What happens After the Six Week Check?

What happens After the Six Week Check?

IMG_5086-1So this is timely. I’m having my 6 week check this week. The fact is that I am 10 weeks post partum speaks volumes about how over stretched the NHS are, but also how the system falls short of giving women the full care they need.

Further more ‘being signed off’, runs the risk of suggesting that life is a-ok and truth is having a baby takes a huge amount of recovering from. And all too many of us are guilty are learning to run before we can walk. Both emotionally and physically. Which is why this list from Anya aka @mothers.wellness.toolkit is so brilliant:


 

  • You have a baby. You take it relatively easy for the first 6 weeks, maybe doing the odd squeeze of your pelvic floor (clenching your buttocks hopefully and raising your eyebrows?) when you remember/can be bothered, but you’re itching to get back into it and “lose the baby weight”, “get your body back”. Pictures of Kardashians pinging back into their pre-baby shape make you feel like you’re lagging behind, being “lazy”, stuck somehow “doing nothing” under your baby when there are more important things to do. You feel like 6 weeks is a LIFETIME before you can be “signed off as back to normal” and ready to get stuck into regular activity, sign me up for baby Zumba now please!

  • Even if you’ve been “signed off” at your 6-week check, this should be seen as the START line of the marathon of your body healing itself, not the finish line. Your 6-week check is often cursory and currently skips over some fundamentals of your healing. 

  • The 6-week check usually marks the formal end of maternity care, and you may think woo hoo the doctor has told me I’m fine, I’m good to go, baby hot spinning yoga here I come! – but at six weeks your body is not yet healed. Too often the GP only has time to give you a quick glance, ask you about contraception (!) and check in on your mental health. They may not ask you in depth about pelvic floor healing or assess your abdominals for separation (see below). And you might feel shy to talk about it. So you shouldn’t take it as read that you’re now all clear to get into high impact exercise – particularly if you weren’t an exerciser before pregnancy.

  • Six weeks is enough time for your organs to settle back to their original position once baby has evacuated that space, and the first stage of soft tissue healing. And potentially healing takes much, much longer if you’ve had a caesarean or a severe tear. It can take months for the abdominal and pelvic muscles to recover, and for the connective tissue to completely firm up. Your body is healing, there is so much going on under the skin that you can’t see, it needs nurturing and kindness.

  • Running and HIIT exercise appeals to mums because it requires no equipment, costs nothing, and can be crowbarred fairly easily into a suddenly-chaotic yet full-of-nothing-much day. You think getting back into it will make you feel great, lose all the weight, find your mojo. And yes, it might. Exercise is so important to wellbeing. But going straight into high impact activities like running at 6 weeks because “your 6-week check was fine” (was exercise even mentioned?) may not be the best plan for your long term healing.

  • Breathing is the most crucial starting point for your recovery, physically and mentally. Sooo boring, right? Well, your breathing enables you to release tension and anxiety, to allow your body space to recover from your birth experience, to move you from “fight or flight” into “rest and digest” mode. Breathing is intrinsically connected with the efficacy of your abdominals and pelvic floor, as the diaphragm has to learn how to communicate with your pelvic floor now that your baby is no longer hogging the space between them. Breeeeathe, wide and full into your belly, allow your diaphragm to fully descend and open and it will stimulate the conversation between the pelvic floor with its symmetrical rise and fall motion. It’s the most overlooked healing tool we have: it’s free, you’re doing it anyway might as well make it count, it doesn’t take any extra time ladies.

  • Diastasis whatsi? Diastasic recti – abdominal separation. Your rectus abdominis – your six-pack muscle, has separated during pregnancy due to stretching of the linea alba ‘fascia’, the connective tissue that holds the two bands of muscle together, sort of like unzipping at the front. Trying to flatten the mum tum with sit ups is not the solution as it will make the separation worse. We need to strengthen the deeper stabilising muscles: the pelvic floor, your corset muscle the transversus abdominis, and, fundamentally, get the diaphragm firing properly with proper breathing.

  • NO SIT-UPS. NO CRUNCHES. NO PLANKS. These are strictly contra-indicated in the early months of your postnatal recovery, due to weaknesses caused by diastasis.

  • If you’ve never been checked for ab separation and you’re not a “new” mum, this rule still applies. 

  • If you’ve got abdominal separation – sometimes the gap doesn’t close naturally – it is going to cause problems such as backache and general weakness, however “new” or old a mum you are. ‘Ab exercises’ cause an increase in intra-abdominal pressure, which in turn increases the load placed on your weakened pelvic floor – sort of like building a loft extension on top of a house where you’ve knocked down a load-bearing wall. It’ll cause back pain, may exacerbate pelvic floor problems, it’ll make your foundation weaker not stronger.

  • If you do go to a buggy running-type group, or attend any fitness group in the year after your baby, your instructor must check your abdominals for separation and at the very least ask you in detail about your birth experience, how your pelvic floor is feeling, whether you experienced pelvic pain during your pregnancy. If the PT or instructor omits any of these essential postnatal duty-of-care issues, and particularly if they launch into AB EXERCISES, planking, sit-ups, leg lowers, flat tummy exercises etc., DO NOT DO THIS CLASS. Run, run away (slowly and with care).

  • Bum deal. Your pelvis has taken most of the burden of carrying your baby and probably also provided the exit route, so we need to give it some strong scaffolding. Hormones are still flooding your system, which keep your ligaments and joints unstable for up to nine months (and if you are breastfeeding, potentially longer), so it’s important to regain strength in your glute muscles, in order to stabilise your lower back and hips. If they aren’t firing on all cylinders you’re more likely to experience low back pain or have issues with your hips, knees and ankles. Strong bums are particularly important if you want to ultimately get back into high-impact movement such as HIIT and running…or day to day craziness with your minis – I mean, that can be a bootcamp workout in itself, right?

  • Posture matters. Everything hinges on your alignment in terms of your body systems working effectively post-birth. No amount of pelvic floor exercise will be truly effective if your alignment is poor and you’re not breathing fully. You do a lot of lifting, pushing and bending when you have small children  – especially if you are breastfeeding. So you need to soften, lengthen, balance and even out your spine. Try lying on the floor at the end of the day, legs bent, palms facing up, and just take 2 minutes to breathe deeply.IMG_4658

  •  I wet myself! LOL! IT’S NOT FUNNY. The main thing to remember about your pelvic floor after birth is that you should not suffer in silence or laugh it off. There is absolutely no evidence to suggest that pelvic floor issues get better if they are ignored. If you are struggling with pain, discomfort, lack of sensation, a feeling of heaviness or ‘bearing down’, or even if things simply don’t feel ‘normal’ – not asking for help only means that the problem will definitely get worse over time.

  • Consider your 70-year old self and how you want her to feel. There is a real risk of pelvic organ prolapse postnatally, and it is so important to strengthen your pelvic floor to increase your chance of avoiding this, particularly if you want to have more children. If you feel any sensation of your insides ‘falling out’, please do not ignore this. A prolapse is when the uterus, bowel or bladder descends into the vagina. Go to your GP and ask to be referred to a women’s health physio. There is always something that can be done.

  • I had a C-section, pelvic floor exercises don’t apply to me. Sadly you don’t get let off the hook. Your pelvic floor has provided a neat pillow, punch bag and trampoline for your baby for 9 months, and if you laboured, there may be trauma to your pelvic floor. It needs some attention even if it didn’t serve as the exit turnstile.

  • Whatever birth experience you had, start your pelvic floor exercises as soon as possible. The sooner the better. BUT IT’S NEVER TOO LATE. So start now. NOW. If you had a perineal tear, whatever grade, begin these exercises without delay, as they’ll promote healing, send blood circulation to the area, reduce swelling, increase sensation and help you to regain your strength and function.

  • Start now.

  • To do your pelvic floor exercises correctly: lift your back passage – imagine you are trying to stop breaking wind – then travel the engagement forward as if you want to stop the flow of wee, squeeze and lift forward and up.

  • Try not to hold your breath: lift up with an exhale, and then allow the entire pelvic floor to fully open, soften and relax on the inhale. Do a few repetitions, slowly and intentionally, a few times every day with this breath pattern. Then progress to doing some quickly. Squeeze and repeat 10 times, breathing normally without holding your breath, and always fully releasing and resting with an in breath at the end.

  • Remember that when you lift your pelvic floor there should be no clenching or tension anywhere else: bum, shoulders, jaw, inner thighs. It’s an internal engagement. A strong pelvic floor is the key to healing your mum tum.

  • Look at the Squeezy app for more guidance and physio-led information about pelvic floor exercise.

  • Your postnatal mojo is so linked to how your body FEELS and how you’re functioning. If you’re weeing when you exercise, or even when you cough and sneeze, that’s going to make you feel like shit, and make you scared to speak up about it or to continue to exercise, which perpetuates a negative cycle for your wellbeing.

  • Depletion in body: make no mistake, pregnancy withdraws all you got. It takes you well into your overdraft of energies, nutrients, minerals, strength. And then you don’t often choose to make deposits back into your account once baby is out (the “bounce back”!).

  • Your gut health may well be affected by your birth experience – antibiotics, caesarean birth – which will compromise your absorption of nutrients from your food. And crucially, may compromise your production of serotonin – the hormone of JOY, which is largely produced in the gut and therefore arguably could be one of the missing links in some out of the blue experiences of postnatal depression.

  • You’re not sleeping well, and probably not drinking enough water so you’re dehydrated. And you may only be eating toast, biscuits and mainlining coffee anyway, so your poor gut doesn’t have that much to work with.

  • Postnatal depletion is not depression. But it can make you feel generally a bit meh and crap. Which lends itself to becoming depression if left unchecked over time. The most basic form of selfcare is to tell yourself that you matter, to feed and water yourself adequately. How do you FEEL? Are you strong? Are you strong enough to carry a toddler in your dungarees like a sling for a mile when they refuse to go in the buggy?

  • It’s normal not to feel amazing all the time. But if it’s affecting your every day and you just feel “not right”: this is the tipping point. Check your PHYSICAL needs today: drink enough water, breathe properly and fully – this will be affecting your mind and spirit too. Our body image is so intrinsic to our happiness and identity, and postnatally this can take a real kicking.

  • It takes time to heal and regain your strength, you are only human, you’re not a Kardashian. It’s not frivolous to prioritise you and getting your body back safely and effectively. If you return to sit-ups, planks, running, HIIT too soon you can do more harm than good.

  • So ladies: drink enough water, remember to breathe, be kind to yourself, and if you’re at all worried about your “mum tum” not going away or about your pelvic floor healing, ask your GP to refer you to a women’s health physiotherapist. Look after YOU!IMG_3767

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