Recovery after Childbirth
Pregnancy and childbirth (by whichever means) take a gruelling toll on the body and far too often, physical recovery after birth if not a high priority for women.
Your whole world is revolving around your new baby’s every need and all of the visitors - however, you need to stop and take care of yourself.
Physical Recovery after Childbirth: RICE
‘RICE’ injury principles are often applied in the context of sporting injuries, but they are equally as applicable for soft tissue healing after childbirth. This is a relevant injury principle to follow after vaginal tearing, episiotomy or c-section incisions/scars.
REST
Give your pelvic floor muscles and abdominals some time to rest and restore without gravity
Spend at least 1-2 hours per day lying horizontally
ICE
Particularly after a vaginal delivery, ice had an anti-inflammatory effect and can be used on the perineum
Apply for 10 minutes every 2-3 hours
Ice is useful for a minimum of 72 hours but recommended for longer if you have discomfort
Use an icepack inside your pad or freeze a wet pad
Alternatively reusable perineal icepacks such as Body Ice Women
COMPRESSION
Support is essential after childbirth to limit strain through weaker areas
SRC recovery shorts can provide abdominal and perineal support
Larger sized Tubigrip can provide excellent abdominal support
EXERCISE
(For sports injuries, it’s elevate but we are changing it up a little!)
Gentle pelvic floor contractions can help to manage swelling and increase awareness in the area
Start once you have emptied your bladder (and catheter is removed)
There is no set dosage, aim for 1-2 sec holds every few hours
Early activation is trying to re-establish the connection between your brain and pelvic floor
Pelvic Floor Exercises
Gentle pelvic floor activations can be started whenever you feel ready after childbirth, as long as your catheter has been removed (if you had one) and you’ve done your first wee. Often midwives will measure the amount of urine in your first wee to check your bladder is happy.
You may feel apprehensive in the early days if you have had stitches or significant swelling, but the research tell us to START EARLY & START GENTLY!
Following childbirth, you shouldn’t be aiming for long pelvic floor muscle holds and really strong, quick activations, but SLOW & STEADY.
It is also really normal to not feel much happening in those early few days… however, awareness will improve over the coming days. You are trying to re-establish the connection between your brain and your pelvic floor with these early activations.
C-section mums:
This is really important for you too, don’t forget about it! Regardless of the delivery method in childbirth, pregnancy itself places a crazy demands on the pelvic floor muscles causing stretching and weakening. You are not immune from Pelvic Floor Dysfunction if you have a c-section, these rules apply to you too.
Key pointers for early pelvic floor activation
Start gently with small contractions for 1-2 seconds
Perform in a position of ease (laying, sitting or even laying on your side to start)
Aim to repeat every few hours, there is not set dosage in the early days; focus on small activations to increase awareness
Ensure you are breathing as your practice
As the awareness in your pelvic floor improves over the next few days, see if the contraction can be maintained for a few seconds longer. Ideally, you should be able to ‘feel’ the pelvic floor muscles lift and tighten.
A general rule:
If you are able to feel the muscles hold for 2-3 seconds; start to repeat the holds 10 times in a row. Try to perform 3-4x per day.
Keep in mind, everyone is different and this is a guide!
As you become for aware of the pelvic floor muscles and have reduced discomfort from childbirth, start to increase the length of your holds and the intensity of the contraction (try to contract a little stronger, whilst still breathing). If you are able to hold a contraction for 8-10 seconds, progress your exercise program in STANDING. As you get longer and stronger holds with more repetitions (aim for 10 reps of 10 second holds) in standing - it would be recommended to see a Women’s Health Physio for a functional assessment of your pelvic floor to work to specific goals.
Bladder and Bowel Significance after Childbirth
Regardless of the method of delivery in childbirth, midwives will be concerned about your bladder and how it is functioning. You should be able to feel the sensations of needing to urinate, be able to urinate with ease and feel like you have completely emptied after going.
If you experience large gushes of urine when standing or feel unable to empty the bladder, alert your midwife or contact your doctor.
The first bowel motion after birth can make some women anxious and quite fearful. However, there are some ways to help reduce that anxiety by ensure adequate fibres and fluids. A stool softener (such as Movicol) may be useful to help keep your bowels softened and easier to pass.
A pressure over the perineum or abdominal incision can make toileting more comfortable. With clean hands covered in toilet paper (or a pad), pressure can be applied over the incision or perineum when passing a bowel motion.
Straining whilst passing a bowel motion should be avoided when recovering after childbirth. It’s a term used to describe downward bearing pressure that can put strain on abdominal wounds, perineal stitches and the pelvic floor muscles. Continued fibre intake or stool softeners can manage bowel firmness, especially over the first 4-6 weeks. To reduce the strain on perineal wounds and pelvic floor, a foot stool or squatty potty can be used to place the body in a more optimal position.
Abdominal Muscle Separation
Diastasis of the rectus abdominis (DRAM) or abdominal muscle separation occurs during pregnancy as you accomodate the growth of the baby. Naturally, the separation will start to decrease over the first few weeks after delivery. Compression garments or tubigrip can provide abdominal wall support to assist in the recovery of the abdominal muscles.
After childbirth, it is recommended to reduce heavy lifting, avoid prolonged trunk bending and strongly reduce straining on the toilet. Gentle core activation can be started early to assist with the healing process.
Early Core Activation
Gently draw in lower stomach (like you are getting into a tight pair of jean). Try to keep the body still
If you feel just inside your hip bones, you may feel a tightening of muscles under your fingers
Keep the chest relaxed and continue to breathe gently into your stomach, whilst maintaining the contraction
Let the stomach relax and the muscles soften again
This is a guide - you should not experience any central bulging in the abdominal muscles with with exercise