WellMom: Physiotherapy guided post natal recovery and fitness

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The WellMom service aims to educate and support you in your physical healing post delivery, and to guide your safe return to exercise.

A challenge that moms face after having a baby is that we don’t know how to help our bodies heal well after the pregnancy and delivery.

Moms are still asking the same questions related to self care, or getting our body back: what exercises are safe to do post c-section, when is it safe to return to exercise, how do I lose baby weight and get a flat tummy again?

The reality is, we don’t know what questions we should be asking to help ourselves heal. And we accept changes to our bodies as normal when they really aren’t.

Our awkward questions get pushed to the back of our minds as we don’t know who to ask to get honest and helpful answers:
Am I doing my Kegel exercises correctly? How do I manage constipation post delivery, or prevent leaking when sneezing, and enjoy sex again? What do I do about the split in my tummy (DRA – diastasis rectus abdominis) to help it heal?

There hasn’t been much research in the field of post natal healing and wellness. The recent evidence hasn’t reached the mainstream. So most of the general information in circulation isn’t based on evidence. The advice that we accept is often unrealistically optimistic, and not holistic in considering our unique pregnancy and birthing experience.

An instrument assisted delivery, a caesarean section especially with complications, post natal depression, severe sleep deprivation, breastfeeding, poor nutrition, and a diastasis all affect your rate of healing.

The timeline for scar healing after caesarean section

Read more about the timeline…

Because each person’s unique history influences their healing time, each journey is different. The result is that we have expectations that aren’t aligned with our body, we can’t optimise our healing, and preventable problems persist well beyond the time they should and predispose pelvic dysfunction around menopause.

WellMom checks your physical healing, gives you the information you need to help your body heal well, and to safely return to training in tandem with your body’s healing.

It’s never too late to do to your post natal assessment!

Contact us to book your WellMom Post Natal Assessment

What is normal after childbirth?

Grab a cup of tea, find a quiet corner, and take 15 minutes to read through this questionnaire. This is a comprehensive list of questions to see if your bladder, bowel and sexual function is normal. The ideal score for this outcome measure is 0 which indicates normal pelvic function for a woman of any age.

Interesting fact on the prioritising of post natal care

Every woman in France receives a physiotherapy assessment at 6 weeks post delivery with treatment and/or rehabilitation sessions to help her heal well physically and prevent problems which may arise later in life with menopause.

The story of WellMom

WellMom arose from my own need to find honest answers in my post natal recovery.
I resumed running once the medical all clear was given and I felt ready to, but a new injury forced my runs into walks. My usual sports physio approach did not solve the problem and this led me to attending my first course in Woman’s Health.

A whole new world was opened. Now I wanted information on how I could heal (or could have healed) better and evidence based guidelines for my return to training. This led to hours of doing online courses, sitting over text books and listening to podcasts.

The results were:
I fixed my injury and could run pain free again.
I saw that most general post natal advice is not based on anything concrete and certainly does not take the individual woman’s healing and circumstances into consideration.

I was left with the conviction that every woman should know:
…how she is healing physically after childbirth
…what she can do to help herself heal well
…how to return to training in a safe way in tandem with her body’s healing
…what normal pelvic function is
…and that it’s never too late to have a post natal assessment! Menopause would be a good time!

This is the journey that led to me becoming a Mummy MOT practitioner. This, together with the Modern Post Natal Assessment, Core Restore, and Functional Exercise Programming, has given me the tools to do the safe, fun and results oriented rehab for moms.

That’s where WellMom started.

WellMom offers the following services:

• 1. WellMom Post Natal Assessment from 6 weeks (to any date) after delivery.
• 2. Restore Your Core Rehabilitation, a program for 6 weeks to 12 weeks
• 3. Fit2Train Assessment before returning to high impact sport and weightlifting
• 4. Ready2Run Assessment, that specifically to checks your readiness to return to running

WellMom Post Natal Assessment

is done from 6 weeks (or any number of years!) post-delivery and after your gynae check-up.
At your appointment, your abdominal wall, pelvic floor (external and internal), scar, postures and relevant movement patterns will be checked. It’s a safe space to ask weird and wonderful questions… if I can’t answer them, I will refer you to a professional who can. You will be given a report, individualised guidelines, and pertinent information to set you on the path to healing well.

Restore Your Core Rehabilitation

is individual or small group specific postnatal rehabilitation.
Learning how to do Kegel exercises correctly is only the first link in the chain to achieving a normal functioning pelvic floor.
In the Restore Your Core program you will add the links to this in a sequence that is suited to your body, to the point where you’re able to use your core muscles correctly, and they’re strong enough to return to, (or even take up!) high impact training.
The exercises are tailored to challenge all levels of strength and fitness. It is safe to return to high impact sports such as CrossFit, gym, weight lifting and running after having a baby, as soon as you have healed and regained sufficient strength and endurance of your core.

Fit2Train Assessment

looks at whether you have sufficient pelvic floor and core strength, endurance and coordination, as well as sport specific strength, to safely return to high impact training such as functional gym and CrossFit.

Ready2Run Assessment

assesses if you have the muscle strength and endurance in both your core and legs to hit the road. Your tailored Return to Running Program, which you will get after the assessment, is aimed to help you become a resilient runner and give you 30-45 min of fun ‘me time’!

Common physical problems after pregnancy:

Common problems after pregnancy can include:

• Diastasis rectus abdominis (DRA)
• Stress urinary incontinence (SUI)
• Pelvic organ prolapse (POP)
• Constipation
• Painful sex
• Injuries on returning to training
• A weak core

The reality is that pregnancy changes one’s body. “Pregnancy (> 20 weeks), regardless of the mode of delivery, greatly increased the prevalence of major pelvic floor dysfunction, defined as any type of incontinence, symptoms of prolapse or previous pelvic floor surgery” (1)

To illustrate this, let’s look at a group of post partum women. Stats (from the UK) show that that 1 in 3 will have symptoms of incontinence, and that incontinence is the second biggest reason why elderly move into a care home! Sadly, we don’t talk much about these invisible problems, and hide in shame.

But these problems shouldn’t be things that you 'just live with'! Education is key – if you know that a problem is common, it makes it less daunting to seek help. And learning about a condition will give you the know-how to manage it well.

Our expectations of life demand a body that can keep up – one that enables us to be a hands-on mom, manage the demands of family and work, socialise, and even achieve the required Vitality points!

Diastasis rectus abdominis (DRA)

Tummy gap, or ‘split in the tummy’ can be seen as tenting of the tummy on contraction. It’s due to a loss of integrity of the midline connective tissue that connects the two 6-pack muscles, called the Linea Alba.

Facts:

• It’s been shown that all women will have a diastasis by the 35th week of pregnancy (1)
• Studies have shown that 30-40% of ladies will still have a diastasis at 6 months post delivery (1,3)
• A diastasis in and of itself is not a cause of back pain (1), but it means is that you may not automatically regain the core you had which supported your back. We see it as poor coordination between the ‘core’ muscles.
• This is not just cosmetic! Although the ‘mummy tummy’ is what bothers moms most, the poor muscle coordination results in higher pressures on pelvic organs (bladder, uterus and rectum) their support structures, as well as on the pelvic floor.
  Years of poor loading strategies can result in weakening of these support structures and problems related to incontinence and pelvic organ prolapse and pain occur. (2)
• Most women can learn to control the tenting without surgery by following a dedicated and specific rehab program.

More information on DRA

Stress urinary incontinence (SUI)

This is leaking when you cough, sneeze, skip, or lift heavy weights. It usually happens because the pelvic floor – which helps to support the bladder and close off the ureter – isn’t doing its job well enough and can’t stop unwanted leaking. There can different causes of incontinence, this is but one (3).

Facts:

• Urinary incontinence during pregnancy nearly doubles the likelihood of urinary incontinence at three months post baby regardless of delivery method (so Caesarean section or vaginal) (1, 3)
• Incontinence is not unique to vaginal deliveries. 1 in 3 women will have incontinence at 3 months post vaginal delivery. Women who have Cesarean delivery are half as likely to have incontinence (3).
• Four years after first delivery, the prevalence of stress urinary incontinence is as high as 29% - that’s about 1 in 3 ladies! (4)
• Incontinence in NOT NORMAL, not even a little!
• Exercise is effective in managing SUI: “Pelvic floor muscle training remains the first-line treatment for female UI (urinary incontinence) with high levels of evidence and grades of recommendation.” (5)

Pelvic organ prolapse (POP)

A prolapse describes a shift in the position of organs within the pelvis. It can be felt as a heaviness within the pelvis, incontinence, constipation, and painful sex. (2)

Facts:

• “Pelvic organ prolapse is considered to be one of the major anatomical sequelae of childbirth. Globally up to half of all parous women have some degree of clinical prolapse and 10–20% are symptomatic” (1)
• Knowledge is the key to managing a prolapse well for long term pelvic function.
  Learning synchronised activation of the muscles surrounding the abdomen will manage intrapelvic pressures support the pelvic organs (3); this is an important compensation mechanism to manage functional defects (4)
• Menopause results in a drop of oestrogen and with this a reduction in the elasticity of pelvic organs and their supports. This can result resulting in regression of an existing pelvic dysfunction.

Constipation

Everyone has their ‘normal’ but does your normal equate to good health?
Did you know there is a chart classifying stools? Bristol Stool Chart (take note of this for your kids and husband as well!)
And that there’s an ideal posture which makes a big difference to voiding without straining which results in excessive pressure and weakening of the pelvic floor?

Straining is not ideal as it results in excessive repetitive pressure on the pelvic floor.
Constipation is not all about gut health but is also mechanical - ‘the pipes lining up with the holes’? Pregnancy and childbirth, vaginal or c-section delivery, can cause unexpected changes.

Painful sex

Again the function of the pelvic floor comes to light. It is as important to be able to relax your pelvic floor as is it to contract it. Aside from the physical aspects, hormones and emotions come into play as well. There are specialist Woman’s Healthy physios and therapists who can help address problems.

Injuries when returning to training

Injuries when you return to training can be a result of ‘core malfunction’, technique changes (due to posture changes that you are unaware of), or breastfeeding (which results in a slower return of your body to full strength). Or it could simply be ‘too much too soon’ – doing an assessment will help you know what your body can cope with.

A weak core

A functioning core depends on your posture, individual muscle strength, and synchronicity of the muscles in the area. Pregnancy and delivery changes this.

Pregnancy affects pelvic floor muscle strength and changes your posture. Your ab’s can be weakened by a tummy gap (DRA), and the scar from a c-section incision affects the contraction of the abs (even though they don’t cut through the muscle).

The knock-on effect of a weak core can be back pain, pelvic pain, a back that is easily strained, and mummy-tummy that won’t budge.

How to get your core back (which is controlled movement) is both a learning process and a strengthening process (1).

Does exercising really help improve and prevent post natal complications?
And what exercises work?

Yes exercise most definitely works! Or more specifically, an exercise plan that is adapted to the individual, and includes all muscles groups, is effective (1,2,3).

The core is not just your tummy muscles. It includes the deepest layers of tummy muscles, the diaphragm (main breathing muscle), deep back muscles and the pelvic floor. These all need to work together in a synchronised way.

From there up the large muscles need to provide more support for heavier loads and movement. These include the superficial tummy muscles, large back muscles, glutes, lats, and even the notorious hip flexors.

Getting rid of your mummy tummy is a process that involves learning movements, strengthening muscles and working with your body as it heals.

Strengthening a few muscles in isolation, or doing one dimensional exercise, will not result in you being stronger.

Contact us to book your WellMom Post Natal Assessment

It’s never too late to do to your post natal assessment!

References