Physical Wellbeing in Pregnancy and Beyond

I've written this blog post off the back of a recent event I was lucky enough to speak at called The Mother Fair. Following conversations with lots of expectant and new mothers there seemed to be a common stream of questions revolving around the subject of "what should I do now to keep fit and healthy?"

Today we're going to discuss the changes that happen to our bodies during and after pregnancy, how we can take care of ourselves during this time, and how exercise and lifestyle can impact our recovery.

Firstly, pregnancy affects everyone differently so I would always recommend seeking specific advice if you have any pregnancy related injuries or complications.

I'll begin with Exercise in pregnancy as it's a question I get asked a lot. Guidelines now suggest that exercise during pregnancy should be encouraged, for both the health and wellbeing of mother and child.

The type or intensity of exercise will depend on what your level of physical activity was before pregnancy and what your personal reasons are for exercising throughout pregnancy.

It is not recommended that you start anything new in the first trimester, but if it is something you have done regularly and it doesn't put you at risk of falls or impact there is no reason to stop if it feels comfortable and you are having a healthy pregnancy.

Some of the benefits of exercise during pregnancy are: Reduced pain, eases constipation, promotes healthy weight gain during pregnancy, improves overall fitness strengthening the heart and blood vessels & aids weightloss after delivery.

Exercise may decrease risk of preeclampsia, gestational diabetes & unplanned c-section delivery,

We should be aware there are some contraindications for exercise in pregnancy such as,

Placenta previa, pre-eclampsia, poorly controlled blood pressure, gestational diabetes, preterm labour (or waters have broken) during this pregnancy (or previous pregnancies) or severe anaemia.

How often should you exercise? - It is recommended that pregnant women should aim for 150mins per week of moderate intensity exercise (same as usual adult guidelines). Moderate intensity is best described as 'enough to raise heart rate and sweat but could talk normally.' To achieve this intensity you may not require the same level of effort while exercising as you did prior to pregnancy, because there are now other demands on the body, so it is likely you may modify here.If you are completely new to exercise you should aim to build up to this recommended amount slowly, in the same way anyone else would.

You must stay hydrated, avoid overheating, wear a supportive sports bra!, be cautious of exercises that involve standing still or lying flat on your back for any length of time to avoid feelings of breathlessness and dizziness.

You should know the warning signs: bleeding or leaking fluid, feeling dizzy or faint, experiencing shortness of breathe before starting exercise, chest pain, headaches, muscle weakness, calf pain / swelling or regular painful contractions are all reasons to stop exercising and seek medical advice.

So let's bring our attention back to what's happening to your body during pregnancy. Your rib cage flares and widens and the abdominal muscles separate to make room for your growing baby. Pressure around the abdomen therefore increases so the pelvic floor muscles have more work to do to keep everything in place and supported.

After pregnancy, the rib cage is still flared and abdominals are still separated. Although this does often begin to correct itself within the first 6 weeks, there are some simple exercises which help to improve the overall outcome.

Breathe work can be practised during pregnancy as preparation for after birth and should include both lateral and abdominal breathing. (See Instagram posts for demonstrations of breathe techniques).

The breath pattern I'm about to describe is called 'piston breathing.' As we Inhale the diaphragm flattens and lowers causing a downwards pressure through the abdomen and pelvic floor muscles (PFM) should follow this movement by releasing tension and lowering. The diaphragm lifts as we exhale to expel breathe from the lungs and this lifting action helps to lift the pelvic floor muscles with it. So simply by breathing we can affect the pelvic floor function.

As you are practising your PFM exercises during and after pregnancy it helps to work with the piston breathing in order to work with the bodies natural movements, otherwise it is very difficult to activate them properly. 

I want to emphasise here the importance of being able to relax and lower the PFM as well as lift and contract it. The advice most women receive during and after pregnancy is to 'do pelvic floor squeezes' but the reality in clinic is that a large majority of women present with 'overactive' pelvic floor muscles. Often people ask "isn't that a good thing?" But in fact a too tight muscle is also usually a weak muscle. The reason for this is that if you're unable to fully relax a muscle, it's impossible to then perform a full contraction - which is needed to strengthen it. Performing 'squeezes' or 'kegals' repeatedly on an overactive muscle will not only not achieve the strengthening you're aiming for, but is also likely to cause other symptoms. Exercises need to address your specific dysfunction and so can't be generalised into one rule fits all. This is why I am so passionate about encouraging women to assess their pelvic floor function properly before embarking on any form of exercise following birth.

Exercise after pregnancy:

The Fourth Trimester refers to the 12/52 following birth. It's a useful term because it reminds the mother and those around her that she should still be taking care of herself as she did during pregnancy. So often it's the case that women pay more attention to their health and wellbeing during pregnancy and are better at 'listening to their body', but as soon as they have given birth the focus switches immediately to taking care of their newborn. This is completely understandable and very important, but somewhere in the midst of sleepless nights and 24/7 care, it's essential that we recognise this is also a time of healing and repair for women.

Self-care could mean many things but a couple of the most important considerations in the very early days are rest and nutrition, both of which are essential for healing and recovery. I'd recommend thinking about preparing some nutritious meals prior to your due date or planning some meals your partner could make during the early weeks to ensure you will be feeding the body well to help with repair and give you energy to manage the demands of taking care of a newborn. 

Be considerate of the fact that initially this is where your energy stores should be directed (as well as feeding baby if you're breastfeeding). When you introduce exercise into your routine it will require energy from your already depleted stores. Therefore it's important you listen to your body and recognise if you're ready to begin exercising. 

When you do feel ready, exercise is recommended for both physical and mental wellbeing of new mothers. 

You can begin to exercise gently from very early on  - one of the most useful and important exercises you can do are the breath exercises I've just demonstrated which aid the recovery of the diaphragm, abdomen and pelvic floor muscles. It also has the additional benefit of stimulating the bodies parasympathetic nervous system which is our internal control panel for reducing stress and anxiety.

In the first 6 weeks after giving birth the body will be constantly changing as it recovers and heals. With this in mind it is best to keep activity to a gentle level and avoid putting any extra stress on the body or use up energy which is already in short supply. 

Another common misconception is that your 6 week GP check-up is sufficient to give you the go-ahead to begin exercising again. This appointment is usually no more than 5-10 minutes long and it is very rare that you will have a physical examination at all. With this in mind, I would urge you to consider how your GP could possibly know whether you are physically ready to exercise. 

Guidelines For Returning to exercise* now say if you have no symptoms of pelvic pain, urinary or faecal incontinence, pelvic floor dysfunction, abdominal pain or any other MSK pain you can consider returning to running (or other similar higher intensity exercise) from 12/52 after birth. However this means BEGINNING the process of starting slowly and building up fitness as you would do normally after a break - not immediately going back to the level you worked at before pregnancy. Your physio can guide you with some preparation strengthening exercises to do before 12/52 in order to prepare you well for your return. 

If you do have symptoms above, it doesn't mean you can never return to your sport, but you may have to work on a programme to recover full function before it is safe to do so.

Common concerns such as Diastasis Recti and pelvic symptoms are best to be assessed and addressed around 6 weeks post-birth since it may well be that things will change anyway if seen before that time. 

Another common misconception that a C-section is less traumatic to PFM. In fact - it's the effort of carrying baby for 9 months and working to counterbalance increasing abdominal pressure and weight of uterus which causes the most change to the PFM. There's likely to be other considerations such as scar tissue from C-section that will affect PFM function and therefore needs to be assessed just as much as vaginal delivery. 

A Post-natal MOT / Mummy MOT is advised for EVERY woman following birth - and it's never too late to treat any of the conditions mentioned in this post. Following a thorough assessment your Women's Health Physio will be able to provide you with a programme of exercise which is tailored specifically to you to both aid your recovery and regain fitness and strength. The focus is always on empowering you to self manage and improve your symptoms so for many women it is a one-off appointment.

Take home message: Please also be aware that many women do not experience symptoms such as urinary incontinence immediately following birth but without a proper recovery programme or due to overdoing it with exercise in the weeks after birth can cause problems that manifest later in life - usually during periods of change such as later pregnancies, peri-menopause and menopause. All of these issues can be prevented by taking part in simple exercise routines that can be provided following a physio assessment, so if there's one thing you want to do for your long-term health and wellbeing I'd really encourage you to plan a trip to a women's health physio!

*Postnatal Return to Running Guidelines by Emma Brockwell, Grianne Donnelly, Tom Goom 2019