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
Good Article