TPS' Recovery Guide for the First 6 Weeks Postpartum
Our top 5 tips to optimise your postnatal recovery
from a pelvic floor physio
The weeks and months after your delivery are an important emotional and physical transition time. Although no postnatal body is the same and postnatal recoveries vary, The Pelvic Studio has created a general guide designed to bridge the gap between the delivery of your baby and your 6 week postnatal check with your antenatal team and pelvic floor physiotherapist.
This guide includes 5 important tips to optimise your postnatal recovery! Please note these tips are general in nature and do not supersede the advice you receive from your antenatal team or pelvic floor physiotherapist at your 6 week postnatal assessments. If you are having any issues or concerns, please do not hesitate to reach out to our team, there's plenty of tailored advice we can offer in the early days to help support your recovery!
Tip 1 - Regular Rest Lying Down
Horizontal rest (lying down) is GOLDEN during the first 6 weeks after delivery, especially in the first 3 days. Horizontal rest helps to bring cortisol levels down, reduce vulval swelling and encourage healing. Horizontal rest also reduces the impact of gravity on the pelvic floor giving the muscles time to rest and recover. We recommend 10-45 minutes of lying down a few times a day during awake times. Intersperse your horizontal rest with gentle activity such as walking around your room/home. Gentle activity is important too, as it reduces DVT risk and assists with muscular recovery. So, it's a bit of yin-yang, i.e. balancing rest with gentle movement for optimal recovery. A great way to fit in enough horizontal rest is to breastfeed lying on your side. Here is a guide on how to breastfeed in side-lying.
Happy Bowels
Some people feel nervous about opening their bowels after delivery. Constipation postpartum is extremely common, especially if you are taking pain medication. Avoiding constipation and straining is the best thing you can do for your pelvic floor recovery. Good bowel habits also keep your parasympathetic (rest and digest) nervous system happy, which has been shown to reduce the chance of postnatal depression (Musser et al, 2012).
Here are some tips for happy bowels after delivery.
· Don’t delay the urge – if you feel the urge to use your bowels, act on it immediately! Try not to delay the need to go
· If you feel nervous or sore, place some toilet paper around your hand and place a gentle upward pressure on your perineum, then lean forward and relax your pelvic floor
· Use good pooing posture – you bet we have a blog on how to poo!
· Happy bowels require adequate hydration (1.5-2L per day, more if breastfeeding)
· Eat plenty of fibre (fruits, vegetables, whole grains)
· Speak with your midwife, doctor or pharmacist about stool softeners
Support Garments
Support to your back and pelvis via compression garments can feel so good in the early stages of your recovery! Garments can increase your overall comfort levels, reduce aches and pains, enhance abdominal wall and pelvic floor recovery, support a swollen perineum, improve posture and stability, and reduce muscular fatigue. The Pelvic Studio have various compression garments options, including the SRC Recovery range, Tubigrip and Belly Bands.
Compression garments should be firm, but comfortable. They should not cause any pain or restrict movement or breathing. Our friendly team can talk you through the options to find the best fit for you!
Tip 4 - Gradual Return to Activity including Abdominal Wall & Pelvic Floor Exercises
After delivery it’s important to start gradually when you return to physical activity in the first six weeks. Giving your body enough time to fully recover will benefit you for years to come!
Check in with your body as you start to return to exercise, look out for any signs or symptoms that might be a sign that you are over-doing it. Very mild discomfort in your muscles and joints (<3/10) which settles quickly, with no pain lasting into the next day, is usually okay when getting back into exercise.
If you experience the following during or after exercise, you may need to reduce, modify or stop exercise and come in to see your pelvic health physiotherapist:
Bladder/bowel leakage
Bladder/bowel urgency that you can’t defer
Pelvic heaviness/pressure/bulge/dragging
Abdominal doming/excessive abdominal separation
Back or pelvic pain
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Every postnatal body is different, but here are some ideas for those first six weeks:
Gentle Mobility Work:
Gentle mobility exercises are a great way to reconnect with your body and can act as natural pain relief. See our chest and upper back mobility series for some stretches to get your body moving.
Walking:
Take short, gentle, regular walks as tolerated. Monitor for vaginal heaviness and dragging, or leakage. If you notice symptoms, reduce your activity, and get more horizontal rest.
Gentle walking is often enough soon after birth. High impact activity like running or jumping is generally not recommended until at least 12 weeks after birth and after a return to running check with your pelvic floor physiotherapist.
Pelvic Floor Exercises:
Your pelvic floor exercises will likely feel different after birth, this is normal, and as swelling reduces it will likely improve.
You can start gentle pelvic floor exercises 1-3 days after birth. Use our pelvic floor audios as a guide.
Lay on your back, gently squeeze pelvic floor muscles to 30-50% effort and hold for 1-3 seconds. Relax completely. Repeat 5-10 times. Practice 3 times daily.
Over the first few weeks, gradually increase the strength, endurance and speed of your contractions and build up the number of repetitions and sets you are doing. Remember to take your pelvic floor exercises at your own pace but here is a general guide:
Week 1: Squeeze and lift pelvic floor muscles gentle (about 30-50% effort), hold this contraction for 1 sec, then relax muscles, rest for 3 secs, repeat 5-10 times, 3 times a day
Week 2: 50-60% effort, hold 2 seconds, then relax, rest for 3 seconds, repeat 5-10 times, 3 times a day
Week 3: 50-60% effort, hold 3 seconds, then relax, rest for 3 seconds, repeat 5-10 times, 1-3 sets, 3 times a day.
Week 4: 50-60% effort, hold 4 seconds, then relax, rest for 4 seconds, repeat 5-10 times, 1-3 sets, 3 times a day
Week 5: 50-60% effort, hold 5 seconds, then relax, rest for 5 seconds, repeat 5-10 times, 3 times a day
Week 6: 50-60% effort, hold 6 seconds, then relax, rest for 6 seconds, repeat 5-10 times, 3 times a day
Diaphragmatic Breathing
Place your hands on your outer ribcage and take slow deep breaths into your hands, feeling your ribs flare outwards stretching your bra's waistband
Deep Abdominal Core Exercises:
Lay on your back with knees bent and feet on the floor. Breath in, then as you breath out, gently engage your deep core by pulling your lower belly in towards your spine (or draw the hip bones together), hold for 5 seconds and breath normally. Repeat 5 times, relaxing completely your lower tummy between each repetition. Gradually build up to 10 second holds and 10 repetitions, practicing 1-3 times a day.
Use this same deep core engagement just prior to moving/changing positions. Our core muscles usually turn on naturally without us knowing, just before as we move our bodies. However, this natural reflex in our deep core is often absent or delayed in the early postpartum period. Practicing consciously engaging these muscles helps your body relearn this automatic reflexive response.
When able combine your deep core exercises with pelvic tilts (see instructions below).
Pelvic Tilts
Pelvic rocking - lay on your back with knees bent and feet on the floor. Breath in, then as you breath out engage deep core and gently tilt your pelvis under, drawing your pubic bone up and in towards your belly button, subsequently tucking your tailbone between your legs, then tilt back the other way, gently arching your back away from the floor. Repeat 10 times, 3 sets.
Tip 5 - See your pelvic floor physiotherapist for your 6-week postnatal check
During the first months after delivery, medical check-ups are often focused on your bub. While we love to hold your new baby, our main focus is to hold you! In other words, we are here to guide and support you through your postnatal recovery and getting you back to the things you love doing.
Research shows that pelvic floor muscle training taught by a pelvic floor physiotherapist significantly reduces the risk of incontinence and pelvic organ prolapse. However, considering every postnatal body and pelvic floor is different it's important you get an individualised assessment. The physiotherapists at The Pelvic Studio are highly trained in performing pelvic and whole body postnatal assessments, and providing tailored exercises and advice. This includes how and when to return to general activity, exercise and high impact training/running/sports.
After the birth of your bub be gentle and kind to yourself both physically and mentally, don't rush your recovery and do things that feel GOOD for both your mind and body.
FAQ:
What to expect at my 6-week postnatal check with a pelvic floor physiotherapist?
Pelvic floor physiotherapists are experts on muscles as well as how to care for your bladder, bowel and pelvic organs postnatally.
We will ask plenty of questions about your bladder, bowel, sexual health, and any other concerns you may be having postnatally.
We also provide a holistic assessment of your postnatal body including:
Pelvic Floor Assessment:
An internal vaginal examination is the best way for your physiotherapist to check for muscle strength, endurance, co-ordination and to check for prolapse or muscle injury. But we can also use ultrasound to assess the pelvic floor if you prefer.
Deep Core Assessment:
Your physiotherapist will check your tummy for signs of diastasis rectus abdominus or DRAM (separation and doming of the abdominal muscles) and the deep core muscles will be checked.
Whole Body Assessment:
Your physiotherapist will look at your posture, the way you move, your pattern of breathing, your strength and stability, particularly around your back/hips/pelvis, and any hand or wrist problems you may be having.
After your assessment, we can provide you with a deep understanding of your body, including how your pelvic floor and abdominal wall are working and provide you with a tailored return to exercise program.
Can a pelvic floor physiotherapist provide advice before my 6-week postnatal check?
To give your tissues time to heal, an internal vaginal examination is not recommended until 6-weeks after a vaginal birth.
However, if you have any concerns such as bladder or bowel issues, prolapse symptoms, mastitis or pain, your pelvic physiotherapist can see you sooner!
What is the difference between a 6-week check with my doctor and pelvic floor physiotherapist?
Your doctor is looking for any medical problems and will check on healing, infection, bleeding, contraception, weight and blood pressure.
Your physiotherapist is looking at pelvic floor and abdominal function and giving you advice on movement and physical activity.
Both these appointments are important for your postnatal recovery, and your physio will work closely with your antenatal team to optimise your care. Everyone has a role, think of us as your postpartum team!
Had a Caesarean Section? We have a more specific blog on c-section recovery too: https://www.thepelvicstudio.com/blog/preandpostcsection