Sunday, July 31, 2011

My GP's Postnatal Exercise Advice

Post pregnancy bodies are special.  They've done a wonderful thing giving birth, and they need looking after kindly.

Dr. Salim is my GP.  She has been a medical doctor for 20 years and a GP for 11, all the mums in my community love her and so do our babies!

Dr. Salim has worked for most of her career with new mums and babies.  Every month she does about ten of the famous "6-week checks".  She makes sure mums feel well and recovery is going as it should. She gives lots of new mums advice on how we can look after ourselves properly in the first few months of motherhood.

Dr. Salim meets many mums who forget about themselves while all the focus is on baby.  She offered to share her experience and advice with new mums through my blog.

Katy: What kind of support do you give new mums after birth?

Dr. Salim: I offer my patients an appointment as early as they want after giving birth.  Lots come to see me before their 6-week check.  They may have worries, be feeling low, have problems sleeping or back-pain, wee when they sneeze... or they just come to ask me "How can my tummy look so slack and horrible?!". 

At 6-weeks I check their weight, urine, blood pressure, any stitches, uterus size and muscle recovery from the birth. I ask whether mums have had a period (most mums have not), discuss contraception, emotions and any worries about incontinence.  I always ask "Is there anything else you are worried about?".

In the early days I give mums information about their pelvic floor and how to activate it. I explain how to pull in the transverse abdominals. 

Katy: So when should new mums think about getting active?  

Dr. Salim: Many mums wait too long. It is almost always helpful to start doing gentle activity right after birth.  Most women don't realise the importance of their pelvic floor.  Invest in your body at this time - for the future. 

I believe in walking and once bleeding has stopped I also think swimming is great for new mums.

I distinguish between proper exercise and gentle activity.  At 6 weeks we usually touch on proper exercise.  Is the rectus abdominus getting back together?  Are there any on-going skeletal or muscular problems from pregnancy? Are scars healing?  I consider these things when advising on actual exercise.  

As for gentle activity?  With very few exceptions, mums will get so much out of being physically active immediately.  Less depression, better sleep, fewer back problems...

Katy: How do babies benefit from having an active mum?

Dr. Salim: Exercise helps keep the woman in control.  It helps structure their day.  The Ready Steady Mums advice is really helpful for this.  Mums sleep better and don't sit at home being stressed, so their babies are more contented.  Both mum and baby have more self-esteem. 

Katy: What are the most common health concerns for new mums and how do they change our ability to get active or exercise?

Dr. Salim: Prolapse, stress incontinence and the challenges of recovering from say a 3rd degree tear. These are the most common physical health concerns I see women for and advise them to take things slowly.  If your "abs gap" is more than 3 fingers wide you need a physiotherapy referral to sort that out before you progress with exercise.

It is still ok to do the gentle activities like the ones you have in the Level 1 section of the Ready Steady Mums programme. 

Katy: What are the biggest barriers to getting active? How can mums get started?

Dr. Salim: Generally speaking, all mums are aware they need to do something.  Some think (wrongly) that they should do nothing active until 6 weeks.  The problem is often knowing - what should I do when?  How do I know it's safe?  It often takes me as a GP, or the midwife or health visitor, to give mums the confidence to start and to suggest some initial activity.

Mums also need good support from family members and friends.  I know mums will do well if their husband is supporting them and the mother or mother-in-law can also be a great help.  They can look after the baby while mum gets time to look after herself and they can really encourage her with her postnatal exercise.

Katy: What are your top tips for a new mum?

Dr. Salim:
  1. Do some physical activity early on
  2. Get out and about
  3. Eat sensibly
  4. Ask for help

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