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Printed at: 08:37:52 / 04-03-2021

Getting back into shape after your delivery

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This leaflet gives advice and exercises that will help you get back into shape after the birth of your baby after having a normal vaginal delivery.

• You will want to give your baby lots of attention, but it is also important to find time for yourself. By regaining your fitness, you will feel good and have more energy. You may also prevent some health problems in the future.
• You can start gentle exercises from day 1 if you feel ready. Start gently and build up.

Pelvic Floor exercises
The pelvic floor is a group of muscles like a hammock at the base of the pelvis. It has three openings – the urethra (the bladder outlet), the vagina (birth canal) and the anus (back passage). It supports the pelvic organs and helps prevent leaking from the bladder and bowels. Your pelvic floor will probably feel very weak after your delivery, so it is important to start your exercises within the first day or two to help it regain its strength.

If you have a catheter wait until it is removed before starting your pelvic floor exercises.

If you have stitches you can still do these exercises – they will help healing by reducing swelling in the area – but start gently.

Using ice wrapped in a damp flannel may help reduce swelling & pain and promote healing – used for 5 mins every hour.

Sit comfortably or lie on your side. Imagine that you are trying to stop yourself passing urine and ‘wind’, draw the area upwards and forwards from bowel to bladder – then let go. Start this ‘squeezing and lifting’ movement gently at first. Then ‘Squeeze and lift’ and try to hold for a few seconds (breathe normally – don’t hold your breath!). This is a ‘slow hold’. Rest for a moment, and then repeat 4 times if you can.

Now try squeezing the pelvic floor muscles quickly 5 times, with a little rest between each squeeze. This exercise helps your muscles react quickly when you cough or sneeze – preventing urinary leakage and pressure on your stitches. Try 5 ‘slow hold’ squeezes, followed by 5 ‘quick’ squeezes at least 4 times a day. As your muscles get stronger, try holding the ‘slow’ holds for longer – aim for 8 slow holds for 10 secs and 10 fast contractions. It can take several months of regular exercises for the pelvic floor to return to its previous strength.

The hardest part is remembering to do your pelvic floor exercises – a good time to do them is every time you feed your baby. Or try the NHS ‘Squeezy’ App – available on all smart phones/devices to get into a lifetime routine of regular exercises – set the exercise plan with programme above to start with.

Don’t stop and start your flow of urine – this can interfere with normal bladder function.

Exercises for the tummy muscles
Day 1
Sitting or lying on your side
Place your hand on the lower part of your tummy, to feel your muscles working.
• Squeeze and lift the pelvic floor, at the same time draw in the lower part of your tummy a small amount, away from your hand.
• Hold for 3 seconds while you breathe out. Relax, and then repeat 5 times. Gradually increase the time you hold the muscle in.

Once you are happy with these exercises, try holding these muscles in a small amount when you are walking about, rather than letting them ‘sag’ – walking tall. Then remember to tighten them during any activity that requires effort – e.g. lifting or changing your baby.

More early exercises
You can add these when you feel ready, from Day 2.
Lying down
1. Bend your knees up. Brace the pelvic floor and tummy muscles as Day 1 exercise, then allow your knees to roll to the right as far as is comfortable. Bring them back to the centre, and then repeat to the left. Try 3 times to each side.
2. Bend your knees up. Tighten the pelvic floor, then hollow your tummy and flatten your back into the bed and allow your ‘tail’ to tilt upwards. Hold for 3 seconds, then gently release. Repeat 4 times.

Exercises to avoid:
Do not try full sit-ups until your tummy muscles are strong. Never do ‘double straight leg lifts’ as these can damage your back and the pelvic floor muscles. Always tighten your pelvic floor muscles first before doing any tummy exercise.

Your deep tummy muscles and pelvic floor are also important in protecting your back from injury.

As you will be doing lots of lifting in the next few months, work on improving their strength.

If you see or feel a central bulge in your tummy when you sit up from lying down – either towards the end of your pregnancy or post-natally; ask your Midwife or GP to refer you to the Women’s Health Physiotherapy service.

For any continence or perineal related problems ask your GP or Midwife to refer you to our services. For bladder issues you can ‘self-refer’ by contacting the physiotherapy department directly on 01908 995432 and requesting a ‘self referral form’.

General advice
Continue with your exercises twice a day, gradually increasing the repetitions as you get stronger. Walking for a short distance each day will improve your fitness and strengthen your muscles.
Start gently with a 5 minute walk at a steady pace, building up the distance and the pace at which you walk as you recover. Adding the buggy can increase the challenge. Care should be taken when returning to high impact activity (jogging, jumping or sports involving running) – don’t start too quickly. Remember always listen to your body and don’t overdo it – hormonal changes from
pregnancy can take up to 5 months to return to normal levels. Backache is common in new mothers, so watch your feeding position – make sure your back is well supported. Ensure you bend your knees and tighten your pelvic floor before lifting and try to avoid holding your breath.

Further information: https://pogp.csp.org.uk/publications/fit-future