Pregnancy and Postnatal Care

Understanding pregnancy and postnatal changes

As pregnancy progresses, changes in body weight and how that weight is distributed can place different demands on the back, pelvis and surrounding muscles. Previous back or pelvic problems may also influence how comfortably you manage activities such as walking, climbing stairs or turning in bed.

The pelvic floor is a group of muscles supporting the bladder, bowel and womb. These muscles contribute to bladder and bowel control and need to contract and relax effectively. Pregnancy and childbirth can affect their function, making pelvic floor care relevant during pregnancy and throughout postnatal recovery.

The abdominal muscles also lengthen during pregnancy, and separation between the two sides of the abdominal wall, known as diastasis recti, is common. After birth, some women benefit from guidance to rebuild abdominal strength and manage the physical demands of lifting, carrying and feeding their baby.

Common symptoms and concerns

Reasons for seeking support during pregnancy or after childbirth include:

• Lower back pain or discomfort around the hips and pelvis.
• Pelvic girdle pain (PGP), including pain around the pubic bone or the back of the pelvis.
• Difficulty walking, climbing stairs, standing on one leg or turning over in bed.
• Muscular aches and tension.
• A feeling of pelvic heaviness or reduced pelvic floor control.
• Abdominal weakness or concerns about diastasis recti.
• Back discomfort associated with lifting, carrying or feeding a baby.

You can also seek support even if you are not in pain. For example, you may want to develop an appropriate exercise programme or prepare for a gradual return to activity after birth.

Assessment and individualised care

Assessment begins with understanding your stage of pregnancy or postnatal recovery, medical history, current symptoms and goals. We also consider previous pregnancies, birth experiences, existing musculoskeletal problems and any advice or restrictions from your maternity team.

Depending on your concerns, assessment may explore movement, strength, everyday activities, abdominal function and pelvic health symptoms. This helps identify what is contributing to discomfort and which aspects of treatment are most relevant.

Treatment positions, exercise intensity and hands-on techniques are adapted to your comfort and circumstances. Where symptoms require specialist pelvic health or maternity assessment, we will recommend the appropriate next step.

Support before, during and after pregnancy

Before pregnancy

Pre-pregnancy support can focus on managing existing back or pelvic discomfort, building strength, developing sustainable exercise habits and improving awareness of pelvic floor function. Your programme is based on your starting point and the activities that matter to you.

During pregnancy

We support women throughout the first, second and third trimesters, adapting care as pregnancy progresses. Sessions may focus on managing discomfort, maintaining comfortable movement, adjusting exercise or providing pregnancy massage where appropriate.

After childbirth

Postnatal care focuses on recovery following vaginal or caesarean birth, rebuilding strength and building confidence in everyday movement. Progression takes account of healing, symptoms, birth-related complications and advice from your maternity team. Recovery varies from person to person, and returning to strenuous exercise requires more preparation than gentle activity.

Treatment options

Pregnancy massage

Pregnancy massage provides hands-on support for relaxation and comfort. Research suggests that relaxation massage may help reduce stress and pregnancy-related back and leg pain, although the evidence mainly relates to women with uncomplicated pregnancies. [1]

Sessions are tailored to the areas that feel tense or uncomfortable, with pressure and positioning adjusted to your stage of pregnancy and preferences. You are comfortably supported throughout treatment, usually while lying on your side.

Your therapist will review your health history and any pregnancy-related concerns before treatment to establish whether massage is appropriate. Massage may be booked as a treatment in its own right or incorporated into a broader plan alongside exercise and practical advice.

Individualised exercise and movement

Exercise programmes are adapted to your previous activity level, current symptoms and stage of pregnancy or recovery. For pregnancy-related pelvic girdle pain, physiotherapy guidance supports individualised exercises and advice on movement, rest and activity modification to help manage symptoms and maintain everyday function. [2]

Depending on your assessment, sessions may include:

• Strengthening exercises for the hips, back and lower limbs.
• Gentle mobility exercises.
• Abdominal and pelvic floor exercises.
• Practising movements used in everyday tasks.
• Exercises to support a gradual return to your usual exercise and activities.

Exercises are demonstrated and reviewed so that you understand how to perform them and how to adapt them between appointments.

Pelvic health and pelvic floor support

Pelvic health care focuses on how the pelvic floor functions and how symptoms affect daily life. Support may include pelvic floor education, exercises and advice on managing activities that provoke symptoms.

The National Institute for Health and Care Excellence (NICE) recommends pelvic floor muscle training during and after pregnancy. Its guidance emphasises assessing both contraction and relaxation, with exercises tailored to the individual’s ability, discomfort and goals. [3]

An individual programme may address strength, endurance, coordination and the ability to relax the muscles fully. The emphasis depends on your symptoms and assessment findings. Where specialist pelvic health assessment is needed, we will recommend the appropriate next step.

Practical advice and self-management

Small changes to everyday activities can make movement more manageable. Advice may cover comfortable resting positions, getting in and out of bed or a car, pacing activity and adjusting tasks that aggravate pelvic pain.

After birth, we can also help you explore more comfortable ways to lift, carry and feed your baby, alongside exercises that support your recovery.

How we help at PhysioB

At PhysioB in Ealing, your treatment plan develops with you. Early sessions may focus on comfort and manageable movement, while later sessions may place greater emphasis on strength, pelvic floor function or returning to exercise.

We review changes in symptoms, movement and confidence with daily activities, adjusting your programme as your pregnancy or recovery progresses.

When to seek medical advice

Contact your maternity team immediately if you develop vaginal bleeding, severe abdominal pain, a severe headache, changes in vision, sudden swelling, reduced movements or a change in your baby's usual pattern of movement. These symptoms need maternity assessment. Sudden breathlessness or chest pain requires immediate medical attention.

Whether you are preparing for pregnancy, currently pregnant or recovering after childbirth, book an appointment at PhysioB in Ealing. We will help you develop an individualised plan for comfort, movement, pelvic health and recovery.