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Importance of postnatal exercises

Physiological changes during pregnancy can lead to a number of issues such as back pain, perineal pain, urinary incontinence etc. Over 40% of pregnant women experience urinary incontinence in their first pregnancy with half remaining incontinent at 8week of post partum and one third experience a new onset of incontinence after child birth. Regular exercise has numerous health benefits all of which apply equally to the new mother as at any stage of life. These benefits include,support with weight loss, increase acerbic fitness and psychological well-being. Exercises after delivery can also hasten recovery and assist with muscle strength and toning.



Main issues after child birth


Perineal pain

Perineum undergoes a lot of stretching and pressure during delivery. The intensity of pain coupled with recovery time and different on the method of delivery. It the vaginal delivery occurs without any tears, discomfort and pain might last for 3-5weeks. But the delivery occurs with episiotomy pain and discomfort might last for 6weeks nearly.


Stress urinary incontinence

Involuntary leakage of urine due to lack of strength and pelvis floor muscles. This can occur during post natal period due to pudental nerve damage, rupture of muscle fibers and connective tissues and over stretch of supportive ligaments. If pregnant women with early urinary incontinence, high BMI, forceps delivery or third or forth degree tear have high risk of getting pelvis floor muscle dysfunction.


Rectus Abdominis Diastasis

This is the partial or complete separation of Rectus abdominis muscle which meet at the midline of your stomach. It is very common during pregnancy due to uterus stretches the muscles in the abdomen to accommodate baby.

If the fetus delivered by Caesarian section delivery instead of vaginal delivery following complications can be occur.

  • Risk of pneumonia

  • Post surgical pain

  • Adhesion formation

  • Vascular complications

  • Faulty posture

  • Pelvic floor dysfunction

  • Abdominal weakness


Benefits and importance of exercise after child birth


  • Reduction of pain, swelling in perineal area

  • Reduction of muscle and joint pain

  • Promote pelvic floor muscle function

  • Improve bowel and bladder habits

  • Correct positioning for feeding and carrying baby

  • Correct Rectus Abdominis Diastasis

  • Restore muscle strength

  • Promote weight loss

  • Improve cardiovascular fitness

  • Improve behavior, relieve stress and help to prevent post partum depression


Contraindications for post natal exercises


  • Preterm Labour

  • Hypertensive disorders during pregnancy

  • Uncontrolled type I diabetes, Thyroid disorders or other serious cardiovascular / respiratory disorders

  • Ruptured perineal area

  • Anemia (Hb < 100g/L)


When to start post natal exercises


Gentle exercises can be started as soon as comfortable after delivery. 6 weeks after pregnancy, most of changes occur during pregnancy will have recovered to normal. But if Caesarian delivery or delivery with complications it may take much longer to feel ready to begin exercises. If the mother did not exercises during pregnancy, should start with easy exercises and slowly build up.


Post natal exercises

  • Abdominal exercises

  • Pelvic floor muscle exercises

  • Lumbo - pelvic stabilization exercises

  • Low impact aerobics

  • Brisk walking

  • Swimming

  • Aqua exercises

  • Yoga

  • Pilates

  • Cycling

  • Gentle resistance exercises


Exercises and activities to avoid

It is very important that a post partum women not do any abdominal exercise or activity until she has checked her Rectus abdminis muscles for Diastasis. If diastasis has been diagnosed here are guidelines to follow :


Avoid all exercise that place a stress on the midline, that stretch or expand the abdominal wall such as,


  • Upper body twisting

  • Arm on that side expands away from the body

  • Crunches

  • Oblique curls

  • Yoga postures that strech abdominal muscles (cow pose, up dog)

  • Quaruped exercise without adequate abdominal support

  • High impact exercises

  • Exercises that require rapid direction changes

  • Avoid heavy lifting and carrying objects

  • Avoid sitting straight up from bed


Breastfeeding and exercise

Do low or moderate impact exercises (avoid high impact exercises) because high impact exercises can cause lactic acid accumulation of breast milk. It can cause sour taste in breast milk.


Safety suggestions

  • Seek support of the partner or family

  • Wear appropriate garments and footwear that provide good support

  • Exercise should be include warm up period and cool down period at the end of exercise session

  • Maintain adequate hydration during exercise

  • Ensure proper body mechanics

  • Exercises should not hurt. If someone experience pain/other unexplained symptom stop exercise and consult physiotherapist



Yashoda Budhdhini



References


  • https://journals.lww.com/acsm-healthfitness/fulltext/2014/11000/postpartum_exercise.3.aspx

  • https://prophysiotherapy.co.uk/blog/postnatal-exercise-important/

  • https://www.slideshare.net/mobile/drjayeshpatidar/post-natal-exercises

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Good Article

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