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Let’s talk about prolapse

Prolapse, much like incontinence, is one of those topics which no-one really likes to talk about. But is so important women understand what’s really going on down there! So we’re going to give you the low down on what it is, how to recognise it, and what to do about it if you have end up with a prolapse…

The organs of the pelvis – the bladder, rectum and uterus – are supported within the pelvis by connective tissue (or “fascia”), ligaments and pelvic floor muscles. If these tissues are stretched or torn, and/ or your pelvic floor muscles become weak, your pelvic organs may not be held in place and may bulge down into the vagina. This is called pelvic organ prolapse or POP.

Pelvic organ prolapse is very common. Did you know that up to 50% of women who have given birth will suffer from prolapse? It can also be seen in women who have not given birth and is often associated with straining at stool. Collagen type is also important, and women who are hypermobile (i.e. extra range of motion in a joint or joints) may be predisposed to prolapse.

Women may first notice prolapse when they find a lump or bulge in the vagina and have a sense of dragging or aching. There may be issues with incontinence or difficulty evacuating the bowel. The symptoms are often worse at the end of the day, particularly if you are on your feet all day or doing a lot of bending and lifting. Prolapse often feels better after lying down.

Childbirth is the most common cause of prolapse. When the baby descends through the birth canal, stretching or tearing of the supportive tissue and pelvic floor muscles may take place. However, chronic coughing, a long history of straining at stool/ constipation and heavy lifting, are other factors that can cause prolapse.

Prolapse is named after the organ that has lost its support and is protruding into the vagina. You may hear terms such as urethrocele (when the urethra protrudes into the vagina), cystocele (bladder), rectocele (rectum), enterocele (small intestine), or uterine (uterus) prolapse. However, new terminology makes it easier to understand with terms such as anterior wall (bladder) and posterior wall (rectum) prolapse.

Women are often devastated to learn that they have a prolapse and are sometimes angry that they were not informed about this as a consequence of childbirth. Many have little or no knowledge of prolapse, so education is the key to helping women understand their body and how best to manage it.

Conservative measures such as pelvic floor muscle strengthening, bracing and correct position for defaecation, can help to reduce symptoms of prolapse. Local oestrogen can help with tissue quality in the vagina for women who are breastfeeding or post menopausal. Pessaries, which are a plastic or rubber device inserted into the vagina, can help reduce symptoms of prolapse by supporting the wall of the vagina. Lifestyle changes such as ensuring adequate fluid intake, a well-balanced diet, maintaining a healthy body weight, and avoiding excessive straining, can all help prevent and assist in the management of prolapse. Being aware of safe lifting techniques, bracing before lifting, and avoiding exercises or activities which cause an increase in intra-abdominal pressure are all important as well.

Lastly, surgery may be recommended if the prolapse is significant and not responding to conservative management. In this case referral, to a gynaecologist or urogynaecologist may be necessary – you should speak to your GP about arranging a referral.

We strongly recommended you see a pelvic floor physio if you are experiencing any symptoms of prolapse, as there is a lot that can be done to help reduce and prevent worsening of symptoms. And education is key to understanding any symptoms and being able to take timely and appropriate action.

Sharyn Wappett
B.App.Sc (Physiotherapy)
Member of the Australian Physiotherapy Association (MAPA)
W: Restore Physiotherapy
FB: Restore Physiotherapy on Facebook

Planning your (birth) plan

My yoga teacher used to say, “If you want to make God laugh, make a plan.” Never were truer words spoken! With the best of intentions we often try to plan our lives but we all come to know in time that things often do not go the way we think they will. Even if they head in the right direction, the path can be curvy and often very steep. The only thing which is certain in life, apart from death and taxes, is change. Moment to moment we are in a state of flux. While we must accommodate to this constant state of change, making plans is crucial to ensuring you are heading in the right direction.

Making choices or a plan for your birth can be contentious, where public and professional opinions abound! As soon as you announce you’re pregnant, a barrage of (often unwarranted) comments and questions arise such as: “Are you seeing an obstetrician or a midwife? Are you taking birth classes? Where? Why would you not have an epidural? Oh you’re going all natural, wow you’re brave…” It can often seem endless. Pregnancy seems to somehow make you public property overnight!

In the end though, the choices you make on the birth journey are yours (and maybe your partner’s). This may seem daunting, but it doesn’t have to be. Embracing the experience and making choices from a place of intuition, true desire, with priority for the safety of you and your baby is paramount to a happy birth process. Here’s a few tips to keep the process authentic, awesome and also real:

1. Become empowered, excited and fearless about your birth experience and meeting this new human entering your world. Nurture a peaceful mind – just some of the ways to do this are:

  • utilise the breath
  • get into yoga (if you haven’t already)
  • meditate
  • get hypnosis
  • use visualization
  • use affirmations
  • try massage
  • find some form of movement
  • or anything that will nurture positivity and will see you into labour with a sense of calm and clarity!

This attitude will enhance the effect of the labour hormone oxytocin and will decrease adrenalin (which inhibits oxytocin). YOUR state of mind really counts. Knowing you have this box of tricks with you as you go into labour will be comforting and encouraging.

2. Know that labour and birth is dynamic and sometimes things happen beyond our control. That’s okay! Just nurture your sense of calm and go with it. The universe always has a grander plan. Some things on the plan will change, and other won’t (hooray!).

3. The baby’s comfort and safety are of upmost importance. Don’t lose sight of that through preconceived expectations of an experience. The aim is a healthy baby in your arms.

4. Trust yourself and your body by honing self-love, self-nurture, self-trust. Check your internal dialogue; are you kind to yourself? A little self-compassion can go a long way!

5. Get yourself an awesome birth partner. That is, make sure your chosen one knows their role in the labour/ birth room. Their role should mainly be to nurture you, keep you calm, and to love and support you. They are your advocate and guide (when you may not be able to express yourself fully!). Share your feelings, plans and thoughts with them leading up to the big day

6. Do seek opinions but make up your own mind about your choices. Trust your own instincts. Other women’s birth experiences are theirs – not yours. Your experience is bound to be different. No two births will ever be the same!

7. Aim for a happy and safe birth. Adding words like ‘normal’ or ‘surgical’ to the word ‘birth’ may foster guilt and a sense of being abnormal if it doesn’t all go the way you intended. You’re not abnormal and you won’t be, regardless of the outcome.

8. Try to have continuity of care such as a good midwife or other support person, who can spend ample time with you during your pregnancy and labour. This is the one thing which has been shown to increase your chances of having a birth without intervention. These people keep you centred, nurtured, and they know you and they know what you want.

9. Be careful of online birth forums, as they can scare you and even give you biased and badly written information. Take them with a grain of salt, and if in doubt, check with your midwife or obstetrician.

10. Know that your caregiver has your and your baby’s best interests at heart.

11. Don’t be afraid to do your research about birth and what’s available (medications, alternate positions, interventions, etc). Delve, read, ask and just do what YOU need to.

12. Invest in an awesome child birth education program; one that nurtures a peaceful, positive mindset and combines practical guidance for birth and motherhood. The program should give you useful coping tools as well as evidence based information (without blinding you with the science). NB: You do get what you pay for!

13. GET EXCITED! Embrace this! It’s soon going to be your baby’s birthday!!! A new beginning where love will take on a whole new meaning! <3

Kerrie Adams
Midwife/Lactation Consultant/Yoga Teacher

M: 0430 849 986
E: kerrie@nurturemama.com.au
W: Nurture Mama
FB: Nurture Mama on Facebook

Healthy eating: conception | pregnancy | post natal health

Optimising nutrition before, during and after pregnancy is vital. If it’s not something you’ve thought about before, here are just some of the reasons why you reviewing your diet may help you:

  • Increased fertility
  • Fewer complications during pregnancy, such as anaemia, gestational diabetes, excessive or insufficient weight gain and high blood pressure
  • Short term foetal outcomes such as gestational weight
  • Long term foetal outcomes such as lowering the risk of obesity, cardiovascular disease and diabetes
  • Better post-natal recovery

 

With the vast amount of information on nutrition provided by in the media, it can become very difficult for most of us to know what really constitutes a healthy, balanced diet. Well-balanced eating incorporates many factors:

  • It optimises our nutritional intake; this includes macronutrients and micronutrients.
  • It allows a healthy relationship with food which is not restrictive or limiting. Food is needed for living, however as humans, we are lucky to enjoy an emotional and social connection with food (e.g. we celebrate birthdays with birthday cake).
  • It does not view foods as bad/ good/ clean etc. All foods are just that: food. However, healthy eating requires that we feed our body with primarily nutrient-rich foods from the five food groups, whilst enjoying other less nutritious foods (such as cake, alcohol and ice cream) in small amounts and less frequently.
  • It focuses on many health outcomes, rather then purely on weight management or an aesthetic focus. Genetically, we are all different shapes – and often quite different to the “ideal” set by society. As long as we are our own healthy ideal, not defined by the scale, but by our lifestyle habits (healthy diet, exercise, not smoking, limited alcohol intake, less stress), then that’s what is most important.
  • It can decrease the risk of chronic diseases such as diabetes, cardiovascular disease, cancers, osteoporosis, and acute risks such as anaemia and fatigue.
  • It can, and should be individualized. This is why so many mainstream diets don’t work long term; because diet “experts” are only able to provide generalized nutritional advice, which may be unbalanced and unsustainable. Dietitians and appropriately trained nutritionists can help you ensure your individual diet and lifestyle is nutritionally adequate, whether you are vegetarian, vegan, fasting for cultural reasons, allergic or intolerant to foods, or have a medical condition.

 

The Australian Dietary Guidelines give sound advice to optimizing nutrition both during pregnancy and while breastfeeding. Our nutritional demands change due to the supplies that need to go to the baby, the placenta, our blood volume, fat stores, milk production, etc, and so our diets can change accordingly.

 

It is advised that women trying to conceive take a folic acid supplement with iodine, or a general pregnancy multivitamin. During the first trimester, it’s advisable to take folic acid to decrease the risk of developing foetal neural tube defects. An iodine supplement during pregnancy prevents a range of diseases in babies collectively termed iodine deficiency disorders. Many women choose to take a pregnancy multivitamin to cover all bases, however, it’s important to remember that a good multivitamin is no substitute for a well-balanced diet.

 

For mothers-to-be who experience nausea or morning sickness, it is perfectly normal to have food aversions. If you are concerned about your nutritional intake being compromised because of these forced changes to your diet, that’s when seeking professional help is advised. Seek out your local Accredited Practicing Dietitian.

 

Here are some reputable links to source information on healthy eating, morning sickness and food safety.

 

 

 

Viktoria Flavel

Accredited Practicing Dietitian


Bachelor of Biomedical Science | Honours in Physiology | Masters in Nutrition & Dietetics

W: Live Wellthy
FB: Live Wellthy on Facebook
P: 0402036072
E: info@livewellthy.com.au

Don’t take it lying down

Have you given any thought to the actual position you will be in while birthing your baby?

Most of us have a picture in our heads of lying in a hospital bed strapped to beeping machines. And yet how many of us know that this position is quite possibly the worst position for the passage of your baby through the pelvis?

Why is this so?

First of all, being upright during labour helps the baby engage within the pelvic inlet (the top of the pelvis). When this happens, the pelvic bones move apart to accommodate the baby’s head.

pelvis

Circling the hips and moving encourages the weight of the baby’s head downwards and aids in opening the cervix. The uterus contracts from the top, pressing the baby towards the cervix and by standing up, gravity can certainly help with this.

As the baby descends into the birth canal, the sacrum shifts backwards increasing the diameter of the pelvis. Most women, if left to their own devices will assume a position that naturally facilitates this action. The best position at this stage is the half squat, because it opens the pelvic bones and stretches the pelvic floor. At this point the baby’s head is supported by the pelvic diaphragm, the deeper part of the pelvic floor muscles.

pelvis standing

The “tipping forward” of the pelvis also encourages the correct positioning of the baby into the birth canal. Similarly, a hands and knees position will have a good effect on the position of the pelvis.

all fours

So lying on your back during labour and birth limits the ability of the pelvis to open up and may be a cause of labour being longer and harder than it needs to be.

It’s a simple thing to stand and deliver.

I think it’s worth a try.

 

Carolyne Anthony

The Center for Women's Fitness
W: The Center For Womens Fitness
FB: The Center For Womens Fitness on Facebook
E: info@thecenterforwomensfitness.com
P: +60173276722

Baby Steps to Exercise

(Pictured: Chelsea Ciano, founder of Family Fit Exercise Physiology, sharing exercise with her daughter!)

Bouncing on a trampoline or simply laughing at a joke can be a tricky experience for new mums and their pelvic floor muscles. Childbirth places tremendous strain on the body, even if the labour and delivery were relatively straightforward.

Regular exercise offers a range of health benefits for the new mother, including faster recovery from the birth process, faster reestablishment of the abdominal and pelvic floor muscles, increased energy to cope with the demands of a newborn baby, increased ability to deal with stress and depression and, of course, faster return to pre-pregnancy shape and fitness.

Nevertheless, don’t feel any pressure to exercise before you are ready – listen to your body.

It’s important to be well informed before starting postnatal exercise. The focus for a new mother should be primarily on recovery and rehabilitation. This is achieved through strength development, postural alignment, functional stability, core strength, balancing opposing muscle groups and flexibility. Exercise post pregnancy should also be about the well-being of the mother and rewarding the body with the energy it requires to be a great mum.

All too often the focus for new mothers is about ‘losing baby weight’ and ‘getting your body back’, and while these goals are achievable, it’s important to understand that if recovery exercises are rushed or bypassed, future injuries are likely. For example, new mums performing crunches, planks or full push-ups before the abdominal muscles have repaired themselves will cause further abdominal separation and damage.

So my message for new mums is: think rehabilitation. Weight loss and aerobic fitness can wait. And remember that weight loss is largely tackled from a dietary perspective.

 

Post baby exercise

It is very important to exercise safely and correctly after the baby is born. Your body has undergone nine months of physical and physiological changes and these do not reverse overnight. Many ‘how to get your body back’ programs ignore the maternal adaptations of pregnancy (which can continue for up to six months post-birth) by prescribing exercises that can aggravate and exasperate postpartum symptoms and discomforts, potentially leaving new mothers with unnecessary injury, dysfunction and pain.

It’s best to omit or modify exercises that require fast movements, jumps, lateral movements, fast changes of direction and extremes of joint flexion and extension (e.g. deep squats). New mothers should avoid exercises that cause a bearing down on their pelvic floor, certain abdominal exercises and high impact exercises until core control, pelvic floor strength, bladder and bowel control has been regained. It is best to listen to your own body and if you are unsure seek advice from an accredited exercise physiologist.

Many new mums love the idea of ‘exercising with baby’, however you must be very careful when using your baby as a weight. Often technique is compromised, thus reducing the benefit of the exercise and increasing the risk to mum and baby. I personally love to workout with my baby girl and she enjoys it too. We often use a mirror to observe technique and avoid unstable objects like fitballs, discs and BOSUs.

Mothers constantly push their bodies to their limits – whether it is carrying your baby throughout pregnancy, feeding your baby with heavy breasts or lugging your toddler until they are too heavy to lift. They often put up with upper and lower back pain, unaware of the safe, effective exercises available to minimise their discomfort.

I’m a mum of two and I have experienced firsthand the benefits of a well-organised postpartum exercise program. My second pregnancy was more physically demanding than my first, probably because I had a toddler to look after and I used more of my ‘me’ time to rest rather than exercise. The progression of the pregnancy triggered several debilitating physical conditions and after giving birth I felt weak, soft and tired. A month postpartum I realised I needed to rehabilitate myself if I were to be dynamic mum. Slowly and gradually my post-baby discomforts were alleviated and corrected through prescribed exercise. Eight months on and I am fit, energetic and strong helping me to be a vibrant, active mum.

Specific exercises are required to heal stabilising muscles, correct any post-pregnancy abdominal separation and strengthen pelvic floor muscles. Concentrate on repairing the body first, which can take weeks or months depending on the individual, and then you will be able to fully enjoy being active with your family, and living your best life without any aches, pains or weaknesses.

Always consult with your doctor or midwife prior to commencing any postnatal exercise regime. Whether you are ready or not is dependent on many individual factors. It is recommended that your return to exercise be gradual and that you progress slowly.

My postnatal approach is to primarily:

  1. Activate your core and pelvic floor muscles.
  2. Heal abdominal separation (diastasis recti).
  3. Correct posture.
  4. Strengthen core and butt muscles.

Vigorous cardio exercise should be avoided until the above has been achieved. Cardiovascular exercise has many benefits, but being exhausted and sore has none, so mum has to be well rested and getting regular restorative sleep.

My recommended modes of exercise are personalised exercise prescription, walking, pram exercises, swimming, Pilates, yoga, cycling and light controlled gym work (preferably with a well-organised program).

New mothers can resume exercise without negatively affecting breastfeeding, provided the mum consumes enough calories to support both breastfeeding and exercise.

An appropriate and supportive bra is essential to any new mum looking to enjoy her exercise. It is best to exercise after breastfeeding, rather than before when the breasts are heavy and full. Don’t perform any exercises that hurt the breasts.

Be careful not to overexert yourself because a tired, sore mum is no fun for anyone. Stop exercise and see your doctor if there are any changes in your lochia.

Don’t expect too much too soon. Many women experience difficulties in losing weight and gaining fitness in the post-partum period. Allow yourself a reasonable length of time, such as a year, to get back into pre-pregnancy shape.

Patience, rehabilitation and sleep are essential when returning to exercise post pregnancy. Listen to your body. Have an exercise plan before you start and remember it is always best to seek professional advice.

Chelsea Ciano
Exercise Physiologist AEP MESSA

M: 0412 198 519
E: chelsea@familyfit.net.au
FN: Family Fit Exercise Physiology on Facebook
In: Family Fit Exercise Physiology on Instagram

Wee-wee woes?

Do you have wee-wee woes?

Do you leak (urine, that is) a little when you laugh, cough or jump? Do you have a sudden, strong urge to urinate? Do you wake more than 2 times to go to the toilet at night? Sound familiar? Well, firstly you’re not alone! Secondly, leaking is not an inevitable part of parenthood or ageing. In the majority of cases, it can be reduced, if not reversed. So, where do we start?

What and where is your pelvic floor?

Your pelvic floor is a sling of muscle and connective tissue that runs from your pubic bone at the front of your pelvis, to your tail bone at the back. Its purpose is to support the organs of the pelvis, i.e. the bladder, uterus and bowel. It also works to close off the opening at your bladder and bowel that helps maintain continence.

What happens during pregnancy?

During pregnancy your body releases hormones that soften the tissues in your body, allowing it to expand to accommodate your growing baby. The softening effect on tissues and the increasing weight of your baby place pressure on your pelvic floor. The pelvic floor muscles and connective tissue are also stretched at birth. This makes it harder for the muscles to do their job.

What to do?

The first thing to do is to start exercising your pelvic floor and keep exercising it for the rest of your life. It is like any other muscle; use it, or lose it!

How to contract your pelvic floor: Imagine that you are trying to stop the flow of urine or stop passing wind. Feel the squeeze in your muscles down below. This is a pelvic floor contraction. Now try and add a little lift to that squeeze. So squeeze in, lift, hold for 5-10 seconds, drop and relax. It is just as important to relax your pelvic floor after a contraction so it is ready for the next one. Three times a day, aim to do 10 quick squeezes and 10 squeeze, lift and holds for 10 seconds. Keep breathing! Holding your breath increases the pressure inside your abdominal cavity and puts more stress on your pelvic floor (that’s not what we’re after!).

NB: It is really important that you do not bear down (i.e. try to push, like the way you would if you were constipated, or having a baby!). The correct technique is vital, so if you are at all unsure about whether you are doing your pelvic floor contractions correctly, it is best to consult a women’s health physio or continence nurse. They can check it out and give you feedback to get you going in the right direction!

Once you have your pelvic floor muscles going, try to switch them on before you laugh, cough or sneeze and before you lift anything. If you have already had your baby, be aware of all the lifting that is involved with prams, capsules, and even just your baby – and make sure you switch on your pelvic floor before you lift.

What else to think about?

It is important to maintain good bowel habits and avoid constipation because straining to open bowels can put pressure on your pelvic floor and cause weakening. So be sure to eat a healthy diet including a lot of fruit and vegetables, maintain adequate fluid intake and take the time to open your bowels. It is easy for busy new mums to ignore that urge to go or not take the time to empty bowels completely and this may lead to constipation.

A final note…

There is still a lot of taboo around discussing bladder and bowel issues and the fact that one may occasionally wet oneself! And it is not normal despite that nearly all the mums in your new mothers’ group can relate! The only way we can break this taboo is to discuss these issues openly and not to be embarrassed. Remember, you are not alone. If you have any issues with your bladder or bowel, the best thing to do is have a chat to your GP, women’s health physio or continence nurse. In 90% of cases something can be done to improve, if not fix the problem. It is not something that you have to live with. By seeking help early you will not only be helping your condition now but preventing further decline in the future.

For more information and some great apps check out The Continence Foundation of Australia or phone the National Continence Helpline on 1800 330 066.

Sharyn Wappett
B.App.Sc (Physiotherapy)
Member of the Australian Physiotherapy Association (MAPA)
W: Restore Physiotherapy
FB: Restore Physiotherapy on Facebook

The go-to guides for basic info on exercise and pregnancy

There is an absolute WEALTH of information out there on the world wide web, relating to topics in health during pregnancy and post-partum. BUT! How do you know who and what you can trust? How do you know it’s from a reliable source? How do you know it’s up to date?

Well, just to get you started, here are just a couple of links to documents created by health professionals from state and national Australian bodies in health:

 

Exercise is Medicine Australia factsheet – Pregnancy and Exercise

Exercise is Medicine (EIM) is a global initiative, managed in Australia by Exercise & Sports Science Australia (ESSA). The focus of EIM is to encourage every individual under the care of a health care provider to engage in a conversation about their physical activity levels. This document was published in May 2014, and is backed by ESSA – the national body for Exercise Physiologists (in case you don’t know who or what an Ex Phys is, they’re health professionals who specialise in the delivery of exercise, tailored to the needs of the individual – whether it be someone with an injury, a chronic disease, looking to improve their sporting performance, or at a particular time in their life, such as pregnancy!). This is a great general guideline for women during pregnancy – outlining the basics. Of course, for individualised advice, it’s best to consult and Exercise Physiologist or Physiotherapist.

 

Exercise is Medicine Australia factsheet – Exercise for Postnatal Rehabilitation

Another one from EIM, this time around post-natal rehabilitation. Like the one above on pregnancy, this document was also published in May 2014 – so very current! It is also backed by ESSA. Again, this is a great document with generalised guidelines for women following pregnancy and birth. If you have any particular needs post-partum, you’re best off contacting an Exercise Physiologist or Physiotherapist with experience in this particular area of women’s health.

 

Sports Medicine Australia – Active Women

Sports Medicine Australia (SMA) is the peak body in Australia for sports medicine and science; a national, multi-disciplinary organisation, recognised internationally. SMA provides a number of resources for women involved in sport, including info on participating in sport during and after pregnancy. There are also resources for teenagers, right through to women during menopause. These documents are currently under review, however they were last updated in 2007/08, so are still a relevant and reliable resource.

 

Kate Faber
Accredited Exercise Physiologist, ESSAM
Bachelor Applied Science (Exercise and Sports Science)
Pre and Post Natal Pilates Specialist

P: 0419 446 189
LI: Kate's LinkedIn Profile
G+: Kate on Google Plus

Welcome to Wonder Women

Hello! And welcome to Wonder Women, you wonderful woman, you! Let me tell you a little about why I created this site…

I had two people very close to me have babies in the last 12 months. During that time, I started getting very interested in pre and post natal healthcare, so I decided to attend a 3 day workshop run by Carolyne Anthony – the Pre and Post Natal Pilates Specialist Program. During these 3 days, my eyes were completely opened to the complex needs of these women – as well as a lot of gory details I wasn’t expecting to hear!

From there, I realised there is a wealth of misinformation out there, thrown at women in all forms of media, creating an unhealthy and unrealistic standard to aspire to. I saw there was not only a negative body image ideal being created, but also this idea that anything “less than” a “natural birth” is a sign of failure by the mother. I also realised that it was not easy to find healthcare professionals who specialise or who have a special interest in women’s health. So I felt the need to make it really easy for women to find anyone they may need, all in the one place.

This is where my project started. Who knows where it will finish.

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