As with all clients, it’s important to complete a pre-exercise questionnaire.
When working with pregnant, postnatal and ‘mum’ clients in general, I believe it is even more important to do so.
From experience, many pre-exercise questionnaires only ask if a woman has had a baby in the last 6 months and often don’t go into any more depth.
As a pre/postnatal or ‘mum’ specialist, my belief is that we need to be asking more in-depth questions to mums with children of any age.
Our first session and assessment is an opportunity to get to know each other, ensure I have a full and complete picture of where she is right now, and for me to take the time to understand her aims and aspirations.
Getting started with any kind of exercise program can be daunting, especially if there has been a long gap in between physical activity. For that reason, your must aim to never overdo it. In fact, your client should walk away from her session thinking it was a little too easy. Trust me, making your first session too difficult greater reduces your chances of them coming back. There is plenty of time for you to increase their effort and intensity.
Guide on technique, support on effort, measure on reaction, set goals on feedback and always be professional
Let’s take a look at what should be on your medical pre-exercise questionnaire:
If they are pregnant:
How many weeks pregnant?
Remember it is important not to train your client lying flat on her back after her first trimester.
Do they have a history of miscarriage or did they undergo IVF to fall pregnant?
If your client has a history of miscarriage or has undergone IVF she will most likely have guidelines around exercise from her medical professional. It’s always a good idea to consult with her care team and stick within their guidelines to be on the safe-side.
For your postnatal mum:
What kind of birth did they have?
- Ask about scarring or pain.
- If your client still has pain, ask if they have spoken to a healthcare professional about it. Suggest mentioning it next time they are there with their baby and monitor it.
- Do they have full sensation back at the scar site?
- Ask your client about their second stage of delivery – the pushing stage. If it was long. If it was 45 minutes or more, then there has been excessive downward pressure on their pelvic floor. This highlights that there may be a weakness to watch out for.
- Ask your client about tearing and/or episiotomy and if they had stitches. If yes, to what degree (they may or may not know)? Ask how they are healing and discuss any pain during the session.
- If your client’s baby is under six weeks old they should not be training with you yet. Longer for a caesarean birth and they MUST have doctors clearance.
- Ask your client if there were any complications during pregnancy and/or delivery that you need to be aware of.
- Even if your client has had a caesarean delivery, please advise them that they have still carried the weight of their baby on their PF throughout their pregnancy.
If they feel their pelvic floor is OKAY:
- Ask what exercise they have been doing, anything other than day-today activities?
- If they have been running, how is their pelvic floor, do they have any symptoms?
- If they feel fine and they are just coming back to exercise, then still let them know your will start off slowly. It’s important to create an environment where they will tell you if something doesn’t feel right or they experience a leaking, dragging or heavy sensation.
- Sometimes women may not be symptomatic until they increase the intensity of their exercise. Stress that they need to let you know what is going on throughout the session.
If they are keen to up the intensity, you need to monitor their pelvic floor and see how they go. This is a good opportunity to suggest seeing a women’s health physio to find out exactly what is happening on the inside.
If they feel they have a weak pelvic floor (leaking or dragging sensation):
- Ask if your client have seen anyone about their pelvic floor.
- Have they had Real Time Ultrasound or an internal examination and what were the results?
- If they haven’t seen anyone and they are leaking, then it’s a very good idea to recommend they do. You can explain that it is quite normal after having a baby and it is a good idea to see a women’s health physio.
- Absolutely no running or jumping in this situation until they have seen a specialist.
- Some clients will be aware of their transversus abdominis and some will not.
- Ask your client where they learnt about their TA, for example Pilates or physio?
- Explain that this awareness is great, review again and explain how to activate and incorporate this awareness into exercises.
- Explain that they are in the right place and go through TA activation when you start the session.
You can ask your client if they have been assessed for abdominal separation. Some may never have been assessed and some possibly only days or weeks after having their baby.
As a Fitness Professional working with mums, it’s important that you can check them and ensure you are prescribing the right exercise for wherever stage they are at.
Exercises to avoid if there is separation:
- No twisting.
- No levering, that is sit-ups or leg lowering.
- No back bends (yoga poses).
- ANY exercise that creates doming through the tummy.
Regardless of whether your client has separation or not, you need to give the abdominals a chance to rebuild from the inside out.
My advice is to treat a new mum as if she has separation whether she does or not for the first eight weeks and assess doming through each exercise.
Many of your clients will have back pain, so ask them to tell you more about it and take notes.
- Pre or post pregnancy pain?
- Are they seeing another health professional?
- If so find out their details and call them.
- Any exercises that aggravate the pain?
- Upper back pain?
- Lower back pain?
- Explain to your client that they need to talk to you and let you know what they are feeling rather than just pushing through. You can adjust or substitute exercises if you know.
Pelvic instability is a condition that causes pain around the joints of the pelvis during and after pregnancy. When the hormone relaxin softens the ligaments around the joints of the pelvis too much, the pelvis can become unstable or out of alignment. Some women can be in a lot of pain.
- Ask your client if they still have pelvic pain?
- Are they seeing a specialist?
- Remind your client to let you know if something doesn’t feel right in the session.
Talk about exercises they should avoid:
- Any unilateral leg exercises, for example lunges, dead lift, opposite arm/leg extension, single leg hip raise etc.
- Any exercises that aggravate the pelvic area.
Along with your pre-exercise questionnaire, when working with mums it’s important to remember there is much more than just the physical happening in her life.
Many women will suffer postnatal depression (PND) symptoms of, or be at risk of, after becoming a mother so creating a safe space that she can talk to you and you can refer her to her GP for further support is important.
For the majority of postnatal women exercise is GOOD!