The postnatal year
It is heartening to read a shared Birthlight perspective on the NHS website
‘It took nine months to make a baby and it could take at least that long to get back into shape again.’
However, due to cultural pressures and media presentation of celebrity overnight recovery many women are simply shocked or incredulous at this idea before birth and in the early post partum period. There are also good reminders about the fact you need to be aware
“Your lower back and core abdominal muscles are weaker than they used to be. Your ligaments and joints are also more supple and pliable, so it's easier to injure yourself by stretching or twisting too much.”
I think, however, my experience echoes that of many Postnatal teachers in that mostly women have no idea about if they have diastis recti (split abdominals) even after their 6-8 week check with their GP let alone what not to do until this has closed. There also seem to be many cases of stress incontinence, pelvic pain, back pain, chronic fatigue, anxiety and depression that go on being unaddressed perhaps because mothers are simply too busy and unsupported to take care of these issues and also they may be discouraged from seeking help because their needs may be dismissed by the general idea that everything should be back to ‘normal’ by now or as quickly as possible. Sometimes women’s worries are met with a sympathetic ear and some practical advice, other times partners, families and friends greet our worries and emotions with comments such as ‘Well just be grateful that your baby is healthy…. Its time to move on, try not to dwell on it.” Or worse ‘well what did you expect?’.
Naomi Stadlen, author of 'What Mothers Do', has done great work in bringing awareness of women’s need to be listened to, and our experiences treated as valid and important. She says in her book:
‘Mothers complain about their physical isolation, but surely a more fundamental isolation is about not being understood. That kind of isolation arises when a person finds it difficult to communicate an important experience to other people.... It’s hard to find the words to communicate what "looking after my baby” really means.'
Maternity rights are very much better in the UK (26 weeks on full pay) than many European countries excluding Scandinavia. Total maternity leave is only around 16 weeks in Swizterland, Holland and 12 weeks postnatal in Portugal with the option to take another 30 days with less pay. An EU proposal to ensure 20 weeks for all women seems to have stalled for many years perhaps due to reluctance to make changes during the recession. In the UK there is no legal requirement for employers to allow paid breaks for breastfeeding or pumping although this exists as a legal right in other countries it is probably easily discouraged or refused by employers. So although there is the WHO recommendation for the duration of breastfeeding it seems this is rarely backed up by policy.
But what about the all important care after birth? In the UK funding has been directed to improve breast feeding support in the UK in part for the ‘potential savings are linked to the reduction in the incidence of certain childhood disease because of the protective effects of breastfeeding. The conditions examined in the (NICE) report include gastroenteritis, otitis media and asthma. It should be noted that other positive effects such as reduced admissions to emergency services and reductions in breast cancer have been reported in the literature.’
For issues of perineal and abdominal retoning and repair, unless there is infection or fecal incontinence, the care seems to be the giving out of exercise sheets or direction to local classes with the recommendation to seek further help if things don’t improve and then perhaps being referred to a obstetric physiotherapist.
I asked some Birthlight teachers in other countries what was on offer where they teach.
Uniquely in my quick survey France seems to invest in women’s long term health by automatically providing 10 sessions with a Physiotherapist or Midwife to ‘retrain’ the pelvic floor and abdominals which start after their 6/8 weeks check with a doctor or midwife. They will check to see if the woman’s rectus abdominus has separated and work with the woman to heal this. Whilst not all women may access this service it is 100% funded by social security.
Even so, Perrine Alliod says that in France women are not always well supported and many professionals don’t have enough time to see everyone. In practice, women are very often alone and postnatal recovery is often difficult. The problems of feeding are frequent and professionals do not give the same information. Services on offer are different from one region to the other. For me, I am convinced of the importance and the need for support in postnatal. The majority of the women that I support experience a difficult time when returning home from the hospital. It is often that I am speaking to help and if necessary refer them to qualified professionals. My role to be a resource and allow them to flourish in their role as mothers but also to be a relay to other structures. Birthlight is really important to France, and I particularly appreciate this complete, comprehensive method and essential care for all families.
When a woman delivers at home, the postnatal nurse (kraamverzorgster) is called before the delivery to assist the midwife during the delivery, helps to support the labouring woman and gets everything ready for the arrival of the baby. After the delivery the postnatal nurse helps the new mum to shower and cleans the bedroom and makes sure it is nice and fresh. The midwife checks the baby, does any possible stitching and stays usually till the woman has showered and eaten something. The postnatal nurse stays and looks after mum and baby, cleans (toilet and bathroom) and often cooks something. She comes for a minimum of 24 hours over a period of 8 days. She checks temperature of the mother and baby, checks the stitches if any and can answer questions about breastfeeding, baby care, care for the mother in the first week. In the booklet that the postnatal nurse has there is some information about pelvic floor exercises, sometimes abdominal muscles. The midwife comes quite a few times in that first week - some about 5 times and the postnatal nurse will call her when anything unusual is going on with the mother or baby so that the midwife comes. Then after six weeks the women can make a final appointment with the midwife to have a last check, and only some midwifes check for a split rectus. This is also the time women reflect with the midwife on the delivery. When a woman delivers in hospital then the postnatal nurse comes when they go home. Under care of the gynecologist then when coming home the postnatal nurse will come and with any complaints the hospital will be contacted. And after six weeks the check up is with the gynecologist who to my knowledge doesn't check for split rectus. And also often gives women the advice not to do any exercise for the first 6 weeks.
Liese Van Dam says “In my opinion (these postnatal exercises are) very basic and nothing like we do in Birthlight. I have quite often heard some women tell me that their midwife told them "not to do any exercise for the first six weeks" which of course in some way is true when you talk about going to the gym, but is also missing any opportunity to help women regain their bodies after birth. When I come to women's houses women often comment that what they are learning is new; how to roll over, how to come out of bed, how to sit and feed, how to do practices for the pelvic floor and abdomen.
For a traditional approach to a straightforward homebirth the midwife will visit on alternate days for the 40 days after birth. The focus is on looking after the physical and emotional well-being of the new mother. This starts with a strict diet to follow and includes massage, body scrub and hot stone pressure massage around the abdomen to reduce ‘wind’ and help the veins shrink. If the mother has a split rectus after the stone massage her abdomen and spine will be covered in a ‘heating’ herbal mixture and she will be wrapped in a tight bandage or sarong to help repair the gap. During the last 7 days of her confinement the mother will be bathed in herbal and floral water to boost the couple’s confidence to resume normal life as husband and wife.
Wan Muzdaliffa Sainsbury says “this is a very traditional approach. Nowadays in the big cities the new generations hardly have time to do the confinement of 40 days but awareness of pre and postnatal preparation is growing. Our Birthlight postnatal exercises are definitely in tune with Asians like me, an added routine to our existing ritual.
Birthlight's Spiral of Joy
So what about the Birthlight Postnatal Spiral of Joy? As specilaised postnatal yoga teachers we can have much to offer, and we may provide an unrivalled continuity of care and support that starts before pregnancy and stretches into the future in subsequent pregnancies. More than just retoning the abdominals and pelvic floor, many issues, spoken and unspoken, can resolve or be helped through a regular time for self in a circle of other women and babies.
As teachers it is a pleasure to be able to complete the full cycle, by accompanying women through their fourth trimester with the expertise of our training.
It’s the Circle of Life
And it moves us all
Through despair and hope
Through faith and love
Until we find our place
On the path unwinding
In the Circle,The Circle of Life
“The Circle of Life” from Disney’s “The Lion King”
Our next scheduled Postnatal trainings are:
Zurich 6-7 June , London 28-29 June , Birmingham 11-12 July , Utrecht 20-21 July , London 8-9 November
With all good wishes and thanks to colleagues around the world
Kirsteen Ruffell, Birthlight Tutor Perinatal Yoga, Postnatal Yoga and Baby Yoga.
Birthlight Postnatal exercises may help reduce the risk of Prolapse: 3D Anatomy video on Prolapse
NHS 'Your post-pregnancy body'
Naomi Stadlen's book 'What Mothers Do' has now been translated into several languages including Spanish, Italian, Greek and Japanese.
National Institute for Health and Care Excellence (NICE) 'Health problems in women and babies in postnatal care'
Maternity and paternity rights worldwide: interactive
When can you stop worrying about getting postnatal depression?