Home Page

Date issued: November 2022

Review date: November 2024

Ref: B-290/Physio/HF/Pregnancy and Post-Natal advice v4

PDF:  Pregnancy and post-natal advice final November 2022 v4.pdf [pdf] 1MB

Introduction

This booklet is designed to help you understand what is happening to your body during pregnancy. It aims to give you practical advice and solutions to minimise discomfort, keep you as active as possible, and to be able to carry out everyday activities as much as possible during your pregnancy.  The booklet will then guide you through the first 8 weeks post-delivery, what you should expect to occur with your body and when further help and guidance should be sought.

Antenatal Advice

To enable a baby to develop and grow inside you, your body has to adapt. Your weight will change and the shift in your centre of gravity and balance may result in different parts of your body having more pressure or load put through it.  Common places to feel this is in the lower back or pelvis.

Your pelvis consists of three bones and three joints, and your low back consists of many small bones (vertebrae).

The joints are supported by ligaments and muscles which provide stability to the joints, allow movement and help to maintain a good posture.

Discomfort and pain in this area is often referred to as Pelvic Girdle Pain (PGP) Various factors can increase the discomfort:

• Poor postural habits

• Poor abdominal and pelvic floor muscle function

• Constipation

• Decreased activity levels

Key elements in looking after your back and pelvis in pregnancy are:

• Good posture

• Appropriate level of exercise

• Maintaining abdominal and pelvic floor muscles

Doing all these elements will enable your body to cope and will reduce the likely hood of discomfort in your pregnancy.

Did you know?

Only 15% of ladies actually exercise for the recommended time during pregnancy.

And that 80% of pregnant ladies report pelvic and back pain.

Added to this 70% of ladies suffer with urinary incontinence due to a weakened pelvic floor during or after pregnancy.

Practical Postural Do’s and Don’ts

There are many things you can do to reduce the risk of strain and discomfort.

• Use your abdominal and pelvic floor muscles to support and protect your spine and pelvis during activities and movements.

• If you are in discomfort consider what you have been doing over the last few hours that could have caused the pain, alter your activity and avoid these aggravating movements next time.

• Listen to your body. Don’t push through pain, rest if you need to. 

• Move so that you are equally taking the weight through both feet i.e. no standing with weight on 1 leg whilst standing in a queue, sit down to put trousers, socks on.

• Avoid carrying a toddler on just one hip for long periods of time.

• When lifting something consider if it needs to be lifted, if anyone can help.  If you have to lift avoid bending and twisting.

• When shopping carry weight evenly in both hands.

• Ensure work surfaces at home and at work are the right height for you, and you are not stooping.

• Keep your knees together getting in and out of bed / or car.

On the following pages are some helpful positions to consider in everyday activities.                     

Posture

Maintaining good postural habits can help to manage lower back and pelvic pain symptoms.

What is a good posture?

1. Your head comfortably positioned so that your ear is in line with your shoulder

2. Shoulders pulled slightly back so your chest feels open not hunched forwards

3.  You have a gentle curve in your lower back half way between sticking you bottom out and tucking it in underneath yourself

4. You are engaging your pelvic floor and tummy muscles

5. You have equal weight going through your hips and feet and you are not hitching or resting onto one side or the other

Do,  when lying on your side, put a pillow between your knees so they remain in line with your hips

Don’t, sit in a slumped posture

Do, sit up tall and use towels and or pillows for support.  Avoid sofas that are too low or soft.

Pelvic Floor exercises and why they are important?

Over 30% of women will encounter incontinence (a leakage of urine) symptoms during pregnancy.  The pelvic floor is put under increased tension during your pregnancy as the size of your baby increases and as your posture changes.  If you have had a previous pregnancy or injury to the muscle during delivery it can prevent the muscle from working fully; as can a lower back or pelvic pain problem or a long history of a respiratory condition.  For many ladies incontinence symptoms and back pain can continue for many years after giving birth, to prevent this or other pelvic floor issues such as a prolapse it is important to continue Pelvic Floor Muscle exercises for life.

Learning to do pelvic floor exercises

• Squeeze/tighten the muscles around your back passage, as if you were trying to stop yourself from passing wind, let go .

• Now tighten/lift the muscles up towards the front of your pelvis, as if you were trying to stop the flow of urine, let go. 

• Now squeeze and lift both the back and front together as tight as you can. We call this your maximum hold.

• You should feel your lower tummy muscles gently working, but your thighs and buttocks should not move.

• Make sure you breathe normally and do not hold your breath.

Exercises

Do your pelvic floor exercises 3 times a day.

Slow pull-ups

Hold your pelvic floor maximal squeeze for as long as possible (up to 10 seconds) and then let go.  See how many times, you can do in a row with a 3-4 second rest

between each squeeze. Record below:

I managed a hold of ______seconds, repeated _____times

My goal is to hold for 10 seconds, repeat 10 times.

Fast pull-ups

Maximally squeeze tightly and quickly then relax your pelvic floor immediately. Count how many times you can do this in a row until the muscles tire.

I managed ______ fast contractions in a row

My goal is to do 10 fast contractions.

Exercises

It is important for you and the developing babies health to keep active through pregnancy. Many studies have shown the benefit of exercise during pregnancy, providing the pregnancy is normal and you are healthy.  

Exercising helps you to:

• Keep your heart, lungs and muscles as healthy as possible

• Keep your weight within a healthy range

• Improve your posture, balance and co-ordination

• Improve your circulation

• Increase your strength and stamina

• Feel better - in body and mind

• Be prepared for labour and delivery

• Do your best for your baby as it develops

• Reduce minor ailments of pregnancy

• Become fitter and may help you to recover more quickly after the birth    

You should listen to your body when exercising and stop if you feel uncomfortable, tired or unwell. (POGP fit and safe)

Antenatal exercise: If you are used to a sport or activity and played before you became pregnant, it is safe to continue many activities such as walking briskly, low impact aerobics or swimming. (If pelvic girdle pain is a problem, avoid the breast stroke kicking motion of the legs).

If attending classes, try to ensure that the instructor has had suitable training to teach pregnant women.  Pilates and yoga, both of which can be modified for pregnancy are popular forms of exercise which have proven benefits.

Precautions to exercise in pregnancy The following conditions may require some caution and it is advisable to seek appropriate medical advice before commencing any exercise

• Vaginal bleeding

• Reduced foetal (baby) movements

• Serious heart, lung, kidney or thyroid disease

• Diabetes Type 1, if poorly controlled

• History of miscarriage, premature labour or ‘small for dates’

• High or low blood pressure

• Placenta praevia after 26 weeks

• Acute infectious disease

• Asthma

• Anaemia

• Extreme overweight or underweight

Stress and Relaxation

Stress can be caused by a variety of situations. As a result of stress you can find your body producing a variety of physical and emotional responses including: an increase in your heart rate and blood pressure, sweating, tiredness, muscle tension,  headaches and difficulty concentrating

The physical and emotional effects of stress can affect your ability to control and manage pain levels.  Many people find it difficult to relax, but it is important that during your pregnancy that you allow yourself time for this.  Relaxation is the process of releasing tension from muscles as well as allowing your mind to become free of the worries and concerns.

There are many different ways to relax.  Some ideas can include breathing exercises and muscle tightening and relaxing exercises.

On the next page is an example of the “Mitchell method”.  It is a technique for relieving muscle tension.  During the process you will be contracting muscles to move you from a stressful posture to one of greater relaxation.  To maintain the change you will then be asked to recognise and feel the difference.

Mitchell method of relaxation

To get started, position yourself so you feel comfortable and at ease.  This can be sitting or lying.  You don’t need a darkened room but allow yourself time to work through the programme without being disturbed.  Work through the list of movements below.

• Pull your shoulders down feel space between your ear and shoulder.

• Elbows straight and out from your sides feel the arm supported on the chair/bed.

• Fingers and thumbs stretched long notice the texture the hand is resting on.

• Let your hips and knees roll outwards feel the relaxation.

• Gently point your toes down relax and feel the tension go.

• Draw your jawbone down feel your teeth are apart.

• Focus on your breathing allow it to feel relaxed and at ease.

Top tips for a healthy bladder in pregnancy

It is important to keep your bladder healthy and minimize trouble during and after your pregnancy. There are steps you can take to ensure this.

• Do pelvic floor exercises As outlined in this booklet.

• Watch what you drink Coffee, tea, and fizzy drink can increase bladder activity and lead to leakage. A good rule of thumb is to consume 8 cups of liquid each day (about 2 litres). Non irritable drinks include water, milk, soups, and diluted juice drinks.

• Don’t smoke Not only can smoking harm the foetus, cigarette smoke and nicotine also act as immediate bladder irritants, and the chronic cough often associated with smoking can also lead to accidental leakage. If you need help quitting visit the NHS website www.smokefree.nhs.uk

• Protect yourself from UTIs Urinary tract infections (UTIs) can cause temporary bouts of incontinence because the bacteria weaken the muscles in the urethra. A UTI will not trigger incontinence for most people, but it can make a difference if you are incontinence prone. Empty your bladder before and after intercourse to cut your risk of UTIs.

• Avoid constipation Keeping the bowels running smoothly with a healthy intake of fibre and fluids can help the neighbouring bladder too.

• Keep a healthy weight The heavier you are the more weight presses on the pelvic floor muscle and bladder.

Talk to your physiotherapist if you need further advice or treatment for your pelvic floor or incontinence.

Management during labour

Importantly plan ahead and consider positions for delivery.

• If you had  pain at the front of your pelvis in your pregnancy inform your midwife, and be aware of the position of your legs in labour, especially when using pain relief /epidural. Prior to delivery, measure and record in your birthing plan the distance that you can part your legs without pain. Record this in your birth plan, and try not to exceed this during delivery.

• Consider your most comfortable positions and try to adopt these during your delivery or when being examined.  Your midwife will help you find a comfortable position.

Positions

There is no right or wrong position to be in in labour. Listen to your body and do what is most comfortable for you.  You are likely to cope best in labour if you can move around and change position.

Lying on your back can be uncomfortable and your midwife is unlikely to suggest it. 

Useful positions to try include:

• Walking and standing

• Kneeling

• Sitting astride a chair and leaning forward onto cushion

• Use a birthing ball

• Supported standing or squatting

• Rock on all fours

Postnatal Advice

What’s normal and when to seek further help?

This part of the booklet will help to explain what to expect post-delivery, what you can do to help recovery, and what to do if things don’t go as expected.  Pregnancy changes your body shape and posture in so many ways.  The postnatal recovery will vary for each lady depending on their pregnancy, labour and delivery experiences.  The hormone Relaxin which played a significant role in softening the ligaments during pregnancy stops being produced once the placenta is delivered.  The changes that took place to the ligaments can take many months to return to normal.

Whether you have had a vaginal or caesarean birth your abdominal and pelvic floor muscles have been stretched, it is important that you get them working efficiently again.  Your body will heal on its own, but by knowing what is normal, and what is not, you can determine if you need help to prevent future problems.

While your main aim may be to lose your “mummy tummy” and get your figure back, how you do this is important to ensure you prevent future back and incontinence problems.

What is normal?

0-8 weeks post delivery

• You may not be able to sit comfortably and you may feel that your bottom and bladder is falling out. The healing of the perineal area will vary depending on amount of trauma at birth. Initial swelling and healing of any stitches takes around two weeks.  Building up the pelvic floor muscle may take months.

• You may experience discomfort in your back, hips or pubic area.

• You may have difficulty controlling urine, gas or stool.

Your neck, arms, back and hips may be sore as you adjust to lifting and feeding your baby.

How to help yourself:

• Think about your posture, try not to slouch when sitting, standing or feeding your baby.

• Regularly do your pelvic floor and deep abdominal muscle exercises.  Remember to do these 6-8 times by linking it to things you do regularly e.g. feeding or changing your baby.  Try to improve on your length of hold and number of repetitions each time you do them

• By strengthening your muscles you can help the ligaments to support your joints.

• Stretch your back, shoulders and legs to relieve soreness.

• Listen to your body, rest as required, it is important that you allow your body time to adjust and for your body to heal itself. 

8 weeks + post-delivery:

• You should be pain free

• Vaginal bleeding should have stopped.

• Any incisions/tears you may have had should have healed: consult your GP if you have concerns.

• You should have control over your bladder and bowel.

• You should be ready to increase your activity levels.

What is not normal?  A symptom check list

• Ongoing back, pelvis, groin or abdominal pain

• Leaking urine, gas or stool with laughing, coughing, jumping, sneezing, lifting, walking running etc.

• Pressure or bulging in your vagina or rectum.

• Difficulty doing any of your everyday activities because of pain, leakage or pressure

• A gap running down the length of your tummy, bulging or doming of your abdomen during any exercise/activity like this .

Two simple self-checks you can do to check for doming symptoms are the Curl Up Test and the Leg Lift Test.

Curl Up Test: Lie on your back with your knees bent. Slowly lift your head and shoulders up off the floor keeping your chin tucked in.

Leg Lift Test: Lie on your back with your legs straight. Lift one leg up off the floor about six inches.

What to do if you have a symptom

None of the above symptoms are normal at 8 weeks post-delivery.  These symptoms do not usually go away by themselves. If you have ticked any of the above, you should get some help and advice from a physiotherapist.

A physiotherapist will do a detailed assessment of your posture, movement and muscle control and give an explanation of their findings.  They can give you treatment tailored to your needs (manual therapy, education and exercises as appropriate)

You need to relearn how to use your core muscles correctly before you can strengthen them.  Your physio can help you with this. They will then give you advice and guidance on increasing your activity levels.

Many health benefits (both physically and mentally) are gained by exercising after your baby is born.  It is important you have good control of your pelvic floor and TVA first.

Returning to Exercise

Return to exercise gradually and enjoy it, take care not to start high impact activities (where both feet leave the ground at the same time) too soon.

Brisk Walking pushing your pram is an excellent form of exercise.  Ensure the pram handles are at a height that enables you to maintain a good posture.

Swimming you can start this after 7 consecutive days clear of any vaginal bleeding / discharge.  If you have had a c-section it would be wise to have your 8 week check first.

Below is a guide of the type of progression you may feel ready for, remember everyone’s pregnancy and birth experience is unique.  Do not overdo it and do not try to be a “super mum”.  Listen to your body and act on what it indicates.

examples of exercise progression

Weeks postnatal	Examples of exercise progression
0-2	Pelvic Floor Muscle Exercises (PFME) Basic core exercise,  i.e. pelvic tilt Walking for cardiovascular exercise
2-4	Progress walking, PFME’s and core exercise Introduce squats, lunges, bridges
4-6	Low impact exercise, i.e. static biking Low impact cross trainer Individualise according to postnatal recovery, mode of delivery, perineal trauma and general comfort.
6-8	Scar mobilisation (perineum or c-section) Power walking Increase low impact walking Add resistance to lower limb and core exercise
8-10	Introduce swimming if lochia stopped and wound healing is satisfactory. Spinning if comfortable
12 +	General return to running/sports Consider any other risk factors, i.e. obesity, blood pressure etc. Modify according to symptoms and well being.