Promoting Postnatal Exercise

CPDTime.
3m

Published: 25 February 2021

In recent years, little has changed in the way that postnatal exercises are taught and promoted - except, that is, for the current focus on virtual consultations and online classes.

Yet, promoting exercise to aid mental and physical wellbeing post-delivery remains as important as ever.

There’s never been any doubt that postnatal exercises form an essential part of the transition into healthy motherhood. Not only do they help to restore physical health, but they also help to relieve stress, improve sleep and prevent postnatal depression.

Of course, every woman is different, and each will follow their own unique pathway to regain their pre-pregnancy fitness levels. What is constant, however, is the need for targeted support, encouragement and education to help busy mothers regain their stamina and cope with the demands of motherhood.

Going Virtual

postnatal exercise virtual consultation

Virtual consultations and video classes are here to stay. Technology enables care to be delivered more cost-effectively by reducing the risk of infection transmission, freeing up valuable clinical space and bypassing the costs and inconvenience of travel.

For new mothers, saving costs and effort can make all the difference between adhering to an exercise regime or giving up due to lack of support.

A 2018 study by Vincze et al. found that video consultations delivered by midwives and physiotherapists for an 8-week postnatal exercise program resulted in statistically significant improvements in waist circumference, body composition, cardiorespiratory fitness, dietary intake and physical activity.

Pelvic Exercises

Pelvic floor exercises or post-pregnancy exercises should ideally be started within 6 hours of delivery to begin regaining strength in the stretched pelvic muscles as soon as possible (Das 2021).

Yet, as Ewers (2018) discovered, according to recent data, one-third of mothers don’t do pelvic floor exercises despite the reported benefits. In fact, a recent online survey of 1000 women revealed that only 29.2% of women who were either pre or post-delivery intended to practice the exercises.

The Benefits of Early Intervention

The advantages of early pelvic floor muscle training (PFME) to prevent incontinence and prolapse in later life are well-documented.

After childbirth, about one-third of women have urinary incontinence and up to 1 in 10 have faecal incontinence, which is why promoting PFMT is of such importance (Woodley et al. 2020).

The Royal College of Midwives succinctly summarise this with the following recommendations:

  • All women in the antenatal period should be given evidence-based information and advice about pelvic floor muscle exercises
  • All women should be given an opportunity to discuss pelvic health care with a qualified healthcare professional
  • Maternity service providers should develop clear standards and a referral pathway to specialist physiotherapy for women who are at risk of developing problems involving pelvic floor dysfunction.

(RCM 2017)

postnatal exercise pelvic floor muscle training

Postnatal Depression

It’s thought that exercise could be considered as a treatment for women who develop mild to moderate depression during the postnatal period (Daley et al. 2012).

A systematic review and meta-analysis by Daley et al. (2009) suggested that compared to no exercise, mothers who exercised regularly during the postnatal period were able to reduce the symptoms of postnatal depression. However, although the trials were generally of a good methodological standard, their limited number and small size mean that the results may be imprecise and should be treated with caution.

Further complicating the results, many participants were also receiving other treatments, which led Daley et al. (2009) to conclude:

‘If exercise is to be recommended to women with postnatal depression, it should be as an adjunctive treatment, as no evidence was found to support the effectiveness of exercise alone as a replacement for standard treatment.’

Further research with longer periods of follow-up is needed to clarify what types of exercise are most effective.

Saligheh et al. (2017) have also explored the impact of exercise on postnatal depression and like many other researchers, have concluded that the benefits are at best variable. Exercises with the most positive impact were those that also included various support strategies to encourage participation, for example, one-to-one supervision, or group supervision with structured sessions and specific exercise guidelines.

Pram Walking

As part of their extensive research into the effect of exercise on postnatal depression, Daley et al. (2007) explored whether pram walking as a form of exercise could be helpful as an adjunctive treatment. Armstrong and Edwards (2003) also investigated this notion by comparing pre‐test data of physical fitness to post‐test data. The results showed that mothers who were in the exercise group that included pram push walking improved their fitness levels and symptoms of depression significantly more than the control group. These are encouraging results, suggesting that pushing a pram combined with other forms of exercise could be an effective treatment for mothers experiencing postnatal distress.

postnatal exercise pram walking

Promoting Postnatal Exercise

Without a doubt, encouraging gentle postnatal exercise from the early hours post-delivery has significant advantages. For maximum benefit, physical activity levels should initially reflect pre-pregnancy activity, increasing gradually and including strength training.

After the six-to-eight-week postnatal check, more intense activities can slowly resume, building up steadily towards vigorous exercise at three months post-birth and beyond (RCM 2019).

Despite the very obvious health benefits of postnatal exercise, a high percentage of women admit they find postnatal exercises an inconvenience, with as few as 22.6% reporting they only ‘sometimes’ attempt to complete them if they ‘remember or have time’ (Ewers 2018).

Likewise, one in five respondents said they would try an alternative to traditional pelvic floor exercises if it worked or saved them time, with many mothers commenting that they would try to do the exercises but didn’t think they would really work.

With challenges like this, it’s clear that active promotion of postnatal exercise is still a vitally important part of postnatal care that requires the right combination of motivational skills and teaching materials to help mothers enjoy the many benefits that exercise can bring.

Additional Resources


References

Author

Portrait of Anne Watkins
Anne Watkins

Anne is a freelance lecturer and medical writer at Mind Body Ink. She is a former midwife and nurse teacher with over 25 years’ experience working in the fields of healthcare, stress management and medical hypnosis. Her background includes working as a hospital midwife, Critical Care nurse, lecturer in Neonatal Intensive Care, and as a Clinical Nurse Specialist for a company making life support equipment. Anne has also studied many forms of complementary medicine and has extensive experience in the field of clinical hypnosis. She has a special interest in integrating complementary medicine into conventional healthcare settings and is currently an Associate Tutor, lecturing in Health Coaching and Medical Hypnosis at Exeter University in the UK. As a former Midwife, Anne has a natural passion for writing about fertility, pregnancy, birthing and baby care. Her recent publications include The Health Factor, Coach Yourself To Better Health and Positive Thinking For Kids. You can read more about her work at www.MindBodyInk.com. See Educator Profile