MY GP 6 WEEK POSTNATAL CHECK

 

 

 

‘Your scar is healing well but you  have a 2 finger width gap in your tummy  Emma, best thing for that is some sit ups!!!!’  Yup, that was it,  my 6 week postnatal GP check up. A quick feel of my tummy, told I had a gap in my abdominals and to add insult to injury, the wrong advice to correct it. Professionally I felt so disappointed that this was the service that my GP advised. Personally,  I felt like the GP wasn’t that interested in my recovery at all. Pregnancy and childbirth place such incredible stresses on a woman’s body. Changes and symptoms occur that nature alone will not resolve. we all need some guidance to help get our bodies back and treat any symptoms that may have occurred as a result.

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A recent survey carried out by ‘Mother and Baby’ found that over half of all women found their 6 week postnatal check to be inadequate. The sad fact is that a check up  for mums does not have to be offered by GP surgeries and more often or not if you don’t ask you don’t get. With this in mind, insist on being seen. The NHS have a list of things that should be done during your check as you can see below. As you can see from my experience if time is of the essence then this list will be deviated from. My advice would be to ask for a longer appointment and  take the list with you.

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  • you should be weighed and can get weight loss advice if you need it
  • your urine should be tested to make sure your kidneys are working properly and that you haven’t got an infection
  • your blood pressure will be checked
  • you may be offered an examination to see if your stitches have healed (if you had any), and that all the muscles used during labour and delivery are returning to normal
  • your doctor may discuss carrying out a cervical screening test (smear test) with you if you have not had one in the past three years – the test won’t usually take place until three months after delivery
  • if you are not immune to rubella (German measles) and were not given an immunisation before you left hospital, you will be offered one now
  • you will be asked if you still have any vaginal discharge and whether you have had a period since the birth
  • Contraception will be discussed

The 6 week check is also an opportunity for you to mention any of the following should they be relevant to you:

  • you are having trouble holding urine or wind, or you are soiling yourself
  • if sex is painful
  • you are feeling very tired, low or depressed
  • you are worried about anything

From here it really is the GPs role to identify the problems and direct you to the correct health care professional. I would encourage you to get a physiotherapy referral if you are told that you have a gap between your stomach muscles (diastsis recti), problems holding urine, wind or faeces, if intercourse is painful or you are a keen exerciser and want some guidance on returning to exercise. We will  discuss what physiotherapy can offer in the next post but in my opinion EVERY woman that has had a baby (regardless of delivery) should see a  trained women’s health physiotherapist. This provides a ‘true’ postnatal check and is the key to recovery – a true MUMMY MOT!……..

THE FIRST 6 WEEKS OF MY POSTNATAL JOURNEY

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GOALS

1.) Flatten mummy tummy – BY EXERCISING CORRECTLY AND SAFELY

2.) Wear a Baby Bjorn baby carrier comfortably and functionally

3.) Run the 5k Chocolate Run- February 2016 & continue park runs on a weekly basis

4.) Complete the Badger half marathon- July 2016

5). To enjoy my maternity leave as much as I can!

INTRODUCTION

Pregnancy is a wonderful gift. Holding my babies for the first time was one of the best experiences of my life. However pregnancy and childbirth come at a price. As well as the not so awesome looking ‘mummy tummy’ there is a possibility that we can be subjected to pain in the pelvis, back, pelvic organ prolapse or a leaky bladder if we do not look after ourselves and rehabilitate.

Both of my children were delivered by cesarean (c-section), Oscar was an emergency c-section and Martha was planned. Having a planned c-section was not a decision I took lightly, it’s major abdominal surgery and not to be underestimated. The recovery is painful, limiting and second time around it seems much harder, especially with a heavy 2 year old to deal with on top. The recovery and healing process is also much slower than an uncomplicated vaginal delivery so I am going to have to learn to be patient (something I’m not!).

From day 1, I made a promise to myself that I would put aside a little time everyday in order to optimise my rehabilitation. So just what have I been doing?

PAIN RELIEF AND SWELLING MANAGEMENT  

After a few days I was placing crushed ice in a plastic bag wrapped in a damp tea towel on my incision (always check with your midwife before doing this) twice a day for 10 min. It didn’t have a huge effect, but it did take the edge off the pain and swelling. Following Marianne Ryan’s advice I also invested in a rather pricey and passion killing pair of medical grade compression shorts.

http://www.solidea.com.au/maternity/high-waist-shorts-for-recovery-detail

These are not the same as abdominal binders which effectively squeeze the tummy too tight and prevent the abdominal muscles switching on. Marianne researched this area thoroughly and found that shorts that offer 15mmHG of compression which reduces to 12mmHG at the top are the best option. The shorts increase lymphatic drainage and speed up healing, decrease pain and the elastic introduces muscle memory to enable a faster recovery to the abdominals. I started wearing them 4 days post op when I felt a little more comfortable. Ideally you need to wear them daily for 3 months. I must confess I probably wear them about 5 days a week as the weather’s been so hot. What do I think of them? Well, so far so good – and i’ll keep you posted. 

AVOID THE SCALES

There is no point weighing yourself until after your 6 week postnatal GP check up. Hormone levels affect fluid retention, the uterus takes 6 weeks to return to its normal size so the scales will fluctuate significantly. Trust me, it does nothing for the morale so hold out if you can. I did however take a picture of myself at 2 weeks in order to monitor my progress over the next few months. Here I am at 38 weeks, a week before having Martha.

IMG_5109and here I am 2 weeks after having Martha

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EXERCISE

When to start…..

Most Mums want to recapture their pre-pregnancy bodies but we must be careful with the level of activity and type of exercise undertaken. As mentioned before, complications such as pain in the pelvis, back pain, pelvic organ prolapse or a leaky bladder may occur if this rehabilitation isn’t done correctly. As a general guideline, after a c-section you can start to do some gentle pelvic floor exercises once the catheter has been removed. If you’ve had a vaginal birth this can be anywhere from between a few hours after birth to a few days – but please check with your medical team first as this will vary depending on any complications you may have experienced.

Do it right…..

1 in 3 women do not activate their pelvic floor correctly so whilst it is still very important that you do this daily visit a women’s health physiotherapist to ensure you are doing so correctly (we will talk about this visit in more detail soon.) This post by Diane Lee may help in the activation of your pelvic floor:

http://www.dianelee.ca/article-training-deep-core-muscles.php#pfm.

What will you be exercising…..

Exercises during the first 6 weeks are designed to awaken and find the muscles that have switched off during pregnancy. The key is to retrain your ‘core muscles’ and lay the foundations before strengthening  anything else. If this doesn’t happen then the likelihood is that your tummy won’t flatten and you are at risk of secondary complications such as pain in the pelvis, back pain, pelvic organ prolapse or a leaky bladder – maybe not today but in the future. First however a bit of background on the muscle group we’re going to be working on:

Your “core” is a group of four muscles consisting of:

  1. Your pelvic floor
  2. The inner layer of abdominal muscles – transversus abdominus
  3. The deepest layer of back muscles – multifidus
  4. The diaphragm.

Essentially these four muscles hold our torsos together.  Let me refer you to the amazing Julie Wiebe’s video blogs where she describes the important partnership the core muscles have. Her other blogs are all well worth a look and will help you understand your body much better.

http://www.juliewiebept.com/category/video/page/2/

Concentrate on your breathing and posture…..

The key to recovering our core strength relies on breathing correctly. Again I’ll refer to Julie Wiebe’s video blog ‘the diaphragm and or internal pressure system’. It is so important to breathe when exercising, moving, lifting etc. So many of us hold our breath and this causes an increase in intra-abdominal pressure. This is the amount of pressure inside your tummy. It is influenced by the way we breathe and good coordination of our abdominal muscles. These 2 things get knocked for six during pregnancy and need to be retrained. Breathing in, increases intra-abdominal pressure, making it harder for the core muscles to work and placing extra pressure on the lower back and pelvic floor muscles. Exhalation does the opposite.

Core muscles work best when you are in a good posture. When you are pregnant, as you can see from my photos your large tummy can cause all sorts of changes in your posture. This needs to be corrected and your body re-educated. Simple exercises can help with this and it is important to check your alignment as you continue to exercise.

Both the Mutusystem and The Baby Bod book address these issues and as a result are the program I am following.

The Mutusystem was designed by Wendy Powell, a mum and postnatal fitness instructor -https://mutusystem.com/about-us

‘ MuTu System training and programmes have a holistic philosophy, which deals with posture, functional exercise (IE metabolic resistance exercise techniques that make you truly strong, lean and ‘fit for purpose’), optimal nutrition for health, hormone balance and energy, specific yoga techniques to help re-settle the pelvic organs,  tone and heal the deep muscles as well as relieve stress and promote optimal respiration… AND at the foundation of it all, a complete 4-Phase program to train (find) and then strengthen the muscles of your core.’

Her’s is a 12 week  program and can be done in the comfort of your own home. I would definitely recommend it, however if you feel at any stage that it is exacerbating problems like incontinence consult your GP or women’s health physiotherapist. The Baby Bod book by Marianne Ryan is also well worth getting your hands on. It allows you to understand your body better and also has a workout program. http://www.babybodbook.com/. Both are very affordable.

How I have been exercising…..

Over the past 6 weeks I have been doing the preliminary baby bod program and core phase 1 from the Mutusystem. I have been activating my pelvic floor daily, attempting to recruit my tranversus abdominus and correct my posture (easier said than done) whilst stretching and working on my breathing techniques through these exercise programs. I have also been walking a lot- perhaps a little too much sometimes which I have paid for with a little back pain so you must get a balance. Ideally aim to start with a 10 minute walk twice a day and build up as you feel able. Movement encourages healing so I can not recommend it highly enough.

That is it for now. I have my GP 6 week postnatal check tomorrow and my first weigh in since being pregnant. Stay tuned!

 

I am a head lady gardener – Gynaecological Cancer Fund

Lady Gardener logoBROCKS LAGY GARDEN

Incorporating fundraising into your training program is  a great way to keep motivated. As well as that, In order to make my mission to get my pre baby body back a little less self-indulgent I have decided to raise money for the new charity Gynaecological Cancer fund. Their goal is to make a significant difference to both funding and awareness of women’s gynaecological cancers locally, nationally and internationally. Gynaecological cancer research is currently massively underfunded. Detection rates are lower and mortality rates are higher than for many other forms. Early detection is crucial and erasing the taboo around these cancers is essential.

This charity really is close to my heart. One of my best friends was recently diagnosed with cervical cancer. Thankfully she is doing well thanks to early detection but not everyone is so lucky. Research is all the more important to me now, having had a daughter recently. It would be lovely to think that by the time she is a young woman that treatment is even more effective and her generation are not afraid to go their GPs and get seek help.

The five cancers that GCF focuses on are ovarian, womb, Cervical, vaginal and Vulva. These can affect any woman and their symptoms should not be ignored. Please check out this link for common symptoms:

http://gcfund.co.uk/gynaecological-cancers/

Over the next 12 months as I continue to rehabilitate and return to running I will be aiming to raise £250 over the year doing various events, so watch this space. If you want to contribute or get involved with the charity there are many ways, buy a jumper from topshop:

Send a selfie of yourself to Instagram with a nickname for your ladY garden. Or for more ideas just click on the link below:

http://gcfund.co.uk/

 

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RUNNING WITH A BUGGY

The time had come, I was ready and strong enough to run with Oscar in a buggy. No more waiting for my partner to get home and go for a run, no more stupidly early morning runs. Yes! Now was the time for myself and Oscar to get out and enjoy the great outdoors together. Oh but wait, so many buggies, what do I look for, what did I need to ensure that I was going to avoid injuries? To be frank there is so much information out there and you do need to research the right buggy for you.  Unfortunately you are susceptible to new aches and pains if your posture and set up is not correct. Trust me, I made some mistakes so I’m hoping that these tips below will help you avoid injury and just enjoy running with baby on board.

BABY SAFETY FIRST

·       Make sure your baby is old enough. It’s not safe to run with a child under six months in any buggy. By six months their spine will be strong enough if they are in a well designed running buggy with rear wheel suspension and a padded seat.

·       In the cold weather be sure to wrap baby up well, you will warm up but they won’t and in the summer a sun shield is recommended.

·       Lots of these buggies come with accessories to improve the comfort of baby, like foot muffs and rain covers but the extras can be costly, see if you can get a package deal.

·       The buggy should have a handlebar brake and wrist strap crucial for those fast and downhill parts of your run. The child’s harness must be fully adjustable and secure, a 5 point harness is essential.

MUMMYS HEALTH AND SAFETY

·       Of course baby being comfortable is important but your comfort is also a priority.  Does the design allow you to run unhindered with a full stride? It should be easy to push and steer with both or one hand.

·       Pushing and running requires extra work and strength of your abdominals, hamstrings and gluteals. Are you strong enough? Have you recovered from a caesarean or significant vaginal tear sufficiently to ensure that your pelvic floor is strong and your abdominals can take the extra load from the buggy? If you are not sure why not have a check up with your women’s health physiotherapist?

·       If you suffered or are still suffering with low back pain or pelvic girdle pain, running with a buggy will shorten your stride and pushing with both or one hands will place strain on your SIJ (sacroiliac joint) which could exacerbate the symptoms described. Again it is worth checking with a women’s health physiotherapist that you are fit to run.

·       Keeping good form behind the wheel is crucial to avoiding injury. Don’t stand upright. Lean forwards, bending from the hips. Keep your head up, your shoulders back and down, lead with your chest.  Maintain a slight bend in your elbows, wrists straight and stay as close to the buggy as you can.

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·        Running with a buggy will prevent your natural arm swing. If you use one hand be sure to swap hands regularly during your run to work both sides.

·       Running is high impact and can place strain on your pelvic organs and breasts, wearing a supportive bra and supportive shorts is highly recommended.

THINGS TO LOOK FOR IN A RUNNING BUGGY

·       During my research I found that many buggies had sport or jogging in their titles but it doesn’t necessarily mean that it is  meant for that purpose. The more a buggy has been adapted for running, the less versatile it will be for day to day use, worth considering if you are just doing the odd run.

·       Most running buggies have 3 wheels. The wheels should be large (ideally 16 inches plus), pneumatic tyres and a fixed front wheel to cope with uneven ground and protect baby.

·       Look for a light buggy, the lighter, the easier it will be to push.