A Professional Physiotherapist Answers Your Most-Asked Pregnancy Questions

A few weeks ago we had the pleasure of chatting with leading London physiotherapist, Francesca Da Costa, who regularly works with pre and postnatal women to help them increase mobility, reduce and manage pain, and improve their quality of life overall. She talked us through the many benefits of working with a physiotherapist during your pregnancy and postpartum journey and you can read more about that here!

When we posted snippets of her interview on our Instagram we were flooded with more questions, so Francesca's answering the most commonly asked "questions for a physiotherapist" here today! But before we dive in, here's a quick note from Francesca:

It is important to note that while I can give general advice, I am not your physio and do not know your personal situation. If you have any concerns please try and seek out a physiotherapist to work with directly or speak to your doctor. Treatment really is individual and every pregnancy and recovery is different!

Alright, let's get to your most-asked questions! We'll start with pregnancy topics:

Is it really safe to work out all the way through my third trimester?

Francesca: Yes, it is absolutely safe to exercise through the third trimester. Research shows that exercise helps to control weight gain, prevent diabetes and reduce high blood pressure problems. It also improves your mood and sleep. A lot of great reasons to stay active! The UK government advise that pregnant women aim for 150 hours a week of moderate intensity activity, but this might look more like pregnancy yoga or pilates classes, swimming, and walking for some. 

You shouldn’t ‘bump the bump’ or do high risk exercises (i.e. contact sports, activities with a fall risk, or high altitude activities). I don’t recommend picking up new activities during pregnancy or trying to go for a personal best! If you were already active before becoming pregnant then you can keep going, and if you weren't as active, it's important to start gradually.

Make sure you listen to your body and only do what is comfortable for you, and the general advice is that you should be able to maintain a conversation during exercise. Remember, I’m not your physio, I'm just giving general advice so if you have any concerns about your specific exercise routine, be sure to speak directly with your doctor, midwife, or physiotherapist.

And of course, Baby2Body is here to help answer all of your prenatal exercise questions and guide you through your weekly workouts!

Is there anything I should be doing to prevent abdominal separation during pregnancy?

Francesca: It’s important to know that you can’t prevent abdominal muscle separation (diastasis recti). Research has shown that 100% of women have some abdominal separation at 35 weeks of pregnancy so the question is, "can I prevent it from being worse than it could be?". It is recommended to modify movements (such as transitioning from reclined to seated) if you see a visible doming or coning down the middle of your tummy. For example, rolling over to your side before sitting up if you're in a reclined position.

Bowel health is actually also very important here! Constipation is common in pregnancy and straining increases the pressure on the connective tissue of your abdominal wall, which can exacerbate that separation.

What advice do you have if I develop Diastasis Recti during pregnancy?

Francesca: The first thing I would say is: don’t panic.It's really the same answer as above and then just focus on modifying your exercises and general movements.

For more on Diastasis Recti in pregnancy and postpartum and what to do about, check out this post.

I’m having a lot of pelvic pain, is there anything I should be concerned about? What can I do to help it? 

Francesca: We actually covered pelvic pain in depth on my last interview with Baby2Body! Check it out and my top 9 tips here.

Are there any exercises you’d recommend for labor pains or Braxton Hicks contractions other than stretching? 

Francesca: When you’re in labour or having Braxton Hicks contractions you might find it useful to get into a UFO position (upright, forward and open). For example: standing or kneeling, lean forward onto something with your hips open. Exercises on all 4s are great, such as hip circles, rocking and an exercise ball is good for bouncing and hip movements.

There’s a good book by Juju Sundin and Sarah Murdoch called Birth Skills: Proven Pain Management Techniques For Your Labour and Birth which gives great techniques to get through labour pains (I found this really useful for my birth)! Hypnobirthing is also very popular at the moment as a powerful way to understand what to expect during labor and how to use your breath to move through the pain -- it might be useful to attend a course or read a book about this. 

We also had a few questions come in regarding a low-lying placenta and if there is anything you can do to help bring it up, but it's important to make clear that this is a question for your midwife or OB/GYN, and not something a physiotherapist can or should directly help with.

Alright, and now for your postpartum questions:

After a vaginal delivery, when can I start to workout again?

Francesca: Generally 6 weeks, to allow some healing time for your body, but this really depends on the individual and doesn’t mean you should start back with a 5k run at 6 weeks as your first form of exercise. 

Slow and steady wins the race here... pelvic floor exercises can be started pretty much after birth (once you’ve done your first wee) and your exercise programme should be viewed as rehab for your body initially, starting with gentle light movements frequently and building into longer exercise routines over time.

After a Caesarean delivery, when can I start to workout again?

Francesca: Generally 12 weeks but it's the same as above, it's going to depend on your unique situation. Early mobilisation is helpful for managing swelling (and therefore pain) so try to get out of bed the same day as delivery if possible. You don't want to lift anything heavier than your baby for around the first 6 weeks as your incision heals. Slowly increase your walking tolerance and remember that no one size fits all!

You’ll also want to monitor any exercises that you feel pulling on your scar and avoid such movements. It’s really important to add in scar massage to reduce sensitivity and scar tissue build up, and that's something I often recommend to my clients.

What’s the best exercise if I have Diastasis Recti postpartum?

When thinking about the best exercise for Diastasis Recti, it’s really important to strengthen your pelvic floor muscle and transversus abdominis (the deep abdominals). Breathing is very important as there’s a strong relationship between the diaphragm, pelvic floor and abdominals. Breathing automatically activates the abdominal wall.

Diastasis rehab does involve the rectus muscles themselves and the oblique muscles so avoiding use of the rectus muscles won’t necessarily help recovery (which is what the advice used to be). The key is getting all of your tummy muscles working again and working together. I’m not saying you should do a full sit up or a plank but assessing where you are at the time and looking at how you’re performing exercises and modifying is important.

Different exercises will be right for different women at different stages depending on her abdominal wall, so if you’re concerned please seek professional advice. Joining a post natal pilates class run by a physio near you would be a great place to start.

I’m struggling the most with postpartum belly fat, I just can’t get rid of it. Is there any advice from a physiotherapy standpoint?

Francesca: I’m sorry to hear that you feel you’re struggling with postpartum belly fat. This is completely normal! There are changes to the entire abdominal wall during pregnancy so graded exercise therapy and loading of the muscles and connective tissue to change the shape is important, which takes months to achieve. These are therapies that a physiotherapist can help you with directly if you are struggling, and they're also part of many exercise programs as well.

Your body has gone through an amazing journey and time and exercise really does change things. Don’t compare yourself to people on social media with their flat tummies -- remember that clothes hide a lot and everyone’s bodies are different going into pregnancy and coming out of it. 

Francesca Da Costa qualified as a Chartered Physiotherapist from the University of Birmingham in 2009. Since then she has gained a wealth of experience working in the NHS, a charity and for the past 7 years a busy private clinic in Marylebone before setting up her own home visit Physiotherapy service. Francesca specializes in pre and postnatal and also treats conditions from work related issues, to traumatic injuries or post operative rehabilitation. She combines clinical pilates with her physio treatment to achieve the best possible outcome. She aims for everyone to take something away from her sessions transferring new skills and body awareness into everyday life and functional activities.