The New Mums Post Baby Guide to Pelvic Changes

The majority of vaginal births are relatively straightforward but some mums are challenged by post baby changes in their pelvic floor and abdomen. I’ve listed 9 possible post baby body changes with actions to improve pelvic control and health.

  1. Post baby give the pelvic and abdominal muscles the same consideration shown to sporting or work place injuries. Follow the principles of RICER: Rest, Ice, Compression, Elevation and Rehabilitation to improve healing.
  2. Pelvic floor muscles (PFMs) don’t always automatically start working effectively after vaginal birth. The enormous hyper-distension to PFMs can sometimes ‘knock’ the muscles out of action. Some women lose the ‘automatic’ action of their PFMs, which means the muscles don’t quickly respond and tighten with activity as they did pre-birth.

    The bladder, bowel and uterus need a firm muscular shelf of support during coughing, lifting and exercise. Without a strong, quick PFM lift, intra abdominal pressure stretches internal supports and the pelvic floor opens instead of closing. Recommendations from the International Continence Society are that all women strengthen PFMs post baby to reduce the possibility of future incontinence and pelvic organ prolapse.

    Seek relief of vaginal heaviness, poor bladder /bowel control, pain and abdominal muscle separation by visiting a women’s health physiotherapist.

  3. It’s normal to have a post baby bump due to the enlarged uterus, fluids and stretched abdominal muscles. Some women experience spinal pain as their body suddenly re-adjusts to no longer being pregnant. For centuries many cultures helped new mothers recover post birth by binding the abdomen.

    Wearing compression shorts for 2 to 6 weeks post baby helps to compress swelling, re-position organs, support ‘looser’ pelvic joints and reduce low back pain and support abdominal muscles as they shorten and heal. 

  4. The internal space between the PFMs (levator hiatus) remains wide at 4 months post baby (compared to non pregnant women). With firm PFM tightening this internal space normally closes to support the internal organs and prevent urine or bowel leaks. 

    When poor bladder and bowel control persists along with vaginal wind noises or weaker strength and sensation in PFMs, request a 3D/4D trans-labial ultrasound scan to view possible birth trauma to PFMs.  Endoanal ultrasound reveals any degree of tearing into the anal sphincters

  5. Only return to running when breastfeeding has finished and regular periods are established. Higher levels of circulating estrogens give a strength boost to all muscles, especially PFMs. A colleague recently told me of his client, a new mum, still breastfeeding, who suddenly developed hip pain when running: the cause of her pain was a stress fracture in her femur. Menstrual status has a marked impact on bone density.

    Consider which exercise programs you return to post baby. Boot camp, heavy weights and strenuous exercise are not pelvic friendly. Choose from swimming, walking, low-level impact, bike riding, tai chi and other less challenging activities. Beneficial Exercise during early post baby months focuses on controlling posture, walking, diaphragmatic breathing, local pelvic floor and abdominal muscle strengthening and lifting the pelvic floor with everyday activity.

    A vaginal pessary device supports prolapsed pelvic organs and helps prevent further strain from ongoing physical demands with home activities and lifting boisterous toddlers.

  6. Abdominal muscle separation (diastasis rectus abdominis) is common due to extreme abdominal stretching in pregnancy. A separation of 2.7 cms or more lasting longer than 4 weeks is associated with persistent lower back, pubic symphysis and sacroiliac joint pain and incontinence.

    Pelvic and abdominal muscles may feel weak and ineffective, as they’ve suddenly gone from major distension to a collapsed shorter position. Avoid trunk-curling exercises as this action pulls the abdominal muscle split further apart.

    Reconnect with the tightening, inner lifting action of the PFMs and the connected tightening in the lower abdomen (the deep core abdominal). Restoring this action with regular exercises improves quick tightening, endurance and strength in PFMs and re-builds pelvic and abdominal control. Hold It Mama has a specific post baby ‘Shrink the jelly belly’ exercise program.

  7. Women who birth via caesarean section (CS) often don't realise the importance of doing regular pelvic floor exercises (PFXs). After the birth scar heals it’s just as important to restore pelvic floor and abdominal strength whatever the mode of birth. 

    Caesarean section mums (elective) when compared to vaginal birth (VB) mums have significantly less major PFM damage but higher rates of abdominal muscle separation. They have similar rates of bladder urgency and urge incontinence to VB mums. Those who labour before having a CS show similar rates of prolapse and stress incontinence as VB mums.

  8. Sex can take a little while to feel comfortable again. While your best friend may be delighted that sex feels better post baby, this isn’t the case for all women. Following a surgical birth, tearing, stitches or ongoing pelvic pain, sexual self-confidence can take a dive. Some women take 6 to 12 months before feeling comfortable and confident to resume penetrative sexual activity.

    Only resume intercourse when your perineum, lower abdomen and vagina are pain free. Take your own vaginal tour to discover the location of any sensitive areas prior to resuming penetrative sex. Ask your partner to read a dad’s guide to sex after pregnancy and birth to improve communication about sexuality.

  9. Think twice about genital shaving or waxing. Science Daily reports that ‘Brazilians and other types of fashionable pubic hair removal may boost the risk of a viral infection called Molluscum contagiousum, according to a small study published online in the journal, Sexually Transmitted Infections.’