i. Pelvic floor muscle exercises (PFMEs)
Circumstances allowing, you can start pelvic floor muscle exercises (PFMEs) immediately after the birth. If you’ve had an instrumental or operative delivery, you may not be able to feel the muscles contracting this early on. Don’t panic, the sensation should increase over time, so regardless of your mode of delivery, try to do a few gentle squeezes as soon as you can.
Continue daily (PFMEs), gradually increasing the repetitions and duration of holds. You are aiming for 10 long squeezes (of at least 8 seconds duration) and 10 quick squeezes, 3 times a day.
As important as the pelvic floor muscle contraction, is the relaxation of the muscle group. Between each long squeeze, make sure you have fully relaxed before starting the next. Try them lying down, sitting and eventually in standing.
For guidance, have a look at the following resources:
1. Squeezy NHS Pelvic Floor App https://apps.apple.com/gb/app/squeezy-nhs-pelvic-floor-app/id700740791
2. Chartered Society of Physiotherapists (CSP) https://www.csp.org.uk/system/files/personal_training_for_your_pelvic_floor.pdf
3. Oxford University Hospitals NHS Trust – A guide to pelvic floor Oxford University Hospitals NHS Trust “A guide to the pelvic floor muscles – women” https://www.ouh.nhs.uk/patient-guide/leaflets/files/5651Ppelvicfloorwomenpdf.pdf
4. Information from The British Association of Urological Surgeons (BAUS) about pelvic floor exercises: https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Pelvic%20floor%20XS%20female.pdf
ii. Mobility exercises
Once you feel ready and recovered enough to start some gentle stretches, these can be helpful in temporarily relieving any muscular aches and pains sustained from prolonged sitting and feeding, and are also a good way of checking in with your new postpartum body and getting used to movement once again. Don’t overdo it; think gentle and slow movement of the spine, shoulders and lower legs. It’s less about flexibility, more about mobility.
Examples of mobility exercises:
Standing spinal roll-downs
Standing thoracic twists
Cat-cows on all fours
For guidance, have a look at the following resources:
- Ready Steady Mums https://readysteadymums.org/our-exercise-programme/core-postnatal-exercise/#core_two
iii. Exercises for core and pelvic stability:
You can also start some very gentle core and pelvic stability work (e.g. pelvic tilting lying flat with knees up), whilst avoiding increasing the pressure on the front of the abdominal wall.
*** TIP! When getting out of bed, or off the floor if you’ve been lying on your back, roll yourself onto your side and push yourself up with your arms, before either bringing your legs over the edge of the bed, or kneeling to stand up. This reduces the pressure on the front of the abdominal wall, preventing “doming” or “coning” through any tummy gap, whilst also reducing outward pressure on a C-section scar, or downward pressure on the pelvic floor.***
Examples of exercises for core and pelvic stability:
Standing, and, four-point-kneeling pelvic-tilts
Diaphragmatic breath work, pulling belly gently towards spine (standing or lying down with knees up, feet on floor)
Knee “fall-outs” lying down with knees up (feet on floor)
For guidance, have a look at the following resources:
- Ready Steady Mums https://readysteadymums.org/our-exercise-programme/core-postnatal-exercise/#core_one
iv. Aerobic activity:
Think about also beginning to increase the distance you are able to walk, or the number of steps you take a day. Any time spent being less sedentary is beneficial, but balance this against your stage of recovery and levels of fatigue. Be mindful of any back, abdominal or pelvic pain; lochia, or vaginal heaviness, incontinence or frank prolapse. If you experience any of these symptoms during or after activity, scale back on the distance, speed and time spent doing them next time. If your symptoms don’t improve, please seek medical advice, but in most cases, they should start to improve day-upon-day in these early weeks.