Obstetrics, Gynaecology and Pelvic Floor Physiotherapy

Enhanced Recovery after Obstetric Surgery in Scotland (EROSS) class

This in an online class available for those who are planning to have a caesarean birth – Caesarean Section Preparation Class. This class is available at the Princess Royal Maternity Hospital every second Thursday at 11.00am on Microsoft Teams. Birthing partners are welcome to attend.

Please discuss this further with your midwife to be booked in and you will be provided with a link to the class.

Pregnancy related Pelvic Girdle Pain class (PPGP class)

This class is available for those who are experiencing PPGP during their pregnancy. This class runs at the Princess Royal Maternity Hospital physiotherapy department every second Friday afternoon at 1:00pm. If you think you would benefit from this class please complete the following self-referral form.

Information about how to manage PGP is available.

Care of your body during Pregnancy class

This class is available between 12-30 weeks pregnant. It will provide you with an opportunity to discuss pregnancy related changes to your body and how to manage them. It also aims to promote health, wellbeing and exercise in pregnancy.

This class will run every second Monday at 1.00pm at the Physiotherapy Department.

To book this class, please self-refer via the following link: Care of body class self-referral

Physiotherapy led Care of your body during Pregnancy class

This class is available between 12-30 weeks of pregnancy. It will provide you with an opportunity to discuss pregnancy related changes to your body and how to manage them. It also aims to promote health, wellbeing and exercise in pregnancy.

It generally runs on the first Thursday of the month from 3-4.30 pm.

If you would like to book, please complete the following form

Pregnancy related Pelvic Girdle Pain class (PPGP class)

This face to face class is available for women who are experiencing PPGP during their pregnancy. This class runs at the Queen Elizabeth University Maternity Hospital once a week on a Thursday morning at 11.15am. If you think you would benefit from this class please complete the following self-referral form.

Information about how to manage PPGP is available here.

Physiotherapy led Care of your body during Pregnancy class

This class is available as a one off class to everyone between 12-30 weeks pregnant onwards. It will provide you with an opportunity to discuss pregnancy related changes to your body and how to manage them. It also aims to promote health, wellbeing and exercise in pregnancy.

It takes place twice a month, on a Monday between 1.15 -2.30 pm at the Physiotherapy Department on the Ground Floor of the Maternity Unit at the Queen Elizabeth Campus.

If you would like to book, please complete the following form

Enhanced Recovery after Obstetric Surgery in Scotland (EROSS) class

This class is available for women who are planning to have a caesarean section – Caesarean Section Preparation Class. This class is available at the Royal Alexandra Hospital every Friday afternoon at 2.00pm on Microsoft Teams.

Class invitations will be sent to individuals once their caesarean section date has been booked.

Pregnancy related Pelvic Girdle Pain class (PPGP class)

This class is available for women who are experiencing PPGP during their pregnancy. This class runs at the Royal Alexandra Hospital on Monday afternoon at 1.00pm. If you think you would benefit from this class please complete the following self-referral form.

Information about how to manage PGP is available here.

Physiotherapy led Care of your body during Pregnancy class

This class is available between 12-30 weeks pregnant onwards. It will provide you with an opportunity to discuss pregnancy related changes to your body and how to manage them. It also aims to promote health, wellbeing and exercise in pregnancy.

This class will run once a month on a Tuesday afternoon, from 1.30pm to 3.00pm in the Parent Education Room 2 on level 3 in the Maternity Unit.

If you would like to book, please complete the following form

Your pelvic floor muscles sit at the base of your pelvis. They help to keep your bladder, womb, vagina and bowel (pelvic organs) in the right place. Your pelvic floor muscles should be kept strong and active, just like any other muscle.

All bladder and bowel functions need good pelvic floor muscles. For example, when you need to go to the toilet, you use your pelvic floor muscles to prevent any leaks. Then, you will fully relax them to pass urine when you physically get to the toilet.

Strong pelvic floor muscles boost your core strength and stability. They can improve your sexual function too. Pelvic Floor Exercises are for life and can help to stop you from having bladder, bowel or prolapse symptoms in the future.

Pregnancy puts a lot of pressure on your pelvic floor muscles and it is normal for the pelvic floor muscles to stretch during a vaginal birth. Your muscles may be weaker and you may feel more pressure vaginally, so it is very important to strengthen your pelvic floor muscles soon after you have had your baby.

By doing your pelvic floor exercises you can avoid having symptoms such as leaking urine when laughing, coughing, sneezing and symptoms of vaginal heaviness.

For further advice on pelvic floor exercises please refer to:

POGP Pelvic Floor Exercises video

POGP Bladder and Vaginal Problems

POGP Constipation During and After Pregnancy

POGP When To Start and How To Do Perineal Massage

POGP After Birth Week One Bladder Care

NHS Highland Pelvic Floor Muscle Exercise Information Video: https://www.youtube.com/watch?v=v731EXFR2k4

Women’s pelvic floor muscles/NHS Inform

Pelvic Floor Muscle Exercises Information Leaflet: https://pogp.csp.org.uk/publications/pelvic-floor-muscle-exercises-women

SqueezyApp for Information Leaflets and Videos on Pelvic Floor Muscle Exercises: https://www.squeezyapp.com

Being physically active in pregnancy has numerous clinically meaningful health benefits and is considered safe if you are healthy and your pregnancy is low risk. Unless you have been advised to avoid exercise during your pregnancy you can follow the advice below.

Guidelines recommend accumulating at least 150 minutes of moderate intensity physical activity every week and doing muscle strengthening activities twice per week. It’s good to try and be active in some way every day, every activity counts.

Moderate intensity physical activity is intense enough to noticeably increase heart rate; you should be able to talk but not sing during activities of this intensity.  Examples include; climbing stairs, yoga, swimming, gym activities such as using the treadmill, carrying grocery shopping bags, cycling, dancing and going for a walk.

Being physically active in pregnancy:

• Helps reduce high blood pressure
• Improves sleep
• Helps to prevent gestational diabetes
• Improves mood
• Reduces risk of pre-eclampsia
• Reduces the risk of having a caesarean or instrumental birth
• Decreases the risk of urinary incontinence
• Reduces the risk of excessive gestational weight gain
• Improves blood sugar
• Reduces the risk of back and pelvic pain

If you are not normally active, the advice is to start gradually. If you are already active, the advice is to keep going. It is important to listen to your body and adapt appropriately.

There is no evidence to suggest that moderate intensity activity throughout pregnancy has any negative effect on either mother or their developing baby. 

Safety Precautions

• Avoid physical activity in excessive heat
• Avoid activities which involved physical contact or danger of falling
• Avoid scuba diving
• Maintain adequate nutrition and hydration – drink water before/during and after

Reasons to Stop and Consult a Health Care Provider

• Persistent excess shortness of breath that does not resolve at rest
• Severe chest pain
• Regular and painful uterine contractions
• Vaginal bleeding
• Persistent loss of fluid from the vagina indicating rupture of the membranes
• Persistent dizziness or faintness that does not resolve on rest

If you are having a high risk pregnancy or are not keeping well please speak to you obstetric team before exercising.

For further advice or ideas on exercises please follow the links below;

Reference Centre

Physical activity guidelines for pregnant women: Physical activity for pregnant women

Fit and Safe: Exercise in the Childbearing Year

POGP Exercise During Pregnancy

After the birth of your baby you will need time to recover. It is important that you listen to your body. You can safely start exercises such as pelvic floor strengthening, pelvic tilting and gentle tummy muscle activation after a day or two. You can also start to gradually build up your walking. These exercises as well as some helpful advice for your postnatal recovery can be found in the following leaflet:

POGP: Fit for the Future

After 6 weeks, if you feel ready, you can return to low impact exercise such as Pilates and yoga. Here are some example of where to start.

POGP: Pilates in Woman’s Health Physiotherapy

NHS Pilates and yoga

You can return to swimming once any scars have healed and lochia has finished, this is usually around 8 weeks.

You may wish to start strength training. Strength training is recommended by the government physical activity guidelines for women after childbirth. You should try to be active every day, the government guidelines further recommend that you aim for 150 minutes of moderate activity every week.

We recommend not starting high impact exercises until after three months from the delivery of your baby to give your pelvic floor plenty of time to recover.

POGP Pelvic Floor Exercises video

POGP After Birth: Return To Exercise

Before the time comes for labour and birth, it will be useful to check out our Reference Centre for information about relaxation, positions and breathing for labour. We recommend you try this ahead of time and with your birthing partner so you can be more comfortable and in control on the day.

If you are having a caesarean birth here are some useful videos:

My Caesarean Delivery Birth

Physiotherapy advice – after your Caesarean Birth

External Resources 

POGP – Preparing for caesarean birth

POGP – Postnatal caesarean birth recovery

POGP After Week One: Pain Management

POGP After Birth Week One Bladder Care

Information about pregnancy, labour and birth and early parenthood – Ready Steady Baby!

Information about pain relief options – Labour Pains UK

Relaxation for Labour Demo Video – BabyCentre UK

Breathing for Labour Video – BabyCentre UK

Positions for Labour Video – BabyCentre UK

Massage for Labour Video – New Life Classes Ltd

Fit for birth

Reproduced with permission of LabourPains.com, NHS inform – Ready Steady Baby!, BabyCentre, New Life Classes and Pelvic Obstetric and Gynaecological Physiotherapy (pogp.csp.org.uk)

After pregnancy and birth it is important to look after yourself. We have put together some advice and information to help your postnatal recovery. Click the link for a range of useful resources reference centre. The POGP Posture and positioning video is also helpful.

If you would like to refer to Physiotherapy with a muscle or joint problem (for example back pain, pelvic pain, hand pain), and it has been less than 6 weeks since you had your baby, please complete the self-referral form.

If it has been more than 6 weeks since you had your baby please self-refer to the MSK Physiotherapy Department.

If you are having problems with bladder or bowel control, prolapse or issues with your pelvic floor muscles or tummy muscles and had your baby less than 6 months ago, please use this self-referral form.

If it has been more than 6 months please see your GP who will be able to refer you into the right service.

PPGP is a term used to describe aches and pains experienced during pregnancy or in the early post-natal period around pubic bone, groin, buttocks, hips and/or lower back.

Use the links below for advice on how to manage PPGP:

POGP Back and Pelvic Pain During Pregnancy

POGP Posture and Positioning

Pregnancy Related Pelvic Girdle Pain and other common conditions in pregnancy | POGP

Video with relevant exercises (Pelvic floor, pelvic tilting and deep abdominal exercise)

External Resources

Working from Home – Advice and Exercises: www.csp.org.uk/publications/do-you-sit-desk-all-day-leaflets 

Reproduced with permission of Pelvic Obstetric and Gynaecological Physiotherapy (pogp.csp.org.uk) and the Chartered Society of Physiotherapy (csp.org.uk). 

NHS Highland Pelvic Floor Muscle Exercise Information Video: https://www.youtube.com/watch?v=v731EXFR2k4

Pregnancy related Low Back Pain is pain experienced during pregnancy or in the early post-natal period around the bottom of your back. If you have pain in other areas around your back, this information will also be useful.

Use the links below for advice on low back pain during pregnancy or after having a baby:

• Pregnancy related Low Back Pain | POGP
• POGP Back and Pelvic Pain During Pregnancy
• POGP Posture and Positioning
• Fit for future | POGP
• Video with relevant exercises (Pelvic floor, pelvic tilting and deep abdominal exercise)

DRAM is part of the normal changes that occur during pregnancy. It involves stretching of the tissues and muscles around your tummy to accommodate your growing baby. This can take up to a year to recover.

Factors that may increase the risk of developing DRAM are;

• Multiple Pregnancy or larger babies
• Stretching in previous pregnancies
• Poor abdominal muscle tone
• Genetics

A small amount of separation of the tummy muscles, 2-3 fingers width, is common after most pregnancies and likely to resolve with time. You can check your DRAM by following the steps below;

• Lie flat on your back with your knees bent and your feet flat on the bed
• Place 4 fingers across your tummy just above your belly button
• Raise your head and shoulders slightly off the floor
• You will feel the two tummy muscles coming together against your fingers

If you notice the following then you may require a specialist physiotherapist to review;

• The space is more than 3 fingers wide
• A visible bulge in your tummy
• Your fingers sink deeply into your tummy

You can self refer for this up to 6 months after you have had your baby by completing the following form;

self referral form

External Resources

• POGP Fit for Future
• POGP After Birth – Your Stomach Muscles
• POGP: Post Natal Pilates
• Reproduced with permission of Pelvic Obstetric and Gynaecological Physiotherapy (http://pogp.csp.org.uk)

You can find information on the Pelvic Floor Physiotherapy section of this website.

If you are seeking advice regarding symptoms following birth then you can contact your local department for advice.

• Obstetrics Anal Sphincter Injuries (OASIS) 3rd / 4th degree tears Leaflet

External Resources

POGP Pelvic Floor Exercises video

POGP Constipation During and After Pregnancy

POGP Bladder and Vaginal Problems

POGP – Management of Continence

POGP – Pelvic Floor Muscle Exercises

POGP – Pelvic Organ Prolapse

POGP – Improving your bowel function

NHS Highland Pelvic Floor Muscle Exercise Information Video

SqueezyApp for Information Leaflets and Videos on Pelvic Floor Muscle Exercises

Reproduced with permission of Pelvic Obstetric and Gynaecological Physiotherapy (pogp.csp.org.uk) and SqueezyApp.com

Coccydynia (tailbone pain) is pain experienced in and around the sitting bone, especially when sitting. This can appear during pregnancy or after birth.

Use the links below for advice about coccydynia or tailbone pain:

POGP Leaflet on Pregnancy Related Pelvic Girdle Pain and other common conditions

External Resources

Working from Home – Advice and Exercises

Reproduced with permission of Pelvic Obstetric and Gynaecological Physiotherapy (pogp.csp.org.uk) and the Chartered Society of Physiotherapy (csp.org.uk). 

Carpal Tunnel Syndrome is pain, numbness, pins and needles and tingling of the fingers and hand(s). There may be also swelling of the hands and you might feel your hands are clumsy, weak and tire easily. This can appear during pregnancy or in the early post-natal period due to the changes happening to your body.

Use the links below for advice on how to manage carpal tunnel syndrome:

• NHS Inform Carpal tunnel syndrome
• Wrist Splint Fitting Instructions

Wrist Splint Size Guide

DeQuervains Synovitis is pain on the base of the thumb, swelling and reduced movement. This can appear during pregnancy or in the early post-natal period due to the changes happening to your body.

Use the links below for advice on how to manage DeQuervains Synovitis:

• DeQuervains Synovitis Information Leaflet

• Thumb Spica Fitting Instructions

Thumb Spica Size Guide