Early postpartum is a whirlwind of emotions and excitement. You finally meet the little human you’ve been nurturing for the last 7-9 months! It’s a time of celebration and change as your heart expands to include its newest addition.

You have just experienced first-hand the changes your body slowly goes through during pregnancy. Postpartum is a new kettle of fish though – your little one is earthside, your pelvic organs are more mobile, and your body is healing from the process of birth. On top of this, you’re attending newborn appointments, learning how to feed and settle a baby, adjusting to a new sleep schedule (or lack thereof), and trying to remember to feed yourself. On top of that, you have family and friends popping in to offer help and congratulations. It’s a lot.

This is where a Women’s Health Physiotherapist can help – we can help direct you on how to look after you.

Within the two first weeks… 

If you are acutely sore – in the hips from labour, in the neck/shoulders from feeding, the wrists from holding and carrying or wherever it may be, a Women’s Health Physio can help. Women’s Health is technically a specialty area, but we still undergo all the usual training a general physiotherapist does. Plus, new mum aches and pains are a common are we see so of course we are trained to help you here as well. We can provide hands-on techniques to relieve your pain, provide ergonomic and postural advice and also prescribe specific stretches and movements to help you manage and recover anything that pops up.

If you have experienced physical birth trauma – such as a high-grade perineal tear, an emergency caesarean or tailbone injury during birth. We are trained as physiotherapists to understand the complications that can occur during labour and delivery, and therefore can help with early management.

Particularly in the case of high-grade perineal tears, the most recent evidence says that early pelvic floor therapy can significantly reduce your risk of complications such as pelvic floor muscle dysfunction or bowel problems (such as poor control of the anal sphincters). We can educate and externally assess you to ensure that you care completing the correct and most specific exercises to accelerate your healing and minimise complications. Research has shown that early pelvic floor rehabilitation significantly reduces women’s risk of gas leakage (49% reduction), stress incontinence (57% reduction) and faecal incontinence (78% reduction)1. Perineal pain is the most reported bother for postnatal women who have had a high-grade tear, so early review is important so that we can ensure stitches hare healing well and begin pelvic floor exercises (which can reduce pain by 58%!)2.

At 3 weeks – the First Check!

We now recommend women book their first postnatal review at 3 weeks postnatal due to research now supporting earlier return to function and exercise within the first 6 weeks3 4. We want all mums to feel like they can return to being active safely and as soon as possible, regardless of delivery type (vaginal or caesarean).

At your 3-week review, your Women’s Health Physio will typically talk with you about your delivery, address any complications, bladder or bowel concerns and ensure that you are starting to get comfortable with walking and new-mum activities.

We will want to assess you for abdominal muscle separation (DRAM) and discuss options for abdominal wall support. Many hospitals prescribe tubigrip as a form of gentle abdominal wall compression, but this will only provide a 7% reduction in abdominal wall separation at rest5. We can use your abdominal wall assessment to identify the right level of compression for you. On top of this, we can prescribe specific abdominal wall exercises to improve your rate of recovery. The idea of avoiding abdominal exercises after you give birth has now been thrown out. Abdominal crunch exercises can help to reduce abdominal wall separation by 19%5. A combination of both early abdominal exercise and bracing/compression within the first 6 weeks postnatally was shown to greatly reduce abdominal separation and improve abdominal muscle strength6. If you have had a caesarean delivery, we still want to prescribe abdominal exercises! We will check your scar healing and ensure the prescribed exercises do not cause any pulling or tugging on the tissue.

We can also include an external assessment of the perineum to check on healing (for our post-vaginal delivery ladies) and ensure you are able to contract your pelvic floor muscles correctly. We avoid internal assessment for women post-vaginal delivery until 6 weeks to allow for healing of the vaginal tissue and perineum.

By 6 weeks – the Full Check!

If you were able to make it in for the 3-week review, great! We use this appointment to check in with how you are going, re-check your abdominals, review your exercise program and complete your pelvic floor check (more on this soon).

If you haven’t been able to get in until now, don’t worry! We understand how busy the postnatal period is, and we will start you off with a recovery plan that matches your current level and fits within whatever timeframe you need.

The full check is comprised of:

  • Talking about your birth and delivery
  • Addressing any concerns with your current level of recovery
  • Screening you for pelvic floor for bladder, bowel, and sexual function problems
  • Abdominal wall assessment for DRAM
  • Internal vaginal examination (with consent) – click here to see what this involves!
  • Postnatal-specific home exercises to accelerate your recovery.

A note on bringing your newborn to your appointments… ABSOLUTELY!

We are so excited to meet your little one! And we are not fussed when it comes to working around their needs during the appointment time. We typically book all new postnatal appointments for a full hour.

We are also very happy for you to feed your baby during our initial chat at the start of the session (or we can switch up the order of things depending on bub). If you would like to bring your partner or a family member along to look after your baby that is also more than okay.

If you have other children who are coming along to the appointment, we can accommodate for them as well. Especially if you are wanting to work on home exercises, having your kids come along can be a great way for us to find out what exercises you can do with your kids.

We are here for you…

Whatever state or stage of recovery you are in, we want to provide a personalised recovery plan that works for you. It’s never too late to prioritise your own healing, and we are always ready to help you find your way.

If you have any specific questions, or you want more information please reach out to us – by phone (0400 573 457) or by email at  admin@femalephysioco.com.

Written by a Women’s Health Physio, Liz Johnson

 

1. Mathé, M., Valancogne, G., Atallah, A., Sciard, C., Doret, M., Gaucherand, P., & Beaufils, E. (2016). Early pelvic floor muscle training after obstetrical anal sphincter injuries for the reduction of anal incontinence. European journal of obstetrics, gynecology, and reproductive biology, 199, 201–206.

2. Von Bargen, E., Haviland, M. J., Chang, O. H., McKinney, J., Hacker, M. R., & Elkadry, E. (2021). Evaluation of Postpartum Pelvic Floor Physical Therapy on Obstetrical Anal Sphincter Injury: A Randomized Controlled Trial. Female pelvic medicine & reconstructive surgery, 27(5), 315–321.

3. Tennfjord, M. K., Engh, M. E., & Bø, K. (2020). The Influence of Early Exercise Postpartum on Pelvic Floor Muscle Function and Prevalence of Pelvic Floor Dysfunction 12 Months Postpartum. Physical therapy, 100(9), 1681–1689.

4. Nygaard, I. E., Wolpern, A., Bardsley, T., Egger, M. J., & Shaw, J. M. (2021). Early postpartum physical activity and pelvic floor support and symptoms 1 year postpartum. American journal of obstetrics and gynecology, 224(2), 193.e1–193.e19.

5. Depledge, J., McNair, P., & Ellis, R. (2021). Exercises, Tubigrip and taping: can they reduce rectus abdominis diastasis measured three weeks post-partum?. Musculoskeletal science & practice, 53, 102381.

6. Keshwani, N., Mathur, S., & McLean, L. (2021). The impact of exercise therapy and abdominal binding in the management of diastasis recti abdominis in the early post-partum period: a pilot randomized controlled trial. Physiotherapy theory and practice, 37(9), 1018–1033.