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Pregnancy – What we can learn about our bodies, and how to safely exercise them pre and post baby.

Discussion with physiotherapist Amanda McDonald, about her experience on the job as a Women’s Health physiotherapist and personally about her experience in pregnancy.

As your body changes during pregnancy it can be an exhilarating or terrifying experience for some - depending on who you chat to. The body is changing and expanding quickly, hormones are pumping, breathing becomes compromised and things you do normally day to day seem a lot more difficult. You may be experiencing back, pelvic, rib or hip pain, wake up continuously at night from the weight of that ever changing stomach, or experience leakage when you laugh/cough/jump/run (known as stress urinary incontinence).

This is where I see women come in to see me – wanting to manage pain, their bladder and pelvic floor issues during pregnancy, or for guidance on safe and effective exercise during this precious time. Pregnancy is a special time, and keeping good physical and mental health is an essential part of enjoying and thriving, both during and beyond this period. Becoming pregnant and entering into motherhood places huge demands on the mother’s physical body, especially around the pelvis.

At Body Align Physio we specialise in treating women’s conditions, from treating a sore pelvis or back, to Pilates classes tailored for pregnant or postnatal women. I have now obtained insight being pregnant myself on what it really feels like to experience some of these aches and pains, but most importantly how to look after my body during the prenatal period.

Common questions I get asked…

What are the most common physical issues that affect women during pregnancy?

The most common physical issues I come across during pregnancy are pelvic, low back pain, rib pain and pelvic floor dysfunction such as urinary leakage, urgency and pelvic organ prolapse.

Are there ways to avoid these issues during pregnancy? And if so how?

I think it is really important to start exercising early within pregnancy under guidance of a qualified prenatal instructor. It is essential that the pelvis maintains good alignment and adequate muscular support (including the pelvic floor) throughout pregnancy. Due to changes in exercise patterns women tend to lose muscle mass during pregnancy. I have found it important to maintain the integrity and strength of your pelvic floor muscles as well as your global and stabilising muscle of your body during this time. Listen to your body - avoid starting anything new and stick to exercise like Pilates, Prenatal Yoga and gentle walking, cycling and swimming – exercise is important yet shouldn’t create pain or discomfort.

What services are available at Body Align Physio for pregnant women?

We offer specific Women’s Health services at the clinic. We treat everything from musculoskeletal pain such as pelvic, hip or back pain, pelvic floor dysfunction such as urinary leakage, urgency and prolapse, prescribing pelvic floor programs. Being a Physiotherapist and Pilates rehabilitation instructor we also run supervised group or private classes for pregnant women.

Do you see a difference in the bodies of women who exercise and those who don’t during pregnancy?

Definitely. Women who tend to have adequate strength (with sessions 2-3x week) and cardiovascular strength (2-3 x week) coming into and throughout their pregnancy tend to cope with the hormonal and postural changes a lot easier. For someone who exercises a lot normally, I have maintained this throughout my pregnancy however have had to listen to my energy levels so I don’t overdo it - a decent swim in the laps pool entitles me to an afternoon nap!

What are the best exercises to perform when pregnant? Pilates or Yoga – In your opinion are their differences and benefits to different women?

Pilates is a targeted approach which incorporates the core stabilising muscles of the deep core and pelvic floor muscles with strength and control exercises of the entire body. It has enabled me to keep up with exercise throughout my pregnancy and endurance for everyday activities.

Yoga has been important for both my mental and physical state of mind, breathing techniques, to prepare myself for labour with position, and reducing stress.

Both swimming and walking has been both meditative and great for cardiovascular endurance. Again be mindful of what you pick up during your pregnancy journey – some of these exercise styles may not be enjoyed as much as others. Check in with a physiotherapist for further guidance if you are unsure of what to start with.

What are the pelvic floor muscles? Do they get weaker during pregnancy?

Your pelvic floor muscles are a sling of muscles that give you control over your bladder and bowel. They also hold your pelvic contents – your bladder, bowel and uterus in place. Pregnancy and birth can lead to weak pelvic floor muscles due to the load of the baby on the pelvis and the stretch of the pelvic floor with birth. If you have weak pelvic floor muscles you may feel heavy around your bottom or vagina, and have difficulty controlling wind, or leak urine when you cough, sneeze or laugh.

We often hear that leakage following a natural birth is quite common because of weak pelvic floor muscles. Women often report that laughing, coughing, sneezing and jumping are typical activities where they get leakage. Can this be avoided? How often must we do pelvic floor exercises during and after pregnancy?

These symptoms where you get leakage of urine during cough, sneeze, laugh are a part of a diagnosis we call “Stress Urinary Incontinence” and they are NOT normal after childbirth.

During pregnancy think of a small elephant sitting on your pelvic floor, it stretches more than 200% its normal length during pregnancy. Evidence suggests that problems can start during pregnancy, not just after birth. Women who have had multiple births, instrumental births (with forceps or ventouse), severe perineal tearing or large babies (birth weight over 4kg) are at greater risk of pelvic floor muscle damage. Therefore, as we rehabilitate a hamstring following an injury we should also rehabilitate the pelvic floor correctly and in correct time frames.

So to be asked the question can it be avoided – yes it can! Following the advice of a Women’s Health Physio and having a pelvic floor examination is the safest transition back to these activities and exercise. To be 100% sure you are doing your pelvic floor correctly, we advise an internal examination with a Women’s Health Physiotherapist. We know from research that when the general population are given instructions on how to do a pelvic floor contraction that greater than 50% do it incorrectly, or which 25% are actually bearing down (the opposite manoeuvre to the lifting up and squeeze action that a pelvic floor activation should be - EEEK!). Therefore there is no recipe for each woman who does their pelvic floor, and each that I see is prescribed their own individual program.

My advice to women is to be proactive in their childbearing years, is to find yourself a good Women’s health Physiotherapist and be sure to see them at least once in pregnancy and then again at 6 weeks postnatal where they can prescribe you a pelvic floor program. These appointments will potentially save your pelvic floor in the long term.

When is it safe to go back to exercise after pregnancy and childbirth?

How long after giving birth can women start to exercise again? What is the best sort of exercise to introduce?

A common question I am asked. The most important thing to remember is that each woman is different, having different body types, different births and different fitness levels going into pregnancy. So each woman’s transition is individual.

Throughout the childbearing year your pelvic floor, deep abdominals and postural muscles weaken. Start with low impact exercise such as walking, Pilates, Yoga, stationary bike cycling, cross trainer and swimming (after your 6 week postnatal check up). If you are a runner or keen to get back to high impact exercise work with your Women’s Health Physio who can assess pelvic floor, abdominal separation and guide you on a safe return. Following this find a specific postnatal trainer (who knows the postnatal body) who can work with you to reach your post baby goals safely.

We only have one body and one pelvic floor – so look after it!

Physiotherapist Amanda and her baby boy - Bobby.

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