A women’s health physio answers your top 5 questions

Conceiving, carrying, birthing and caring for our babies puts huge pressure on our poor mama bodies. If you’re pregnant or postpartum (whether that’s two days or two years postpartum), you’ll be feeling it! 

Come to think of it… our bodies are pretty incredible, considering what they put up with. No one knows this better than a women’s health physio, like Sydney-based Brooke Blair. Brooke has seen all manner of bodily complaints and complications from mums. She works with women to prepare for, and recover from, birth. 

Here, she answers five of the most common questions she gets asked.

1. What changes occur to the pelvic floor during pregnancy and birth?

During pregnancy, your pelvic floor muscles widen and stretch. This is because a big ole baby is sitting on top of them! Some women naturally have tighter muscles before pregnancy, so the degree of widening and stretching is individual. For this reason, it’s great to get assessed by a physio to find out what exercises will be most beneficial for you. 

During a vaginal birth, the pelvic floor can stretch up to 1.5-3 times its normal length. Hectic! This causes some inevitable weakening and thinning of the muscles, making it a lot easier to accidentally pee your pants. Most women will experience some uncontrolled bladder movements after a vaginal birth. This can be assessed at your 6-week postpartum checkup and (thankfully) worked on with the help of a physio. Rest and exercises can assist with recovery after birth. Don’t be too worried if you can’t feel much of your pelvic floor for the first few weeks when trying to squeeze – as awful as that sensation is! If that lasts for a long time, though, definitely see your physio.

After a caesarean birth, you may experience pelvic floor weakness OR tightening (which can contribute to discomfort during sex). It’s hard to know which has occurred, so an internal vaginal examination will help your physio advise what’s changed in your pelvic floor. Even though your pelvic muscles may be less affected than with a vaginal birth, remember you’ve still had a tiny human chilling on your pelvic floor for 9 months!

2. Should I see a women’s health physio before or during pregnancy?

The answer is yes. Both, if you can. And ideally after birth as well!

It would be amazing for all women to see a women’s health physio prior to falling pregnant, but of course this isn’t always possible. Some people don’t even think about it. 

If you’re currently planning a pregnancy and have access to a women’s health physio, go and learn:

  • What and where your pelvic floor is
  • How to contract AND relax it
  • What good bladder and bowel habits are, or how to optimise these things before falling pregnant
  • Strategies for moving well in all areas of your body.

If you’re currently pregnant (whether it’s baby 1 or baby 5), it’s never too late to start

seeing a women’s health physio. We can work with you to help alleviate/manage pregnancy aches or pains.

If you want to have your pelvic floor and abdominal wall assessed, or ask questions about labour, birth and recovery, I recommend a first session at around 20 weeks. This is when we’ll know more about the position of the placenta and can assess your pelvic floor internally. We can discuss ways to optimise a vaginal birth, to try to minimise risk factors for intervention like episiotomy and tearing. We can also chat about exercise options and ways to keep you moving during pregnancy (if you want to).

3. When can I safely return to exercise after giving birth?

This looks different for everyone and will be based on factors such as:

  • What was your activity level pre and during pregnancy?
  • What was your birth like?
  • How are you sleeping?
  • What exercise do you want to get back to? (Are we talking light yoga, or F45?)

Exercise is a major point of discussion at your postpartum check up. Ideally, high intensity exercise like jumping and running should be minimised until 12 weeks (once the muscles and nerves recoil from the stretch of pregnancy and birth). For some women, getting back into exercise may take longer or require more assistance. The exact answer will be based on your postpartum assessment.

In saying that, you’re not just a pelvic floor/vagina/abdominal wall. (It’d be weird if you were.) You’re also a brain and a mind, and if you need to exercise for your mental health then do it! If running is what keeps you feeling like you, and it feels comfortable, go for it. Try to see a women’s health physio so they can suggest ways to keep you running while supporting your body at the same time. Bonus!

4. Will my abdominal separation ever come back together?

Abdominal separation is a tricky one. I never promise to bring a woman’s separation back together. But what we can do is work on increasing the strength of the separation, reducing the depth, and increasing your ability to perform whatever tasks or exercise you want to do.

All women will develop some form of abdominal separation in pregnancy. It’s a normal mechanism to keep your muscles safe from tearing as you grow a baby. How much separation occurs is likely a result of your genetics (NOT, as we used to think, what exercise you did in pregnancy and if you rolled to get out of bed).

In the first three months postpartum, abdominal separation is likely to improve the most due to the hormones in your body. After this point, progress can be less, but improvement can still be made. So don’t give up hope!

If you’re concerned about your abdominal separation, see a women’s health physio to have it assessed.

5. What support services are out there for postpartum women?

Here are some top picks:

Share this article with a pregnant or postpartum mama who needs this info.

Expert Contributor: Brooke Blair

Brooke is a female health physio based in Sydney. You can find her on Instagram here.

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