Six Week Postpartum Checkup

1. Birth History

   Taking a detailed birth history is an integral first step when seeing patients for their six-week postpartum check. It is important to gain an understanding of the pregnancy and birth experience; be it vaginal, planned or unplanned cesarean. Knowing if labour was induced or came on spontaneously, the length of each stage of labour, whether there was any tearing or an episiotomy, how these scars are healing, pain relief that may have been used during labour and if any is still required, what forms of intervention may have been needed and if the patient felt they experienced any trauma, their general recovery and if they have the appropriate support inside and outside of the home. This information is essential to ascertain the individuals physical, emotional and social well-being, allowing you to treat the whole person.

2. General History Taking

   Along with the patients' birth history it is important to be aware of the patients general health status. Some individuals have experienced other hospitalisations, surgeries, medical conditions, musculoskeletal complaints, previous pregnancies and births or take ongoing medication. Knowing and understanding this information allows us to gage how much load their body is currently under, if there are any red flags that contraindicate safely proceeding with treatment and how to appropriately treat and manage their complaint.

3. Assessment

   Assessment begins as soon as we take our patient into the treatment room. A lot of information can be gathered by observing them walk into the room and the position they assume once seated.Once the birth history and medical history has been taken the "official" assessment begins. Starting with the patient standing, we observe their posture, breathing and functional movement. The patient then lies on the bed and we assess their abdominal muscles for any diastasis recti, if applicable we will feel for any tension that may be present around the cesarian scar. We also perform functional tests in this position before going on to assess the pelvic floor. The all important pelvic floor assessment! This involves observing the healing of any tears and episiotomy scars, checking for any signs of prolapse, assessing how the pelvic floor muscles respond to commands such as contracting and coughing, assessing the strength of the pelvic floor muscles and checking if any tension is present.

4. Treatment

   Treatment objectives are based on the patients' history, examination findings and treatment goals. Treatment can incorporate both internal pelvic floor techniques and external treatment techniques integrating all findings to treat the patient as a whole.When treating the pelvic floor we focus on decreasing the load applied to the pelvic floor muscles and any strain patterns that may be present and impacting function. Techniques include internal and external myofascial release to the pelvic floor, other muscles in the body, any scars that are present and joint restrictions.

5. Exercise Prescription

   Exercise prescription is a helpful tool to support patients in reaching their postpartum goals. This often begins with ensuring the patient is able to connect their breath with their pelvic floor. Many people are unaware that our pelvic floor actually rises and falls with concentric and eccentric contractions, as does the diaphragm, on exhalation and inhalation respectively. Occasionally, this movement is not synchronised or may not be present at all so it imperative that this is established first. From here we start including exercises aimed at easing tension or building strength of the pelvic floor in a functional manor and in combination with movement based exercise for the whole body.

6. Lifestyle Advice

   Lifestyle advice is another tool that we use in conjunction with treatment and functional exercise to support patient's working towards their goals. We incorporate lifestyle advice as part of the 6-week postpartum check and future appointments. This may include tips for lifting and carrying their newborn (and other children), pushing the pram, pain management as well as tips around creating healthy bowel habits and strategies to aid in managing other symptoms that may be present like urinary urgency or light bladder leakage. We find that this thorough and holistic approach is most beneficial in achieving positive patient outcomes and helping patients feel supported and empowered during their postpartum journey.

@bump.to.babe.osteo

Everything you need to know about Pilates and Osteopathy for the Pre and Postnatal Period

Why should I participate in specific pre and postnatal pilates?

Prenatal Pilates at Eastern Osteopathy

Your body is doing amazing things to prepare for birth. As you progress through pregnancy, your body undergoes many changes. As osteopaths, we understands the physiological changes your body is going through throughout this period. Mia’s additional pilates training has deepened her understanding of what exercises are safe and relevant during the different trimesters of pregnancy. Exercises can be tailored to you and your individual needs throughout your pregnancy, with the focus of helping to prepare you for your birth and the postnatal period.

Postnatal Pilates at Eastern Osteopathy

Congratulations, you have had your baby and now you are ready to get back to your everyday activities and exercise!

Your body is recovering from the changes it has undergone throughout your pregnancy. Once you have your baby, the goal is to assist in restoring your body’s structure and function. At Eastern Osteo we work with a postpartum exercise guideline, which we tailored to you and your goals. Pilates is great for the postnatal period as we can begin to ease your body back into exercise with low impact activity. Regardless of your goal, if you want to exercise or not, there are many benefits to some postnatal pilates inspired workouts. You are now caring for someone else, this requires strength and function as your baby gets bigger and bigger! 

Mia is currently doing 1:1 consultations, focused on getting back into movement in the postpartum period. This entails a 45 minute consultation where a combination of manual therapy, assessment and implementation of exercises are utilised. This allows for individual time, advice and technique review so that you have the tools to correctly implement these practices at home. 

How does Eastern Osteopathy use Pilates inspired exercises in conjunction with manual therapy?

The beauty of having the combination of osteopathy and pilates is that Mia is able to assist and treat your pain with manual therapy and then prescribe pilates inspired exercises to maintain and improve function. 

Mia and Kathryn work together to formulate the most suitable program for your individual needs. Kathryn treats pelvic floor dysfunction with manual therapy; as we utilise a holistic approach, we know that other structures in the body can contribute to your pelvic floor dysfunction, and Mia works on these through manual therapy. In addition to manual therapy, Mia and Kathryn work together to design movement programs specific to you and your presenting complaint.

Tips for Prolapse During Pregnancy

Have you been diagnosed with a prolapse and are wishing to conceive or are already pregnant?

This can be a scary time. Worried that pregnancy and birth might make your prolapse worse? Trust me this is common concern and a conversation we have with patients regularly. And it is scary and frightening, but it’s important to know that having a prolapse while pregnant is manageable and safe with some guidance, exercises and lifestyle modification. Our tips for managing this time are below.

Connect with your breath and pelvic floor

Spend time observing your breath, feel the subtle lengthening and decent as you breath in & as you breath out notice the pelvic floor engage and lift. Once you have connected with your breath you can add a gentle lift and engagement of your pelvic floor as you breath out. You can do this while in a semi-reclined position, seated, childs pose and standing.

SEE a Pelvic Floor practitioner

If you have a prolapse please make an appointment to see a qualified pelvic floor practitioner (osteopath/physiotherapis) to have your pelvic floor assessed and an individualised pelvic floor rehabilitation program created. This may involve strengthening exercises, breathing strategies and or ways to improve neuromuscular timing and coordination

Manage your constipation

Constipation is commonly experienced during pregnancy and along with straining is a major risk factor for prolapse. Consuming adequate water & fibre along with creating a healthy bowel routine while adapting good pooping posture & not straining is essential for minimising impact of prolapse on the pelvic floor. Oh and don’t forget the squatty potty to help achieve optimal pooping posture and the use of ooo cha to help expel the unwanted waste.

Listen to your body

Take the time to listen to your body; understand that your body, posture and centre of gravity is constantly changing and with this your prolapse symptoms can also change. A easy activity last week can cause a pressure and dragging sensation today. Knowing your body will allow you to alter your movements strategies to minimise impact on prolapse.

Use the Recovery Position

When feeling tired and extra pressure, bulging and dragging sensation in your vagina, taking some time to rest in a recovery position is important. Lying on your back with your legs up the wall or resting on a chair. Placing a pillow under your pelvis encourages your organs to move away from the entrance of your vagina. Then observe the natural rhythm of your breath & gently engaging your pelvic floor with your exhale. If lying on your back is uncomfortable, makes you feel dizzy or nauseous; please stop this exercise.

Exhale with Exertion

As you roll over, sit to stand, lift and other activities that involve some exertion; perform the activity with an exhale. As you prepare to move, exhale and gently blow out. By gently blowing & feeling your core engage & then moving, minimises the force directed to your pelvic floor and pelvic organs.

Look at your Posture

We know postural changes can influence the force and pressure applied to the pelvic floor. We also know pregnancy is a time of ever changing posture. Rather then sinking into these poor postural changes try to stand, sit and lye in alignment with our natural curvature. A quick way to test if your posture is optimal, check in and see if breathing is effortless, then we know our posture and alignment is on point. Having trouble try untucking your butt!!

Stay Active and whole body strengthening

Staying active & strengthening your whole body is great for overall pelvic health. It is important to exercise symptom free and under the guidance of your health care provider and/or within the pregnancy guidelines.

As a bonus regular exercise can help stimulate a bowel movement.

Manage your stress

When looking at our pelvic health we know stress can impact your ability to have a bowel movement and constipation is a risk factor for prolapse. We also know when stressed you will clench your pelvic floor muscles which in turn impacts the ability to contract effectively. Studies tell us when stressed our prolapse symptoms will bother us more. This doesn’t mean the symptoms are worse just that they bother you more causing more stress. Developing good stress management strategies is essential.

Pregnancy and Exercise

Exercise during pregnancy should be done and is safe, in a healthy, uncomplicated pregnancy. In fact, performing the recommended type and amount of physical activity during pregnancy achieves health benefits for mother and baby including reducing risk of pre-eclampsia, pregnancy induced hypertension, a reduction in instrumental delivery and unplanned caesarean section birth, and may help to reduce the severity of lower back and pelvic girdle pain.

According to the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) evidence-based guidelines for physical activity in pregnant women, it is recommended that in a normal pregnancy woman participate in 150-300 minutes of moderate intensity or if previously exercising can continue 75-150 minutes of vigorous intensity exercise per week.
This can be completed over a minimum of three days per week, however, being active every day (ideally 30 minutes per day, less if previously inactive) is encouraged and doing some physical activity is better than none.

Training should be a combination of aerobic (brisk walking, cycling, swimming, dancing, exercise classes) and strength (body weight, light weight or resistance band) exercises and exercise intensity will vary depending how physically active you were or we not pre-pregnancy. Women who were active prior to conceiving can continue with their usual activities for as long as they feel comfortable but are advised to check with a health professional if they would like to continue with vigorous intensity or high impact sports and exercise.

Additionally, some exercises may need to be modified as your pregnancy progresses due to biomechanical changes and pain i.e. after 16 weeks it is best to avoid exercises lying on your back.

Exercise is not recommended in all circumstances. The following are cases in which exercise is not recommended;

• Incompetent cervix

• Ruptured membranes, preterm labour

• Premature labour

• Persistent second or third trimester bleeding

• Placenta previa

• Pre-eclampsia

• Evidence of intrauterine growth restriction

• Multiple gestation (triplets or higher number)

• Poorly controlled Type 1 diabetes, hypertension or thyroid disease

• Other serious cardiovascular, respiratory or systemic disorder
  

Stop and seek advice from a health professional if you experience any of the following while being physically active:

• Chest pain

• Persistent excessive shortness of breath – that does not resolve with rest

• Severe headache

• Persistent dizziness / feeling faint – that does not resolve with rest

• Regular painful uterine contractions

• Vaginal bleeding

• Amniotic fluid loss

• Calf pain, swelling or redness

• Sudden swelling of the ankles, hands or face

• Decreased foetal movement

Still unsure what physical activity you can or cannot be doing during pregnancy speak with your health care provider before starting an exercising program.

*Exercise intensity ratings are based on ratings of perceived exertion on a scale of 1-10 where 1 is not moving and 10 is maximal effort. Activities in the range 3-7 indicate moderate-vigorous intensity and are considered safe and are recommended for health benefits in pregnant women. This can also be judged by the ‘talk test’ in which a conversation can be held during moderate intensity activities but difficult during vigorous activities.

Brown, W.J., Hayman, M, Haakstad, L.A.H., Mielke, G.I. et al. (2020). Evidence-based physical activity guidelines for pregnant women. Report for the Australian Government Department of Health. Canberra: Australian Government Department of Health.

Kate's Tips for Pooping in the Postpartum Period

Now let me tell you something I found out the hard way… NO ONE tells you that having a vaginal birth can feel like the baby is coming out of your bum. Anyone with me??

Postnatally, there are lots of conversations about looking after your vagina; regarding tissue tearing, episiotomy and surgical repairs. Today however, we are doing a 180 and talking about the rectum, and, you guessed it... poop. It certainly makes sense that this area might be tender, and if you have had the privilege of seeing a vaginal birth in person or via photos or video, you can see how the rectum has been pulled and stretched away from its usual position. As unpleasant as this may sound, we do actually need for this to occur, as it helps make room for the little (or in my case - not so little) one, to exit. 

Personally, I had more pain rectally after giving birth than I did vaginally. I actually had no redness, swelling or stitches associated with my magic vagina, but did I have rectal pain? HELL YES! And let me tell you, I was more than a little scared to go poop. However, I knew that prolonging the act was definitely not going to help in the long term. 

So today I'm giving you my top tips for pooping directly after you give birth. 

• This is a biggy.. please don’t delay the poop! It might seem scary, but the longer you wait and the more you suppress the urge to eliminate waste, the more backed up you will get. As the stool backs up, it ends up being stored in the descending colon, and in doing so water is removed from your poop making it harder and harder. This will make it more painful and even harder to pass. If you feel the urge, please be brave and poop. 

• When it's time to go, remember to use the squatty potty. The posture the squatty potty encourages helps to relax the pelvic floor muscle (puborectalis), which straightens your back passage and allows poop to exit with ease. Adding a low tone sound like mooooo, zoooooo or rooooooo can aid in this process by encouraging your abdominal muscles and diaphragm to contract, increasing the pressure around the rectum and stimulating the parasympathetic nervous system.

• Still nervous about doing a poop? Take a small pillow with you, placing it on your lower belly (this is even more important if you’ve had a cesarean section) and adding some pressure. The act of pooping requires tension (intra abdominal pressure IAP) to be created by our diaphragm and abdominal muscles , the pressure from the pillow can help regulate the IAP normally created by our stomach muscles. Plus it takes pressure off your fresh scar. 

• A great way of stimulating the parasympathetic and dampening the sympathetic nervous system is with relaxed diaphragmatic breathing. If you are not sure how to do this, check out this video. When we stimulate our parasympathetic nervous system, it gets our digestive system moving and stimulates our rectum to contract while inhibiting our internal anal sphincter, i.e. the back passage opens. The parasympathetic nervous system is all about rest and digest. This type of breathing will also massage the bowel with the rhythmic motion of your breath. Plus, as a bonus, diaphragmatic breathing will also start building an awareness of your breath and pelvic floor muscles. Did you know that when contracting your pelvic floor muscles you increase blood flow to the area which also aids in healing and recovery?

• As I’m sure you know, things can be a little tender downstairs after a vaginal birth. If you can handle the pain after giving birth, try to avoid medication containing codeine, as it will clog you up even more. There are other alternatives such as panadol for pain relief, and the use of ice to numb the area. Using ice as a cold compress also aids in your recovery by adding compression to your first aid steps. 

• If you are having trouble with passing stool and need help with softening the waste, magnesium oxide can be a great way to achieve this. However, before taking magnesium please consult with your maternity health team. 

• Your first meal after giving birth should be nutrient rich and easy to digest. Why hello Bone broth, this yummy nourishing substance can be a great way to keep you hydrated during the labour, plus it will help to give you loads of energy (trust me when I say you will need it) during the birth, and again once you have your new bubba in your arms. This liquid gold is rich in collagen (did I mention collagen can help repair any tissue damage during the labour), gelatin and lots of minerals which are thought to have many medicinal properties, one of which is strengthening the gut lining and improving our immune system. YAY! This is exactly why people offer to cook chicken soup when we are sick. When I say cook I don't mean reheat from a can. I mean the type of soup our nannas cooked when we were young. Not sure on how to cook a bone broth? Check out Chloe’s blog. You can consume the bone broth on it’s own or use it as a base for your yummy soup.

• Look after your gut MICROBIOME - these are the bugs that live in our gut - with the greatest concentration being in our large bowel, they are very much involved with the health and function of the bowel, and the quality and ease of our poop! Pregnancy and birth interventions can cause lots of disruptions to our microbiome, so it’s important to support and rebalance the microbiome postnatally (in fact it’s super important to optimise it the whole way through pregnancy learn more about that here.

• We need both PRE & PRObiotics to restore & maintain our microbiome - this can get confusing - let me explain; PREbiotics feed the good bugs and PRObiotics are the good bugs. PREbiotics are found food in plant foods (a rich and diverse plant-based diet creates a rich and diverse gut microbiome) and PRObiotics are found in fermented foods and drinks (yoghurt, kefir, kombucha, sauerkraut etc) or supplements can be used. 

Supplemental PRObiotics are amazing to use postnatally for gut health. They help with motility, reducing inflammation, repairing tissue, regulating stool composition (keeping them soft!) etc. BUT (and this is a big but!) not all probiotics are created equal, you need to consider specific strains, mechanism of action (what they do in the body) and also quality of manufacture. We recommend Qiara - it has lots of great research, many of the beneficial mechanisms of action and it’s a quality Australian made product, it’s actually a breastmilk strain (meaning it was originally isolated from healthy human breast milk). As well as having many proven benefits for gut health and the gut microbiome - it also helps breast milk microbiome, breastfeeding outcomes and infant gut, microbiome & immune development. As far as PRObiotics go - it’s one of the best. I wish every mum and baby could have it. 

• When choosing food from a menu in a hospital, or if you have a friend or family member who has organised a food roster (these can be the best!), just remember to be fussy and ask for nutrient rich, organic whole foods that rot and make up the colours of the rainbow. Having a 1kg tray of lasagne delivered to your door, as yummy as it sounds, may not be the best for your digestive system. Chicken soup with a side order of sauerkraut can be an awesome request.

• Most importantly, when eating, take your time to chew, chew, chew your food. Chewing breaks our food down and promotes the production of gastric enzymes. Gastric enzymes are responsible for breaking our food down to an appropriate size for the small intestine to start removing nutrients. The act of chewing, filling our stomach and dumping into the small intestine stimulates a nerve pathway that causes our colon, and it’s natural peristaltic motion, to start. This peristalsis gently propels our stool through the large intestine. Way to go chewing, filling and dumping (pun intended)!

• Water, water, water! Always have a water bottle on hand and take it everywhere. Being hydrated is absolutely essential if you plan to breastfeed. It is vital to be hydrated for the production of your milk. Did you also know that dehydration can be a major cause of constipation? Since you are taking your bottle everywhere, when you have had a poop or a wee, rather than wiping the area with dry toilet paper, try using a soft damp cloth, especially if you have stitches, hemorrhoids or fissures.

• Whether you have, small graze or a minor perineal tear, an epsiotomy or a larger tear involving the external anal sphincter; it’s likely your perineal area ( the space between your vagina and anus) will be tender and need some ice and compression for 24-48hrs. Keep the area dry and clean. When drying after a shower, remember to dab the area dry. 

• Sleep. When you can, get some sleep. Hahaha… I know that this idea is good in theory but quite hard to achieve in practice. However, it is super important that you look after yourself and get sleep when you can. Try to limit screen time - especially at the 2 am feed... as tempting as it is to pick up your phone, DON’T! The blue light can affect your melatonin levels, therefore making it much harder to go back to sleep. 

• Move. This may seem like a hard task, but starting with small walks like checking the mail can be a great way to stimulate your GUT to get moving. 

At Eastern Osteopathy we believe that having good quality poop and optimising your gastrointestinal tract (GIT) health should be part of all new mamas postnatal health plans. Doing so will not just have a positive impact on your git, it will have a positive impact on your immune system, your mental health, the function of your pelvic floor and then there are the health benefits to your new baby. 

Pregnancy and Postpartum during COVID with Bernadette Lack, Midwife and Personal Trainer

As part of our expert zoom series, Liz was joined by Bernadette Lack, a midwife and personal trainer, to discuss all things pregnancy and the postpartum period, and how to navigate these times during COVID.

For more information about Bernadette Lack and pregnancy, visit Bernadette’s website for resources and Bernadette’s program. You can also find more resources on Bernadette’s Instagram page.