4 Reasons Why Every Woman Should Have a Postnatal Check with a Women’s Health Physio After Having a Baby
Did you know that in France every single woman who gives birth, whether via c-section or vaginally, is allocated 20 sessions funded by the government with a women’s health physiotherapist to help their postnatal recovery? Wow! They are certainly leading the way in recognizing the importance of postpartum rehabilitation. It is ideal that every woman sees a continence and women’s health physiotherapist after birth for 4 main reasons:
1. Pelvic Floor Assessment
Pregnancy and delivery result in many changes in a woman’s body and these may include pelvic floor problems. Did you know that during a vaginal birth your pelvic floor muscles have to stretch up to 3.5 times their normal length to allow the baby to pass through? You can see why it can take some time for these muscles to recover! However, a c-section does not prevent you from developing pelvic floor problems as research shows pregnancy is one of the main risk factors due to its effect on connective tissue and muscle structure. Pelvic floor issues, such as weakness, pelvic organ prolapse, leaking urine or faeces and pain with intercourse, are serious issues that can be helped.
There are two ways to assess your pelvic floor. The gold standard by an internal examination. During the internal examination, your physiotherapist will assess your pelvic floor muscle tone, strength, endurance and coordination as well as assessing for any pelvic organ prolapse. This examination is usually done >6 weeks post-birth. The other option for assessing your pelvic floor is with real-time ultrasound which is the same ultrasound used to see your baby! This can be done anytime and is used to visualize the effect of your pelvic floor contraction on the bladder. It is very useful but does have limitations compared to an internal examination.
2. Bladder and Bowel Screening
Many women experience bladder and bowel issues after birth, some of which are problematic in their own right and others which can negatively affect other issues such a prolapse, pelvic floor weakness and RAD. Issues such as loss of bladder sensation, leaking urine or faeces, constipation, going to the toilet frequently and rushing to the toilet are common, but not normal.
Your physiotherapist will ask you questions about your bladder and bowel habits to identify any concerns that may exist. Depending on this, you may be asked to take home a bladder or bowel diary to complete to get a more comprehensive picture of any issues.
3 . Abdominal Diastasis Assessment
By the end of pregnancy, every woman will have some degree of abdominal muscle separation (rectus abdominis diastasis or RAD) between the two “six-pack” muscles. This is a normal adaptation in pregnancy which can take some time to recover after birth. Some signs that your RAD may be an issue are “doming” or “tenting” between the muscles with activities that involve your abdominal muscles, a feeling of “core” weakness or the appearance of mid to lower belly protrusion.
It is important to assess RAD after birth to ensure that the connective tissue between the muscles is regaining its tension to allow your abdominals to function normally and transfer belly pressure well. This is usually assessed with palpation and real-time ultrasound to visualize what the tissue is doing at rest and under load. If a RAD is not functioning well, specific exercises can really help.
4. Guidance on Safe Return-to-Exercise
We know that exercise is very beneficial to physical and mental health but return to exercise after carrying and birthing a baby is often not as simple as it seems. Due to the effects on pelvic floor and abdominal function discussed above, returning to exercise too early (especially high impact activity) can be detrimental to your recovery. Exercise post-birth should be graded and based upon what your body can tolerate at the time.
Assessing risk factors for developing pelvic floor problems in combination with how your pelvic floor is currently functioning allows your physiotherapist to determine what is safe for you to start doing. It is important to set goals with your physiotherapist in terms of physical activity to be achieved in a realistic time frame. There are no standard timelines for return to exercise as every woman’s goals, body capabilities and pregnancy and delivery journey are different. The ultimate aim is to get you back to doing what you want to do!
As you can imagine, it would be tricky to fit all of the above into a standard physiotherapy consult! That’s why the initial consultation with your continence and women’s health physiotherapist is an hour long, with follow up appointments at 40 minutes. You will be encouraged to drink 500ml of water an hour before your appointment (and to avoid going to the toilet in that hour!) for the real-time ultrasound assessment. There are no expectations in regards to internal examinations on your first appointment and your physiotherapist will discuss this with you if they think it is necessary.
If you wish to have a postnatal check, please give us a call on (08) 9797 1111 and ask for a women’s health appointment with Ebony! https://www.physiogroupsw.com.au/book-now/
Written by Australind Senior Physiotherapist, Ebony Ryan.