Physical and Mental Health in the Postnatal Period

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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.

https://maternalmentalhealthalliance.org/physical-and-mental-health-in-the-postnatal-period/#more-3568

Exercise and Mental Health

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.IMG_5450

When can I return to running after baby?

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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.

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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.

https://mutusystem.com/mutu-system-blog/running-diastasis-recti

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.

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NEW YEAR NEW START!

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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 info@halosclinic.co.uk 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 MUMMY MOT
the new little black dress.

little-black-dress-1Every 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!

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EVB SPORT LEGGINGS REVIEW

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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

 

Brilliant blog posts on HonestMum.com

RUNNING JUST GOT SOCIAL

run with me

 

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!

Podcast- tips for when to start running postpartum

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.

https://itunes.apple.com/nz/podcast/run-for-your-life-23-interview/id1008957786?i=358526925&mt=2

Catch up soon, with some more info and tips. X

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!