how to look after an episiotomy or tear

How to look after an episiotomy or tear after delivery

How to look after an episiotomy or tear after delivery

Did you have a vaginal delivery with stitches? If you are not sure how to look after an episiotomy or tear I have links to reliable instructions here. Not sure when you can do pelvic floor exericses (and how?). Wondering when you can massage the scar … and how to do it?

Let me guide you through the different things you need to do at each stage.

What are you dealing with?

Many mums have stitches after they deliver their baby. The area of the vulva where the cut or tear will form a scar as it heals is called the perineum. The perineum is thick tissue between the opening of the vagina and the opening of the anus. An area you normally don’t think about.

This picture from St Georges NHS scar tissue management guide shows the different areas where you might have had a line of stitches

diagram to show where episiotomy scars or tears might be

If you are squeamish it is not always good to look! On the other hand it can be helpful to know where your stitches are. You will feel more confident to avoid disturbing them, as well as caring for them to get the best possible healing.

The reason this area bleeds so much is because it has a great blood supply. This means it heals well too. Your stitches are dissolvable and usually gone by a month. However it is common to wait a full “6 weeks” to be sure that the wounds are fully healed. During these first weeks you want to encourage the healing process, and tissue stretchiness. Balancing being careful not to over exert (which will disrupt the scar as it heals), and avoid an infection in the area.

Nature will heal really well, especially with your help

There are 3 stages to think about to look after an episiotomy or tear, with different priorities to consider and different ways to help at each stage:

Early Days (0-6 weeks)

Initial wound healing and formation of a healed scar

Keep the wound clean & prevent infection

  • prevent infection getting into the area
  • quickly recognise if there is an infection and seek treatment
  • manage the bleeding (lochia) without irritating your skin

Your maternity hospital will usually have given you advice and a booklet or resource. If you didn’t get one, Oxford University NHS Hospital Trust has simple advice on how to keep your stitches clean and cared for: https://www.ouh.nhs.uk/patient-guide/leaflets/files/10929Pperineum.pdf

Leeds NHS Trust made this clear video: Physiotherapist, Jenny Watkins

Follow my RESCue process to reduce pain:

  • reduce the discomfort and pain so that you can enjoy being a mum
  • help haemmorrhoids, brusing and swelling to go down
  • use your pelvic floor exercises to promote blood flow and healing
  • keep pressure off your healing bottom
  • ensure you eat well and stay hydrated to have regular bowel movements. Learn how to sit on the toilet properly!
new mums need first aid

REST – ELEVATION – SOOTHE – CUE the pelvic floor muscles. Read the detail here about how to apply ice, sit comfortably, do the gentlest of pelvic floor, promote best healing.

Start Early days exercises to help the scar stretch naturally:

  • introduce Movement to Feel Good
  • prevent your pelvic floor or gluts muscles tightening up in a guarding pattern around the scar
  • encourage the scar to stretch naturally as it heals so that it is comfortable
  • avoid straining and excess pressure on the scar as it heals

This great booklet of specialist physio advice on moving well, emptying your bowels, & very first days exercises is free to download.


explore the Supported Mums YouTube playlist or my Pilates classes on Beam for Early Days exercises which will gently stretch the area, encourage connection to your abdominals & pelvic floor but not over-exert or put pressure on your healing body too early.


Picking up the Pace (6 weeks +)

promote formation of a flexible, comfortable scar.

After 6 weeks the scar should be fully healed, the scab is gone. Now you can look after an episiotomy or tear further by helping the body form flexible, collagen rich scar tissue. This type of tissue will comfortably move with you whatever you want to do! And you will soon be able to forget all about it!

This is when you can start scar massage

  • use scar massage to encourage the formation of a flexible, comfortable, well formed scar. This leaflet from St Georges NHS Trust is a good starting point. For more depth American Physical Therapist Amy Stein adds detail. In the video, below, my colleague, Clare Bourne explains how to massage your scar from 6 weeks.
  • you can use a natural oil like olive, almond or coconut or there are several commercial ones available with blends of essential oils included. Be sure to check for allergies & I would recommend keeping the oil only for this massage of this area.
  • return to sex. See our Getting back your Mojo series
  • seek help if you are not happy with the way you are feeling
  • do pelvic floor exercises with the intention of improving your strength, endurance and co-ordination. This will prevent leaks, support your pelvic organs. Vital preparation before you return to your hobbies and sports around 3 months. See our Pelvic Floor School for ways to progress from the basics. Including how to relax the pelvic floor & stretch it out to prevent pain. Join me for Postnatal Pilates online?

Finding your new normal (12 weeks – 12 years!)

Life and your body are not the same after a baby, and may change again with baby number two or three. What is normal? Perhaps don’t focus on getting “back” to normal as life is a forward journey? Where will your body and your family take you next?

In this phase be sure to sort out any niggly problems

  • check in on your scar 1-2 x month to make sure it is happy and to maintain it’s stretchiness
  • if you didn’t start scar massage earlier definitely give the scar some love and attention now
  • Persistent pain needs assessing further. Definitely seek help from a specialist physiotherapist. If the scar is painful or tugging as you move or during sex. Or you suspect it might be causing a problem like back pain, difficulty working your abdominals or pelvic floor.
  • give your love-life the time and attention it deserves. Check in with these suggestions if sex is painful or feels a bit flat.

If you can’t access a physiotherapist or want to learn more yourself first I highly recommend these books:

Please let me know if this post was helpful. Don’t hesitate to be in touch if you have questions.

how to look after a caesarean scar

How to look after a Caesarean scar

How to look after a Caesarean Scar

Did you have a Caesarean delivery? Wondering how to look after the Caesarean scar? How to massage the caesarean scar?

This post focuses on looking after the Caesarean scar itself. For general advice about how to get comfortable, moving well, when to start abdominal exercises and why you still need to think about your pelvic floor see this other post:

lady doing exercises after a caesarean

Let me guide you through the different things you need to do to look after your Caesarean scar at each stage.

What are you dealing with?

It is easy to take a Caesarean section scar lightly because we can only see the surface of it. Surgery and surgeons are so good at this operation, modern stitches are dissolvable, so that you will likely only see a neat 10-15cm thin line on your skin. This starts raised and red but over a few months settles to eventually be a thin silvery line.

However, underneath the surface several layers of tissues, such as fat & fascia were also cut and stitched. Fortunately, the abdominal muscles themselves are not cut – they can be pushed apart side to side to let the baby through.

Nature will heal really well, especially with your help

There are 3 stages to think about to look after a Caesarean scar with different priorities to consider and different ways for you to help at each stage:

Early Days (0-6 weeks)

Initial wound healing and formation of a healed scar

Keep the wound clean & prevent infection

  • prevent infection getting into the area by keeping the wound clean & dry
  • quickly recognise if there is an infection and seek treatment
  • avoid straining the scar which might cause it to breakdown as it is trying to heal – this is why you need to get lots of help with caring for the baby & housework and stick to the simple exercises, which make you Feel Good but don’t make the abdominal muscles pull on the scar

Your maternity hospital will usually have given you advice and a booklet or resource. If you didn’t get one, this NHS article has simple advice on how to keep your stitches clean and cared for in the first 6 weeks.

Start Early days exercises to help the scar stretch naturally:

  • introduce Movement to Feel Good
  • prevent your body tightening up in a guarding pattern
  • walk daily (start with just 10 mins then build up) to encourage your circulation, improve posture, boost your mood & move naturally
  • encourage the scar to stretch naturally as it heals so that it is comfortable with simple arm & leg movements
  • avoid straining and excess pressure on the belly as the scar heals

This great booklet of specialist physio advice on moving well, emptying your bowels, & very first days exercises is free to download.


explore the Supported Mums 0-6 weeks YouTube playlist or my Pilates classes on Beam for Early Days exercises which will gently stretch the area, encourage connection to your abdominals & pelvic floor but not over-exert or put pressure on your healing body too early.

Picking up the Pace (6 weeks +)

promote formation of a flexible, comfortable scar.

After 6 weeks the scar should be fully healed, the scab is gone. Now you can look after a Caesarean scar further by helping the body form flexible, collagen rich scar tissue. This type of tissue will comfortably move with you whatever you want to do! And you will soon be able to forget all about it!

This is when you can start Caesarean scar massage

  • use scar massage to encourage the formation of a flexible, comfortable, well formed scar. In the video, below, my colleague, Clare Bourne explains how to massage your scar from 6 weeks.
  • you can use a natural oil like olive, almond or coconut or there are several commercial ones available with blends of essential oils included. Be sure to check for allergies & I would recommend keeping the oil only for this massage of this area.

Finding your new normal (12 weeks – 12 years!)

Life and your body are not the same after a baby, and may change again with baby number two or three. What is normal? Perhaps don’t focus on getting “back” to normal as life is a forward journey? Where will your body and your family take you next?

In this phase be sure to sort out any niggly problems

  • check in on your scar 1-2 x month to make sure it is happy and to maintain it’s stretchiness. My colleague Clare Bourne demonstrates in the video below how to do a firmer massage from 12 weeks.
  • if you didn’t start scar massage earlier definitely give the scar some love and attention now

If you can’t access a physiotherapist or want to learn more to help yourself first I highly recommend these books:

Please do let me know if this post is helpful?

POGP booklet Fit for the Future

Essential advice and exercises after delivery

I believe that if your body is in a good place you will cope better with the physical & emotional demands of motherhood.  

Not sure what you should do? Lost your information from the hospital or midwife? Follow the link below to the best sound medical information put together for you by a team of specialist physiotherapists.

Early postnatal exercises have lots of benefits

Even though you are busy with your delicious newborn baby, taking time out to do some early postnatal exercises will help your recovery:   

  • moving your spine & stretching your muscles will help prevent back pain. You will alsosort out niggles before they build up. 
  • Your abdominal muscles need your attention to strengthen and tone. Exercise will give you back your shape and strength to support your back when lifting and carrying your baby
  • Just carrying a baby for 9 months stretches and weakens the pelvic floor muscles underneath.  A vaginal delivery further strains the muscles and you may have had cuts or tears in the muscle too.  Gentle pelvic floor exercises promote blood flow, reduce swelling and get the healing process off to a great start.

FREE INFORMATION BOOKLET

Physiotherapists promote MOVEMENT as soon as possible after delivery. This helps your circulation, stretches out your abdominal wall, regains your posture, engages your pelvic floor and supports your back.

My professional organisation POGP has developed a fabulous information booklet with all the information you need:

POGP booklet Fit for the Future

This free booklet has clear guidance and advice for the early days after your birth.  You can download a free pdf of “Fit for the Future” here.


The booklet includes pictures of rest, changing & feeding positions, getting in & out of bed, and bowel emptying. Specific advice for after a caesarean.  Detailed pelvic floor exercises, also starting and progressing your abdominal exercises.

new mums need first aid

First Aid for a sore bottom -RESCue remedy

Just had your baby? How to do first aid for a sore bottom

The pelvic floor needs the same love, care and attention as any other injury. What first aid should you do in the first hours and first days after delivery? How do you get the best healing and recovery?

There are proven first aid methods to encourage optimum healing  and reduce complications after a soft tissue injury. The same methods work for a new mum’s sore bottom as for a footballer’s sprain.

In sport there is  a snappy acronym to help  remember the routine RICE: Rest-Ice-Compression-Elevation. I have coined my own:

Copy the sports teams with my new mums RESCue remedy:

 REST – ELEVATE – SOOTHE – CUE

R IS FOR REST

Relative Rest.  It’s a sad fact that we don’t live in a culture that respects rest. I know you have a newborn – and possibly other children too, as well as a home to clean and visitors to entertain! However, rest is important. It doesn’t need to mean do nothing. However it does mean watching out for signs that you have been literally ‘on your feet’ for too long. This causes blood to pool and congest in the perineum.

What are the warning signs?

  • swelling and puffiness in the perineal area
  • being achy & sore underneath
  • feeling numb
  • being bizzarely irritable

You likely won’t be sore enough to realise why you feel out of sorts and grumpy. But you will find yourself fidgeting and wishing everyone would go home! It’s your body telling you to sit down (or even better lie down) to take the pressure off.

So…..that’s what you NEED TO DO…. and while you do……

E Is FOR ELEVATION

Elevate  Ideally get your bottom higher than your heart so the swelling will be drained back into your lymph system.  Just 10 minutes with the weight off will make you feel like a new person. You don’t have to be unproductive(!):

  • have a luke warm bath (hygiene etc!)
  • lie on your side to cuddle or feed the baby
  • snuggle up to watch telly or read with your toddler
  • lie on your back on the sofa, pillow under your bottom & phone a friend
  • have a power nap to help you cope better with tonight

S IS FOR SOOTHE

Soothe  Cold usually feels wonderful against hot, bruised tissues, and then the cold makes blood flow to the area increase. You will see your skin go pink as the blood vessels dilate. With lovely open blood vessels you can then help drain the swelling by pulsing the pelvic floor muscles. This will push the congested fluids back into your blood stream to be carried away.

How to cool your sore bits? Most purchased cold/gel packs can go directly on your body but if you make a DIY ice pack wrap it in a damp cloth to prevent the pack sticking to your skin. Apply to the sore area for just 5 minutes. You only need the cold for long enough to bring a nice rush of blood flow to the area. This opens the blood vessels up wide to help take the swelling away.

Just cooling will feel nice … and then even better – help the swelling material move back into the blood stream by moving the affected tissues …

CUEYOUR PELVIC FLOOR

PIcture of POGP booklet Fit for the Future with good advice for new mums

Download this free booklet  “Fit for the Future” for clear instructions on pelvic floor exercises, comfortable positions, & early days exercises.

POGP booklet

Cue the pelvic floor.  In the early days of healing don’t be overwhelmed by the idea of having to do hundreds of pelvic floor exercises.  ‘Training’ your pelvic floor comes later. In these first few weeks the priority is MOVEMENT and CONNECTION. Aim to move the muscles to get the swelling down, to make you feel comfortable and to remind the muscles how to work.

Who’s looking after the Chicken?

Mama Chickens, you can’t love & care for your eggs if you are sore and uncomfortable. Use this First Aid for a sore bottom process regularly. Especially in the early days – to help you love and nurse your bottom back to health quickly.

Share the love & most importantly The knowledge. Please let your mum friends know what to do to feel more comfortable.

New Mum’s RESCue Remedy  Rest – Elevate – Soothe – Cue

www.supportedmums.com/firstaid
exercises for the early days

Postnatal exercises for the early days

  • Are you overwhelmed by which postnatal pilates exercises are best for you and when you should start them?
  • Would you like to get going but not sure what you can do safely in the first few weeks?
  • Want to tone your abdominals without creating a pot-belly or putting too much pressure on your pelvic floor?
  • Are you looking for guidance about when to progress on to more challenging exercises?

I have developed a complete sequence of progressing postnatal Pilates classes for you to do at home. They are hosted on BEAM, an online platform specialising in providing friendly on demand and live exercise to mums.

Click through to BEAMfeelgood.com and use my affiliate code BEAM-WITH-SUPPORTED-MUMS for 30 days free Gold Membership. This gives you full access to my on-demand and LIVE classes as well as others on the site such as HIIT, Babysleek Barre and yoga.

Many mums are worried about exercising after their delivery. These exercises are for the first stage of your postnatal recovery. That tricky time from after delivery  to 6 weeks – full of myths & scare stories! Specialist physiotherapists like myself can guide you at this stage.

 Follow me through a sequence of  gentle but effective Pilates movements. The exercises safely mimic everyday activities like walking , climbing stairs & stretching. But I add clear cues about how to use your abdominal & pelvic floor muscles correctly at the same time. You will quickly feel stronger, more supported and comfortable again.

If you had a caesarean delivery I have made a special video for you to follow. Read  more in this post.

If you have exercised through your pregnancy you will LOVE to be using your body safely and effectively again.  If you are new to exercise, welcome to a wonderful fitness journey!

Can you help other mums?

Please help us let other mums know about our safe, pelvic floor friendly exercises & resources.  Many mums are worried and nervous about exercising. We want Supported Mums & BEAM to be friendly, safe places to get sound information and support on your postnatal journey. Please write a review at BEAM, and share the videos with a friend!

10 tips to make the first postnatal poos more comfortable

10 Tips to make those first postnatal poos more comfortable

When you are feeling sore after giving birth, the first wees really sting and it is hard to even contemplate how you are going to manage to open your bowels without pain. Postnatal poos need a bit of encouragment.

Here are some tried and tested simple tips to help you have a more comfortable time.

TIP #1   PATTERN

Bowels love a routine and you can train a “bowel habit”.   Try to establish a ritual that your body can get used to and lets you empty your bowel regularly before you become constipated. 

In the near future you will be so much happier if you can relax in the knowledge that you will have had a poo in the privacy of your own home before you have the earliest visitors or want to get out for the day. 

It is very rare to need to open your bowels at night.  But as we get up gravity gets the gut started with some movement (peristalsis) as does movement. Best of all though is the gastro-colic reflex – which means that the sight, smell or taste of food gets the gut going and the bowels moving. 

So have a drink as soon as you can (hot water with lemon used to be served on gynaecology wards) and try to have a small breakfast even if you don’t feel like it.  Clean your teeth and as you clean your teeth start thinking to yourself…next I am going to……….…    

TIP #2  BE PREPARED

Listen out for the alert signal that there is a stool ready to come out.  You absolutely don’t want to miss this.

  The bladder alerts you when it is being stretched so that you can’t overfill it  – but not the bowel – it can get very full and distended without us feeling a thing.  The signal you are looking for is the feeling of pressure and irritation low down on the back passage (the anal sphincter).  This is the stool pushing against the nerve endings at the anal sphincter opening.  You could be a bit numb straight after delivery, and certainly after an epidural, so you may have to really look out for this feeling.

You could be half-way through your breakfast or middle of changing a nappy……if you possibly can, stop what you are doing and get yourself off to the loo.  Even mid-nappy change – just take the baby with  you – they can lie on the changing mat outside the door and get some bottom air!

Don’t put this feeling off.  It is the sign that the body is ready to go and the best poos are the ones the body does naturally.  If you put it off (I’ll just change a nappy…. I’ll just phone my mother……..) you accidentally squeeze it back up inside you where you can’t feel it and then it sits there getting drier and drier making you constipated.

TIP # 3   PRIVACY

Having your bowels open is an intensely private activity.  Make sure that you feel safe and relaxed.  If you are in hospital this might be walking a bit further to find a more tucked away toilet where you don’t feel you will be rushed.  At home, if there are people about ask them to watch the baby (so you can relax about that), excuse yourself,  take yourself off upstairs or as far away as possible, close the door properly.  If you are on your own at home and will worry about the baby – take them with you – leave them on the floor outside with the door ajar.   Ask a toddler to read the baby a story.

TIP # 4   POSITION

They have actually done lots of research about the best way to sit on a toilet.  Yes really.  In Australia.

Nature did not intend us to sit lady like on a ceramic toilet.  We are supposed to squat down behind a tree.  

The key thing is knees higher than your hips.  This un-kinks the bowel and relaxes the pelvic floor muscles.

There are super pictures and descriptions in the booklet “Improving your Bowel Function” which is free to download from my professional organisation www.pogp.csp.org.uk

  • Sit with your feet up on a toddler step or box
  • Bottom well back on the seat
  • Rest your elbows on your knees
  • Untuck your tail bone keeping your back relatively straight
  • Let all your body muscles relax, especially your pelvic floor and abdominals

TIP #5  DON’T THINK ABOUT IT…..AND BE PATIENT.

Emptying the bowel is a natural thing that the body does best on automatic pilot.  It is not something that ‘we’ do.  Like sneezing.  The best ones come from nowhere.  And just like a juicy sneeze that you can feel coming – if you think about it too hard (and especially if you say “I think I am going to sneeze”) – it will disappear!

An age old trick – read a book/magazine/back of a shampoo bottle….anything to distract your corticol (thinking) brain and let your automatic brain do it’s own thing.  Give your body some time.  You are waiting for something solid to move out – it doesn’t just fall out like liquid.  Your body needs to accept that it is a quiet, private moment.

TIP #6  DON’T PUSH……PANT

A traditional ‘push’ involves a big breath, closes your mouth, hooks in your abdominal muscles and then bares down.  This action draws the pelvic floor muscles UP and closes the hole that we want the stool to travel through.  Exactly the opposite to what you want.

Remember ‘panting’ in antenatal classes?  To let the baby’s head birth gently without getting in the way with our own muscles.  Use exactly the same type of breath as you feel the stool coming, soft and gentle, little sighs and slow out breaths.  Nurse it along.

TIP #7  SUPPORT YOUR PERINEUM AND PELVIC FLOOR

The downward pressure of the poo passing through the rectum and bowel opening is going to stretch the perineum which will be tender, sore and healing from your delivery. 

Take a pad of toilet tissue and press it over the whole of your perineum, just leaving the small anal sphincter free.  Press upwards to support your soft bits as the poo is coming down.  This will also direct the poo backwards to come out the anal passage easily,  rather than the pressure coming forward into the vagina area. (Lots of people carry on doing this for ever because it is so helpful). See the picture above and more detail in the booklet “Improving Bowel Function” available to download free from www.pogp.csp.org.uk

TIP#8  PAUSE

Now relax, sit back and just wait a good minute before you dash off.  There could be a bit more.  Sometimes there is a pocket of wind which needs to move through and then there can be a ‘second wave’ of stool that could come out.  Again you might not even be able to tell it is there until you have a sudden new urge.  If you don’t wait for this bit and it gets left behind it can act as a ‘bung’ and become windy or uncomfortable later.  Remember to do this for a few weeks and you will get to know your body better and how it is likely to behave.

TIP #9 PROTECT YOUR SKIN

Treat your own bottom just like you do your baby’s.  Wipe gently from front to back.  Don’t scrub at your skin with dry tissue.  Dampen some cotton wool or use a non-alcoholic wet wipe.  Wait for your skin to dry and then apply a baby-bottom cream for you too.  This helps your skin heal and acts as a thin barrier from rubbing against your underwear.

TIP #10   YOU MIGHT NEED TO GO AGAIN…..

You body can be all over the place for several weeks after a delivery.  All the hormones, broken routines for your eating, sleeping and exercise play havoc.  Your pelvic floor muscles are stretched and weakened so you will feel more vulnerable and less certain of your holding powers.

Once you start applying the tips above, and especially once you start really listening out for the signals to go to the toilet, you can be surprised to find that you need more than one poo in a day.  This is perfectly ok.  Often each time  you eat a big meal you then need a poo.  Traditionally most people go after breakfast – but you may need an after lunch one too!   It is that great mechanism the gastro-colic reflex again, triggering  the gut to work after eating.  Make the most of that and keep alert for opportunities.  It is much more comfortable to poo when the poo is just right and wants to come out naturally.

OR YOU MIGHT NOT……

However, guts can also go into shut down after delivery, leaving you feeling constipated. If you suspect at all that you are constipated ask the midwives for a softener or laxative.  The right kind of stool is firm but soft with a beginning and an end.  Too runny and you will feel that you can’t hold it in or will have an accident, but too hard and it is sore and uncomfortable to pass through the soft delicate opening.  Make sure you are are you drinking enough

How are you finding coping with your bowels after having your baby?  If you are feeling up to sharing with other mothers, on this very personal topic,  we would love to hear from you.  

the best position to sit to have a poo
lady doing exercises after a caesarean

Can I do exercises after a Caesarean?

Many women are worried about doing any exercises after a Caesarean section. But then they find themselves becoming very stiff, hunched over and uncomfortable.

You can do exercises after a Caesarean! Specialist physiotherapists like myself can guide you which ones to choose.

Physiotherapists promote MOVEMENT as soon as possible after a Caesarean. It helps your circulation, stretches out your abdominal wall, regains your posture, engages your pelvic floor and supports your back.

POGP booklet Fit for the Future

There is an excellent booklet, “Fit for the Future”, published by the POGP, my professional physiotherapy network, full of clear guidance and advice for the early days after your birth, with a special section for after Caesarean.  You can download a free pdf of “Fit for the Future” here.


Caesarean to 6 weeks postnatal exercise video

I have made a video of safe & effective exercises suitable for mums after a Caesarean Section. It is hosted by online platform BEAM

These exercises are for the first stage of your post-op recovery. From coming home from hospital to your 6 week check up.  You can follow me through a sequence of  gentle but effective Pilates movements.  These mimic daily activities you are already doing like walking around, climbing stairs, stretching. I will add lots of cues to show you how to use your abdominal & pelvic floor muscles correctly. You will quickly feel more supported and comfortable.

Click through to BEAMfeelgood.com and use my affiliate code BEAM-WITH-SUPPORTED-MUMS for 30 days free Gold Membership. This gives you full access to my on-demand and LIVE classes.

BEFORE you follow the video  >>>>>>

A caesarean section is a surgical procedure and the post-op period needs to be approached with sensible caution. Before you start the video take a moment to ask yourself the following 3 questions:

  1. Why did you need a Caesarean section?
  2. Was the Caesarean operation straightforward, and have you had any post-op complications?
  3. Do you have any other medical issues?

30% of women deliver routinely by Caesarean section. There are many reasons such as breech presentation, prolonged second stage or foetal distress. Recovery is usually straightforward & this exercise programme will be lovely for you.

 However if you needed a Caesarean section for an unusually complicated reason? Or you could write a small essay in answer to No’s 2 or 3 (!) this video might not be suitable. You may be better served by a 1:1 personal assessment of your situation and needs, rather than an online video.  Do see the page about how to find a local women’s health physiotherapist.

Straight forward recovery?

 If after pondering these questions, you feel that you are  progressing as well as expected after C-section, please come and join in! Remember that MOVEMENT is good for you! Exercise will help you feel more flexible, stronger and in tune with your body.

  • Take a little time each day to focus on some proper exercise for you.
  • Do read the special guidance in “Fit for the Future” (download the free booklet here)
  • Wait to start the “Caesarean to 6 week” sequence until you return home from hospital as the midwives will have checked that your wound is ready for you to move about freely.  

At any time you have any concerns at all about your caesarean scar oozing or bleeding, or feeling anything but mildly sore as you exercise or after, then it is very important that you stop straight away and ask your GP or midwife for advice before you continue.

Women recover at different rates from a caesarean section.  It is ok to just try 2 or 3 of the exercises at first. Then each couple of days add another one until you feel you enjoy doing the whole sequence. 

CAN YOU HELP OTHER MUMS?

Please help us let other mums know about our safe, pelvic floor friendly exercises & resources.  

Many mums are worried and nervous about exercising after a Caesarean. We want Supported Mums & BEAM to be friendly, safe places to get sound information and support on your postnatal journey. 

Please write a review at BEAM, and share the videos with a friend!

Best way to start abs exercises – lie on your side!

Are you starting out on your post-baby journey – the place where you are not sure you have necessarily even got any abdominal muscles left? Or did you find them again but now you are having one of those days where you feel heavy and bloated and like you can’t hold them in? In this post you can discover the best way to start tummy exercises.

Standing up is the hardest place to hold your tummy in

When you have just had your baby, standing up is the hardest place to connect to your lower abdominals. You will look down and see them sagging out in front of you. This is because gravity is relentlessly pulling you both down and out. Now there is no baby filling the internal space the skin and stretched muscles droop down. It is such a strong force that when you try to pull your tummy in it is easy to accidentally hold your breath and “hitch” your muscles up rather than what you really want which is to pull the lower belly in to make it look and feel flatter.

When the tummy muscles are strong enough to stay flatter they will also be strong enough to support your back and your pelvis as you do all the lifting and carrying that motherhood requires. Happy body – happy Mummy!

Best way to start tummy exercises..

My magic tip for you? The best way to start tummy exercises – Lie on your side! Nowhere fancy – roll on your side in bed, or the sofa will do.

Lying on your side is a magic position for working out where on earth your lower belly is

Notice how when you lie on your side you can SEE your belly and you can TOUCH it. Both these things help your brain to focus on where to send the exercise messages.

Feel your tummy with your hand

Let your tummy really really sag out against your own hand. Have your hand quite low, below the belly button. Not under your ribs (those are your “upper” abs). Do your worst. Only you are looking. It will be very stretched – it just did the equally magic trick of carrying a baby to full size. This is a joyous thing, don’t be too hard on what it looks like now.

Notice how your breathing and abdominals connect

Become aware of yourself breathing. Your lungs filling up and emptying air. Notice your abdominals do a very similar thing. It is weird when you notice that as you breathe in your abdominal wall will swell up, then as you breathe out it shrinks in a bit. Make this happen on purpose. First take a breath in and let the belly swell up as much as it can. Then as you breathe out (as if blowing out a candle) you will find the belly muscles want to draw in. Help them along with your brain power and with your inside muscles. These are the abdominals below the belly button which wrap around you like a wide belt.

The abdominals move similar to the lungs. And the pelvic floor moves similar to the abdominals! They are all connected! We have lots of videos to help you understand this – have a look in the Pelvic Floor School.

in this video I use that colourful toy to show how the breathing, abdominals and pelvic floor work and how to co-ordinate your breathing to make them work even better

Think M&S knickers!

Think of trying to shrink wrap ourself a size smaller – or of putting on an excellet pair of M&S tummy support pants.

Then HOLD your shrunk position and BREATHE. If you can’t breathe you are pulled in too tight. Just breathe in and out a few times, just normal everyday breaths (great video of how to do the breathing here). After a minute or so you may begin to even wonder if you are doing anything at all? – but you are – you can prove it to yourself by letting go…..watch how the tummy suddenly reappears in front of you!

Now try same trick sitting up

Practice this focused drawing in sequence for a few minutes in side-lying. Then try it sitting in a chair – again hand on your lower belly (like where a seat belt goes over your lap). It will be trickier here not to hitch up the upper abs again.

Once you have repeated it a few times in these less gravity-demanding positions it should be easier to find them when standing up. If it doesn’t work standing up yet – don’t even worry. Rather use any opportunity to be sitting or lying down.

The party trick to practice practice practice…

  • If you are adept at feeding on your side, this is the ideal time to get two jobs done at the same time. Or after a seated feed snuggle up on the sofa for a cuddle on your side. Take an extra 2 minutes to connect to your belly.
  • Lie on your side to watch TV or make a phone call?
  • Sitting opportunties? Again – feeding! it comes around over and over. And anytime you are the passenger in the car! Nothing else to do and the seat belt is the perfect position to pull your belly away from and drop it back against. See how many lamp-posts you could hold in for?

It will make a difference

In short – don’t be disheartened by what your belly looks like and/or fails to do when you are standing up at the moment. Put your efforts into re-finding the belly muscles. The best way to start tummy exercises is lying on your side but quickly moving on to sitting. Then very soon you will be surprised to find yourself naturally holding them in standing too.

Do let me know in the comments below if this advice was useful? Do you have any questions?

bladder leaks when running

Bladder leaks when running? 6 discreet ways to keep dry and avoid a VPL

What do you do if you worry about bladder leaks when running? Or at the gym, your exercise class, or playing with your children ?? Mums I meet in clinic tell me that they are avoiding events that require them to look “sporty”.  They worry about a VPL if they wear normal figure hugging gym kit.  They don’t want to stand out in a baggy tracksuit trying to hide a pair of substantive knickers with a pad.  Heaven forbid a party or wedding?

I’m an experienced women’s physio so I know pads aren’t (and don’t need to be) the solution but they could be a vital part of your journey out of the Miserable Place.⁠

Tips to manage bladder leaks when running or active:

full disclosure: this article contains some affiliate links marked*. As an amazon associate I earn from qualifying purchases. If you make a purchase by clicking through from an affiliate link I receive a small commission  at no further cost to you. Thank you, this helps to support this blog.

#1.  Use a pad designed for bladder leakage not menstruation

Sanitary pads and incontinence pads are not made of the same thing.  

The products designed to be used for menstruation are great for that purpose but do not to cope well with liquid.  As they are predominantly cottonwool based, if they get wet, they just go soggy and mis-shapen. If you are moving about they can get scrunched up, rub and leave your skin in contact with urine causing chafing and soreness.

The right pads for the task are worth the little bit of extra cost.   With the advent of new technology you will be amazed how slim a proper bladder leakage pad can be to hold a large amount of liquid. They also use fabrics that can wick fluid away from the surface. This keeps damp away from your skin and reduces your worries about odour.

what to look for in the shops
Some of the main UK brands are Tena, Always, Poise  and Boots Staydry range. All will send you free samples from their websites.  Unfortunately, the organic brands (Natracare and Cottons) don’t have a specific incontinence product (yet).

 The products are usually in the same ‘feminine hygiene’ aisle (or website section of an online store) but separated into one column of shelves for products for periods and one for bladder leakage.

The most common indicator is a row of variously filled ‘drip’ or circle symbols to indicate the level of leakage you wish to contain.

In general, pads for ‘lighter’ bladder leakage look and feel like pantyliners and come in boxes to keep them flat and compact.   This makes a good starting point if you are looking for something to keep you confident and safe against a small leak. 

but if you need more than a light pad

If you suffer with more severe leakage and could potentially empty half your bladder, or would risk getting wet clothes, then look at the pads in bags which will be more absorbent.  However, if you are getting that wet when you play sport your priority should be to solve the bladder problem further.  Talk to your physio about what they recommend.

#2   MODERN waterproof knickers

Forget dated images of plastic pants, which rustle and sweat. The modern waterproof knicker is a far more sophisticated item!

Discreet panel to protect from bladder leaks when you run

Pretty Clever Pants

from stressnomore.co.uk * (use SUPPORTEDMUMS at checkout for a 15% discount)    or * amazon.co.uk

Annabel Croft, the tennis player and TV presenter Carole Smillie (Strictly 2013!) invented these knickers. She originally thought of the concept for her teenage daughters coping with their periods. Now they are marketed for periods, postnatal and pelvic floor. 

They look exactly like the classic cotton “girls pants” we’ve all worn in our day. Complete with little middle bow! But with a discreet waterproof panel back and front, which just feels like thicker cotton and importantly doesn’t rustle. They are designed to be worn with a pad but should give you the confidence to keep a pad thinner and lighter or to reduce your anxiety that your pad might overfill.

Available in a selection of colours including nude, spots, grey marl and black lace.

#3  Knickers with inbuilt protection

We are so lucky to be in the era of textile research and design and I am delighted to see this being applied to underwear. 

Good for the environment.  Great if you are usually fine but like to know you have back up.  Possibly more discreet if you need a thicker pad than a liner. 

Disadvantage – once they are wet you need to change the whole knicker.  However, ideal for things like the gym – if you get bladder leaks when running on the treadmill or other higher impact classes. Strip off in the changing room and no worry to dispose of a pad. 

Note: a couple of clients who have tried this option swear they will never wear pads again, certain that the pad itself  was irritating their vulva and making their incontinence worse.

black knickers absorbent for incontinence

Pro TechDry panties and maxie panties  

  www.stressnomore.co.uk    * use SUPPORTEDMUMS at checkout for a 15% discount

The gusset in these  ProTech knickers is hardly thicker than your normal good robust cotton “pants” but is made of 3 layers, an absorbent fibre (holding up to 40ml = 2+ tablespoons), an odour retention layer and wick away surface.  Like some of the best quality pads but fixed in place with sealed seams.

SPEAX (previously Icon Undies)

shethinx.com

These are made by the same manufacturers as the Thinx range of period pants.  A forward thinking company with their open-ness about the need for products to empower women to be active.  And addressing sustainability and waste. They have a rather quirky style of presentation and some bold adverts. 

Five different styles: from Hip Hugger, through classic bikini to thong.  Varying prices depending on style £16 – £24 .  They sent through some samples lately for me to show in clinic.  The colours are fun: deep orange, blue, nude, grey and black.  They are made from a silky rather than cotton fabric, much more like an ordinary fashion knicker.

NB: they  are  hand wash only which you might miss in the instructions (and then be very cross about!).

#4   A subtle cover-up with skorts and skirts

picture of a skort to hide pads if you get bladder leaks when running

It started with school uniform but now we can all wear skorts!  Perfect for just hiding a good pair of  pants with a pad and getting on with whatever you wanted to do. 

£20-£80. Offered by brands Decathalon, Salomon, Reebok and many others.

prettyfit.co.uk are stockists of the US brand runningskirts with a limited range but fun unusual prints £62.

#5   Add extra support to your core from the outside

If your bladder leaks when you run EVB shorts give extra support to your abdominals and pelvic floor

EVB Sports

EVB Sports range of shorts, leggings and capris

www.evbsport.com  *  £60-£80

Have a look at these if you feel just generally ‘unsupported’ at the moment. 

Maybe not so much worried about leaks?  More that your entire lower half moves about too much? Or that exercise is straining and fatiguing your pelvic floor and core muscles. 

EVB Company founder, Yvonne Brady tells her story of returning to running after her third baby and struggling with muscle strength.  Women’s health physiotherapists like myself are recommending these as an ‘extra’ layer. To create more lift and support for the pelvis, abdominals and pelvic floor.

Most of my clients have gone for the shorts style, giving the option of wearing them underneath any of their other leggings.

# 6   Add extra support to your bladder from the inside

The options have recently expanded for devices that aim to give support to your bladder from inside the vagina.   Often called pessaries. The devices/brands you may see advertised include Contam, Contiform (available on prescription) and Uresta.  The devices increase in price, partly reflecting the number of times that they can be used – from single week use only to monthly to reuseable for a year.

These work particularly well where you or your physiotherapist feel that the bladder has dropped only a little bit (prolapse of the anterior wall/cystocele).   Yet everything else inside (particularly the uterus) is still well supported. You both feel you have created a good layer of muscles through exercise but could do with a bit more support when you are trying to be more active?

This market has recently expanded. I have written a separate post explaining how these products work, the differences between them & where to get them from.  :  Bladder Support Devices to reduce stress urinary incontinence: how do they work?

water lily to illustrate bladder support devices
For more detail, pictures & videos see this in-depth post

Before you go…a promise?

……that you will not use these ideas to make you complacent about a leakage problem.  Nor as an excuse to avoid the issue of your bladder for another 3 months!

Incontinence might be “common” (45% of women report bladder leakage at 3 months after birth, even 10% of those after Caesarean) …. but it is never “normal”. 

Incontinence  is a sign of pelvic floor (or bladder) dysfunction. Something that needs addressing. And that can be greatly improved or completely resolved with the right exercise and help.

Incontinence is also a sign of lack of pelvic floor support.  You may need to consider how pelvic floor friendly your sport is (ummm….trampolining….)??   Or you may need to modify activities to protect yourself from risk of pelvic organ prolapse. 

pelvic floor for runners
and choose your sport wisely…or make modifications…

To summarise! Do use these stop-gap options to get comfy, happier and more active NOW.  But please, please commit to doing something about your pelvic floor muscles.  Book an appointment with you GP to get a referral to a Specialist Physiotherapist for full assessment,  support and advice.  You can be much better than you are right now. 

What are your tried and tested tips?  Please share your experiences with other mums in our comments section below.  Your story will inspire others.

#beyouroptiMUM  #pantsnotpads #NoMoreMiserableMums

woman with a cup of tea for self care

Why self-care is a revolutionary act: advice from a life coach

Guest post by:  Lavinia Brown aka BoboMama

Cambridge is a wonderfully small place.   I am delighted to host a post specially written for you by Lavina Brown, a local Life Coach.  Lavinia came to my antenatal pilates class a few years ago.  Now, like many women, she has returned to her work with a change of focus – drawn to helping other mothers be their best selves:

As a life coach for mums who want the most from life – to be the best mama they can be AND to find fulfilment and happiness in the workplace – self-care is one of the most important items in my coaching tool kit. 

Why? Because we can’t have it all and do it all, all at the same time, without it.

Ambition is a great thing – especially when, on the whole, we women tend to seriously undersell ourselves – but it needs to be tempered with a reality check:  

First, that women are naturally empathetic and often also highly sensitive.  If we take on too much, this means we also take on too much of other people’s stuff (emotional and physical) leading only to burnout, depression and disease.

Second, that parenting takes up a huge amount of energy (whether we want it to or not). We simply don’t have the full tanks we used to pre-kids, to expend on what we choose. So we need to be careful about what we commit ourselves to and even more careful about taking time-out to replenish those precious tanks of ‘you juice’.

And that means self-care.

Yes, it’s an overused, slightly wishy-washy umbrella term that could mean lots of different things to different people, but that’s the whole point. Self-care is what makes YOU feel better about yourself, however weird and wacky that activity might seem to others. It could be picking your spots last thing before bed, going for a walk in Nature, indulging your inner neat-freak by colour-coding your wardrobe or learning to fly a plane.

I see self-care as falling into two camps: the nourishing sort (think cups of delicious tea, massage, lying in the sun, reading in bed, chats with your bezzies, steaming hot salt baths) and the revitalising sort (think sports, gardening, dancing etc). It doesn’t matter which camp is your natural self-care go-to, what does matter is incorporating at least one item from either list into your routine, on at least a weekly basis.

And there’s the rub: fitting it in. Actually doing it. Scheduling in time for yourself somewhere near the top of your to-do list rather than at the bottom underneath a myriad of chores.

Why is this so hard to do? Because as a society, we have not been taught to value ourselves over and above what we DO in the world. We have forgotten what it is like to be a human being rather than a human doing and in a world that glorifies the term ‘busy’, we have assumed that to get ahead and achieve our maximum, we should always be switched on.

But is this how we want our kids to grow up? No! So why should we fall in line with this crazy, short-termist attitude to life and health? Why not be pioneers instead?

Let’s see rest as a revolutionary act and start implementing it as though our lives depended on it! (Mama truth bomb: they do).

And if you’re still feeling like self-care is indulgent and selfish, keep my top four reasons to ditch the mama guilt close to hand:

  1. Just think how many hours you have been ‘on duty’and tally that up against how many you plan to take time ‘off’. There’s bound to be a huge imbalance.
  2. Remember that giving yourself permission to do something that feels good and gives you joy, is also allowing others to do the same. By expressing your needs and asking that these be met (something we all struggle with as remote descendants of Victorian disciplinarians), you are showing your partner how they too are worth investing in
  3. Partaking in some self-care without the kids is showing your children that life doesn’t have to be all work and no play. Hard effort deserves celebration – you would celebrate their achievements, so why not celebrate yours, however small, menial or routine they might seem to you at the time?
  4. Happy Mama = Happy Family (and vice versa) You wouldn’t want to inflict shouty, resentful mama on them, would you?

So, self-care or be square. Your kids/partner/health will thank you for it…

Lavinia Brown (aka BoboMama) is a qualified transition coach for mothers. She supports women to reach their greatest potential – at home and in the workplace – whilst successfully managing the ‘life bomb’ that is kids. See www.bobomama.net for more details or follow her on social media for daily doses of mama medicine: click here for Insta and here forFB