Definition
Postnatal exercises are designed to help new mothers recover strength, restore posture, and support emotional well-being after childbirth. The key is to start gently, listen to your body, and progress gradually.
Purposes
- To improve the tone of muscles which are stretched during pregnancy and labor especially abdominal and perineal muscles.
- To educate about correct posture and body mechanics.
- To minimize the risk of puerperal venous thrombosis by promoting circulation and preventing venous stasis.
- To prevent backache.
- To prevent genital prolapse.
- To prevent stress incontinence of urine.
Procedure
Teach exercises in the early postpartum period to strengthen the abdominal muscles and firm the waist. The exercise can be started soon after childbirth and repeated up to five times, twice a day, at first. The number of exercises is gradually increased as the mother gains strength.
| Nursing action | Rationale | |
| 1. | Explain the procedure to patient. | Minimizes anxiety and facilitates patient cooperation. |
| 2. | Provide privacy. | Makes patient comfortable. |
| 1) Abdominal exercises | ||
| a. Abdominal breathing: | ||
| Instruct the woman to assume a supine position with knees bent. | ||
| Instruct her to inhale through the nose, keep the rib cage as stationary as possible, and allow the abdomen to expand and then contract the abdominal muscles as she exhales slowly through the mouth. | Strengthens the diaphragm. | |
| Instruct her to place one hand on the chest and one on the abdomen when inhaling. The hand on the abdomen should rise and the hand on the chest should remain stationary. | Ensures that the exercise is being done correctly and ensures adequate intake of air while inhaling. Provides adequate aeration of lungs. | |
| Repeat the exercise five times. | ||
| b. Head lift: This exercise can be started within a few days after childbirth. Instruct the mother to lie in supine position with knees bent and arms outstretched at her side.Instruct her to inhale deeply at first and then exhale while lifting the head slowly to hold the position for a few seconds and relax. | Strengthens abdominal muscles. Helps strengthen neck muscles. | |
| C. Head and shoulder raising: On the second postpartum day instruct woman to: Lie flat without pillow and raise head until the chin touches the chest. | Helps strengthen head and shoulder muscles. | |
| On the third postpartum day instruct her to: Raise both head and shoulder off the bed and lower them slowly.Gradually increase the number of repetitions until she is able to do this for 10 times. | ||
| d. Leg raising: This exercise may begin on the seventh postpartum day. Instruct woman to: Lie down on the floor with no pillows under the head, point toe and slowly raise one leg keeping the knee straight. Lower the leg slowly.Gradually increase to 10 times each leg. | Improves muscle tone and circulation. | |
| e. Pelvic tilting or rocking: Instruct woman to: Lie flat on the floor with knees bent and feet flat, inhale and while exhaling flatten the back hard against the floor so that there is no space between the back and the floor. Inhale normally hold breath for up to 10 seconds and then relax. Repeat up to 10 times. | Tightens abdominal muscles and muscles of the buttocks. | |
| f. Knee and leg rolling: Instruct woman to: Lie flat on her back with knees bent and feet flat on the floor or bed. Keep the shoulders and feet stationary and roll the knees to side to touch first one side of the bed, then the other. Maintain a smooth motion as the exercise is repeated five times. Later, as flexibility increases, the exercise can be varied by the rolling of one knee only (the mother rolls her left knee to touch the right side of the bed, returns to center, and rolls the right knee to touch the left side of the bed). | This exercise will strengthen the oblique abdominal muscles. | |
| g. Hip hitching: Instruct mother to: Lie on her back with one knee bent and the other knee straight. Slide the heel of the straight leg downward, thus lengthening the leg.Shorten the same leg by drawing the hip up toward the ribs on the same side. Repeat up to 10 times keeping the abdomen pulled in. Change to the opposite side and repeat. | This is very easy exercise that will strengthen the deep transverse muscle which are main support for the spine and play a large part in prevention of long-term back problems. | |
| h. Abdominal tightening: Instruct woman to: Sit comfortably or kneel on all fours. Breathe in and out, then pull in the lower part of the abdomen below the umbilicus while continuing to breathe normally. Hold for up to 10 seconds. Repeat up to 10 times. | Strengthens abdominal muscles. | |
| 2) Circulatory exercises | ||
| a. Foot and leg exercises: Instruct mother to: Sit or half lie with legs supported. Bend and stretch the ankles at least 12 times. Circle both feet at the ankle at least 20 times in each direction. Brace both knees, hold for a count of four, and then relax. Repeat 12 times. | This exercise must be performed very frequently in the immediate postnatal period to improve circulation, to reduce edema, and to prevent DVT. | |
| 3) Pelvic floor exercise (Kegel exercise) | ||
| Instruct woman to: Sit, stand or half-lie with legs slightly apart, close and draw up. Around the anal passage as though preventing a bowel action. Then repeat for front passages (vagina and urethra) as if to stop the flow of urine in midstream. Hold the contraction for 10 seconds (to a count of six). This is repeated up to 10 times. Continue to do this exercise for 2 to 3 months. After 3 months if the mother is able to cough deeply with a full bladder without leaking urine, she may stop the exercise. If leaking occurs, she may continue the exercise for the rest of her life. | This exercise increases strength and tone of the chest muscles. | |
| 4) Chest exercise | ||
| Instruct mother to: Lie flat with arms extended straight out to the side, bring both hands together above the chest, while keeping the arms straight, hold for a few seconds and return to the starting position. Repeat the exercise five times initially and follow the advice of the healthcare provider for increasing the number of repetitions. Instruct the mother to bend her elbows, clasp her hands together above her chest, and press her hands together for a few seconds. Repeat this at least five times. | This exercise helps to regain full bladder control, prevents uterine prolapse, and ensures normal sexual satisfaction in future. | |
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Annamma Jacob, Manual of Midwifery and Gynaecological Nursing, 4th Edition, 2023, Jaypee Publishers, ISBN: 978-9356961593
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