When you get to six weeks post baby and you are told you can magically return to all normality. Is that realistic? What now…Marie Fell The Pilates Physio

Post baby the initial euphoria and ecstasy quickly turns into serious sleep deprivation and the realisation of “what now” sinks in, your personal care often gets pushed way down the list, infact no, it gets buried below the ground. If you manage to brush your teeth and hair some days you are winning at life!


You will tentatively tip toe through those first few days and weeks wondering strange things like how your first wee and poo will be? Processing that you did really just grow and birth another human being? Forgetting your own sanitary products after meticulously packing your baby bag, etc.

Being awake most of the night and day and after several days or weeks of this the cracks and strains of all this “newness” may start to show for many of us.


Most of us will get to six weeks post natal and think where did that time go? How is my baby six weeks old already? You may have had umpteen appointments for your baby by now also. So when the six week baby check rolls around and you are asked the ONE QUESTION about you in your baby’s red book:

“Do you feel well in yourself?” Yes/No.

The Yes/No answer is a complete cop out. NICE guidelines state maternal mental health must be screened and so it is this ONE question at your babies six week check up that literally TICKS THAT BOX.

It is ludicrous really.

For many it is also laughable that your GP’s main concern is contraception! Having just birthed a human many of us don’t have this at the forefront of our minds.

Before my six week post natal period a letter landed on my doormat from my GP saying “unless I had persistent pain/bleeding or wanted contraception then a six week review post baby was not deemed necessary”!

As a women’s health physiotherapist I was pretty outraged by this. I wanted a check up OF ME, FOR ME.

Second time round I knew two pregnancies on my pelvic floor definitely deserved being checked out. I wanted…

  • reassurance my tummy muscle separation was within normal limits.
  • guidance on return to safe exercise for me personalised to my pregnancy, birth history and fitness levels.
  • an assessment of some sort and someone to talk to, listen, advise and guide me. Instead I got sweet fanny adams!


This got me thinking…many gyms, fitness professional & personal trainers and crikey even me as a women’s health physio previously and very naively said “once you’ve seen your GP at six weeks post birth and they are happy, you are cleared to exercise safely”.

I have a huge problem with this on many levels. It is WRONG. It is NIAVE. And like me, if there was no six week GP check up who on Earth gives you that “all clear”?


Even myself as a pregnant and post natal physiotherapist & pilates teacher post birth I felt lost. I felt unable to judge what was safe and what wasn’t safe for my body. I was struggling to breastfeed, therefore spent many hours in awful postures and positions and I was recovering from a second c-section whilst also looking after an older child to.

I could not practise what I preached and I felt:

  1. A fraud
  2. Anger and frustration
  3. Something needed to change.

So I campaigned and lobbied parliament by writing a petition asking for improved post natal care for all women. This created great waves and is helping today to change matters as I write.

The purpose of this blog was to educate and inform about the WHY a six week post natal check up is IMPORTANT FOR EVERY WOMAN.

what exercise is safe after giving birth Marie Fell - The Pilates Physio

There are lots of variables to consider and here are a few for you:

  1. Your pregnancy – how many have you had including miscarriages? Any complications physically, medically, mentally?
  2. Your birth – type of delivery, how long you laboured for, position of delivery, any complications or injuries, any cuts or tears to your perineum?
  3. Your previous fitness levels – what type of exercise did you do before and during pregnancy?
  4. Do you have other dependents to look after?
  5. What support do you have at this current time for you?
  6. Are you planning to return to work? When? What does your job entail?
  7. Feeding regimes – how is your baby fed and are you coping with it?
  8. Bladder and bowel functions.

All this information is needed before the following can be assessed:

  1. Your tummy muscles for separation and your breathing technique.
  2. Your pelvic floor muscles ?strength, ?function, ?incontinence concerns, ? prolapse concerns.
  3. Return to exercise advise based on all the first set of questions and then the two above.

For a GP to deem this not necessary and for fitness professionals to say as long as the GP has cleared you to exercise without the above screening is COMPLETELY BONKERS!!!

Also those who question why you would need to know any of the above before working with post natal ladies ? Walk away from them quick smart.

I know a lot of ladies feel six weeks is to soon for a check up as you’re still in la la land and haven’t a scooby about your bits.

Many ladies wrongly assume if they are NOT leaking they are completely fine.

A lot of women also believe if their pregnancies and births had no complications and they are not leaking then they are fine also.


Lack of awareness of post natal pelvic health can lead to pelvic organ prolapse in 1:3 post natal women. Pelvic floor dysfunction may not materialise until your next pregnancy, your next birth or the menopause but it it EXTREMELY COMMON that this WILL and DOES HAPPEN to many of us.

Marie Fell The Pilates Physio

I love this quote I heard from Michelle Lyons (women’s health physio, ) the other day “Menopause is when we see the after effects of obstetric events 20years ago with pelvic floor dysfunction, prolapse and incontinence”.

As women we are often so embarrassed by our symptoms we do not discuss them and so the 1:3 statistic of women experiencing incontinence is likely to be a LOT HIGHER.

What I want you to think about is this: your pelvic floor muscles are muscles.

They lengthen and stretch throughout the nine months of your pregnancy. Regardless of a sun roof delivery (c-section) or a down and out through your love tunnel (vaginal delivery) they take A LOT of excess WEIGHT. Times this by the number of pregnancies you have had and that is a HUMONGOUS STRAIN/WORK OUT.

To then not give them any thought or any time of day afterwards until da, da, dummmm, they FAIL YOU 🙁 which can be years down the line then I’m pretty certain you will kick yourself and say “WHY DIDN’T ANYBODY TELL ME?”.


Well, here I am ladies, I am telling you. Hell, I’m even SHOUTING this at you.

Marie Fell The Pilates Physio

Pelvic health is for LIFE.

It affects all women.

Women who don’t have children can also be at risk of pelvic floor dysfunction. Being overweight, a smoker, having a chronic cough, suffering with chronic constipation and lifting heavy weights regularly with poor technique – we’ve all seen the crossfit ladies who pee themselves doing it! Not good or clever.

Anything that causes you to regularly BEAR DOWN and perform the “valsalva manoeuvre” frequently is BAD. Bad news for your Pelvic health.

I hope this blog gives you food for thought? I am still working hard to provide follow up post natal physio for all mums in the UK in future. It is not going to happen overnight as there just are not enough women’s health trained physio’s to meet demand BUT we have a plan and we are hoping to start as soon as possible with piloting it.

We are also hoping that the six week post natal check will involve self referral and be open ended so it doesn’t need to be taken in the first six weeks. I would URGE all ladies to be screened even if you are NOT leaking because your pelvic floor muscles will have been undoubtedly stretched and could do with some TLC before you hit the gym or the park for a run!


Respect your body. It has just after all grown and birthed a tiny new human being.

A true miracle in itself and it deserves your TIME, CARE, PATIENCE and ATTENTION.


I hope my passion on this subject has shone through here. I am starting online consultations for women Thursday afternoons 12.30 – 2.30pm UK time from 28th Feb 2019. Please contact me for prices and availability if you would like to discuss your pelvic health with me and thank you for your time reading this all the way through.