Pelvic health support and information

Know your vulva

Get to know your vulva! Quite often many women and birthing people will refer to their vulva as the vagina, however this is anatomically incorrect. The vulva is what you see from the outside and the vagina is the muscular structure inside. Every vulva is different. Take a look at the diagram and see if you can identify these on yourself. Sometimes your vulva may look different during pregnancy due to the increased pressure and weight of baby(s). It is useful to get to know your vulva to be able to identify any changes from what is normal for you and you can also look to see if you are doing pelvic floor exercises correctly.

Where is your perineum?

Your vagina is the passage through which your baby passes during vaginal birth. Above your vagina is your urethra, the small hole you wee from. Either side are your labia: the larger labia are on the outside, and the smaller labia on the inside. Below your vagina is your anus, which is a ring of muscle which helps to control when you need a poo (open your bowels). Your anus has two sphincter muscles, an internal ring which sits inside an external ring, like a circle inside a circle. Between your vagina and your anus is your perineum. 

For more information about perineal injury care and support, click here. 

Your pelvic floor

The pelvic floor muscles are a group of muscles that sit inside the pelvis. They attach from the pubic bone at the front, to the coccyx bone at the back, forming the floor of your pelvis. The functions of the pelvic floor muscles are:

• Control - they help you to control wee, wind and poo.
• Support – they act like a hammock to support your pelvic organs (bladder, uterus and bowel).
• Sexual function – they can help improve sex by increasing your sensation and orgasm.
• Stability - they help to manage forces going through the pelvis.

Your pelvic floor muscles...

...in pregnancy

During pregnancy your body goes through many changes and it can be difficult to know what changes are normal and when you should seek help. As your pregnancy progresses, changes can happen to your bladder, bowel, vaginal, and sexual health as your pelvis comes under more pressure. This causes stretching and tiring of the pelvic floor muscles meaning they may not work as effectively. It is important to be aware of how to optimise your pelvic health to support your pelvic floor function.

...after childbirth

During a vaginal birth, your pelvic floor muscles will stretch for you to birth your baby. Some births may cause an injury to the perineum and pelvic floor muscle which will take time to heal. This can affect how well the muscles work. During birth, the nerves that control the pelvic floor muscles will have been compressed and after birth they may take time to recover. During this time the muscles are likely to feel weaker than normal.

Why are pelvic floor symptoms not talked about?

There are lots of reasons women and birthing people tell us why they may not seek help with pelvic floor problems. This includes:

• "It's normal after childbirth"
• "I'm too embarrassed to talk about it"
• “Not sure which health care professional to talk to”
• “I don’t identify as a woman, will they (health care professional) understand this”
• "I don’t know if there is a treatment that can help me?"
• "I'm too busy with my new-born baby"

Please remember - help is always available.

Healthy bladder

The bladder is a storage organ in your pelvis that is continuously filling until it reaches its full capacity when you would then go to the toilet for a wee. Most people will recognise they need to go for a wee when the bladder has about 150ml in it, but usually this signal can be comfortably ignored. Then you may get another signal around 300ml, and could may well ignore it still. But it is usually when the bladder is approximately 400 to 500ml that you can’t hold any longer and have to go for a wee. If you aim to drink one and a half to two litres of water per day, you can expect around five to eight visits to the toilet a day.

There are several things that can affect bladder health, these include:

• Toilet facilities – if you can’t go as regularly or have difficulty accessing them.
• Fluid intake - this should be mostly water. Other drinks such as milk, herbal (caffeine free) teas, diluted squash and juices can be ok. Caffeinated or fizzy drinks may cause bladder irritation causing you to wee more often.
• Bowels – constipation, straining can cause bladder problems.
• Difficulty emptying your bladder.
• Urine infections.

Common bladder symptoms include:

• Urinary incontinence – leaking wee, either with stress or urgency.
• Urgency.
• Frequency.

For more information, read the Promoting Continence leaflet here.

Healthy bowel

Having good bowel health and function is really important to keep you feeling healthy and usually when things aren’t working as they should be, it starts to have an impact on your day-to-day life.

What’s normal?

• The normal number of trips for a poo can be from three times a day to three times a week.
• Your poo can look very different in shape, size and even colour.
• Optimal consistency of your poo should be around type 4 on the Bristol Stool Chart below. It should be firm but not hard and easy to pass without the need to strain.
• Poo like this is easier to hold onto and less likely to cause urgency or leaking.

Common problems:

The two most common problems with bowels are anal incontinence (leaking of wind or poo) and constipation (difficulty in having a poo and causing regular straining).

The best way to poo:

• Listen to your bowel, it will tell you when you need to go. If you miss the signal to poo, it can then be harder to open your bowels later.
• Use a footstool. Placing your feet on a stool or toddler step will bring you into a squatting position and will help you to poo more comfortably and without straining.
• Don’t strain, this can contribute to the weakening of the pelvic floor muscles. Relax the belly as you breathe in and as you breathe out imagine making the sound “moo”. These together will help poo move through the bowel.

For more information, visit the Improving your bowel function leaflet here.

Pelvic floor exercises:

Pelvic floor muscle training:

• The correct way to contract your pelvic floor muscles is tighten from back to front as if you’re trying to stop wind and wee.
• You need to be able to draw those muscles upwards and forwards from the back passage towards the bladder.
• There are various different cues you can try to initiate a contraction if thinking about wind and wee doesn’t work for you.

You can try:

• Just imagine stopping wind.
• Just imagine stopping wee (don’t actually stop the flow of urine).
• Imagine a lift that is on the ground floor and needs to travel up to the top floor.
• Imagine a blueberry at the entrance to the vagina and you are trying to draw it up and in.
• Imagine an escalator, tailbone is at the bottom and you're travelling up the escalator to the pubic bone.

What position do I do the exercise in?

• Lying/side lying.
• Sitting.
• Standing
• With movement.

Pelvic floor exercise programme:

There are two types of squeezes to do:

Long holds:

• Tighten your pelvic floor muscles, keep holding them tight, then release and let them fully relax, make sure you breathe normally throughout keeping all other muscles relaxed.
• How many seconds or how many breaths in and out can you hold the squeeze?
• Repeat the long squeezes, with a rest in between, until the contraction isn’t as strong or you can't feel the muscle relax. How many times can you repeat the squeezes?

Quick squeezes:

• Quickly tighten your pelvic floor muscles, then immediately let them go again.
• How many times can you do this quick squeeze before the muscles get tired?
• Always let the muscles fully relax after each squeeze. If you can’t feel the muscles relax then the chances are the muscles have become tired.

How many am I aiming for?

• Long holds: the aim is to work up to between eight and 12 second holds, repeated ten times.
• Quick squeezes: contract for one second, relax for one second and repeat this ten times.
• The 'knack': if you have symptoms (leaking of wee or poo) when you cough/sneeze/laugh/lift something then it is good to contract your pelvic floor muscles beforehand. This will help to stop or reduce any leaking.

Things to know:

• Ten long holds and ten quick squeezes makes up one set of exercises.
• Aim for three sets per day for strengthening.
• It can take between three and four months to see improvements if you’re doing them correctly and regularly.
• Once you’ve achieved this and your symptoms have resolved, you can drop down to once per day or three times per week for life-long maintenance.

Things to look out for:

Pay attention to what the rest of your muscles are doing, make sure you are not:

• Holding your breath.
• Squeezing your legs or buttocks.
• Gripping with your belly.

It is easy to forget to do your exercises, it can help to do them at the same time as something else you do regularly. Other things that can help you to remember are:

• Setting alarms or reminders on your phone.
• Try a pelvic floor exercise app, for example the NHS squeezy app.
• When you’ve finished having a wee, do them while you’re still sitting on the toilet (but don’t do them to stop your flow).
• During a regular journey in the car, bus or train.

If you find symptoms aren’t improving, it is important to ask for help. You can complete an individualised pelvic health assessment through the MyPathway app. Your assessment will be triaged by the Perinatal Pelvic Health team and you will get access to additional pelvic health resources and an appointment with one of the team if required. You can access this here: (LINK). If you are unsure speak to your midwife or healthcare professional for support.

For more information, read the pelvic floor exercises leaflet here. 

Perineal Massage

Perineal massage can help to prepare your pelvic floor muscles for birth. Click here for more information.

Exercise in pregnancy

Why exercise in pregnancy?

• Helps controls your weight gain and improves your mental health.
• Improved chance of a shorter labour.
• Lower chance of emergency caesarean section.
• Reduced bodily aches and pains.
• Healthier blood pressure.
• Lower risk of pre-eclampsia and gestational diabetes.
• Less chance of an early birth.
• Quicker recovery after birth.

What am I aiming for?

It is a good idea to discuss exercise with your midwife at your booking appointment.

Pregnant women should aim for about 150 minutes of moderate aerobic exercise across the week. So about 30 minutes, five times a week – or you might decide to do it in shorter bursts.

What does Moderate Aerobic Exercise mean?

This means:

• Your heart beats a bit faster and you might get a bit sweaty.
• You can still talk but wouldn’t be able to sing.

If you were already doing this much exercise, or more, before you got pregnant then you can usually carry on.

Things to consider:

• Depending on the type of exercise you do, you may need to adapt how you exercise as your baby grows.
• Make sure you warm up and cool down as this will reduce your chance of getting injured and will allow your heart rate to return to normal.
• Extra consideration required when exercising in hot weather; early morning or late afternoon will help to avoid the hottest time of the day.
• Keep hydrated – aim for the recommended one and a half to two litres of water per day.
• If you go to a gym or exercise class you should always let the instructor know you are pregnant.
• Be cautious with exercises that require you to lie flat on your back from around 16 weeks of pregnancy; the weight of baby can compress the main blood vessel returning blood back to your heart and can cause dizziness and/or fainting.

If you already exercise:

For those who already exercise is part of your normal routine, then it is safe for you to continue to do so during your pregnancy for as long as you feel comfortable.

New to exercise:

If you are new to exercise you should take it slowly and build up to the advised amount.

• Gradually increase how long and how often you exercise. Perhaps start with 15 minutes, three times per week then build it up to 30 minutes, four times per week and eventually you should be able to exercise daily.
• Listen to your body and don’t push yourself too hard. You are taking an important step towards good health and there is no rush.
• Exercising in water is good during pregnancy as it supports your weight.
• Daily activities such as walking to the shops, doing the housework or putting on your favourite tunes and having dance all count!

Activities to avoid:

There are a few activities that are not advised. These include:

• Contact sports such as martial arts or rugby (although you could still do the training even if you have to miss matches).
• Sports using rackets or bats where the ball will travel at high speed.
• Sports where you are at risk of falling like, cycling, horse riding or skiing.
• You should not scuba dive or climb to high altitudes.

For more information, read the Fit for Pregnancy leaflet here.

Pelvic floor dysfunction (PFD) is used to describe conditions that are caused by the pelvic floor muscles not working as they should.

Symptoms can include:

• Urinary incontinence - leaking of wee.
• Overactive bladder - urgency to wee more than seven times a day.
• Pelvic organ prolapse - one or more of the pelvic organs start to come down into the vagina.
• Anal incontinence – leaking of poo or wind.
• Dyspareunia – pain or discomfort during sex.

Is pelvic floor dysfunction normal?

We prefer to say symptoms of pelvic floor dysfunction can be common but they do not have to be your new normal and it should not be accepted that it’s a normal part of pregnancy and giving birth. Symptoms can occur but should only last for a short time and should be mild.

The most common symptom to experience during pregnancy and after birth is urinary incontinence (leaking wee).

• It occurs in around 40 to 50 per cent of women and birthing people as pregnancy progresses and immediately after birth.
• Around 25 per cent of pregnant women and birthing people can also have anal incontinence (leaking poo).

Please complete your individualised risk and symptom assessment on MyPathway to gain access to help and advice or further support from the Perinatal Pelvic Health Service.

Leaking wee – stress incontinence

This is the most common symptom that occurs during pregnancy and after birth. It happens when you do something that increases the pressure in your tummy such as:

• Cough.
• Sneeze.
• Laugh.
• Lift something or your baby.
• Jump.
• Dance.
• Run.
• Sing.

This is usually because the pelvic floor muscles aren’t able to fully support the closure of the tube leading to the bladder (urethra), during these activities to prevent any wee from escaping.

Overactive bladder

This is when your bladder has become sensitive to the feeling of filling with wee and will give you sensation to wee more often and sometimes more urgently.

You may find you don’t get a break overnight and the urge to go can wake you up. Sometimes with strong urges, you may leak wee when trying to get to the toilet that you’re not able to control.

Try to avoid drinks that can irritate the bladder such as fizzy or caffeinated drinks. It is normal to go more often towards the end of pregnancy and should settle down in the weeks after birth.

If it doesn’t, please complete your individualised risk and symptom assessment on MyPathway to gain access to help and advice or further support from the Perinatal Pelvic Health Service.

Pelvic organ prolapse

A prolapse, sometimes called pelvic organ prolapse, is when one or more of the vaginal walls or the top of the vagina weakens and moves downwards causing pressure, bulging or heavy feeling inside the vagina or at the vaginal entrance. Whether the bulge stays within the vagina or starts to come out will depend on the factors causing the prolapse.

A prolapse is common (around one in 12 people) if you have had a vaginal birth although this is not the only cause, it can occur at any time even in someone who hasn’t had children.

The symptoms you will most likely feel are:

• Vaginal heaviness.
• Awareness of a lump of bulge.
• Deep lower abdominal aching.
• General vaginal discomfort.
• Or you may have no symptoms at all.

Having a prolapse can also affect how your bladder and bowel function and can also make sex uncomfortable.

For more information, read the pelvic organ prolapse leaflet here.

Leaking poo (anal incontinence)

Anal incontinence is leaking wind or poo, sometimes with urgency and sometimes without warning. It is less common than any bladder symptoms, however it will still affect around one in ten adults and will have a higher impact on quality of life and can be very upsetting.

Please complete your individualised risk and symptom assessment on MyPathway to gain access to help and advice or further support from the Perinatal Pelvic Health Service.

Discomfort with sexual intercourse

Your vagina can sometimes feel different during pregnancy or after birth. This can be due to the changes that occur to your body during pregnancy and birth. However, sex should never be painful. Should you experience any pain with sex that does not settle. Please complete your individualised risk and symptom assessment on MyPathway to gain access to help and advice or further support from the Perinatal Pelvic Health Service.

Pelvic girdle pain (PGP) / Symphysis Pubis Dysfunction (SPD)

Some women and birthing people may develop pelvic pain in pregnancy; this is called pelvic girdle pain (PGP) or symphysis pubis dysfunction (SPD).

PGP is an umbrella term for the collection of uncomfortable symptoms that occur in the pelvis. Pain can occur in just one or several areas.

• Approximately one in five women and birthing people will get symptoms of PGP in their pregnancy and it can happen at any stage
• Most of the time symptoms disappear once baby is born. However, some people may continue to have pain after birth
• The most common type of pain experienced is lumbopelvic (pain in the lower back and/or back of the pelvis)

PGP is not harmful to baby but it can make day to day activities more difficult.

Common types of pain can include:

• Burning
• Deep aching
• Throbbing
• Clicking/cracking/clunking
• Stabbing/shooting
• Feeling of instability - for example, feeling like the hips could pop out or everything could fall out (although it may feel this way, this is not what is actually happening. Your pelvis is really strong and designed to adapt to your pregnancy.)

The most common activities that women and birthing people struggle with are:

• Walking
• Standing on one leg - for example, when getting dressed, using stairs
• Moving legs apart - for example, turning in bed, getting in and out of bed or the car
• Getting comfortable in bed and issues with quality of sleep
• Sexual intercourse

After birth, poor postures when sitting for a long-time feeding baby, lifting and carrying baby and baby equipment can put large amounts of strain on the back and pelvis while your body is still recovering which can also cause pain.

Pain is a complex problem and we know it can have more than just a physical cause; our emotions, previous experiences and beliefs play a part in how our brain perceives pain.

For more information, read the PGP leaflet here.

Patient Information | POGP (thepogp.co.uk)

Why Choose a POGP Registered Physiotherapist | POGP (thepogp.co.uk)

Medications for Pelvic Floor Dysfunction

There are medications that can help with bladder and bowel symptoms if it is required. Most commonly for overactive bladder, which can calm down the urgency, and medications can be given to speed up or slow down transit of poo through the bowel for constipation or leaking poo.

However, all conservative treatment with physiotherapy advice and/or support should be followed first and this is often the most helpful treatment.

Being able to discuss your choices, preferences and options with all healthcare professionals is vital to ensure that you feel listened to and that they are able to support you in your choices

Things that may help you:

• The best advice is to be informed. Absorb as much information as possible to learn about what your body is going through and will go through
• When going to appointments, if allowed, take someone with you as a second pair of ears
• Prepare questions to take to appointments with you
• Trust your gut and listen to your body. If you are being told something or advised about a decision, don’t feel pressured or coerced into a decision you don’t feel happy with. Any healthcare professional will be happy to listen to your concerns and discuss all options with you for you to be able to make an informed decision about your care

BRAIN is an acronym and simple tool used to help with decision making.

• Benefits – what are the benefits of the options you have?
• Risks – what are the likely risks of the options you have?
• Alternatives – are there any alternatives to the options you are considering?
• Information – what other information do you need to make the right decision?
• Nothing – what would be the impact if you did nothing?

When it comes to birth, it can be an unpredictable process and it is good to be open-minded about your birth plan. However, be informed of all your choices and if you have a strong opinion on any aspect, discuss this with the person looking after you.

Fit for birth

There will be a time in your pregnancy when you need to consider your birth plan. Labour and birth can be an exhausting process and there are some things to consider that may help you through this process:

• It is a good idea to attend an antenatal class to get the best advice and information.
• It is essential to start pelvic floor exercises during pregnancy to help these muscles cope with the changes that occur during pregnancy, birth and postnatal recovery. See the pelvic floor muscle training section for further information on this.

Things to consider in preparation for labour and birth are:

• Perineal massage.
• Pain relief options during first stage of labour.
• Positions of ease during first stage of labour.
• Management of contractions during late first stage.
• Management of second stage of labour.

For more information on Perineal injury and care, click here. For further information, read the 'Fit for Birth' leaflet here.

It is important to allow your body time to recover from labour and any type of birth. The information below will help to aid your recovery in the days and weeks after birth.

You should have a check-up with your GP around six to eight weeks after you give birth. This is to check on your recovery and health of your baby(s). This is a good opportunity for you to discuss any problems you might be having, either with:

• Healing of your stitches.
• Bladder problems.
• Bowel problems.
• Pelvic floor.
• Pelvic pain.
• General mood and wellbeing.

When you feel able to, please complete your individualised risk and symptom assessment on MyPathway to gain access to help and advice or further support from the Perinatal Pelvic Health Service.

Bladder care

Pain Management and Wound Care

Your stomach muscles

Diastasis Rectus Abdominis is a separation of your 'six pack' muscles. During pregnancy, as your baby starts to grow, all of the muscles in your tummy are stretched and it is a normal part of pregnancy for these muscles to separate. It can occur anywhere down the middle of your tummy, from just under the ribcage down to just above your pubic bone.

It can be more noticeable after birth and up to 60 per cent of women and birthing people can experience symptoms. You may notice:

• Bulging or doming in the middle of your tummy when you sit up, lie down or pick baby up.
• Discomfort along the middle of your tummy, particularly if you’ve been more active.
• Feeling a gap between your muscles when you feel down the middle of your tummy.
• A change in how you feel about your body and how it looks.

It is something that can be improved with the right advice and exercise.

Return to sex

It can often feel daunting returning to sex after birth for many reasons, particularly if you’ve had a physical or emotional birth trauma. Some women and birthing people may prefer to wait until after the GP check at six to eight weeks but others may prefer to wait longer. There is no right or wrong timing of when. If there are no physical problems then you can return to sex whenever you feel ready.

Things to consider:

• It is really common to experience vaginal dryness in the months after birth. This is due to the reduced amount of oestrogen in your body after birth, which should resolve itself once your normal menstrual cycle returns. If you are breastfeeding, this may continue for longer. You can be prescribed local topical oestrogen to help to resolve this.
• If you’ve had stitches and now have a scar, it is common for this area to be uncomfortable during penetration. Take it slow and have lubrication on standby (water-based is best) to reduce any potential for discomfort. It is also worth experimenting with different positions to redirect any pressure away from your scar.
• Contraception - your fertility can return soon after birth and can return while breastfeeding. Your midwife or GP will be able to discuss your options after birth with you.

If you do experience persistent discomfort, pain or difficulties returning to sex, or even if the problem is not physical, sometimes it can be an emotional barrier to sex.

Please complete your individualised risk and symptom assessment on MyPathway to gain access to help and advice or further support from the Perinatal Pelvic Health Service.

Recovery after a caesarean section

A caesarean section is a major operation and can take longer to recover from. There have been several layers of tissue that have been cut through or moved around in surgery. The pelvic floor has still had additional strain throughout pregnancy. It is really important you take the time to rest and recover well.

There are many things to consider when looking after your body and recovering from a caesarean.

• Birth to two weeks:
  • Pain and discomfort are to be expected, speak to your midwife or GP about appropriate pain relief as this is essential to keep you mobile after surgery.
  • Pain can increase when getting in and out of bed, walking, doing anything that causes any strain on your tummy and going to the toilet.
  • Try to avoid constipation by keeping hydrated and eating a balanced diet. (Visit the 'What can I do to help my pelvic health > bowel' section)
  • The bladder can be irritated after surgery, this may make you want to wee more regularly. Maintaining good bladder habits will help this to settle down. (Visit the 'What can I do to help my pelvic health > bladder' and 'Pelvic health dysfunction > overactive bladder' sections.)
• Three to four weeks:
  • The wound itself usually heals well and scar tissue will start to form.
  • Daily activities start to become a little easier but you will still feel bruised and tender.
• Six to 12 weeks:
  • You are likely to be back to doing all of your day-to-day activities comfortably.
  • This is the time you can look to return to exercise, a gradual return is essential. Please see 'Return to exercise' section.

It is important to look out for signs of infection, these include:

• Heat at the wound
• Discharge
• Pain that doesn’t settle

If you notice any of these symptoms, you must speak to your GP or midwife straight away.

It is normal for the scar and the surrounding area of skin to feel different. The sensation can be reduced or even feel numb for some time, this is completely normal. For some people, extra scar tissue can form which can leave the scar feeling tight and sore.

You’ve given birth and can finally start to have your body back. It will take time for your body to recover back to good health.

Things to consider:

• Strengthening your body will take several months
• Postnatal bleeding can be at its heaviest in the first few days but can last up to 36 days or longer. It is a mixture of blood, mucus and tissues from the lining of your uterus
• Maternity pads are better suited as they have a higher absorbency
• Do not use tampons as they can cause infection

Things you may not have expected:

Aches and pains everywhere!

• Be mindful of the positions you get yourself into when completing daily tasks.
• Reduce repeated bending or slumped postures
• If you are uncomfortable sitting; support yourself with plenty of cushions and pillows to allow yourself to relax fully
• Move and change your position regularly

Cramps

• These happen in the days/weeks after birth. This is your uterus returning back to its non-pregnant size.
• If you are breastfeeding, you may notice cramps during or after feeding as breastfeeding releases the hormone oxytocin which stimulates these contractions.

Vaginal dryness

• This can be an issue until your menstrual cycle returns to normal
• After birth you will generally have lower levels of oestrogen
• Oestrogen helps to keep the vaginal tissues lubricated and healthy, low oestrogen can cause dryness, irritation and sometimes bleeding
• Exclusive breastfeeding can make dryness last for the duration of this time
• It is not permanent, as soon as your menstrual cycle returns, these symptoms will stop. If it becomes a problem, using a lubricant can help you feel more comfortable, apply after a shower and to help with sex
• You can also be prescribed local topical oestrogen to help reduce/resolve this

Haemorrhoids (piles)

• These are swollen blood vessels that can occur inside or outside of the back passage
• They are more common in pregnancy due to the hormonal changes and increased blood flow and weight gain
• They are made worse by straining, therefore if you have had a vaginal birth, these are a common occurrence
• Avoiding constipation is essential to avoid the piles getting worse
• Symptoms you would expect are itching, pain on having a poo (opening your bowels) and fresh blood seen on wiping
• There are treatments that can help with these, speak to your pharmacist or GP

Breasts changes

• They are likely to be bigger, tender, painful, leaky, with sore or cracked nipples
• If you are breastfeeding, a few days after you’ve given birth, they are likely to feel full and tender as they start to produce milk.
• If you’re not breastfeeding, it will typically take seven to ten days for your breasts to return to normal

Baby blues

• It is really common in the days after birth to feel low and emotional
• This usually occurs from around three days after birth but should settle down
• This is because of the hormonal changes your body is going through as well as your change in routine and lack of sleep
• However, postnatal depression is not the baby blues and will usually persist for longer

It is important to talk to people you feel comfortable with and also seek support from a healthcare professional if needed. Your 6-8 week GP check is a good opportunity to discuss this

Exercise is an essential part of maintaining your general health as well as good recovery after birth. It can often feel daunting to even move around normally, particularly if you’ve had a perineal injury or caesarean section. Your body has gone through a lot of changes during pregnancy, labour and birth and it is not realistic to expect your body to “bounce back”.

Birth to six weeks:

• It is important to allow your body to rest and recover following birth
• Find comfortable resting positions that allow you to fully relax and be supported
• It is important to move well and maintain good postures when caring for your baby(s) and completing daily tasks
• It is important to start/resume pelvic floor exercises to optimise your pelvic floor muscles before considering starting or returning to exercise. See section on pelvic floor muscle training.

After six weeks:

Things to consider:

• Return to exercise should be gradual
• Hormonal changes that happened in pregnancy can still affect your body for 6 months or more after you’ve given birth
• You need to be able to enjoy exercise to be able to maintain a routine with it
• If you have any concerns with bladder, bowel, prolapse, gap in your tummy muscles or any ongoing back or pelvic pain, please complete your individualised risk and symptom assessment on MyPathway to gain access to help and advice or further support from the Perinatal Pelvic Health Service.

If you’ve never exercised, here are some simple suggestions to get you started:

• Brisk walking with the pram/pushchair - ensure the handles are at the right height for you so your shoulders are level and you don’t need to bend forwards
• Baby carriers – make sure they are properly fitted to avoid back or neck strain, but are a good way to load your muscles
• Basic abdominal exercises – these can seem simple but done properly they are very challenging but effective
• Swimming – this is a great high intensity but low impact form of exercise, however you can only start swimming once you have had 7 days clear of vaginal bleeding/discharge. It may be wise to discuss it at your GP 6-8 week check

Make sure you wear comfortable supportive bra and clothing when exercising. Keep hydrated, and more so if you’re breastfeeding. Always listen to your body and pace yourself. Make sure you get plenty of rest and allow offers of help.

It is important to not start high impact exercise too soon either. Any exercise where both feet leave the ground at the same time is considered to be high impact e.g., jumping, jogging or sports that involve running.

For information is available on the Exercise and advice after pregnancy leaflet here.

Read more on the Fit for Future leaflet here.

We are sorry you have lost your baby. We understand how devastating it is when a baby dies, and we know that each person will grieve differently, and there is no right or wrong way.

There are different types of support, and your needs can change over time. Some people may want to talk, some may find it comforting to read about others experiences, some find it helpful to start doing some form of exercise, starting with a little and building it up slowly over time.

Both your physical and emotional recovery after the loss of your baby will take time. When you’re ready, this information booklet will guide you on your early recovery after birth.

Please speak to your midwife or GP about how to access additional support for your mental health.

Birmingham and Solihull Perinatal Pelvic Health Service recognises the need for holistic care for every individual. We encourage use of pronouns, use of personal preferences for names of body parts and discussions around sexuality.

The Pelvic, Obstetric, Gynaecological Physiotherapy (POGP) has coproduced an information booklet with trans/non-binary people to provide information on all aspects of pelvic health which will be helpful to you in your perinatal journey.

Click here to for more information.

There are a number of resources which have been developed for use by services users and clinicians to help support good pelvic health. Click on the links below to access the leaflets. There are also a number of videos at the bottom of this page which you may find useful.

• How to discuss the care that's right for you with your healthcare professional
• Helping you take care for your wellbeing, during pregnancy and after
• Don't ignore your pelvic floor - your invitation to optimise your pelvic health
• Pelvic health exercises
• Pelvic girdle pain myth buster
• Pelvic girdle pain top tips
• What is pelvic health anyway - pictorial resource
• Pelvic health physiotherapy - what to expect
• Pelvic health top tips
• Perineal tears during pregnancy
• Taking care of your vulva