Postnatal Education Booklet - For the best recovery after birth - Lifecare
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Postnatal Education Booklet
For the best recovery after birth
Contents
• Introduction
• Southcare Classes
• Perineal Care
• Caesarean Care
• Breast Care
• Nipple Care
• Pelvic Floor Muscles
• Bladder and Bowel
• Rectus Abdominis
Diastasis
• Caring for Your Body
• Exercises and Stretches
• Return to Exercise
• Postnatal Depression
Introduction
Postnatal Physiotherapy
Postnatal recovery time can last for 12 months, and the first six weeks
are particularly important. Your pregnancy hormones have caused a lot
of changes over nine months, and baby’s delivery (whether vaginal or
Caesarean) means your body needs extra care. This booklet can help
guide you in your recovery so that you can enjoy this special time with
your baby.
2
Postnatal Physiotherapy Assessment
A postnatal assessment with a women's health physiotherapist is
recommended six weeks post-delivery. This is different from your
appointment with your obstetrician, and an important part of postnatal
recovery. In this assessment we will screen, assess, and treat you for
any bladder, bowel, pelvic floor muscle, abdominal muscle, or
musculoskeletal issues.
Please call Southcare Physiotherapy on (08) 6332 6666 or visit
https://www.lifecare.com.au/clinic/lifecare-southcare/
to book your postnatal assessment today.
3
Southcare Classes
Mother and Baby Pool Class
The Southcare Physiotherapy Mum’s and Bub’s hydrotherapy exercise
class is offered between 8 weeks and 6 months postnatal, commencing
with mother and baby nursery rhymes and introduction to water
exercises. Following this, our lovely volunteers come in to look after bub
while new mums take part in an aqua-aerobics class. The classes run for
approximately 1 hour 30 minutes at the following times.
Monday 11.15am
Tuesday 12.15pm
Wednesday 11.15am
Thursday 11.15am
Clinical Exercise Classes
Clinical Exercise classes are 60 minute sessions run by
physiotherapists. Each client receives a tailored program at every
session which uses a variety of equipment, including Pilates equipment
and gym equipment. These classes are run at a variety of times
throughout the week. If you are interested in attending, please call
Southcare Physiotherapy on (08) 6332 6666 to book in your clinical
exercise assessment, or speak to your Southcare Women’s Health
Physiotherapist at your 6 week check.
4
Perineal Care
The perineum is the skin and muscle between the vagina and the anus,
and is under stretch when baby is born. Some women who have a
vaginal delivery will need stitches to repair their perineum after childbirth,
either from a tear or an episiotomy.
King Edward Memorial Hospital
How do you take care of your stitches?
• Showering daily and after bowel motions
• Patting (rather than wiping) dry, with a towel after showering or
toilet paper after emptying your bladder
• Changing your maternity pads every 2-3 hours
• Support your stitches by wrapping your hand in toilet paper and
applying pressure to your perineum during bowel motions
What should you avoid in the first six weeks?
• Direct soap, cream or powder onto the stitches
• Baths
• Tampons
• Sexual intercourse
5
How can you manage the pain and swelling from stitches?
• Rest: Lie flat on your back or side every few hours and avoid
sitting for long periods
• Ice: Freeze a maternity pad with water and place between two
pairs of underwear for 10 minutes. You can repeat this every
two hours
• Compression: Wear a double pad and firm fitting underwear
• Pain relief: Take paracetamol tablets as directed
• Pelvic floor: Regular, gentle pelvic floor squeezes (not holds)
can help to resolve swelling through the muscle pump
mechanism
• Therapeutic ultrasound: A treatment done by your women’s
health physiotherapist that can decrease pain and swelling in
the early stages of healing.
• Laser: A treatment done by your women’s health
physiotherapist that can decrease pain and speed up the
healing process in the later stages of healing.
What should you watch for?
• An increase in pain after pain has improved
• An increase in bleeding
• Smelly discharge
• Bladder discomfort or burning when emptying your bladder
• Report to your midwife or obstetrician if you notice any of these
• It is useful to use a hand mirror to check your stitches so that
you can notice any changes in their healing. This can also make
you feel more comfortable with the healing process
Your perineum usually heals in two to three weeks and can be checked
by your obstetrician at your six week check if you have any concerns.
6
You can request a visit in hospital or book an in clinic appointment
with your Southcare Women's Health Physiotherapist for
ultrasound or laser treatment of your perineum.
7
Caesarean Care
A Caesarean is major abdominal surgery and it may take your body 6-12
weeks to heal completely.
What should you do in hospital?
• Deep Breathing
o Deep breathing helps to reduce the side effects of
anaesthesia
o Sit upright in bed, knees bent, feet on the bed. Place one
hand on your abdomen above the navel
o Breathe out gently, then take a slow deep breath getting in
as much air as possible. Relax and gently breathe out
o Aim for 5 deep breaths per waking hour
• Ankle pumps
o Ankle pumps help to improve circulation
o Move feet up, down and in circular motions briskly at the
ankles at least ten times per hour
• Huff
o Coughing places stress on your abdomen and pelvic floor
muscles, it is better to huff to clear phlegm from your lungs
o Take a medium breath in and then force the air out through a
rounded mouth as if you are fogging up a mirror
• Supported Cough
o If you need to cough, sneeze or laugh hold your abdomen
gently with a hand or place a rolled up towel gently over the
area.
8
What should
you avoid in the first six weeks?
• Heavy lifting
o Try not to lift anything heavier than baby
o Be particularly careful with prams, capsules, loads of
washing, and food shopping
• Strenuous activity
o This includes mopping and vacuuming as this strains the
abdominals
• Driving
o You are required to avoid driving until you have medical
clearance from your obstetrician. If you have an accident
before this time you may not be covered by your insurance
How should you get out of bed in the first six weeks?
• Bend your knees up and roll onto your side. Keep your knees
together and pulled up towards your chest
• As you push up with your hands to a sitting position, swing your
legs down over the side of the bed
• A hand or rolled up towel can be gently held against the incision
9
Your Southcare Women’s Health Physiotherapist can check your
Caesarean scar at your postnatal assessment and give you advice
to help decrease scar tissue.
Breast Care
Milk in your breast is carried from your mammary glands to the nipple
by breast ducts. Poor emptying of the ducts or pressure on the ducts
can cause the duct to become blocked. A lump will form as the milk
builds up behind the blocked duct, your breast may feel hard and sore
in one area, and may look red. If you develop fever or flu-like
symptoms you may have mastitis, an inflammation of the breast tissue
that may progress to infection.
It is very important that you see a GP as soon as possible if you
believe you have mastitis, as you may need antibiotics.
10What can you do to prevent blocked ducts and mastitis?
• Ensure correct attachment with your lactation consultant
• Avoid missing or putting off feeds, and breastfeed your baby as
often as they want to feed
• If your breast becomes uncomfortably full and your baby is not
interested in feeding, express a small amount of milk for comfort.
• Avoid tight tops or bras, or anything that compresses the breasts
• Alternate which breast you begin each feed with to ensure they
both get drained regularly
What can you do to treat blocked ducts and mastitis?
• Rest as much as possible
• Feed from the sore breast first, when baby's sucking is stronger
• Change feeding positions to help empty the breast completely
• Gently massage the breast during feeds and in a hot shower
• Apply a cool pack after the feed for pain relief
• Therapeutic ultrasound: A treatment done by your women’s
health physiotherapist that can decrease pain and speed up the
healing process of blocked ducts or mastitis.
11You can book an appointment with your Southcare Women's
Health Physiotherapist for ultrasound treatment of your
blocked ducts or mastitis.
Nipple Care
It is expected that your nipples will feel sensitive or tender in the first few
weeks of breastfeeding, however sore, painful, grazed or cracked
nipples are not normal, and breastfeeding should not hurt.
It is important to identify the cause of grazed or cracked nipples so that it
can be fixed, as they will usually improve quickly. Causes may include:
poor positioning or attachment, skin infection or dermatitis, tongue-tie in
your baby, and incorrect use of breast pumps.
What can you do to improve nipple pain?
Before feeds
• Look for early feeding cues (e.g. hands to mouth, open mouth,
sticking tongue out) to offer a feed before your baby starts crying
• Offer the less sore side first
• To ensure your baby will be gentler on your nipples, start your milk
flowing by gently massaging your breasts and applying warmth. To
12lubricate the nipple and soften the areola, express a small amount
of milk before feeding
During feeds:
• Ensure correct attachment with your lactation consultant
• Before removing your baby from your breast, insert a clean finger
into the corner of baby's mouth to gently break suction
After feeds:
• Express a small amount of breast milk and apply to nipple
• Allow your nipples to dry before closing your bra
• Change nursing pads frequently, use washable nursing pads if
disposable pads cause chaffing
• To stop clothes rubbing, use breast shells or nipple protectors
• Avoid products or materials that will dry or damage your nipple skin
(e.g. soap, shampoo, rough towels)
Laser: A pain free treatment done by your women’s health
physiotherapist that can decrease pain and speed up healing.
You can request a visit in hospital or book an in clinic appointment
with your Southcare Women's Health Physiotherapist for laser
treatment of your nipples.
13Pelvic Floor Muscles
What are the pelvic floor muscles?
The pelvic floor is made up of layers of muscle and tissue. The muscles
attach at the front of the pelvis at the pubic bone and finish at the back at
the tail bone, making a hammock or sling.
What do they do?
The pelvic floor muscles have four main functions:
• Support of the pelvic organs (the bladder, uterus and bowel)
• Control of the bladder and bowel
• Improve vaginal tone to help with sexual enjoyment
• Support the back by working with the abdominal muscles
What makes the pelvic floor muscles weak?
• Inactivity of the pelvic floor
• Pregnancy
• Constipation
• Heavy lifting
14• Chronic coughing
• Ageing
What are the signs of a weak pelvic floor?
• Accidentally leaking urine when you exercise, laugh, cough or
sneeze
• Not making it to the toilet in time
• Difficulty controlling wind
• Prolapse symptoms (this may be felt as bulging into the vagina,
heaviness or discomfort, or a feeling of pulling, dragging or
dropping down)
• Lack of sexual sensation
What are the signs of a tight pelvic floor?
• It is important to relax your pelvic floor muscles when they are not
under load, they should not be held tight all day
• You should not have any pain with sexual intercourse or vaginal
examinations (this may indicate your pelvic floor is not relaxing)
What can happen when the pelvic floor muscles are weak?
Urinary Incontinence
Urinary incontinence or leakage can occur when the pelvic floor muscles
are weak. The two most common types are stress incontinence and urge
incontinence. Stress incontinence is the leaking of small amounts of
urine during activities that increase pressure inside the abdomen and
push down on the bladder (examples: coughing, laughing, and
sneezing). Urge incontinence is a sudden and strong need to urinate
that stops you making it to the toilet.
Prolapse
Feelings of heaviness or dragging are common after vaginal delivery
and indicate your pelvic floor is still recovering. It is important to give
your body lots of rest when these symptoms occur by lying down
throughout the day.
When to start pelvic floor muscle exercises?
Begin your pelvic floor exercises within 24 hours after delivery even if
you have stitches and/or swelling. The gentle muscle pumping action will
15improve the circulation and reduces the swelling which helps with
healing. If you have a catheter in, then you should wait until your
catheter has been removed to start pelvic floor exercises.
How do you do pelvic floor muscle exercises?
• Squeeze and lift the muscles around your back passage, vagina
and front passage and then fully relax the muscles
• Quick and short for strength and coordination:
▪ Squeeze and lift as strong as possible
▪ Aim is to perform 10 repetitions
• Slow and sustained for endurance:
▪ Squeeze and lift for as long as able
▪ When you can feel a definite relax at the end of the hold then
you should try to increase the hold time in each set by 1-2
seconds. Your aim is to eventually complete 10 repetitions of
a 10sec hold.
• Complete these exercises 3 times per day
Your Southcare Women's Health Physiotherapist will check your
pelvic floor at your postnatal assessment with our real time
ultrasound machine and provide a specific exercise program. A
vaginal examination may be recommended by your women’s health
physiotherapist.
Bladder & Bowel
Good Bladder Habits:
• Drink at least 2L of fluid a day, ensuring your urine is a light straw
colour (this is a sign of adequate hydration)
• Caffeine, alcohol, soft drinks and artificially sweetened drinks
should be minimal (only one third of your fluid intake)
• Go to the toilet when your bladder feels full, not “just in case”
• Normal frequency for urinating is 4-8 times in 24 hours with a
volume of 250-400ml during the day and 400-600ml at night
Good Bowel Habits:
• Normal frequency is from 3 times a day, to once every 3 days
16• Never defer a bowel motion, if you feel the urge to go respond
immediately or as soon as possible.
• Do not strain to empty your bowels
• Passing a stool should not be painful, it should be a well formed
stool, a smooth and cohesive paste that is easy to pass
Sit leaning forward with a flat
back
Feet flat on a small stool
Abdomen relaxed and
'floppy'
Sit supported on the seat
Elbows resting on the knees
Relaxed breathing
This position helps to relax the pelvic floor
and sphincters, to help with ease of toileting.
Your Southcare Women's Health Physiotherapist will screen you for
bladder and bowel problems at your postnatal assessment.
Rectus Abdominis Diastasis
What is it?
Rectus Abdominis Diastasis (RAD) is the stretching of the linea alba
ligament causing the separation of the two rectus abdominis muscle
bellies. It is a common condition that develops during pregnancy due to
the growing baby.
17How do you look after your abdominal muscles?
Natural resolution of the RAD generally will occur in the first 8 weeks
after delivery. To aid in the natural resolution it is advised to avoid over-
using the abdominal muscles (sits ups, leg lowers, planks) and to avoid
heavy lifting. If it is still present after 8 weeks, specific exercises are
required to assist with resolution of your RAD.
Getting in and out of bed:
• Roll onto your side and push up onto your elbow
• Slowly lower your legs to the ground while pushing up on hand
Lower abdominal (transverse abdominis) contraction:
• You can co-contract your transverse abdominis with your pelvic
floor. Try to do your lower abdominal contractions when performing
your pelvic floor exercises (see page four)
• As you contract your pelvic floor, gently contract your lower
abdomen as if you are trying to draw your hip bones together
• Your upper abdominals should stay relaxed, with no rib movement
Your Southcare Women's Health Physiotherapist will check your
RAD at your postnatal assessment, and can provide exercises to
assist with resolution.
Caring for Your Body
18The postnatal period is a time that can be challenging for the body, as it
involves new movements (e.g. feeding, carrying lifting) that are repeated
multiple times per day with the added weight of your baby. Most
musculoskeletal issues do not go away by themselves and will need the
correct assessment, diagnosis, and advice on management.
Common areas of postnatal pain that can be helped with physiotherapy:
• Neck pain
• Upper back, rib and shoulder pain
• Lower back and hip/pelvis pain
• Wrist pain
Before baby, such issues are easily managed as you are able to rest
from most tasks for recovery. Postnatally, your baby needs you to take
care of them, even if the tasks are those that are causing problems.
That’s why it is important to have these issues managed as soon as
possible.
Common tasks that contribute to postnatal pain:
• Feeding (whether breast feeding or bottle feeding)
• Carrying and settling baby
• Lifting baby from capsules, car seats, prams, change tables, cots,
and bassinets
• Bathing baby
19What can you do to prevent postnatal pain?
• Good posture is the position that puts the least load on your body,
not necessarily sitting or standing straight
• When settling baby, a variety of movements and positions will help
to distribute the load. This might include carrying, baby wearing,
and bouncing on a fit ball
• Ensure your back, feet, and arms are always supported during
feeding. You should be able to relax and maintain good posture
• When lifting, keep neutral spine, use your legs as much as
possible, and keep baby as close to your body as you can
Your Southcare Women's Health Physiotherapist can assess you
for musculoskeletal problems at your postnatal check, and provide
treatment, exercises, and advice.
20Exercises for Spinal Mobility
Animal stretches on hands and knees: Hold each stretch for 20 seconds.
Cat – Arch your back so that your bottom tucks towards the floor, then
come back to neutral
Dog – Bring your hips around to one side and turn your head to the
same side so that you can see your hips
Elephant – Open one arm up to the ceiling and then take the arm
between opposite arm and leg
21Lying on your back with knees bent and feet flat on the floor:
Pelvic tilts – Tilt your pelvis so that your lower back flattens into the
bed/floor and then come back to neutral
Knee rolls – Keep the knees together and rock them side to side while
keeping your shoulders flat on the mat. You can also do this with legs
draped over a fit ball
22General Exercise Recommendations
Remember, the below time periods are guidelines only. You should not
have any vaginal heaviness, abdominal pain, or bladder leakage during
exercise at any time. Return to exercise is very individual and based on
your exercise experience, as well as your body and genetics.
0-6 weeks • Pelvic floor exercises (page four)
• Transverse abdominis exercises (page five)
• Graduated return to walking (30-60min by 6 weeks)
It is recommended you wait until your obstetrician’s
postnatal check before starting any further exercise
6+ weeks • Exercise may include:
o Postnatal Hydrotherapy and Pilates classes
o Low impact cardio
▪ E.g. swimming, cycling, or elliptical
o Light weights or body weight movements
• Exercise to avoid until seeing your physiotherapist:
o High impact movements: running, jumping,
skipping etc.
o Heavy lifting: If you have to hold your breath,
the weight is too heavy
o Abdominal exercises: sit ups, leg lowers,
planks (including full push ups)
It is recommended you wait until your postnatal
physiotherapy assessment before starting any gym
classes or high impact exercise
3-9 months • Most mothers achieve clearance from their women’s
health physiotherapist at 3-9 months for high impact,
heavy lifting, and abdominal exercises
• This is based on your bladder, bowel, pelvic floor,
and musculoskeletal results from your postnatal
assessment
Your Southcare Women's Health Physiotherapist can help you with
a specific return to exercise program at your postnatal assessment.
2324
Physiotherapy for Newborn Babies
Right from birth, the way that we position, carry and interact with our
babies can make a difference to their development.
What is torticollis?
• Torticollis is the tightening of the
muscles on one side of the neck
• Baby may be born with this asymmetry
due to their position in the womb or the
way they were delivered
• Baby may develop this after birth, as
baby’s head turning control is poor and
they may only turn the on direction
What is plagiocephaly?
• Plagiocephaly is a flattening of the
baby’s head on one side
• Caused by the large proportion of
time baby is on their back
• Does not negatively affect baby’s
brain development, but may affect
their ability to move their head and
explore
What can you do to prevent asymmetry of baby’s neck and head?
• Place baby the opposite way in the cot at each sleep, so what they
look at is on a different side each time
• Be aware of how you and baby’s other caregivers hold him or her,
and regularly try to swap the side you are holding them
• Tummy time limits the pressure on the back of the head, and helps
baby develop strength in their muscles
• Use toys with contrasting patterns and faces to move baby’s
attention to the non-preferred side
Your child health nurse can refer you to a local paediatric
physiotherapist if you are worried about baby’s development
2526
Postnatal Depression
What is postnatal depression (PND)?
Having a baby can be an exciting time, full of intense emotions. Some
emotions may be good, while others are more challenging. PND is
depression occurring in the months following childbirth. Research shows
around one in seven mothers and around one in ten fathers will
experience PND, but mild to moderate cases are sometimes not
recognised by the individual themselves.
What are the signs and symptoms of PND?
The experience of PND can vary from person to person, but usually
includes several of the following:
• Feelings
o Shame, guilt, failure, inadequacy or hopelessness
o Tearfulness, persistent low mood, confusion and exhaustion
• Behaviours
o Lack of interest or pleasure in activities normally enjoyed
o Withdrawal from social contact
o Lack of motivation
o Poor self-care and inability to cope with daily routine
o Insomnia or excessive sleep
o Not eating or over-eating
• Thoughts
o Fear of being rejected by partner or baby
o Worry about harm or death to partner or baby
o Lack of concentration and poor memory
o Wanting to run away or escape
o Inability to think clearly or make decisions
o Thoughts of suicide or self-harm
Treatment Options
There are several treatment and support options for parents experienced
PND. These might include things like practical support at home, lifestyle
changes (e.g. diet, exercise), counselling, and medication. For more
information visit https://www.panda.org.au/.
If you suspect you or someone you care about is suffering from PND it is
recommended to seek help from a health professional like your GP,
27obstetrician, or child health nurse.
Elements of this excerpt were originally created by the WA Dept. of Health
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