Sabine Vesting

The AfterBabyBodyStudy- A study about clinical assessment methods and exercising postpartum and, their associations to urinary incontinence and lumbopelvic pain as well as the women´s thoughts and concerns about the postpartum body.

The many health effects of physical activity and exercise are well known. However, during and after pregnancy, many women adopt an inactive lifestyle. Muscular alterations and physical health problems can be preventing them from resuming exercise.

One muscle group of concern are the pelvic floor muscles which are overstretched up to three times their length during a vaginal delivery. It takes about one year to full recovery. Furthermore, the distance between the two bellies of the musculus rectus abdominis is increasing during pregnancy. Twelve months after pregnancy, 33% of the women have a persistent diastasis recti abdominis (DRA). Related physical health problems are urinary incontinence and lumbopelvic pain. As a result of overstretched muscles, hormonal and biomechanical alterations postpartum, the risk for urinary incontinence and lumbopelvic

pain increase during and after pregnancy. These may also prevent women to engage in exercise.

An increasing number of women are asking for a postpartum check-up of physiotherapists. However, clinical assessment methods for postpartum muscle alterations are insufficiently tested for their reliability and clinical relevance and, there is no consensus about safe exercise advice after pregnancy. Furthermore, the motivation for help-seeking of postpartum women is poorly understood.

Evaluation of clinical assessment methods and how these as well as exercising postpartum are associated to muscular recovery, urinary incontinence and lumbopelvic pain after pregnancy and, exploring the women´s thoughts and concerns about the postpartum body:

  • To test the reliability of clinical assessment methods for pelvic floor muscles and DRA postpartum.
  • To evaluate whether clinical assessments of pelvic floor function and DRA three months postpartum predict the severity or persistence of urinary incontinence and lumbopelvic pain during the first year after delivery.
  • To evaluate if the time to resume exercise and specific types of exercise affects the muscular recovery (pelvic floor/ DRA) and the development or persistence of related symptoms (urinary incontinence/ lumbopelvic pain) during the first year after delivery.
  • To describe and explore women’s thoughts and concerns regarding muscular alterations and recovery postpartum.

For study I-III, a total of 500 women who have given birth, at maximum three months ago, were recruited to a prospective observational study. Their pelvic floor muscles and DRA were assessed four times during the first year postpartum. For reliability, the first 222 women were assessed according to a standardized protocol by two physiotherapists, consecutively, at the first assessment (study I). Before each assessment, the participants completed a questionnaire about urinary incontinence and lumbopelvic pain (dependent outcome variable in study II+III) and about exercise habits (predictor in study III). For study IV, 30 participants will be recruited to five focus groups. The interviews will be audiotaped, transcribed verbatim and analysed using qualitative content analysis.

This thesis will provide knowledge about the clinical relevance of a muscular postpartum check-up and exercising postpartum and, providing the women´s perspectives. This will help physiotherapists and midwives to advice women for a safe return to physical activity/exercise postpartum.

This thesis will provide knowledge about the clinical relevance of a muscular postpartum check-up and exercising postpartum and, providing the women´s perspectives. This will help physiotherapists and midwives to advice women for a safe return to physical activity/exercise postpartum.

Department of health and rehabilitation, unit physiotherapy, at institute of neuroscience and physiology, Sahlgrenska academy, University of Gothenburg

Main Supervisor: Maria Larsson, PhD, Associate Professor, RPT