Having a baby changes your life...but one needs to get back to the fighting FIT self and embrace the new life with zest and joy...

1. POST PARTUM
FITNESS
COMPIlEd by
dR AShwINI VIVEk
SExUAl hEAlTh CONSUlTANT
Zest Sexual Health Clinic, East street , Camp Pune

2. The moment a child is Born, the mother is also
Born. She never existed before. The woman
existed, but the mother, never. A mother is
something absolutely NEW.
~ RajneeshZest Sexual Health Clinic, East street , Camp Pune

3. Zest Sexual Health Clinic, East street , Camp Pune

4. After my daughter popped out at 8 pounds, 2 ounces, I stared at my
still-protruding belly in shock, and cried when someone man asked me
when I was due — two weeks after I had delivered.
I cried pretty often back then: news stories, Kleenex commercials, at
one wrong word said by my husband. I spent my days at home, wishing I
could get some sleep and kept lying to my friends who called to ask if
everything was okay.
I was exhausted, hormonal and grumpy, and I felt trapped in my house,
wondering if I’d ever feel normal again.
I knew those first weeks with baby would be hard, but I didn’t know how
hard. And I just didn’t know what to do …….
Zest Sexual Health Clinic, East street , Camp Pune

5. Beware
 More than 60% of maternal
deaths take
place during postpartum
period
 First 48 hours are most crucial;
hence length of stay in health
facility is 48 hours , Most
maternal and neonatal
complications
occur during this period.
 Excessive bleeding after
delivery
 Perineal pain - Haemotama/
incisions/lacerations
 Vaginal discharge
 Breast problems, such as
swollen breasts, infection and
clogged ducts
 Hemorrhoids and constipation
 Urinary or fecal (stool)
incontinence
 Thrombophlebitis
 Hair loss
 Stretch marks
 Postpartum depression
 Discomfort during sex
Zest Sexual Health Clinic, East street , Camp Pune

6. Zest Sexual Health Clinic, East street , Camp Pune

7. MASTITIS
BREAST ABSCESS
Zest Sexual Health Clinic, East street , Camp Pune

8. PUEPERIAL INFECTION:
Warning signs
 Fever
 Abdominal pain
 The woman feels ill
 Swollen, red or tender breasts, or sore nipples
 Dribbling of urine or painful micturition
 Pain in the perineum, or pus draining from the
perineal area
 Foul-smelling lochia.
 INFECTION OF THE GENITAL TRACT, usually of
the endometrium, that may remain localized
or may extend to various parts of the body
 Diagnosis is made by
sustained fever of 38°C
(100.4°F) or higher occurring
on any two of the first 10 days
postpartum, excluding the
first 24 hours
Zest Sexual Health Clinic, East street , Camp Pune

9. Post Partum care & Hygiene
 Not to be left unattended; any change in condition should be reported
 Not to insert anything into the vagina.
 To change the perineal pads every 4-6 hours, or more frequently, if there is
heavy lochia.
 To wash the perineum daily and after passing stools. Wash in an
anteroposterior direction from the vulva to the anus.
 To bathe daily, wash her hands before handling the baby..
 To have enough rest and sleep.
 To avoid sexual intercourse for the first six weeks or until the perineal wound
heals, whichever is later.
Zest Sexual Health Clinic, East street , Camp Pune

10. Post partum depression/Psychosis
1. Exaggerated and prolonged
periods of irritability,
moodiness, hostility, fatigue
2. Ineffective coping
3. Withdrawal and
inappropriate response to
the infant or family
4. Loss of interest in activities
5. Insomnia
Zest Sexual Health Clinic, East street , Camp Pune

11. Differentiate
 BABY BLUES : developmental crisis – adjustments -new role of parent,
added responsibilities, fatigue after all the excitement that goes with
the birth. 70-80% of women will experience depressive symptoms that70-80% of women will experience depressive symptoms that
disappear within a few weeksdisappear within a few weeks
 POSTPARTUM DEPRESSION: 10% experience some degree of postpartum10% experience some degree of postpartum
depression which can last a yeardepression which can last a year
 POSTPARTUM PSYCHOSIS: Higher risk associated with bipolar disorder
and schizoaffective disorder
If left untreated, can lead to:
 Child Abuse
 Suicide
 InfanticideZest Sexual Health Clinic, East street , Camp Pune

12. Postpartum care may be affected by
cultural beliefs, Gender bias
Signs and symptoms may be overlooked, making the
diagnosis of depression difficult
Management:
 Counseling – psychologist/psychotherapist
 Medications- SSRIs - fluoxetine (Prozac) 10-60 mg/d,
sertraline (Zoloft) 50-200 mg/d, paroxetine (Paxil) 20-60
mg/d, citalopram (Celexa) 20-60 mg/d, or escitalopram
(Lexapro) 10-20 mg/d
 SNRIs such as venlafaxine (Effexor) 75-300 mg/d or
duloxetine (Cymbalta) 40-60 mg/d
Support from
family
and friends
Zest Sexual Health Clinic, East street , Camp Pune

13. Breastfeeding
Technique
Teach correct positioning &
attachment for breastfeeding
Zest Sexual Health Clinic, East street , Camp Pune

14. Zest Sexual Health Clinic, East street , Camp Pune

15. Accepting the new NORMAL
Take care of the
mother so that
she can take
care of the baby
Zest Sexual Health Clinic, East street , Camp Pune

16. Family planning - Cafeteria Aproach
 When not exclusively
breastfeeding can become
pregnant as soon as four weeks
after delivery if sexually active
 Non-hormonal methods –
LAM-lactational amenorrhea method
Barrier methods
IUCD
Sterilization
 Hormonal methods:
POP progersterone only pills- Milk
production unaffected.
Estrogen may reduce the amount of breast
milk.
 Safer for women who are older than 35
and smoke, have high blood pressure, or
have a history of blood clots
Inform about all contraceptive choices in postpartum period
ALLOW TO MAKE FREE INFORMED CHOICEZest Sexual Health Clinic, East street , Camp Pune

17. What is the new acceptable “NORMAL”
Accumulating the
pregnancy flab-
has been
associated
with being
overweight or
obese 15 to 20
years later in
life"
Zest Sexual Health Clinic, East street , Camp Pune

18. DIET AND SUPPLEMENTS
 SHE CAN EAT NORMAL FOOD
 NONE OF THESE will harm the breast fed baby
 Diet to be rich in iron & fiber
 Counseling family members like mother in law, husband
 Counseling on diet especially for adolescent mother
 IFA Supplementation
 Women with normal Hb are advised to take 1 IFA tablet daily for 3 months
 If Hb below 11 gm%, advise her to take 2 IFA tabs daily and repeat Hb after
1 month
Zest Sexual Health Clinic, East street , Camp Pune

19. Keep going- One step at a time
 If you started out at a normal weight and gained the 25-35
pounds your doctor probably recommended, it shouldn't
take you more than a couple of months to get back to your
pre-pregnancy weight if you watch what you eat
and exercise
 If, on the other hand, you were overweight before your
pregnancy or you put on more weight than your doctor
advised
 It could take much longer -- up to a year -- to get the
weight off. Any baby weight you don't take off could stick
with you for a long time.
Zest Sexual Health Clinic, East street , Camp Pune

20. PATIENCE
GOING ON AN OFFICIAL "DIET" could derail your post-
pregnancy weight loss goals.
Feeling deprived of your favourite foods while you're already
stressed out by your new role as mom could actually cause
you to gain weight
"It took nine months to get there.
It should take at least that long to get back
to the fighting weight”
Zest Sexual Health Clinic, East street , Camp Pune

21. Go NATURAL
 "If you go back to eating healthy and eating for your
hunger, most women find that the weight comes off
pretty naturally
Instead of dieting, it is recommended eating a well-
balanced variety of foods. Keep different snacks in the
house to keep you from feeling hungry and give you
energy throughout the day. Apple slices, carrot sticks, dry
fruits almonds, raisins, walnuts, figs, are all good for
noshing
 No matter how much you want to lose weight, try not to
dip below 1800 calories a day, particularly if you
are breastfeedingZest Sexual Health Clinic, East street , Camp Pune

22. Drink up
 Prevents you from getting dehydrated.
 It also fills you up so that you don't eat as much
 Research has found that it may speed up
your metabolism
 How much is enough ?? - your urine should be
relatively clear, and you should be going to the
bathroom about every three to four hours.
Zest Sexual Health Clinic, East street , Camp Pune

23. Get some sleep.
 Being sleep deprived could make it harder for you to shed the baby weight.
 When you're tired, your body releases cortisol and other stress hormones that
can promote weight gain. "Also when you're exhausted, you don't feel like
taking good care of yourself,“
 "You are less likely to choose healthy foods. You are more likely to grab
something like fast foods or sweets.
 You're also less likely to get physical activity.
 RECOMMENDED- SEVEN HOURS
Zest Sexual Health Clinic, East street , Camp Pune

24. ASK FOR HELP
Zest Sexual Health Clinic, East street , Camp Pune

25. When to resume sex life ??
 Men crave sex more even when
they are tired
 to feel emotionally close to their
partners and also to relax
 Four to six weeks, i.e. after stopping the
vaginal discharge (lochia- Predisposes to
infections)
 Vaginal delivery/C-section
 Stitches on the perineum – wait longer
Zest Sexual Health Clinic, East street , Camp Pune

26. Challenges
 Lack of sleep- smothers the sex
drive
 Hormonal changes after birth-
lack of lubrication
 Lubrication issues go away after
stopping breast feeding or
resuming your period
 Constant breast feeding duties get
in the way
 Constant nursing or pumping milk
makes the breasts tender
 And they look different –
frightening for males
 Body changes – how woman feels
about her post baby body- Is she
feeling sexy
Zest Sexual Health Clinic, East street , Camp Pune

27. There are not just TWO people in the bed
But THREE !
Explore the alternatives
Zest Sexual Health Clinic, East street , Camp Pune

28. Be honest- what is holding you back
A common feeling is
resentment about being stuck at home,
feeding and changing diapers
While the male partners get to go out,
work, socialise and spend time with friends
Zest Sexual Health Clinic, East street , Camp Pune

29. Intimacy
 Sex is not about just sexual intercourse, it is about “pleasuring each other
and there are many ways to do that”
 Consider other modalities even erotic massage or manual stimulation
 Even if you are not feeling sexual try and connect with your partner, kissing,
holding hands, hugging or cuddling
Zest Sexual Health Clinic, East street , Camp Pune

30. Importance of Post-Natal Exercises
 Improve circulation
 Strengthen pelvic floor muscle
 Prevent backache
 Strengthen the tummy muscles
 Low impact exercise is preferable
during postnatal period
Zest Sexual Health Clinic, East street , Camp Pune

31. Principles
 Frequency
 Intensity-mild to moderate exercise are recommended
 Duration-30 minutes of exercise per day
Zest Sexual Health Clinic, East street , Camp Pune

32. Begin as early as you can
 Deep breathing exercise
Lie on bed with knees bent, with a pillow behind
Breathe in deeply through nose. Sigh out. Repeat 5 times.
Breathing exercises help to improve your circulation
 Foot And Ankle Exercise
Keep Knees Relaxed For Both Exercises.
Bend and stretch ankles vigorouslyup and down for 30 seconds.
Circle both feet 10 times in each direction.
Zest Sexual Health Clinic, East street , Camp Pune

33. Concentrate on your below navel area
 Pelvic floor muscles are stretched
during pregnancy and childbirth.
 Strong pelvic floor muscles are
essential to prevent leakage of
urine when sneeze or cough, for
enjoyable sexual intercourse and
to give complete control of
bowels.
 Strong muscles will also help
prevent developing uterine
prolapse
 KEGELS:
 can do this exercise standing,
sitting or lying.
Pull the area around vagina up and
down
 The contraction should be held for
10 seconds (to a count of 6) and
repeated upto 10 times
Zest Sexual Health Clinic, East street , Camp Pune

34. Create a Routine
 WALKING
 Low Ab Leg Raises
 Pelvic tilt
 Cat arch pose
 AB Crunches
Zest Sexual Health Clinic, East street , Camp Pune

35.  PELVIC TILT
Lie on a firm surface with knees bent and a
comfortable pillow beneath the head
Abs CRUNCHES
On the 2nd
post partum day-Lie flat and raise head until the
chin is touching the chest.
On the 3 rd post partum day-raise both head and shoulder
off the bed and lower them slowly , increase gradually.
Zest Sexual Health Clinic, East street , Camp Pune

36. Zest Sexual Health Clinic, East street , Camp Pune

37. LEG RAISES- can begin
from the 7 th post
partum day
KNEE ROLLING- to strengthen the
oblique abdominal muscles
Zest Sexual Health Clinic, East street , Camp Pune

38. Abdominal Crunches
Twisting Sit Ups
Zest Sexual Health Clinic, East street , Camp Pune

39. Move it !
 Incorporate aerobic exercises: taking a brisk
walk with your baby in the stroller is enough to
get your heart pumping and muscles working.
 Strength training exercises : Use light weights
-- couple of soup cans, frozen milk bags for
resistance, or even pick up your Little one
 Many health clubs and community centers offer
"Mommy And Me" classes that will let you
incorporate your baby into your workout
routine.
AT LEAST 150 MINUTES A WEEKZest Sexual Health Clinic, East street , Camp Pune

40. REMEMBER
Zest Sexual Health Clinic, East street , Camp Pune

41. Zest Sexual Health Clinic, East street , Camp Pune

42. Zest Sexual Health Clinic, East street , Camp Pune

43. THANK YOUZest Sexual Health Clinic, East street , Camp Pune