2. The Postnatal Client Overview Guidelines Presented by Cherry Baker

3. Postnatal periods It is illegal to return to work within 2 weeks of delivery Early postnatal period 0 – 6 weeks Full postnatal period 6 weeks to 12 months

4. Postnatal Screening It is important you ask the following specific questions to ensure the class is suitable for your client: 1. Have you stopped bleeding? 2. Have you had your postnatal check? 1. Do not accept in class if still bleeding chance of air embolism or haemorrhage 2. Client should not return to a main stream class until they have had their postnatal check

5. Postnatal Screening Cont…. 3. How old is your baby? 4. What type of delivery did you have? 5. Do you feel well? 6. Do you have any joint pain? 7. Are you breast feeding? Don’t accept without postnatal check C- sections may take longer to recover surgery is super imposed on childbirth. Scarring & loss of feeling Client should not feel ill or feverish Check for back / sacroiliac pain. Consider calorie and hydration implications Rec Check

6. Benefits of Postnatal Exercise The correct type of exercise in the postnatal periods may: Promote circulation and aid repair Maintain energy levels Aid physical recovery Aid psychological recovery Aids symptoms of mild postnatal depression Aid recovery of the abdominal area Repair pelvic floor prevent prolapse and stress incontinence Prevent or improve back and sacroiliac pain Aid weight reduction Lessen recovery time Ability to cope with new born

7. Adaptations Carpal Tunnel Pelvic Girdle Pain Abdominal weakness and stretch Breast feeding

8. Abdominal Separation Gap between muscles due to excessive lengthening & influence of pregnancy hormones or labour Specific transitions getting up and down from step & lifting weights needs extra care Avoid direct work on rectus abdominus till the gap is two finger widths or less It is the linea alba that thins rather than ‘splitting’

9. Testing for Diastasis Postnatal-2 finger gap Test below and above the belly button Support during the sit up phase Protect modesty Self testing

10. Factors affecting Stability in the postnatal phase Posture Lots of bending, lifting and sitting Centre of gravity changes Stretched abdominal muscles Round and broad ligaments stretched Diastasis Lengthened glut max and med

11. Core Stability Transversus / internal oblique's Pelvic floor Multifidus

12. Facia Connective tissue Thoracolumbar facia Sacral Facia Facial lines

13. Core Stability Deep and superficial muscles Back pain can occur due to the spine being able to ‘wobble’ through lack of stability Correct movement patterns Correct muscle balance Deep muscles restrict unwanted or excessive movement

14. Trunk stability against limb loading Standing stability! Focus on pelvic stability – lumbar pelvic rhythm and lifting techniques

15. Abdominal Repair Teach abdominal hollowing Challenge abdominal hollowing against limb loading Abdominal hollowing and posterior tilt Abdominal hollowing, posterior tilt and sit up activity Teach correct lifting Teach good posture thoracic and lumbar extension Shoulder and pelvic stability

16. Shortening within the inner range Shorten within the inner range Abdominal hollowing Maintain hollowing & pelvic tilt Maintain abdominal hollowing add pelvic tilt & thoracic flexion Combine the above and lift into the inner range Muscle balance from lower fibres of rectus to upper fibres of rectus

17. Setting up classes NCT Local Community midwifes Doctors surgery Health visitors Friends who are pregnant TIME!!

18. Contacts Local maternity hospital Community midwifes NCT Guild of postnatal teachers