Postnatal physiotherapy exercises for patients - Alfred Hospital

POST NATAL PHYSIOTHERAPY INFORMATION
ALFRED HEALTH
Sandringham Hospital
As you will soon be going home from hospital, we would like to remind you of exercises and advice
that will maximise your post-natal recovery. Try also to attend one of the Post-Natal classes, which run
on Mondays, Wednesdays and Fridays at 10.30a.m. If you did not attend a class before going home you
are welcome to attend as an outpatient after going home.
PELVIC FLOOR EXERCISES
It is important for all women to exercise these muscles every day, especially after having a baby. We
recommend you start now while in hospital to assist healing and to get into good habits. The pelvic
floor muscles support the pelvic organs (bladder, uterus and bowel) help with good bladder and bowel
function and increase your sensation during intercourse.
Begin exercises on Day 2
• Start lying down.Tighten around your back passage, then your vagina and then your front
passage and draw them up inside.
• Hold this for up to three seconds. Let go and rest six seconds. Repeat up to four times.
• Do these exercises four times each day.
• Remember not to hold your breath or squeeze your legs or buttocks together whilst doing this
exercise. It is normal, however, to feel your lower abdominal muscles contracting at the same
time as your pelvic floor muscles.
• Aim to progress to doing 10 repetitions with a 10 second hold as well as 5 short strong lifts.
• Your physiotherapist in the Post Natal Class will show you other positions in which you can do
this exercise. Over the next few weeks progress to exercising these muscles in standing as you
feel able.
• Get into the habit of always tightening these muscles before you cough, sneeze or lift.
• To check that you are performing these exercises correctly, hold a small mirror so you can see
the outside vaginal area. When you squeeze you should see the anus tighten and lift away from
the mirror. Alternatively you can place your hand over your perineal area to see if you can feel
your pelvic floor lifting away from your hand.
ABDOMINAL EXERCISES
You may start exercising your abdominal muscles as soon as you feel comfortable. In fact, after a
Caesarean birth, bracing your muscles when rolling, getting out of bed and out of a chair will make you
feel more comfortable as this helps support the incision site.
You can do these exercises in a number of positions ie. lying on your back or on your tummy, in
sidelying, in four point kneeling, standing and sitting. You will be shown the exercises in these
positions during your post-natal class. Your physiotherapist will also teach you ways to progress these
exercises over the next few weeks as your muscles get stronger.

• You can start doing abdominal bracing while lying on your back with knees bent and feet
resting on bed
• Gently draw the lower belly (between belly button and pubic bone) in as if to tighten your belt.
Keep breathing normally whilst you do this exercise and keep your spine still. Hold this
position for up to ten seconds then relax.
Repeat this exercise up to 10 times, 2-3 times a day. As your muscles get stronger you can progress to
doing this exercise in other positions.
REST
To help your body and especially your pelvic floor muscles recover after birth, you need to spend time
each day resting. For the first two weeks after the birth you should spend at least 2 hours lying down flat
during the day. This can be divided into 2 one hour sessions. You might like to ask one of the nursing
staff to help you learn to feed your baby whilst lying down on your side. This is especially useful if you
are going home to look after other young children. For the following six weeks you need to continue to
lie down flat for at least one hour every day. This may be two sessions of half an hour each. Try also to
avoid prolonged standing, choose to sit down whenever you can.
EXERCISE
As in hospital, we encourage you to have short walks at home each day. Start with 10-15 minutes at a
slow pace on flat ground and gradually increase the speed and distance as you feel able. Remember to
listen to your body and don't push yourself. By your six week post-natal check you should be walking
30-40 minutes each day at a moderate pace. Other exercise, such as swimming, yoga, pilates, gym and
cycling are not recommended until after your six week check-up.
It is recommended that competitive sports or high impact activities not be resumed for at least three
months, as your muscles and joints may still be softened from the effects of pregnancy.
Doing the ‘star jump’ test, which involves performing 5 star jumps with 5 coughs whilst your bladder is
full will indicate whether your pelvic floor muscles are strong enough for you to return to any impact
sports or activities. Returning to such sports when your pelvic floor muscles are not strong enough may
lead to urinary stress incontinence.
Jumping on a trampoline is not recommended for 6 months.
BACKCARE
As a new mum, you will be lifting, pushing and pulling during everyday activities, therefore it is
important to protect your back against pain and injury. It is especially important to avoid any prolonged
forward bending of your back. Always make sure your nappy change area and baby bath are at waist
height to prevent unnecessary strain on your back.
Be aware of your posture when standing, sitting and moving around. When sitting have your bottom
well back in the chair and try not to sit on your coccyx. Gently rock your pelvis forward and support the
lower curve of your spine with a rolled towel or small cushion. You may need a small stool under your
feet to help you maintain this posture, especially whilst breastfeeding.

When feeding your baby use pillows only as long as you need them, until your upper back muscles
become stronger. This simple postural exercise will help strengthen your back for carrying and feeding
your baby.
• Stand with your hands behind your back. Broaden across your collar bones and then gently pull
your shoulder blades down and slightly back. Hold for five seconds and then relax. Repeat up to
ten times.
To avoid placing stress on your pelvic floor and abdominal muscles you should not lift anything heavier
than your new baby for the first 6-8 weeks. Try to get into good habits so that you can avoid heavy
lifting all together. Avoid carrying a capsule as they are heavy and awkward. Leave the capsule in the
car and use a sling or pram for carrying your baby. Train older children to help as much as possible,
spread loads out (ie. one grocery bag in each hand not three!) and if a situation arises where you must
lift, make sure to tighten your pelvic floor and abdominal muscles first. Even with small objects, always
bend your knees and keep the object in close.
DRIVING
Most doctors advise waiting 2-6 weeks before driving after a caesarean birth. Check with your doctor
and also your car insurance company.
BOWELS
Straining on the toilet to use your bowels (or bladder) can weaken the pelvic floor muscles. Hand
support to the vaginal area during bowel emptying can help protect this area. Bowel motions need to be
soft and easy to pass.
To avoid constipation a fibre supplement may be necessary for at least the first 6 weeks. Discuss this
with the midwives before you go home. Regular exercise, six to eight glasses of fluids including water
each day and adding fibre to your diet can also help. As a guideline, 3 pieces of fresh fruit and 5
vegetables each day are recommended. Try oat bran or psyllium husk on your cereal or in cooking. If
you feel unable to go to the toilet without straining then you should seek advice from your GP or
contact a Continence Physiotherapist.
Should you have any questions, problems or experience pain or discomfort with the exercises above
please see the ward physiotherapist or telephone the physiotherapy department after discharge.
FREE CONTINENCE PHYSIOTHERAPY ADVICE CAN BE SOUGHT FROM
Kingston Continence Service
Caulfield Continence Service
C/- Kingston Centre
C/- Caulfield General Medical Centre
Warrigal Road
260 Kooyong Road
Cheltenham 3192 Caulfield 3162
Phone No: 9265-1401 Phone No: 9076-6102