to strengthen the muscles by clenching hard and holding for 5 to 6 seconds. Relax for 5 or 6 seconds. Remember not to hold your breath. Repeat this “max clench” twice or three times to start, adding on as you get stronger—though no more than 10 times in a row, twice or three times daily.

To practice endurance, clench using half your muscle strength and hold for as long as you can. Aim for two minutes, at least once a day. You can practice clenching while sitting and standing. Make the most of any opportunities that present themselves during the day.

Remember to clench your pelvic floor muscles when you sneeze, cough, lift, jump or exercise your abdominal muscles. In other words, every time pressure in your abdomen increases.

Why are pelvic floor muscle exercises important?

Well, they can improve your sex life and prevent the risk of urine leakage and vaginal prolapse. That is why it is important to regularly practice your pelvic floor exercises your entire life. Check your clenching ability when you go for a checkup at the maternity clinic. It’s also good to check your clenching ability at future gynecologist appointments. After a pregnancy, your pelvic floor muscles have been stretched out. While they have enormous recovery capacity, they need help to regain their original elasticity. As we age, our muscles become less elastic, which is why a life-long practice of Kegel exercises is important, even if you have no problems today.

Pelvic floor muscles, from the bottom

Pelvic floor muscles, from the side

Breastfeeding ergonomics

Consider what position you are sitting or lying in when you breastfeed so that you do not tire your back and shoulders. If you have had a cesarean section, remember to protect the wound.

When you are lying on your side or back

Place a pillow under your neck and between your knees.

When you are sitting

Support your back. Make sure you have proper support under your arm, ideally a cushion. Support your feet too so you are not dangling your legs.

Regardless of what position you decide to breastfeed in, sit comfortably so you are as relaxed as possible. This will both prevent pain and make it easier for your milk to flow.

Exercises to prevent tired neck and shoulders

Pull your shoulders up toward your ears, hold and release.
Pull your shoulder blades together, hold and release.
Think about your posture. Stand up straight.

Avoid heavy lifting and carrying heavy objects the first six weeks.

When you have to lift something, place your feet slightly apart with one foot in front of the other. Remember to keep your back straight. Hold the object close to your body. Clench when you lift.

Practice good posture

Stand with your back against the wall and your feet a little bit in front of you.
Bend your knees and press the small of your back against the wall and suck in your tummy.
Hold, then relax. Suck in your tummy, squeeze your buttocks and clench. Try to maintain this posture when you walk.

Advice for pelvic floor problems

It takes about 6–12 weeks before the hormone relaxin leaves the body. During that time, you would be wise to follow this advice. It is important to rest your back! The best resting position for you is to lie on your side with a pillow between your legs so that your hip, knee and foot are at the same height.

Remember

Take small steps. Do not walk with your legs apart or too fast, and avoid longer walks.
Stand with your weight evenly distributed on both legs. Do not hang on one hip.
Avoid stairs and steep inclines. It is easier to walk downhill if you walk backwards.
Avoid sitting with one leg over the other.
Do not balance on one leg when you undress. Sit down or lean against a wall.
Wear low-heeled shoes.
Avoid lifting and carrying heavy objects.
Keep your thighs parallel as much as possible.

In the maternity ward/birth center

Get out of bed as often as you can and take short walks. Ask for pain medication if you are in a lot of pain. It is better to get out of bed and on your feet than to lie in bed in pain. At least once a day, lie flat in the bed with your hands behind your neck for about 15 minutes.

Think about your posture. Stand up straight, even if you have had a cesarean section.

At-home exercise

If everything looks good at your checkup with your midwife or physician, then you can start doing light exercise that is suitable for new mothers about 6–8 weeks after childbirth. Such exercises include biking, core exercises for new mothers, longer walks and mommy-baby exercises. You should wait three months after childbirth before you do heavier weightlifting, jogging, horseback riding and so on.

Advice and exercise for new mothers

Here are a few easy exercises to start. Go slow. Listen to your body and obey it! None of these exercises should hurt!

1. Lie with your legs straight

Pedal your feet back and forth as much as possible. This will prevent cramping in your calves, swelling and blood clots.

2. Lie with your knees bent

Press down the small of your back. Clench! (This is sufficient for mothers who have had a cesarean section the first six weeks.)

If it feels Ok—clench and lift your head and arms while exhaling. Your shoulder blades should lift off the surface. Do this exercise up and down and to your sides. You can increase the intensity level after a few weeks by crossing your arms across your chest or placing your hands behind your neck.