Please note these guidelines are currently under peer review and not for public use by anyone. They are posted for copyright protection only and will be published once deemed suitable for public use
The Maternal Mental Health Alliance (MMHA) is a coalition of UK organisations with a vision to see all women across the UK get consistent, accessible and quality care and support for their mental health during pregnancy and in the year after giving birth.
If you have had or are about to have a baby do take a look at their website, full of amazing resources about maternal mental health, contacts and links to various projects.
Here I talk about the strong links between physical and mental health in the postnatal period and the relevance of postnatal rehabilitation to improve both a woman’s physical and mental recovery after baby.
Today is World Mental Health Day – a day for sharing and talking openly about mental health issues, this year with an emphasis on mental health in the workplace. My workplace sees at first hand the effects of a very serious and common form of a mental health condition called postnatal depression. For many of us it’s something that lasts for a short while causing us to feel down, energy less, tired and can affect our appetite. For others the symptoms are more serious leading to feelings of guilt, self-blame, difficulty bonding with your baby and even suicide.
Physical inactivity and mental health issues are becoming increasingly linked and just last week Sarah Bosley reported in The Guardian last week that a study by The Black Dog Institute in Australia found that even one or 2 hours exercise a week can help depression. Researchers from Birmingham University, in a study published this year in the British Journal of General practice, found that exercise is effective in reducing postpartum depressive symptoms. The PHE has also been working with the World Health organisation on a new global action plan for physical activity. Dr Justin Varney from the PHE wants us to get hot and sweaty for 10 minutes every day. Not much of an ask when you think about it or is it?
When you peel back the onion it soon becomes clear that the right type of exercise comes into play. The minimum recommended exercise length is 150 minutes of moderate aerobic activity a week (brisk walking, water aerobics, tennis doubles) or 75 minutes of vigorous activity (running, hockey, uphill cycling), or a mixture of both. The more activity you do and the higher the intensity, the greater the benefit.
As a women’s health physiotherapist, keen exerciser and runner I am thrilled that the power of exercise is being recognised. However I also recognise that many of the postnatal patients I see suffer urinary leakage, pelvic organ prolapse and diastasis recti. Vigorous, intense exercise will only worsen these very debilitating physical conditions if they are not rehabilitated correctly. For this very reason I look at you holistically, encouraging and supporting your return to running and high impact training safely and effectively.
In November I will be launching a running clinic that will assess your running technique. The aim is to rehabilitate you safely taking care to offer sensible, professional advice. There will be more information to come over the next few weeks detailing the criteria that must be met to have this assessment but suffice to say it will be a useful adjunct for any woman keen to run post baby. Your physical and mental health are very important to me, stay tuned for further details.
This is a question I get asked in my clinic all the time. The majority of women I see post baby want to run. I get it! I love running. Running is seen as a sure way to lose weight, it is the easiest type of exercise to ‘fit in ‘around your new baby and it is an enjoyable popular way to exercise that makes you feel like you again. However pregnancy places untold demands on your body and weakens your core (made up of your diaphragm, pelvic floor, multifidus (deep low back muscles) and your transversus abdominals (deep tummy muscles)). These muscles need to be strong and working together to withstand the forces put through your body when you run.
WHAT ARE THE SIGNS THAT I AM NOT READY TO RUN?
• If you ever leak urine (or worse) when working out
• If you experience pelvic or lower back pain during or after exercise.
• If you feel unstable in the core or like you’re ‘falling-out at the front’ when you perform any exercise.
• If your body shakes or trembles during any move or hold.
• If there is bulging, straining, protrusion or doming anywhere on or from within your abdomen or pelvic floor when you work out.
WHAT WILL HAPPEN IF I RUN TOO EARLY OR HAVE THESE SYMPTOMS?
There is a chance that if your body is not ready for you to run then you could suffer with the following:
• Pelvic organ prolapse
• Urinary / Faecal incontinence
• Diastasis Recti (mummy tummy)
• Dyspareunia ( pain during sex)
• Low back pain or other musculoskeletal injures.
SO WHEN SHOULD I RUN?
The general guidelines are as follows:
• If you have had a non-complicated vaginal delivery then the minimum time to wait is 6 weeks.
• If you had a complicated vaginal delivery (perineal tears incurred) or a c- section then you need to wait a minimum of 12 weeks.
However in my opinion these guidelines are too vague and rarely would I recommend they be followed. I recommend the following:
• If you have any of the signs mentioned above you should not run.
• If you are breast feeding, chances are your hormone levels won’t return to their normal monthly cycle until a year or so. Your hormone levels affect the “laxity” of the pelvic floor so in general I do not advice any new mum to run for a minimum of 6 months and only then if you are symptom free and have had 2 periods.
• If you are symptom free and have had at least 2 periods then I will assess your core strength, alignment and breathing and if all is well I discuss a return to run program with you.
• See a women’s health physiotherapist. We will assess your tummy, your pelvic floor, global strength and posture. Once assessed we will put you on a guided strengthening program that builds up your core safely.
• Once you are ready to run I will watch you run and see what additional things we can change / add to formulate a structured training program that will maintain your strength and keep you running in the long term.
• Maintain a core strength program for life to prevent any women’s health related problems.
• These rules apply to not just the novice runners but the well-seasoned runner. Listen to how Jen Saint Jean (No1 US 1500m runner) ran with a diastasis recti without core strengthening. She adopted a core strengthening program and not only did she lose her ‘mummy tummy’ but her times also improved.
You only have one body and you need to protect it. Rehabilitation after baby is so important and essential to every woman even if you do not wish to run.
Please do contact me for further information on postnatal recovery, The Mummy MOT and return to running or call The Halos Clinic on 01883 713434 . I also run the Oxted Ladies Run Club in oxted so once you have returned to running I will support you on your return to running if you wish to join the club.
Happy new Year to all you wonderful women out there!!! I’m very excited to announce that in 2017 I will be starting out on a new and very exciting venture. I will be joining the Halos team from the 6th January 2017 (as well as continuing my hours at London Bridge Hospital.)
I’ll be offering a full women’s health service including the must have, Mummy Mot every Friday from 9-3pm.
For more details or to book an appointment please contact Josie at email@example.com or check out my contact page.
This new year make your body and well being your priority and treat yourself to a women’s health assessment with Physiomum.
THE MUMMY MOT
the new little black dress.
Every woman should have a Little Black Dress (LBD) in their wardrobe (or at least that’s what all the fashionistas say). An LBD symbolises elegance and class and let’s face it most women want to feel elegant and classy from time to time. However what every woman should have and what every woman gets are two very different things that transcend across all aspects of life.
Take having a baby for example. In France every woman is given up to 20 free sessions of women’s health physiotherapy after baby in order to rehabilitate their pelvic floor and get their tummies “back”. In the UK, if we are lucky we have a quick 5 minute chat with our GP.
Postnatal recovery is something I am passionate about! Becoming a mummy is incredible and I’m not ashamed to say, my crowning glory. However during pregnancy your body changes immeasurably and childbirth tests the strongest of us physically. If you were to undergo anything else as physically demanding, requiring the body to heal and re- calibrate you would be given rehabilitation and time to heal.
In France it is recognised that the body doesn’t just ping back to normal without a helping hand, women in the UK are no different and deserve just the same service!
The Mummy MOT provides this! There are currently 80 specialist postnatal physiotherapists in the UK qualified to carry out this unique body check.
Childbirth can lead to incontinence of urine, a prolapse, diastasis recti (mummy tummy) pelvic pain, low back pain, common symptoms but not normal. After baby most women want to regain their figures and will naturally take up exercise, but what is the correct exercise and who is to say certain exercise won’t create or worsen symptoms you may be suffering from?
The Mummy Mot is a service suitable for all women from 6week to 6 years post baby. The assessment is a full body check, looking at posture, breathing, tummy gap and pelvic floor, all things that are affected during pregnancy and need addressing post baby. From the findings the physiotherapist will create a bespoke post-natal recovery programme plan devised especially for the woman, her lifestyle and fitness goals, including specific and safe post-natal exercises to regain stability and optimum recovery.
The Mummy MOT is the new must have, the next LBD. It will allow you to feel elegant and classy and ensure you recover optimally. Take a look at my services for more information and treat yourself to feeling you again! I did it, I do it, I’ve seen the results and I know you deserve it!
They might look like any other pair of running leggings but ladies, listen up, this pair of sports apparel do more than just look good on. When I shop for sportwear, its always important to me that I spend that little extra on a decent bra and pair of trainers. These are 2 parts of the body that we all know needs support and I personally am prepared to pay that little extra in the hope that said chosen items will provide support. Since having Martha, one area of my body that hasn’t felt all that supported has been my tummy. In fact its been quite sore after running more than 5k. My knees and feet have also been painful. Although I’m strengthening on a daily basis and have been very sensible with my return to running the reality is that things are still not 100% yet.
Luckily I stumbled upon a tweet that mentioned EVB sportswear.This sportwear is designed to support all the core muscles including the pelvic floor, tummy and low back. Probably a gimmick I thought but what harm would it do to contact Yvonne Brady, CEO and founder of the company and ask her more about her product. Well Yvonne not only told me about her product she also very kindly sent me a pair of new sports leggings to try out myself (a definite perk of the job!)
So I did just that. For the past month, on every run I have worn my EVB leggings and let me tell you a thing or two. Wow! I think they are FAB. First of all they look great. They are tight, very tight which I like. I feel supported around my low back, tummy, my pelvic floor and pelvic area. Although tight they don’t hinder my running stride. Here’s the interesting bit, my tummy is definitely less sore. My knee pain has stopped and my foot pain has significantly improved.Of course I can’t be sure that I owe this all to the leggings but I would say without doubt that it is more than coincidence that my symptoms have improved since wearing them.
I will most definitely be recommending the leggings and shorts to all relevant patients that I see. Remember ladies, if you love running, it is high impact which can lead to pelvic dysfunction particularly , if you are pregnant, post baby, hypermobile, menopausal or overweight. Even if you are any of the above but symptom free take it from me prevention is better than cure. So whilst you consider that next pair of £120 trainers to wear because ‘they will improve your running style’ think about spending a little more on your running leggings. Not only will your core muscles thank you but you will look hot too.
Many thanks to EVBsports for allowing me the opportunity to try out the leggings and providing our Women’s wellness evening with leaflets and neck scarves for all participants in their goody bags. For more information on EVB sportswear go to http://www.evbsport.com
I was meant to have achieved one of my goals this weekend, to run The 5k Chocolate Run. To tell the truth I’m still struggling to do more than 30 minutes of walk to run (3.5 min:1.5 min) due to my diastasis and discomfort around my scar but I was determined to go ahead. However it wasn’t meant to be, the race got delayed by 3 hours and my children were not going to hang around for 3 hours whilst I completed the run. Not to be deterred I decided to do my own first 5 k run closer to home.
Who would have thought going on this run would have made such an impact. Not only did I complete the 5k (all be it slowly (31 minutes)) but along the way I bumped into a friend. Both of us have children of the same age and both of us were runners pre baby. We are also fighting that uphill battle to get out and exercise and return to running. We stopped, chatted and congratulated each other on getting out and both agreed how precious this 30 minutes of running was. Quiet time away from the kids, doing something just for ourselves. My friend then asked me if I would set up a little running group for ladies, an opportunity to run, catch up with a few friendly faces and have an uninterrupted chat (depending on how breathless we get)!
I’ve toyed with the idea for a long time now but never felt I had the confidence to do such a thing. More importantly I have always felt that I had to be super fit to lead a running group. However my friend made a great point and that was that most of the girls that would join us would be new mums, women with hardly any time on their hands, of a similar fitness level and women who just wanted to do a little something on their own away from the hustle and bustle of their normal lives. So I’ve decided to go ahead and set something up. Who knows what it may bring but what I do know is that running with others is a great way to stay motivated and as a mum a great way to steal some adult, quiet time and achieve a little something for yourself, goal met I think you will agree!
Post pregnancy care is a subject very close to my heart and women should be a focal point for healthcare. A woman’s life course offers multiple opportunities to prevent predictable morbidity and mortality and to empower them and through them their children with information to take positive steps to health. Women’s health physiotherapy is a specialist area of physiotherapy which focuses on problems related to the pelvic floor and the pelvis. These problems may be either gynaecological or pregnancy related and include conditions such as incontinence, pelvic organ prolapse, pelvic pain, constipation and painful intercourse. For years, this speciality of physiotherapy has allowed physiotherapists the privilege of focussing just on the woman and the so called ‘taboo’ subjects mentioned. It is an incredibly successful area of physiotherapy but still one that women are not tapping into enough in order to improve their health.
The Chief Medical Officer’s annual report was released in November 2015 and dedicated to women. Professor Dame Sally Davies makes recommendations that will benefit women’s health and encourage a normalisation of the conditions which are very common amongst women but yet still do not get treated because women remain embarrassed about them. The statistics within the report make for a depressing read and the disparity and urgent need for care to be updated is evident. The report covers all things related to women’s health from female genital mutilation to incontinence, to the menopause.
A chapter in the report that stood out for me was one on post pregnancy care. 80% of women will have a baby in this country. During the pre and postnatal stage of a woman’s pregnancy she will come into contact a lot with various healthcare providers. In my opinion it is around this time that women are a captive audience and educating and treating them at this stage of their lives will result in successful treatment of many problems that may be developing or worsening. In my ideal world women would receive the postnatal care that the women in France have been receiving since 1985. In France, postpartum women are routinely prescribed “la re-education perineale,” 10–20 visits of physiotherapy designed to retrain the pelvic floor muscles, to be followed by “abdominal re-education” after the pelvic floor sessions are completed, if necessary La reeducation perineale” has been subsidized by French Social Security since 1985. The French state health system subsidizes 60–100 percent of the cost; private insurance typically covers the rest. France is one of the only countries to sponsor such a program for women postpartum. Read more about it here:
Postnatal care in the UK is usually concluded by 6-8 weeks post birth which marks the formal end of maternity care in England. The aim of care is to enhance birth recovery, promote maternal and infant physical and psychological health and support infant feeding. The current timing and content of postnatal care originated in the early 20tn century in response to the then high maternal mortality rate. Unfortunately this has been subject to minimal revision, despite a dramatic decline in maternal mortality, increasingly early postnatal discharge and evidence of widespread and persistent maternal morbidity. The health profile of women giving birth in 2015 is not reflected in postnatal care provision and the postnatal care is not fit for purpose, lacking any evidence or maternal need. C section has increased by 3% over the past 10 years. Maternal factors e.g. obesity, increased maternal age and conditions like diabetes are on the rise. Incontinence, perineal pain, anxiety and depression are common and can persist for years. Revisions to the GP contract in 2004 removed an item of service payment for maternity care which has led to a decline in GP involvement. An online survey of 4000 self-selected women found that a third reported that their 6 week routine GP appointment did not meet their emotional needs and almost half said that it was not thorough enough.
I strongly believe that every woman should be offered at least one session with a women’s health physiotherapist after having a baby. Most women, after giving birth will have a weakness in either the tummy or pelvic floor which then creates instability and poor core strength. The result can be back pain, pelvic pain, bladder and bowel weakness. Most Women Health Physiotherapists offer a postnatal check from any time after a woman is 6 weeks postnatal. They will check and test the muscles of the tummy and pelvic floor, provide advice on safe exercises, posture, personal goals. Such a check helps avoid any long term issues and if necessary treatment can be provided and an optimal postnatal recovery programme commenced.
When I was 8 weeks postnatal I was lucky enough to have a postnatal check (Mummy MOT) from two outstanding physiotherapists, Lisa Few, based at London Bridge Hospital and Maria Elliot based in Harley Street. During the sessions sensitive subjects like incontinence, prolapse and sexual intercourse were addressed. Both assessed my scar tissue (from my c sections), pelvic floor, tummy as well as my posture, musculoskeletal system, and general core stability. Without their input my recovery would have been hindered and my return to running much slower. I am one of the lucky ones, knowing such wonderful colleagues. I also have private health insurance. However this service is available without health insurance via self-funding or it is possible to request a referral via your GP in the NHS.
This Valentine’s day do something for yourself. Whether you had a baby 6 weeks ago or 6 years ago book to see a Women’s Health Physiotherapist. Show that body a little love, you deserve it!
Sorry, life has been hectic, I will never underestimate how hard it is to have 2 or more kids ever again, God knows how people make it look so easy!
Anyhow as a result I am massively behind on my blog but just wanted to tell you about a podcast that I have just done. I was lucky enough to speak to Alison King a fellow 261 fearless ambassador from New Zealand the other night. She is a mum of one, a running coach with her own business and also provides a great blog and podcast to anyone out there about running. Find out more about her at http://www.runforyourlifecoaching.co.nz
She asked me to do an interview about the pelvic floor and running postpartum. Please check it out – you may find it has some good tips.
Catch up soon, with some more info and tips. X