POST NATAL PILATES

Post Natal Changes

Diastasis Recti
Caesarean
Nutrition & Weight Loss

Josie McKenlay – Post Natal Pilates

Post Natal Changes
Relaxin
Although the production of this hormone ceases after delivery of the placenta, its effects take 5
months or more to disappear. Joint instability is therefore a concern.

Abdominal Muscles
As a result of the postural and other changes during pregnancy some muscle groups will have
become too tight, others will have weakened, most notably the abdominal area.

Pelvic Floor
Another area of the body that can be subjected to considerable stress and trauma during pregnancy
and delivery are the pelvic floor muscles (PFM). These muscles run like a hammock from the pubic
bone to the tail bone and support the pelvic organs.

• Stress incontinence: pressure on the pelvic floor muscles can cause stress incontinence.
Pelvic floor exercise can help to cure this, but if there is no improvement by your post-natal
check, do mention it.
• Elasticity: The PFM will also undergo considerable stretching during delivery of the baby.
• Perineum: The perineum - between the anus and the vulva - can be sore for days or weeks
after delivery. Pelvic floor exercises can help heal of the perineum.
• Episiotomy: Healing normally occurs within approximately ten days but it can take up to six
weeks for the stitches to dissolve.

Prolapse
The greatest incidences of prolapse occur after childbirth. Supporting the weight of a baby as it
drops lower into the pelvic region and the strain of delivery weaken the pelvic floor and create the
conditions for a prolapse. There are two types of prolapse:

• Bulging of the bladder or rectum through the wall of the vagina (the most common post-
natal prolapse)
• The descent of the uterus into the vagina.

These organs are held in place by supporting ligaments, the pelvic floor muscles and layers of fascia,
all of which are affected by relaxin. Pelvic floor exercises can be extremely beneficial and may
prevent the need for surgery.

• Avoid high impact activities until healed

• Lift only light weights and avoid straining
• Perform only gentle abdominal exercises
• Engage the pelvic floor muscles during effort.

Breasts
Although not particularly relevant to this exercise programme, it’s useful information as you move
forward beyond this healing process.

The breasts increase in size from the early months of pregnancy and undergo further changes soon
after birth, necessary for milk production, especially after the third or fourth day post-delivery.
Points of which you should be aware:-

Josie McKenlay – Post Natal Pilates

 • Engorgement: when the milk comes in after delivery, breasts become hot, hard and swollen,
due to an increased blood supply and retention of fluid in the breasts causing swelling. This
is relieved once your baby begins to feed.
• Mastitis: Some women develop inflammation of the breast, caused by milk not being
emptied from the breast as quickly as it is produced.
• Exercise considerations: breastfeed or express milk before exercising to reduce the load and
wear a good supportive exercise bra. Any prone positions may need to be avoided.

Pelvic pain
Both pregnancy and the process of giving birth place considerable strain on the pelvis and spine.

• Pubic symphysis pain: pain can range from mild to severe in the area of the pubis and groin
radiating down the inside of the leg and often starts midway through pregnancy. It will
gradually disappear post-delivery.
• Sacroiliac pain: Sacroiliac pain (where the pelvis attaches to the spine at the back) can occur
during pregnancy or postpartum. Some cases may correct themselves after the birth
although in others it may continue for some time afterwards. If this is the case, a
physiotherapist will be able to help.

High impact activities and those involving hip abduction, such as breast stroke, or extension may
further irritate the pubic joint. Fast walking may also aggravate the condition.

Damaged coccyx
The coccyx can be bruised or even fractured if it is forced backwards during delivery. You may not
be able to lie supine in neutral alignment. Pelvic floor exercises, deep breathing and pelvic tilts with
a scoop and hollow (all standing) may be the only exercises you can manage until you have healed.
If there is no improvement by your post-natal check, be sure to mention it.

Back pain
Lordosis and kyphosis – exaggerated curves in the lower and mid back area – are common and can
occur as a result of postural problems during pregnancy, as well as carrying your baby and
breastfeeding positions. Loss of stability is the result of weakened abdominal muscles. You will
notice a huge improvement as you work your way through this exercise programme.

Varicose Veins
Varicose veins are quite common but should start to improve after delivery. Avoid standing or sitting
still for long periods of time

• Avoid sitting cross legged or sitting on your heels as this will compress the blood vessels
• Whenever possible sit with legs elevated
• Perform a range of motion exercises: lifting and lowering alternate legs and pointing and
flexing your feet
• Perform exercise such as walking which enhances the return of the blood back to the heart.

Diastasis Recti
Post pregnancy, the combination of poor posture, weak abdominals, hormonal changes, weight gain
and the abdominal wall stretch during pregnancy cause your belly to bulge out and be very weak.
This is likely to lead to or cause continuation of back pain and may even affect your ability to look
after your new baby. It is also something that many women find distressing from an aesthetic point

Josie McKenlay – Post Natal Pilates

of view, but rest assured that if done regularly and correctly, this exercise programme will help
considerably.

Many women also experience a separation of the rectus abdominis muscles, a gap down the centre
of your abdomen known as a diastasis recti. Over a third of women will have a gap of two fingers or
more after their first baby. This figure is more like two thirds of women after the second or
subsequent pregnancy, especially if the gap wasn’t closed effectively after the first baby. By 6-8
weeks the recti gap should be approximately 20mm or 1-2 fingers or less.

This exercise programme has been devised to aid core restoration and should be followed at least
until your post-natal check, even if there is a gap of less than 2 fingers. These exercises are the
essential starting point for all women following delivery. The gap should begin to close and the
integrity, density, strength and function of the linea alba – the connective tissue between the two
sides - will increase. If you have a persistent gap of over 2 fingers, you should discuss it with your
doctor.

Pelvic tilting, low load stability exercises for the transverse abdominis and gentle curl ups where only
the head and shoulders are lifted to the point before doming occurs are perfect for the healing
process to take place from the inside out and will start to flatten your belly.

Doming must not occur. If doming does occur reduce the intensity of the exercise or avoid the
exercise until the abdominal wall can be held flat. Doming is where the two halves of the RA push
out rather than pulling back and flattening. It looks like two ridges with a gap between.

Testing for diastasis

This course is the starting point for everyone, so this test isn’t necessary. However, if you are
curious or have been told that you have a separation, you may want to check and measure your
progress.

• Neutral alignment: lie supine in neutral alignment with your knees bent and feet flat on the
floor and abdomen relaxed.
• Place two fingers of one hand horizontally across the abdomen with the finger tips down the
centre of the abdominals just above the navel. Gently press in and out to feel between the
two halves of the muscle.
• Inhale and as you exhale, engage your pelvic floor muscles, draw your navel towards the
spine and lift your head and shoulders slightly up off the floor, keeping gentle pressure on
the abdomen with the finger tips. Hold the position, while continuing to breathe, and
register the sensation under the fingertips.
• You should be able to feel the two bands of the rectus abdominis closing in on either side of
her fingers, with the soft dip of the linea alba in the centre.
• If the gap between the two bands appears to be wider than 2 fingers, repeat the test using 3
fingers.
• Test a couple more points along the mid line: just above the pubic bone and just below the
navel.

This is not a highly specific test, but it will give you an idea and also help measure progress.

Josie McKenlay – Post Natal Pilates

Caesarean
C-section procedure: most C-section incisions do not actually cut through the abdominal muscles. An
incision is made through the skin and connective tissue, while the abdominal muscles are pushed
aside to open the uterus and deliver the baby.

• Gentle pelvic floor and deep breathing exercises (without the “Ha”), engaging the core
muscles as soon as possible
• gentle walking by week 2 is usually possible.

Your level of discomfort and fatigue should determine your level of activity and progress, so listen to
your body. You have undergone major abdominal surgery and may have pain and tenderness in the
abdomen for some time, so expect to take longer to heal. Tingling and numbness will be
experienced around the scar and sensation will return in patches bit by bit, taking up to six months
to fully recover. Expect this programme to take longer.

Nutrition & Weight Loss

Breast Feeding
Breast is best, so if you can, do. The unique composition of breast milk provides all the nutrients
that a baby needs. Breastfeeding is a drain on the mother’s nutrient stores and so a varied,
balanced and healthy diet is needed. World Health Organization (WHO) guidelines recommend that
all mothers breastfeed their babies exclusively until they are six months old and then continue to
partially breastfeed their babies until they are two years old.

Benefits for Baby

• Reduced incidence of gastrointestinal infections and other infectious diseases, especially
respiratory, ear and urinary tract infections
• Reduced risk of being obese in later childhood
• Reduced risk of developing both types of diabetes
• Reduced risk of constipation
• Reduced incidence of some childhood cancers
• Reduced risk of Sudden Infant Death Syndrome
• Reduced risk and reduced severity of allergic conditions including asthma and eczema

Benefits for Mum

• Aids faster recovery and helps uterus shrink back to normal size
• Breastfeeding encourages bonding between mother and baby
• The production of breast milk uses an extra 500 kcal per day which can help with weight
control
• Breastmilk is free and convenient
• Exclusive breastfeeding stops ovulation and menstruation which helps a woman’s iron stores
return to normal after pregnancy.
• Women who breastfeed have a reduced risk of developing ovarian and breast cancer

Josie McKenlay – Post Natal Pilates

Diet
No special diet is recommended while breastfeeding but follow these guidelines to ensure that you
both get all the nutrients you need.

• Breastfeeding can use up an additional 500 kcal per day which can leave you feeling hungrier
than normal. Respond to these signals and eat regular, healthy meals and snacks in order to
maintain energy levels.
• Meals need to be quick and easy to prepare
• Ensure you stay hydrated and drink regularly throughout the day. Aim for a couple of litres
of fluids.
• Tea and coffee should be limited: caffeine is excreted in breast milk and may keep a baby
awake as babies aren’t easily able to metabolise caffeine.
• The Department of Health recommends that breastfeeding women take 10 mcg of vitamin D
as a daily supplement whilst breastfeeding, same recommended dose as during pregnancy.
The vitamin D supplement helps to boost the levels in the mother’s milk to satisfy baby’s
needs.
• Consumption of oily fish needs to be limited to two portions a week while breastfeeding due
to the pollutants it can contain. Marlin, shark and swordfish should be limited to one
portion per week. There is no limit on other fish.
• If you choose to drink while breastfeeding, limit your intake to one to two units once or
twice a week. The impact on your baby can be limited by drinking after a feed so that her
body has time to process the alcohol before the next feed is due.

Losing fat
It is normal for a woman’s fat stores to increase considerably during pregnancy. If you did gain a lot
of weight though, it’s important that you lose it as this can lead to long-term obesity. It is especially
important to return to a normal BMI prior to becoming pregnant again because being obese
increases the risk of complications during pregnancy and has a negative impact on the health of your
unborn baby.

Don’t try to lose weight until after your post-natal check and then only if you put on too much
weight during pregnancy. If you follow the above healthy eating guidelines and if you are
breastfeeding, you will find that you naturally start to lose weight. You need energy and your body
needs the resources to recover. Once you increase your activity and you have a routine, your weight
will gradually get back to normal, so don’t panic and take the time: it will take 6 months to a year.

This course is not about weight loss. However, here is a useful guide should you need it after your
post-natal check:

The most effective way to achieve long term weight loss and gain control is to reduce energy intake
from food and increase energy expenditure through exercise.

If you can cut 250 kcal per day and use 250 kcal per day by exercising, this will result in an energy
deficit of 500 kcal per day. This equates to 1lb loss in body fat, an ideal rate post-pregnancy to
ensure the weight stays off long term. Losing more weight than this might impair your nutrient
intake, leaving you tired and more prone to illness.

Josie McKenlay – Post Natal Pilates