During labour and delivery, whether you give birth vaginally or by C-section, your body undergoes tremendous changes as you bring a new little human into the world. Most women recover very well and go on to lead active, pain free lives. However, many do not. Often we aren’t sure what to expect as we recover from pregnancy and childbirth, what is normal, and what to do if we have concerns. It is very common for women to take a prenatal class to learn what to expect during pregnancy and delivery, however, it is less common to learn what to do to heal the body, prevent complications, and return to an active lifestyle after your baby arrives,
What is Normal:
You may feel as if your bottom is falling out, and not be sure how to comfortably sit or stand.
You may have aching/stiffness in your back, hips, or pubic area. However, pain that makes it difficult to walk without limping, or carry out basic daily activities is NOT normal.
You may have difficulty controlling urine, gas, or stool.
You may have sore arms, neck, or upper back as you adjust to carrying and feeding your new baby.
This is an important stage of healing. Allow yourself time to adjust, and take time to listen to your body! Returning to higher impact activities too soon after delivery can put you at higher risk for incontinence or prolapse of the pelvic organs (the bladder, or uterus drooping into the vagina)
What to do:
Use pillows to support your back and baby
Although good posture can be important, try not to overcompensate with rigid back or “sucked in” tummy. A variety of positions can be more important than perfect posture. Experiment with different positions, such as nursing in side-lying, or propped up on pillows.
Gentle stretches for your neck, shoulders, hips/buttocks can relieve soreness.
Begin to gently contract your pelvic floor muscles and lower abdominal muscles. Take a gentle, long inhale and feel the pelvic floor muscles relax. Then exhale with a slight “hiss” while pulling the pelvic floor muscles up and in. You should feel no pain. Hold the contraction for 5 seconds and repeat 10- 15 times.
Short walks are a great way to start to return to exercise. Listen to your body, you should not feel fatigued, experience increased bleeding, feel heaviness or bulging in the vagina.
After 8 weeks:
What is NOT normal:
Ongoing back, groin, pelvis, or abdominal pain.
Leaking urine, gas or stool with coughing, sneezing, jumping, walking, etc. Leaking anytime other than when you are sitting on the toilet is not normal, and can be helped!
Pressure or bulging in the vagina or rectum – Trauma during pregnancy and labour can cause the pelvic organs to droop into the vagina. Caught early, physiotherapy can prevent the need for surgery.
Pain during intercourse. 25% of women continue to have pain with intercourse, however,” many women suffer in silence. Physiotherapy can be very effective in treating pain due to scarring or damage to the pelvic floor muscles.
Bulging or tenting of the abdominal muscles during exercise or lifting. The abdominal muscles will separate down the middle in the third trimester of almost all pregnancies. The majority will heal back together with no difficulties. However, in about 25% of women the separation remains. If you are concerned you have a separation, ask to have your health professional (Dr, nurse practitioner, or physiotherapist) check your belly. A physiotherapist with advanced pelvic floor training can provide you with information on how to return to exercising while promoting healing of the separation. Be very careful about returning to a core exercise program as exercises such as sit ups, downward dog, push ups etc, can make the separation worse.
Don’t be a victim of “Blush and Stay Hush”
Problems in THAT area can be just as valid and distressing as problems in any other part of the body. But, for a variety of reasons ranging from embarrassment, to thinking it is “normal” or that there is nothing that can be done, we just “put up with it”
In many parts of Europe, Australia, and Scandinavia it is accepted practice that all women will see a physiotherapist for a post natal screening at 6-8 weeks to ensure the abdominal wall, pelvic floor, and other muscles and joints are recovering well from pregnancy and delivery.
If you are concerned about how your body is recovering from pregnancy, if you are limiting your daily activities due to bulging, pressure, or leaking, or having difficulty returning sexual activity, or even if you just don’t feel “right”, book an assessment with a Women’s Health Physiotherapist with advanced training in treating pelvic floor disorders. These symptoms, although common, are not normal.
I tried Kegels and I still have symptoms.
Kegels can be an effective exercise when done properly, however, research shows that 50% of women do them incorrectly. Depending on the problem, Kegels may not be the best exercise, and can sometimes make things worse. The pelvic floor muscles work very closely with the other muscles of the trunk, and a good rehab program takes all of the core muscles into account.
It’s been months (or even years) since my baby was born, is it too late?
It’s never too late!
Do I need a referral from my doctor?
In New Brunswick, physiotherapists can treat without a doctor’s referral. However, I encourage women to discuss any new symptoms with their primary health care provider. Some insurance companies require a physician referral for reimbursement. A call to your insurance carrier can tell you what is required for your specific plan.
Is pelvic floor physiotherapy covered by medicare?
In NB, only physiotherapy in the hospital system is covered by medicare. Private physiotherapy clinics are unable to bill medicare. Most private extended health care plans such as Blue Cross or SunLife cover physiotherapy.
Originally from Sussex, Frances graduated from Dalhousie University School of Physiotherapy in 1992 and has been working in the field of orthopedics and sports medicine since then. Frances enjoys working with people with a variety of musculoskeletal injuries, however, she has a particular interest in treating issues related to pelvic floor health. Frances has gone on to take many post graduate courses in the field of pelvic floor dysfunction and pelvic pain. She owns her own physiotherapy clinic in Saint John, and sits on the governing board of The Canadian Continence Foundation. www.archstonephysio.com