ADDITIONAL ARTICLE: Exercise in Pregnancy and Post Natal Care

Exercise in Pregnancy and Post Natal Care

Plus One Wellbeing Team

Introduction

Larissa Botherway, Juliet Bartholomew, and Kelly Owens are the PlusOne Wellbeing team based in Auckland’s North Shore. Each of them are mums who understand the unique demands that pregnancy and motherhood place on the body. They are all AUT graduates who work closely with other health professionals to ensure the best outcomes for pregnancy and beyond for their patients.

Why is ante and post natal exercise so important?

As Physiotherapists we know that exercise is medicine. It is encouraging to see recent Canadian guidelines published in 2019 (ref) noted that there was a positive relationship between physical activity and health benefits in pregnancy. It is interesting to note that no upper limit of exercise was established. So more is not more! One of the recommendations was to continue using the “talk test” where Women should be able to maintain a conversation while doing cardiovascular exercise. We recommend that Women exercise throughout their pregnancy and make modifications as needed. We often see Women who have completely changed their exercise regime when discovering they are pregnant and subsequently sustaining injury. There is no one size fits all and screening for risk factors and pelvic floor problems is imperative. This is also true Postpartum, there is a vast array of options out there for Women and unfortunately we see many Women returning to high intensity exercise too quickly. We hope by providing good education and working with trainers and other Physiotherapists that we can assist these Women to return to their desired activities.

What are the common issues you see in mothers post natally?

We see a variety of issues post natally. Most commonly we see Women with concerns about diastasis recti (abdominal separation), pelvic floor issues such as incontinence or sexual dysfunction and pelvic girdle pain. We also see Women who just don’t know where to start, so we are there to provide assessment and to give them appropriate management which enables them return to exercise.

What specific things do you do in your clinic?

As well as treating ante and post natal musculoskeletal conditions we have developed a Post Natal Check. This is a comprehensive assessment where we do a musculoskeletal screen including assessment of diastasis recti, a vaginal exam, assessment of scars and a functional real time ultrasound to look at TVA and Pelvic floor. We find patients find the Ultrasound helpful in terms of biofeedback. There is no set standard of checks for Post-natal women in New Zealand and we often see Mums who have never had anyone focus on their recovery as the attention turns to the baby. Considering 1 in 3 Women who have had a baby experience incontinence, working with these Women in the immediate Post Natal period is helpful. We also have a 6 week Post Natal Rehab class. Due to the current situation with Covid-19 we have developed a digital version of this programme. We are also in the process of developing an assessment for those wishing to return to CrossFit/ F45 or higher intensity exercise. We are working with Kirsten Harris of Evexia Performance to cater for these Women. In France, the government subsidise every post natal Women to have access to Physiotherapy. While that may be a way off in New Zealand we do have a great network of Women’s Health Physiotherapists throughout New Zealand passionate about assisting Women throughout this special time. It is important to remember that Pelvic Floor symptoms and pain although common in pregnancy and post natally, should not be considered normal and Women shouldn’t have to struggle through.