Almost within 48 hours of delivery most of the mothers are at their homes and the time taken to return to fitness varies according to the lifestyle and the type of delivery. It takes longer to recover from a cesarean section than from an uncomplicated delivery, the recovery also depends upon the fitness level of the woman. Besides visiting an obstetrician, the women should also be visiting a physiotherapist (the professionals trained in women’s health and incontinence). A physiotherapy session should be attended within the first 6 weeks. The physiotherapist plans designs and repeats the body movements to ensure fitness.
Why should we exercise after Pregnancy?
Doing exercises during the postpartum phase of pregnancy provides the following benefits;
· Provides post-operative care for a cesarean section.
· Strengthens the pelvic floor muscles.
· Relieves perineal pain.
· Strengthens abdominal muscles.
· Prevention of back pain.
· Improves fitness and decreases weight.
Exercise techniques used by the physiotherapist during the post-partum phase:
Deep breathing, huffing, and coughing exercises are used to prevent pulmonary complications. Coughing is difficult because of incisional pain, an alternative method is huffing. Huffing must be done quickly with the pillow or hands held over the incision and say ' ha ' forcefully and repetitively while contracting the abdominal muscles.
Initiate ankle pumps, active lower extremity ROM exercise, walking to promote circulation and prevent venous stasis. Bed mobility- rolling into and out of the bed should be taught.
Pelvic floor muscles
It is important to start Pelvic floor exercises within 6 hours of the delivery to regain the strength of these stretched muscles. The contractions should be done four to five times at frequent intervals throughout the day. The exercises are done to treat stress incontinence. The exercises increase circulation, promote healing, decreases inflammation thus relieving pain. Interferential therapy is used to re-educate the pelvic floor muscles. Initiate pelvic floor exercises to regain tone and control the muscles of the perineum.
Abdominal exercises are important to maintain mobility and increase circulation to promote healing. Initiate non-stressful muscle setting techniques and progress as tolerated. Avoid activities like lifting heavy objects, avoid straight sit-ups, bed mobility – rolling onto the side to get out and into the bed should be practiced, because normal support of the abdominals for the lumbar spine is diminished and due to the ligamentous laxity the lumbar is prone to strains.
Diastasis is more common in women who have had several pregnancies. Check for diastasis recti and protect the area of the incision as with diastasis exercises. The abdominal muscles should be contracted and released slowly at first and jerking must be avoided.
Relief of perineal pain
A ring cushion can be used for sitting so that pressure on the perineum is relieved. Side sitting or side-lying may be tried for breastfeeding. Prone lying with pillows under the lower legs and the abdomen to relieve pressure on the breasts may be restful. Cryotherapy can be applied for 4- 5 minutes twice a day. Ultrasound can be used around the scar to soften the tissue.
Retrain postural awareness and help realign the posture. Develop control of the shoulder girdle muscles which often get stressed due to the increased stress of carrying the new baby. Instruct to stand straight, stretch tall tighten buttocks, walk tall to prevent backache. During lactation, the mother should take care of her posture. Pillow should be kept under the thighs to prevent sliding and another pillow under the knee on the side of feeding.
Exercises after 6 week
The exercise regime should be continued and progressed to enable the mother to return to her normal activities.
· Hydrotherapy exercises can be done to strengthen the abdominal and pelvic floor muscles. General trunk, leg, and arm movements can be done.
· Sit-ups, leg lifts,
· Abdominal and pelvic floor contractions and pelvic tilting can be performed during activities such as washing dishes or standing in a queue in the market places.
· Crook lying exercises can be performed by making the baby lie prone on the mother's tummy and chest
· In prone kneeling, the baby can lie between the mother’s arms.
· Other exercises are back humping and hollowing, pelvis swinging from side to side, alternate leg stretching backward with abdominal contractions.
· In standing, the baby can be held in arms and the mother bends and stretches the knees and hips with her back against the wall.