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DO: Check with your doctor before you start any exercise programme that is strenuous and will involve weight lifting, abdominal or high impact exercises.

DON’T: Start high impact exercises, such as running and jumping, too early. There are two reasons for this; one is to protect your pelvic organs and to prevent prolapse of the bladder, uterus or rectum (this is when one or all of the pelvic organs ‘drop down’ from their original anatomical position). The other one is to protect your joints and ligaments, which are still under the effects of the hormone relaxin. When is too early? If you are exclusively breastfeeding, clinical experts recommend that you wait until your period has returned. Although you stop producing relaxing when the placenta is delivered, the effects of laxity on your ligaments continue up until six months postnatal.

DO: Start pelvic floor muscle strengthening from Day 1 postnatal, unless you have a catheter in place or it is too uncomfortable to do them. Contracting your pelvic floor muscles from Day 1 after you have had your baby helps to improve blood circulation and aid in healing any perineal stitches. Even if you cannot feel much happening, the exercise of thinking about the contraction has been shown to be valuable at ‘kick starting’ those muscles!

DON’T:: Do sit-ups and abdominal crunches or lifting both legs up at the same time whilst lying flat on your back until you have checked that your tummy muscles have joined back together. Most women have a separation towards the end of their third trimester, and most recover spontaneously in the first 4-6 weeks postnatal. It is extremely important to be prudent during this time and allow the muscles to heal and return to their original position.

How to check for the muscle separation:
Lie on your back with your knees bent and feet flat on floor. Place two fingers of one hand sideways around the area of the tummy button and apply gentle pressure. Raise your head and shoulders off the floor. You should feel two ridges of muscle on either side trying to close around your fingers. If you cannot feel these ridges, try to place 3 or 4 fingers. By 6 weeks postnatal, this separation is normally 2 fingers or less. If in doubt, ask your doctor or a physiotherapist to check! The most important thing is: do not let your muscles ‘dome’ up like a pyramid when you raise your head off the floor.

DO: Contract your deep abdominal muscles from Day 1 postnatal. That involves gently drawing in your muscles to ‘flatten’ your tummy and narrow your waist. This action works well together with your pelvic floor squeezes. Avoid heavy lifting in the first 6 weeks but if you have to lift your toddler, make sure you draw in your pelvic floor and tummy muscles to prepare your body for lifting.

Monica Donaldson
Physiotherapy