Why it’s so important to see a women’s health physiotherapist after you give birth

Why it’s so important to see a women’s health physiotherapist after you give birth

Everybody has seen the adverts….the middle aged women sitting on the couch laughing with their friends before they look away, looking ashamed or worried because they’ve leaked a little bit of wee, only to smile and continue laughing because they’re wearing some kind of incontinence pad that keeps them nice and dry.

The problem with this kind of ad is not the incontinence itself (well, ok that is the problem but stick with me…) the problem is the normalisation of this situation where a grown woman wets herself doing something as mundane as laughing or sneezing or coughing or any other action that can happen a hundred times a day and the problem is fixed with a pad.

One in three women experience incontinence after giving birth[1]. The more babies you have, the more likely you are to experience some level of incontinence. And if you think having a cesarean means you won’t have issues, think again. According to the Continence Foundation of Australia ‘A cesarean birth might reduce the risk of severe bladder control problems from 10% to 5% for a first baby, but after the third cesarean there may be no benefit at all.[2]’ It’s not just mums who can be affected. The problem can extend to women who’ve never had children and men. As one of my gorgeous clients likes to remind people, as a physio, she’s treated nuns before!

The reason for stress incontinence is weakness in the pelvic floor muscles that support the bladder, bowels and uterus. As you can imagine, the weight of a growing baby and uterus coupled with hormones designed to make your bits stretchy can weaken those muscles over the course of your pregnancy and if this weakness isn’t addressed by restrengthening the pelvic floor muscles, stress incontinence can follow or even worse, prolapse where the muscles don’t work to keep internal organs where they belong and they effectively fall out of your vagina or rectum. I’m not joking.

The good news is that in most cases (although not all) stress incontinence can be prevented or fixed by strengthening the pelvic floor, observing healthy toilet habits and easing back into exercise slowly post-natally. Pads are not the only solution to leaking, thank goodness (although it is wonderful that we do have these options when all else fails).

The BEST weapon in your fight to avoid and fix stress incontinence and prevent prolapse is – hands down – your local women’s health physio. These wonderful people are specifically trained to work with the pelvic floor and will arm you with the skills and knowledge you need to address any issues you have.

I just recently went to see my women’s health physio to check out how things were going down there after having my third baby six months ago. I have been lucky in that I’ve never experienced any leakage or pressure in my pelvic floor region and have successfully returned to running and weight training between and after my first two babies. As a post-natal trainer, I’m all too aware of how exercise can exacerbate an existing issue or help to create an issue (think heavy weight training, running, incorrect form, plyometric exercises that put pressure on the pelvic floor causing weakness) so I knew it was important to have it checked even if I wasn’t having any issues. To be honest, I expected that I would get a big tick in the box and I could continue on my way.

What we discovered however, is that some of my pelvic floor muscles weren’t firing the way they were supposed to, most likely from my first labour where my son was vacuumed out, and if I didn’t take any preventative measures (pelvic floor exercises to strengthen and get them firing again), then it was very likely I would end up with an organ prolapse sometime down the track. Given I had planned to return to running in the near future, I would likely have sped up this process by placing additional pressure on the muscles as I pounded the pavement repetitively. At my follow up appointment three weeks later, the physio found that my pelvic floor strength had increased significantly with the targeted exercises she gave me, and they only take about 5 minutes to do each day. I set a reminder in my phone for 10pm and do them as I climb in to bed.

I’ll be honest, the examination can be a little confronting. It requires gloves and lubricant so that should give you a pretty good idea of what’s involved. But I’ve also given birth three times, and after you’ve had a 24-year-old trainee obstetrician poke around down there to learn about the stages of dilation, this is a walk in the park!! According to my physio, up to 70% of people do their pelvic floor exercises wrong, so having the correctly trained person check not only the strength of your muscles, but whether you’re doing your exercises right is truly the best way forward!

So, you may be thinking ‘didn’t my obstetrician check this already at my six-week check up’ and the answer is probably not. In most cases, your doc will check that you’re healing well, you don’t have any infections and that you’re not showing signs of post-natal depression. They’ll ask how bubs is doing and then refer you on to a paediatrician, if they feel it’s warranted. My gorgeous, brilliant doctor did ask if I had any leakage to which I replied in the negative, as at the time it was true, but we didn’t discuss what I would need to do if I did start to exhibit symptoms (to be fair to my OB, he knows what I do for a living, so he could have rightly assumed that I would know what steps to take). Unless someone is actually testing the strength of your pelvic floor by getting you to squeeze their finger internally – yes, internally – then your pelvic floor hasn’t been properly checked!

A 2011 report by Deloitte for the Continence Foundation of Australia projected that by 2020, the Australian Health Care system expenditure on incontinence would be around $420 million.[3] This figure doesn’t include the cost of productivity losses, formal care and aids. What we don’t measure in dollars is the pain, stress and shame that women can suffer when they have stress incontinence or have a prolapse. Preventing those things alone are worth the price of admission to see your local women’s health physio…it really is a very wise investment!

In a perfect world, every woman would have their pelvic floor health checked in tandem with their 6-week post-natal check-up and it would be common practice to have it done every few years, like a pap smear or a tetanus booster but until we get to that point, keep up the flow of information! Any time one of your friends jokes that their pelvic floor isn’t what it used to be since they had babies and they can’t even jump on the trampoline with their kids, tell them to get themselves to a women’s health physio ASAP!

[1] https://www.continence.org.au/pages/pregnancy.html

[2] ibid

[3] Pg V, The economic impact of incontinence in Australia by Deloitte Access Economics https://www.continence.org.au/data/files/Access_economics_report/dae_incontinence_report__19_april_2011.pdf

Preparing for baby’s arrival – what you really need to organise!

Preparing for baby’s arrival – what you really need to organise!

As I enter the final stages of my pregnancy, I am starting to think about all the things I need to do to prepare for the arrival of my third child. My To-Do list is immense, but I also know that I’m the kind of person who works better to a tight deadline so to be completely honest, 8 weeks is just too far away for it to be effective for me! So, while I’m content to keep adding things to my list so I can scramble around (yes, and panic) closer to the time, it has made me think about all the things I feel are important to get done before baby arrives…and I don’t mean getting nappies and clothes sorted or painting the baby’s room a new colour.

Having ridden in this rodeo before, I know that stuff will get done – it may not be perfect but school shirts will get ironed, dinners will be cooked and washing will be hung out to dry …possibly for several days straight before they’re brought back in. And being the third time, I like to think I kind of know what I’m doing (debatable some days) so I feel a lot more relaxed than I did when my oldest was born. However, I also remember acutely how completely and utterly overwhelming it was when I brought my first-born home. It was like starting a new job with no manual and the stakes were kind of high! Everything I thought I knew flew out the window and instead I found myself floundering to get even the basics sorted while I navigated the new waters of motherhood.

So, what are those things I think are important to do before baby arrives to make life that little bit easier? Here are just a few things that are top of my personal list and that may make the transition a bit smoother for you:

Prepare as many frozen meals as you can fit in your freezer

Full disclosure – I LOVE to cook. I have hundreds of recipe books. Every time I buy another one my husband purses his lips and gives me a look that I know translates to “did you really need another Donna Hay book”? Pre-kids, weeknight dinners were always a cut above. Don’t get me wrong, I wasn’t the type to spend hours preparing meals but your basic meat and three-veg didn’t cut if for me. Cooking was a joy so naturally I thought I would have all the time in the world to keep that tradition alive….babies sleep 18 hours a day, right? Plenty of time to fit a Nigella creation in before the next feed, isn’t there? I remember my mum asking me if I wanted her to cook anything before the baby came and instead of gratefully accepting and requesting several of my childhood’s greatest hits….I said no thanks.

For the first few weeks of my oldest son’s life, the lead up to dinner (or any meal, really) consisted of me freaking out because a) I hadn’t been to Woolies in ages so all the vegetables in my fridge were wilted or mouldy; b) I was stressed as I felt like I was putting too much pressure on my hubby to do ‘my jobs’ after he had gone back to work – surely I can pull a meal together, I’m an adult and c) helpless and hopeless, I mean if I couldn’t manage to combine motherhood with something I truly enjoyed like cooking, what did that mean for me? How did it come to this? In my previous professional life, I was a highly competent operator and now I was reduced to calling my husband to pick up takeaway every night? How is that possible?

In the nearly six years since then, I’ve cut myself a bit of slack. It’s ok to eat scrambled eggs on toast for dinner now and then and no-one is expecting gourmet creations when you’ve got a newborn. But if you do love good food, get cooking and freezing ASAP. There’s nothing better than defrosting a bit of homemade lasagne, throwing a quick salad together and sitting down to a nutritious meal that took minutes to prepare. Plus it’s better for you than pizza night after night! And it’s also better than trying to navigate the shops with a newborn that decides to meltdown in aisle 4 because they’re cluster feeding and need the boob every 15 minutes. I speak from experience.

If you don’t want to pre-prepare, then I highly recommend looking into a meal or ingredient delivery service, like Hello Fresh or Youfoodz (there are so many options these days). You want to take the thinking out of it. With pre-cooked meals or a meal service, you don’t have to think about what to eat, check your fridge, write a list, go to the shops when you’re figuring out this mama business. That’s a win for everyone!

Hire a cleaner

I know, that sounds very bourgeois but hear me out. When my first baby arrived, I was clearly delusion about how much time I would have keep up my household duties (refer to above – babies do NOT sleep for 18 hours a day….well, at least it doesn’t feel like it!). My oldest had a tongue tie so feeding was an awful, painful and time-consuming effort that usually had to be followed by chunks of time spent pumping. Throw in baby nurse visits, mothers group meetings and other general survival requirements, and mopping the floor suddenly takes a back seat. Or if you do have the time, invariably you would get half way through the job and bubs would wake up, so a 20-minute job would end up taking 3 hours.

Take it from me, if you have the means, hire a cleaner. It doesn’t need to be a weekly thing or even a full top to bottom spring clean but having someone come in once a fortnight to vacuum your carpet and clean your toilet will quickly become the best thing you’ve ever done for yourself.

Remember too, it doesn’t have to be a permanent arrangement but if you can do it for the first three months, it will save your sanity. Plus, everyone is going to want to come and visit you to meet baby, so it’s worth it if only you don’t have to stress about the state of your bathroom. I know what you’re thinking – ‘that’s not the kind of stuff I would stress about’ – and you shouldn’t….but sometimes those new mum insecurities win out and you stress anyway.

Save up your birthday pennies or ask your parents to chip in as an early Christmas gift. You won’t regret it. Oh, and by the way – if your husband says he’ll do it so you can save the money, DON’T BELIEVE HIM!!!!

Find Friends who are in the same situation as you

I am blessed to live close to (and get on with) both sides of my family but when my oldest was born, I was living in Perth – a 5-hour plane trip from said family. In my innocence (also referred to as BCN – Before Children Nicky), I did not realise how life changing having a new baby would be so it didn’t occur to me to search out people who would understand.

Between the lack of sleep, the hormones, my struggles with breast feeding around the tongue tie and my hubby’s return to work, I felt so lonely and isolated. Yeah, I had wonderful friends over there but none of them were in the same situation – they were either kid-free or had older kids and had gone back to work, so I didn’t feel I could call on them because I didn’t want them to suspect I wasn’t ticking the boxes. What I really needed was my mum and my best friends, but they were in different states. I needed the people who could see me at my very worst – think un-showered, possibly with a pump attached to each breast whilst eating chocolate in a classic stress relief move.

Luckily for me, we moved back to Sydney six weeks after I gave birth (which was an adventure in itself), and shortly after I started meeting up with my mothers group. That for me was a game changer. Sure, all we talked about was our lack of sleep, cracked nipples and dirty nappies but we were all going through the same thing at the same time. They may not be friendships that last forever but they are important in the moment and will help you get through. These mums will ‘get’ you in a way that no other person can in that moment.

Don’t click with your mothers group? Not unheard of so try other options in your local area – libraries often run programs for babies such as ‘RhymeTime’ or you can search for your local mamas FaceBook group to tap in to other mums in your ‘hood. Most importantly, don’t stick around if something feels toxic. If your new mum friend continually tries to tell you that there’s something wrong with your baby because they don’t sleep for 12 hours straight or that you gave up breastfeeding too quickly, shut that down immediately! Life’s too short for that crap!

Get the names of some good health professionals in your contacts

Think lactation consultants (LC), paediatricians, GPs, women’s health physiotherapists and of course, personal trainers. You’ve probably got a few of those names in your contacts already, but if you don’t, now is the time to prepare. Ask your friends and friends of friends for recommendations, especially if they’ve gone through the experience recently. You want to be able to pick up the phone and call someone you feel you can trust when you need it.

While I hope that all women can breastfeed naturally and painlessly from the get-go, sadly that’s not always the case and having the name of an LC can be a god send. You’re going to want to find someone who suits your personality. Personally, I found the ‘breast feed at all costs’ mentality of some of the LCs and midwives I met when I had issues with my oldest son to be detrimental to my mental health, so the right LC (public or private) can be the difference between a healthy feeding relationship with your baby and something else entirely.

Similarly, a GP who you know, and trust is worth its weight in gold. There’s something so comforting about seeing a person you know won’t condescend to you or make you feel like crap just because you’re a first-timer and don’t know all the answers.

As a PT who primarily trains mums, I’m a strong believer that all post- natal women should see a women’s health physio to check their pelvic floor and their abdominal separation even if you feel fine and aren’t having any issues as a WH physio will set you on the best path for the future health of your pelvic floor and core. Don’t be lulled into a false sense of security!! Sometimes problems can present months and even years later so get yourself checked out now to safeguard for your older years.

And finally, if you plan to return to exercise after you get clearance from your obstetrician (usually 6 weeks post-natal for vaginal deliveries and 12 weeks for c-sections), start thinking about how that will look for you. It’s extremely important that your trainer has qualifications in post-natal exercise as things are not as simple as returning to the gym and going straight back to the kind of training you did before you were pregnant. Your body has changed even if it doesn’t look that different! Also, think about how you can make it work with the baby – do you want your baby close to you when you train or are you cool with them going in to a gym creche? Talk to your local post-natally qualified trainer so you know what to expect and where to go once you get the all clear.

Get your partner on board to help out from day one

And by this, I don’t just mean for the first two weeks while his work gives him a token chunk of paid parental leave. I mean with everything – cooking, cleaning and looking after baby – for the months beyond birth and further into the future. Life changes significantly when you add a baby in to the mix.

All too often I hear that since the birth of their baby, partners revert to this weird ‘breadwinner and

breeder’ mentality. The general feeling is that ‘I’m out there working, bringin’ home da’ bacon’ so any of these jobs I used to do beforehand to keep the house and life in general running smoothly now fall in to your domain, ‘k’.  Even people I know who had a pretty solid 50/50 split pre-kids have found that suddenly, the new mum is responsible for 100% of the household duties. Take it from me, this quickly leads to resentment, fighting and fractures in what once was a healthy, happy and stable relationship. I’m not saying that your marriage will collapse, but the feelings it engenders can be awful.

To be clear, I understand and respect that there are some situations where the breadwinner has to take a big step up to keep the family financially stable during a maternity leave period, so I’m not talking about the partner that works from 5am to 11pm, 7 days a week just to put food on the table but to the person who now walks past the wet laundry that needs to be hung out or who will sit in front of the telly when there’s dishes to be stacked.

Sometimes, it’s just a case of communication. Some partners don’t realise they are doing it and only need to be reminded that while you might be home more than you were before, you’ve still got a really important JOB to do so it’s imperative that they still help out at home.

Others do truly believe in that ‘breadwinner and breeder’ mentality – the minute you stop earning money (even if you’re getting some paid maternity leave), the breadwinner abandons any and all household duties leaving you to care not only for your new baby but everything else domestically as well. From personal experience, I can tell you that this is also best resolved by reminding the breadwinner that you are still working, even if it’s not paid and when you (inevitably) get the reply that because they work all day they deserve to be able to come home and relax, then your response should be (in as calm a manner as possible) to a) remind them that you ARE still working, just for little to no pay and that b) they are effectively telling you that their time at home is more valuable than yours so they are entitled to relaxation more than you. I found that by saying straight out “what you are implying is that you and your mental health and relaxation takes priority over mine and that’s not fair”, I got my point across. In my case I wasn’t quite able to maintain the façade of calmness, so I’m pretty sure the neighbours four doors down heard me alternately sobbing and yelling. Not my finest hour to be sure, but the message was received nonetheless!!

It’s also extremely important that your partner takes care of the baby at certain points. Yes, you may be the primary carer, but that shouldn’t mean you have to stay at home all the time. You should be able to go out to dinner or a movie with your friends or to pop out to do the shopping on your own (it might not seem possible in the early days but trust me it gets easier). And remember, it’s not babysitting if it’s their own child!! Let them know before the baby comes that you expect to be able to resume normal activities at some point and you need them to support that – whether it be coming home half an hour earlier to help with bathtime so you can make the 8pm movie or making golf a 9-hole game instead of the full 18 so you can get your toenails painted!!

All in all, having your first baby is the single hardest and most life changing experience most people will ever have. It is in equal parts exhilarating and exhausting, challenging and amazing. The first time you look in to you new baby’s eyes is something you will never forget. It takes time to adjust, no matter how awesome your baby is, so do what you can to make it as easy as possible for you and your partner.

What did you do to make the transition to parenthood smoother?

Comment below

The Importance of Self-Care

The Importance of Self-Care

I know this is a little confronting but it’s only 92 days until summer hits us. That’s right, only 92 days….eeek!! That also means it’s only a little over 15 weeks until Christmas! I’m serious! And with term 3 school holidays just around the corner, it got me thinking about how there never seems to be enough hours in the day, especially when it comes to looking after our own needs.

Our days just seem to get busier, amiright? Between the kids, partners, part-time or full-time work, the shopping, the cooking and the cleaning a mum’s work is never truly done. We also seem to be the only ones doing it! Did you know that the recent 2016 Australian census showed that Aussie women on average do up to 14 hours of unpaid domestic work per week whereas men do less than 5 hours? That hardly seems right, does it – add a couple of kids to your happy home and suddenly, you’re not just caring for their needs but doing the majority of the domestic stuff as well!

It makes sense that in this time of our lives – when we are at our busiest – we should be more vigilant of taking care of ourselves and investing in our mental health and wellbeing. The sad truth is, though, that we don’t. Sometimes it’s just too hard to find the time (with the amount of washing I do each week, I swear there are people living in my house I haven’t met yet) and if you do find the time, it’s not as simple as just walking out the door with your keys and wallet anymore.

But here’s the thing so many mums struggle with – we are so busy focusing on everyone else’s needs we just don’t prioritise ourselves, or worse, we feel like we shouldn’t take that time out (oh, mummy guilt, you insidious creature). I don’t know how these feelings came to be such a common theme for women (I’m certainly not immune), but so many of us truly think that we can’t take the time for ourselves (there’s so much to do! I need to iron! I have to be there for bath time!) because our family’s needs come first. The simple truth is that making that time for yourself is not going to bring your family’s world crashing down around their ears and they will be able to carry on without you for a few hours. You, on the other hand, may not…well, at least your mental health may not.

Let me put it this way. In the safety presentation at the beginning of any flight, you will always be told that if an oxygen mask drops from the ceiling, you need to fit your own mask before helping others, even your children. It makes sense, right? Get yourself sorted so you can EFFECTIVELY help others. There’s no point helping everyone get their mask on if by the time you get to yours, you’re ready to pass out! And that’s the crux of it. If we don’t take time to look after ourselves, then it makes it harder for us to look after others. If you’re exhausted and stressed, it makes looking after your kids that much harder. Your temper is shorter, your attention is split and our bodies and minds become run down. Self-care gives us the opportunity to re-energise ourselves and treat ourselves as worthy and deserving of that care.

One great way to commit to self-care is to join a community, whether it be a book club, a fitness group or a regular scheduled catch up with your friends. This not only provides you with an activity to look forward to and participate in but you will be doing it with a bunch of people who will notice if you’re not quite OK and will listen if you need to talk or require support in other ways.

Other great ideas are taking some time out for yourself with a massage, a movie (kids movies don’t count) or going for a run. Just sitting in the park on your own enjoying the sun with a book is another great option. You don’t have to spend a lot of money, but you do have to spend the time. It goes without saying that looking after your physical health will benefit your mental health which is where BounceBack Fitness comes to the party, but sometimes we also need to just look after ourselves with a good mani/pedi and a trashy mag. So please, make some time for yourself ASAP! Oh, and tell your hubby it’s his turn to cook dinner – there’s half an hour right there 😉

Nic x

What does your self care look like? Comment in the box below

‘Should’ free zone. By Joan Markwell

‘Should’ free zone. By Joan Markwell

Should we stop using should? Yes we should.

What a terrible word. Who would have though such a strange little, seeming harmless word could in fact inflict so much guilt, shame and heartache on mothers everywhere.

  • I should be…
  • We shouldn’t be…
  • He should be sleeping by now…
  • She should be on the bottle by now…
  • He should be better at breastfeeding…
  • I should know how to…
  • At 6 months shouldn’t they be…
  • At 12 months she should…

Good grief, it’s horrible to see the power of this little word reduce intelligent, thinking, responsible, mature women to tears and misery on a daily basis. There is no should. Sure, there is a basic guideline that some midwives, doctors, paediatricians or (insert other “expert here”) have put together for new mums to refer to and ponder in the wee hours of the morning when baby isn’t doing whey he/she “should” be. But really? When did we stop listening to our gut? When did we stop using our own process of deduction and instead immediately google everything to find ‘the’ answer and another ‘should’ to try to live by? Its exhausting to think about, let alone live through.

I really urge you mums – be kind to yourself. Try, really try to rid this awful, insidious little word from your vocabulary and life. There is no should. The notion of should is directly implied from and tied to someone else’s experience or opinion, not yours. By all means, listen to friends, or valued people in your life, but please avoid adopting their should’s into your life. It doesn’t help and it sure as hell won’t make you happy on those big dirty stone days. (You know how it goes – some days are diamonds, others are big dirty great stones).

I get to see these days in my work role and have very mixed feelings about it. First and foremost I feel very privileged and proud that I have provided an environment that women feel they can let it out, be themselves, ask for help and seek some comfort or reassurance from other women. Secondly it rips my heart out as I feel their pain and wish I could do more to help. Thirdly I wish and encourage women on these days to just take a deep breath, ignore the shoulds and do whatever they need to do for themselves to get through that day.

If baby needs to be held, sometimes it helps to just go with it. Forget what you had in mind that you “should” do and just make a cuppa, sit somewhere comfy and get through the next hour, afternoon or evening. If the pram works, just pop bub in and go on an adventure. If baby passes out in the car, pull up under a big shady tree, recline your seat and have a sleep yourself. You would be amazed how much better you feel after a 20-30 minute power nap.

Keep water, a book, nappy change, spare clothes, wipes, food anything your need in the car so whatever arises you are both comfy and happy as can be.

Honestly some of my most refreshing naps were in the car. Aircon in the summer, nice warm sun in the winter, what’s not to love about that? My number two was a shitty day sleeper at home but get her in the car and bam. I had some great little spots that I knew so would just make a beeline there and pass out for a bit myself. I’m sure an expert would tell me I ‘shouldn’t’ have done that but it worked for us. We both got some much-needed shuteye and more importantly Katie got a much better version of mummy afterwards. I am not very patient, rational or calm when sleep deprived.

Whatever you need, work out how to get a dose of it on those stone days. Ask friends, training buddies, your mum, other family, but stay off the net and don’t listen to shoulds.