Health: looking after mothers

Pregnancy and childbirth is a massive physical journey for the body and almost all pregnant women will suffer some degree of physical implication after they’ve had their baby,” the Kilkenny-based chartered physiotherapist says.

“Very often they think ‘I’ll bounce back’ and there is a lot of pressure on women now to do that and look fabulous after a baby is born, but there is research now from the University of Salford which shows that it takes women a year to recover physically and mentally from having a child.”

New mothers should therefore respect that pregnancy and childbirth are major events for their bodies and allow themselves time to recover, she believes.

“They may also need some rehabilitation assistance to get themselves back to where they need to go because otherwise they run the risk of long-term health problems.”

Problems after the birth often come as a shock for new mothers, she says. The pelvic floor is very often damaged following pregnancy and childbirth and this can result in significant problems. The pelvic floor is a layer of muscle that lines the base of the pelvis, she explains.

“It holds the bladder, the bowel and the uterus in place and forms a seal around the urethra to keep women continent.

Stress and urinary incontinence

“The pressure of pregnancy and the weight of the baby bearing down on the pelvic floor, plus the trauma associated with the vaginal delivery can cause damage and weakness to the pelvic floor, however.”

This damage can lead to urinary incontinence after childbirth – either stress or urge incontinence – and in some cases also to faecal incontinence which is reduced control over the back passage.

Stress incontinence means leakage when you cough or sneeze or perform some sort of physical activity like jumping or running. Urge incontinence is a sudden urge to void.

“That can be very upsetting and embarrassing as well. It might start off as a little problem, but it generally gets worse to the point where your life starts to revolve around where the nearest toilet is and you can’t wear a white trousers in summer for fear of leakage, for example. That can be very upsetting. Faecal incontinence and poor control of flatulence can have an even bigger impact on women’s self-esteem and confidence. Getting back out to normal activities can be really challenged.”

Prolapse – dragging pressure

Pelvic floor weakness can also cause prolapse.

“That’s where there is some weakness in the vaginal wall. This can cause the organs like the bladder, bowel or uterus to drop down and very often women might experience a dragging or dull pressure in the vagina related to this. The patient might find they are OK in the morning but as the day goes on and they are on their feet a lot they might notice it more.”

All these issues are things that a women’s health physiotherapist can assess, she says.

“It is very much recommended that any new mum should seek an assessment at about the six-week mark after they’ve had their baby.”

But is their six-week GP/consultant check-up not enough?

“When women go to see their GP at six week mark very often that check-up is more a quick chat than a proper physical assessment.

“Sometimes women then go back to their high-intensity interval training (HIIT) activities or to Zumba classes and that’s when they realise that there’s an issue, that they’re leaking or they are having to stop and go to the toilet.

“Also, if they have symptoms of prolapse after their first baby and go back to normal activity without addressing it, problems may arise if they go on to have further pregnancies.”

Physiotherapists, particularly those who specialise in women’s health, can assess the pelvic floor, determine the level of weakness and advise on a programme of exercises to rehabilitate the pelvic floor.

“Women should just know themselves that it is important to seek help. If they tore their cruciate or calf muscle, for example, they’d go to a physiotherapist for help with rehabilitation. Sometimes we under-estimate the physical impact that pregnancy and childbirth has and therefore don’t pay enough attention to the problems that can develop.”

Pelvic floor exercises – do them correctly

Eighty per cent of women perform pelvic floor contractions incorrectly, she states. “Sometimes doing them incorrectly can make our problems worse. That’s why a quick assessment is worthwhile so at least you know going forward what to do and how to do it.”

Separation of rectis abdominus muscle

It’s also very common for the abdominal muscles to be separated during pregnancy.

“This is caused by the pressure of the growing baby on the rectis abdominus muscle and most women will have a degree of separation of this during the pregnancy.

“By eight weeks the separation should have healed, however, but if the abdominal muscles remain separated at the eight-week mark then that woman needs extra help. This condition is called diastasis of the rectis abdominus muscle (dram) and women might know they have it because they have that ‘mummy tummy’ appearance ie they still appear pregnant.”

To solve this problem a women’s health physio can measure the degree of separation they have and recommend exercises to strengthen up their core muscles.

“Lots of women end up doing things like lots of sit-ups, planking and burpees to try and address their mummy tummy, but actually all of those things make it worse so it’s really important if they do feel they’ve got that problem to seek advice on it as your core and back is going to be affected.”

Caesaerean births

Bernie Leamy has had two caesarean births herself so she knows the score there.

“It is major abdominal surgery and any surgery through muscle is going to leave you with weakness. The return to exercise should be done, in a very controlled, safe and structured way after a C-section.”

Back pain caused by bad posture

Back pain is also common after childbirth.

“That’s because in pregnancy, posture and how we hold ourselves can be different so it is important to readjust our posture to a pre-pregnancy status.”

Bottle and particularly breastfeeding can have huge implications for our posture too, she says.

“It can cause neck, shoulder and back pain if we are not sitting properly so we should be mindful of how we lift, carry and feed the baby in those weeks after birth because our muscles may be weak after having the baby.”

She advises using a supportive chair.

“It’s really important to sit well back in the chair and make sure you are well supported. Bring the baby up to you to breastfeed and prop the baby on a cushion to help offload some of the pressure on your neck and shoulders.”

She also advises care when it comes to heavy lifting.

“The baby car seats most parents use can be very heavy in the early days after childbirth, especially if you’ve had a section. In that situation you shouldn’t lift anything heavier than your baby for the first six weeks as it’s a huge load that one arm is carrying.

“Often over time mothers present with neck, shoulder and elbow pain. Thumb pain is common with mums too because they are lifting the baby so often. There can be overuse syndrome in their wrist that can be helped by modifying how they lift the baby. Mums with twins can often develop this type of repetitive strain injury.”

Ireland behind with recommendations

Ireland is somewhat behind the rest of the world in putting emphasis on women having this kind of check-up after a birth, she says.

“Our French and German counterparts will not go near a gym until they’ve had several appointments with their women’s health physio to make sure they’ve got their abdominal and pelvic floor muscles and their posture and alignment sorted. They are trying to prevent issues down the line. It’s when we hit into our 60s and 70s that these things can become issues if they aren’t addressed now.

“It’s important to remember that it is recognised now that pregnancy and childbirth does take a serious toll on the body so you need to give yourself time to physically and mentally recover from it.

“Women need to nourish themselves and rest and only when their body is feeling able again should they start back to activity but they should do it in a safe manner.”

Top tip

New mums should roll onto their side rather than sit up when they are getting out of bed.

Information

For more information, click here.

A pelvic floor exercise booklet is available on Irish Society of Chartered Physiotherapists website and more information about women’s health physiotherapists in Ireland.

Predictive factors for pelvic floor damage

There are some predictive factors that will increase a woman’s risk of pelvic floor damage. These include: