What is postnatal period?
Postnatal or postpartum period is the first 42 days after the birth of a child. In this period of recovery, the new mother is encouraged to be mobile to help the mother’s body return to “normal”. Definition of exercise Exercise is defined as an activity that requires physical effort. It is carried out to sustain or to improve health and fitness. (Oxford dictionary) It is a planned, structured and repetitive physical activity for the purpose of conditioning any part of the body. (cited from: the free dictionary)

The importance of postnatal exercise

Fig. 1 Source : Unit Fisioterapi, Hospital Wanita & Kanak-kanak Sabah

Pelvic floor muscle The pelvic floor muscles are tightly slung between the tailbone (coccyx) and the pubic bone, providing support for pelvic viscera (organs). e.g. the bladder, intestines, the uterus (in females), and in maintenance of continence as part of the urinary and anal sphincters. Fig.2 Childbirth can weaken these muscles and cause problems of uterine prolapse and incontinence later in life,  due to stretching and trauma sustained during vaginal or instrumental delivery.

Fig. 2 Source : google.image.com

Pelvic floor exercise (PFE), also known as Kegel exercises, may improve the tone and regain back the function of the pelvic floor muscles, which is of particular benefit for women who experience urinary stress  incontinence. Perform this exercise as often as you can (recommended hourly) anytime, anywhere and in any position.  Continue doing your exercises for at least 3 months after the birth of your baby, it can take several months for the pelvic floor muscles to return to their pre-pregnancy strength.

Abdominal muscle The abdomen is completely enclosed and supported by its muscles. As the baby grows, stretching of the muscles occur, and sometimes they separate centrally. The entire abdominal “corset” will be weakened because of the changes in hormonal levels and/or prolonged inactivity postnatally. A  combination of a strong abdominal muscle, pelvic floor muscle and deep abdominal muscle are essential to provide stability to the back.

Back pain Back pain may not be a symptom during pregnancy but it frequently occurs following delivery. The possible factors are; the resultant stretching of the ligaments of the pelvic joints, the lithotomy position, poor feeding or nappy-changing postures, tension and fatigue.

Oedema Many women complain of heavy, oedematous, aching legs, swollen feet and ankles during the immediate postpartum period. The causative factors may be due to prolonged pushing during labour, pelvic congestion or dysfunctional urinary tract.

Exercise guidelines For the first 6 weeks post delivery, all the exercises should feel comfortable and should not hurt. However, pelvic floor exercises may feel a little difficult at first. Consult with your obstetric doctor or physiotherapist for more information before starting on any postnatal exercise program. Listed below are some exercises to strengthen abdominal, pelvic floor, upper back and lower back muscles.

Warning signs to slow down Don’t overexert yourself. Your body gives out warning signs if you are exercising too hard, and these signs may include:

• Increased fatigue
• Muscle aches and pains
• Colour changes to lochia (post-partum vaginal flow) to pink or red
• Heavier lochia flow
• Lochia starts flowing again after it had stopped

Exercise 1 :  Circulation exercise   Ankle exercise

Start position	Push the foot away from body. Hold for 3 seconds and repeat 5 times	Pull the foot toward the body. Hold for 3 seconds and  repeat 5 times
Start position	Push the foot hold for 3 seconds and  outward   repeat  5 times	Pull the foot inward  hold for 3 seconds and repeat 5 times

Source : Unit Fisioterapi, Hospital Wanita & Kanak-kanak Sabah
Exercise 2:  Abdominal and thigh strengthening exercise Straight leg-raise

Start position	Lift leg off from bed, hold for 5 seconds and bring it down. Repeat 5 times

Source : Unit Fisioterapi, Hospital Wanita & Kanak-kanak Sabah
Exercise 3 :  Abdominal strengthening exercise Partial sit up

Start position	Lift head off bed, hold for 5 seconds and back. Repeat 5 times

Source : Unit Fisioterapi, Hospital Wanita & Kanak-kanak Sabah
Exercise 4:  Back and buttock muscles strengthening exercise Bridging exercise

Start position	Lift Buttocks off bed and hold for 5 seconds and back.  Repeat 5 times

Source : Unit Fisioterapi, Hospital Wanita & Kanak-kanak Sabah
Exercise 5 :  Pelvic floor exercise Kegel exercise

Start position	Bring the ball forward  Hold for 3 seconds and return. Repeat 5 times	Push the ball backwards. Hold for 3 seconds and return. Repeat 5 times

Source : Unit Fisioterapi, Hospital Wanita & Kanak-kanak Sabah
Exercise 6 :  Pelvic Tilt  exercise Cat and Camel exercise

Start position	Arch your back, Push your spine down. Return to start. Repeat 5 times.	Curve your back, push your spine up .Return to start. Repeat 5 times

Source : Unit Fisioterapi, Hospital Wanita & Kanak-kanak Sabah
Exercise 7. Exercises for breasts     

Source : Unit Fisioterapi, Hospital Wanita & Kanak-kanak Sabah
Wall push up against the wall. 15 – 20 repetitions.  Perform 2 or 3 times a day	Press your palms together while pointing your elbows out to the sides, hold for 3-5 seconds for 10 – 15 times. Perform 2 -3 times a day

References

1. Artal R and O’Toole M. 2003 Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. Br J Sports Med. 37:6-12
2. Jawatankuasa Teknikal Profesyen Fisioterapi. 2013 Buku Garis Panduan Perkhidmatan Fisioterapi Di Klinik Kesihatan. Kementerian Kesihatan Malaysia
3. Mantle J, Haslam J & Barton S. 2004 Physiotherapy in Obstetric and Gynaecology. 2nd ed. Butterworth Heinemann
4. Postnatal exercise – sample workout. 1999. State of Victoria. Reproduced from the Better Health Channel.www.betterhealth.vic.gov.au
5. Unit Fisioterapi. 2009 Senaman Selepas Bersalin. Hospital Wanita & Kanak-Kanak Sabah
6. Women’s Health Physiotherapy Wythenshawe Hospital. 2009 Physiotherapy Post Natal Exercises and Advice. University of South Manchester. Review date: Feb 2011
7. Postnatal Exercise For The First first 6 weeks.   http://www.babycenter.in/a749/ postnatal-exercises-for-the-first-six–weeks#ixzz3kOUANOoG29th August 2015

Source images

1. Google images.com
2. Unit Fisioterapi, Hospital Wanita & Kanak-Kanak Sabah. 2015. Retrieved August 27th 2015.
3. Wikipedia.org. Retrieved August 29th 2015. https://en.wikipedia.org/wiki/pelvicfloor