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May 13th, 2020
May 13th, 2020 / Nicki Chick
By Camilla Lawrence May 2020
Following on from our article on C-Section recovery, our Lead Women’s health Physio Camilla Lawrence has complied her top 10 tips for early physical recovery following a Vaginal delivery:
Try to avoid prolonged sitting or standing for the first few weeks as this will put extra pressure on your perineum whilst it is trying to heal. If sitting is uncomfortable, place rolled towels or pillows under each thigh, to raise you up and take the pressure off down below (it is not advisable to sit on a rubber ring as this may actually increase the strain on your perineum). If you have had a perineal tear or episiotomy it is important to keep this area clean and dry in between loo visits to avoid infection. It can be helpful to pour lukewarm water from a squeezy
bottle or jug over your perineum during or after you pee and pat dry after with a towel. Ensure you change your sanitary pads regularly.
Keep taking any pain relief that you have been prescribed/advised regularly by your Doctor or Midwife for as long as you need it – this might be weeks. It is better that you aren’t in pain and are able to move and breathe well, than you suffer and end up restricting your movement.
It is important to be drinking and peeing regularly after you have had your baby – aim to drink every time you feed your baby (2-3 Litres a day especially if you are breast feeding) and peeing every 2-3 hours. If you do not get a normal urge to pass urine or have pain when peeing please tell your Doctor or midwife.
Every new mother is anxious about opening their bowels the first time after delivery. Try not to put off opening your bowels once you have had the urge to go, as this can make you more constipated. Constipation and straining to open your bowels puts significant extra pressure on your perineum and pelvic floor muscles, and increases your risk of developing or worsening haemorrhoids. Eating regular meals, with a well-balanced diet (including plenty of fibre) and fluids and taking any laxatives you may have been prescribed, will help keep your stools soft as well as optimizing your healing and recovery. When you go to open your bowels, try to rest your feet up on a small box or step and lean forwards with a straight back. Let your abdomen relax and bulge outwards and keep breathing to avoid straining. You can use a sanitary pad or wad of tissue to splint the perineum at the same time if needed. Please speak to your GP if you are struggling with constipation and they can advise you on medication that can help.
It’s vital to get sufficient rest especially in the first few weeks after your delivery to recover from your labour. If you are up feeding during the night try to get regular rests or naps during the day when your baby sleeps. Accept any help that you are offered.
It is also important to gently keep mobile each day to maintain your strength and blood flow. Start with just pottering around your home to begin, and then very gradually build up your distances outdoors as you feel able.
Try to be aware of your posture, standing and sitting well can reduce the risks of developing future aches and pains – particularly with repetitive tasks like feeding, changing and carrying your baby. Make sure you are sitting comfortably with support for your back when you are feeding, stand tall when you are carrying your baby (either in your arms or when using a sling) and try to change your baby’s nappies on a surface that allows you to stand straight and not hunch over.
During a pregnancy, the organs in your abdomen and your growing uterus push upwards, limiting the space for your diaphragm to move. So by the end of a pregnancy most women breathe more from the upper chest and neck region. Postnatally you want to aim to get back to breathing slowly and deeply down the bottom of your lungs again (diaphragmatic/belly breathing). This is a much more efficient way of breathing and has been shown to reduce your blood pressure, aid relaxation and help to regain your deep core muscle function again. For more information on how to do this please see our online video or book an appointment with one of our specialist physios.
Your pelvic floor muscles fill in the underside of your pelvis – running from the pubic bone at the front, round between your legs and up into your coccyx at the back. They wrap around the entrance to your urethra (that your urine comes out of), your vagina and your rectum, and so control when you do or don’t have a pee or open your bowels. They are usually weakened by pregnancy and delivery, which can lead to symptoms of incontinence, prolapse and reduced pelvic control as well as altered sensation during sex. The best way to strengthen them back up is to squeeze them – take a breath in, and on the breath out try to squeeze and lift up your pelvic floor, as if you were holding in a fart or stopping yourself from peeing, and then let go fully. You want to aim to do 10 squeeze and releases, and 10 squeeze and holds for up to 10seconds. Make sure you relax the muscles fully between each squeeze. You can start to do these exercises from day 1 after your delivery (if you have a catheter in, wait till this is removed). We advised you do a set every feed during the day for at least the first 6 weeks postpartum. If you are getting any symptoms (difficulty controlling your bladder or bowels, or feeling a heaviness/pressure/pain in your pelvis or vagina) or if you just can’t work out how to do these exercises, please contact a specialist Women’s health Physio and we can help you sort it out. These symptoms are common but not normal and are easily treatable.
For the first six weeks following your delivery, you should focus on gradually getting back to walking, getting your pelvic floor muscles working well again (see above), and resting and bonding with your baby! At 6-weeks postnatal try and book a Postnatal Body Check or Mummy MOT Appointment with a Women’s Health physio – they will give you a full assessment of your posture, spine, abdominal muscle and pelvic floor recovery and function and advise you on a safe graded return to exercise plan. General recommendations are to start with low impact exercise that focuses on rebuilding your core and global body strength and control for at least 6-8 weeks before gradually resuming impact exercise (jumping, running etc) – everyone’s recovery is different though for some it may take far longer than this.
Here are some exercises you can do pretty much straight away: