BUMP + BEYOND : 5 COMMOM PRE & POST NATAL QS ANSWERED BY PHYSIO CHLOE DOVE
We feel so lucky to have Pelvic Health Physio Chloe Dove on the Bump and Beyond team to answer all your questions as you navigate through this new stage of life. Here Chloe answer some of those more commonly asked questions - from ‘how much should I be exercising during pregnancy?’ to ‘when can I start running again after birth?’ Make sure you check out the educational videos with Chloe on Bump + Beyond!
1 . Is exercising during pregnancy safe?
As long as you have an uncomplicated pregnancy and you have not been advised not to, then yes! The government advises at least 150 minutes of exercise a week during pregnancy.
Even if you haven’t exercised much prior to being pregnant or the amount you would normally exercise reduced due to feeling unwell in the first trimester, you can absolutely start exercising in a steady and safe way. Take things slow and gentle, for example start with gentle walking or swimming and build up to faster paced as you feel able. Do some gentle breathing and core exercises and build up following a strength training programme suitable for pregnancy. I would absolutely recommend seeing a specialist trained pre-natal fitness trainer and see a physiotherapist if you have any concerns with pain, vaginal heaviness or leaking.If you have always exercised to a high level and you feel well, then continue with what you are able to. As an example, Serena Williams won the Australian Open tennis tournament whilst 8 weeks pregnant. She obviously had a team of doctors and health professionals around her, but she continued to function at the level her body was used to. However, this isn’t to be taken lightly and to be expected for everyone!
Every pregnancy is an individual journey and you should always listen to your body and take specific advice where necessary.
In early pregnancy, your safety and the safety of the developing embryois paramount. In the early days relaxin surges in your body effecting not just the ligaments but the way your cardiovascular and respiratory system work, so you are more likely to feel dizzy and lightheaded and feel more breathless. Seek advice from your midwife or health professional if this is happening and tailor down the type of exercise you were doing. For example avoid exercises with your arms above your head, use body weight rather than weights and stop as soon as you feel any dizziness or lightheadedness.
The key message is, listen to your body, adapt and don’t bump the bump.
2. How often should I workout when I’m pregnant?
The government advice is 150 minutes of moderate intensity exercise a week including muscle strengthening activities twice a week. But depending on whether you are a first time mum or already have children at home, will depend on how you spend your time exercising. For example taking a toddler to the park or soft play for 1/2 hour will
absolutely count as moderate intensity exercise, a trip to the supermarket with a toddler lifting and carrying both your child and the shopping and manoeuvring a shopping trolley can also count as strength training. It is all about finding the balance for what works for you.
Staying fit and active during pregnancy is important, as you are helping to support your body adapt to the changes it is going through whilst pregnant. We often compensate for the growing bump by over arching our back and gripping with our bum and inner thighs. This can lead to pelvic girdle pain which 1/5 of pregnant women will encounter. By exercising to stay fit, stay strong and stay supple, you can support your body during pregnancy but also will aid your recovery postnatally.
So do what works for you, a good breakdown of exercise during the week would be walk/swim once or twice, a session of strength training, a yoga session, but also carrying on with your every day life. This is by no means prescriptive and should be adapted to suit your body and your interests.
As always, listen to your body, adapt where able and if you’re too tired to exercise, don’t push through it.
3. Is seeing a Women’s Health Physiotherapist really necessary after giving birth?
This is a good question. During the 9 months of pregnancy, your body has been changing and adapting to the growing baby, uterus, placenta and water, your muscles have been stretched, your posture would have changed and you wouldn’t have been breathing as deeply as before. When you give birth either vaginally or via caesarian, your tissues experience trauma and therefore need time and support to heal. By seeing a pelvic health physiotherapist from 6-8 weeks post natal, preferably one who has had training in post natal assessment, all the changes and adaptations your body has been through can be assessed and treated, to help the body recover quicker and more efficiently in the hope to prevent pelvic floor issues like urinary incontinence, prolapse and pain.
A Mummy MOT is a post natal assessment which specifically covers all of this. During the assessment I will look at your posture, your functional movements like bending, squatting, assess your balance, assess your back and hip movements and assess your pelvic position. I will also assess your breathing, feel your tummy muscles to assess for abdominal muscle separation and check your connection with your breath and your core. With your consent I will then carry out an internal
pelvic floor assessment. The purpose of this is to look and feel any scars and how they have healed, if they are tight and if they are causing pain. I will then assess how your pelvic floor reacts with your breath, feel the tone of the muscles and check your pelvic floor contraction technique. From this I advise on the direction of treatment, whether it is strengthening or relaxing the pelvic floor and together we will come up with an exercise plan to suit your needs and your goals, whether that is to comfortably be able to baby wear or to return to Hiit training or weight lifting.
4. Do I need a physio assessment after caesarian birth?
Another good question. Even though your vaginal tissues haven’t experienced trauma through delivery, they have still had to work to support your growing baby, uterus, placenta and waters during pregnancy and your body will still have adapted and changed during pregnancy. Your vaginal tissues may not have undergone the trauma of
a vaginal delivery, but your abdominal muscles have experienced trauma and need treatment to ensure healing and recovery is as optimal as possible. Someone who has had a caesarian section is still at risk of pelvic floor disorders such as leaking, pain and prolapse. The main goals of treatment following caesarian is both emotional support, especially if it was a traumatic or emergency caesarian but also scar treatment. The incision for the caesarian has to go through 9 layers or tissue, which will create scar tissue and may create tethering, tightness and pain either at the site of the scar or just above or just below. This is why having a Mummy MOT after a caesarian is equally as important as after a vaginal delivery.
5. After having a baby, when should I start exercising again?
With regards your pelvic floor, as soon as you have had the first wee after delivery and as long as there are no complications or you have been advised not to, you can start pelvic floor exercises straight away. It is really important to regain connection with your breath and your pelvic floor after birth. This doesn’t mean go fully at it squeezing your pelvic floor as much as possible, it just means thinking about the connection to your pelvic floor, working with your breath to always lift the pelvic floor with the out breath and fully relax in-between contractions.
As you regain connection and strength, you can try and hold the contraction for a few breaths until you feel comfortable to hold for 10 seconds. This can take up to 12 weeks of practice so it isn’t a quick fix and slow and steady is the way to go with your recovery. It is really important in the early days to listen to your body, don’t push yourself to exhaustion and have a good diet and fluid intake to support tissue healing. This is why a lot of the early exercises are about breath and connection to set the foundations of your core and allow for progression of exercise. When thinking about exercising further, 3 brilliant physios Emma Brockwell, Grainne Donnely and Tom Goom wrote the post natal return to running guidelines and created this infographic.
It highlights examples of exercises to follow to train to return to running and advises not to return to running until 12 weeks post natal and as long as you are able to exercise without pain, vaginal heaviness or urinary or faecal leaking.