Healthy Habits - Exercise for post-partum

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hi hey everybody and welcome today to talk about exercise pt and training postpartum
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my name is major raylene grant i'm a physiotherapist and oc of the physical performance squadron which manages the
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nine nzdf gymnasiums over the past six months i've been working closely with
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the medical officers physiotherapist exercise rehabilitation instructors
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physical training instructors and the humans performance team to put together this guide to assist our wahine come
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back into work training with the aim to return to full operational deployability
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um moving into these four words here from
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the bosses acknowledge the really unique position that new zealand defence force
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is in in the way that we're probably only comparable to professional sports women that we are required to get back
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to fitness following pregnancy and childbirth and that new zealand defence
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force acknowledges this and wishes to support and provide
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all the resourcing that we need to get back uh from the forward on the
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the right which is from uh my boss fran cook who manages all the garrison support for new zealand defence force
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i really like what she's put here and that she encourages us to use the service all
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the services provided as we support through the transition back to work full fitness and full deployability
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in the contents page yes it does look a little bit overwhelming but i i guess i'm pulling this up to show that the
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booklet although it is big it's broken down into first trimester second trimester third trimester and the ones
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that we will be talking about specifically today is from the postpartum stuff the reason that i'm
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bringing this up is some of the content that i refer to ie teaching us how to do our deep core and
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pelvic floor work is covered in the pregnancy part and um
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when this booklet is released so it's just a couple of weeks away from being printed and putting it all in all the
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defense health centers and then shared on the internet internet and social media this is i guess sort of a sneak
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peek but if you i'm happy to send out the this in its
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current format through laura so if you do want it now and want to have a look through it yeah just please just leave
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your details with laura at the end and she'll flick it out to you so we're going to start from the
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postpartum and start talking about yeah geez what does this mean for us
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here so first of all um you know in this time the weeks 0-6 following having baby
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you know congratulations this is a pretty wild time and a blur of feeding and nappies and trying to fit in
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sleep in and around a baby and babies requirements
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and in terms of exercising at this point we want to treat this as our fourth
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trimester and baby's going to be really demanding as it is baby adapts to life outside us and is
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going to want lots of us and lots of cuddles so we really want to put four hour
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the exercise is not our sort of main goal at the moment
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in many asian cultures you know this fourth trimester the you know wahine
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don't even leave the house and you know that that fourth trimester is really
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about the mother recovering and you know adapting to
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life with a new life so within this first zero to six weeks
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your body is going to be recovering from birth and now is the time to concentrating on
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healing and looking after your baby and saying this it's you know it's completely fine to walk and good to
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start gentle pelvic floor exercises and deep core exercises that we cover earlier in the booklet
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but in terms of the first few weeks nothing more than that is
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recommended on these couple of pages we talk about birth injuries and for some
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of our military wahine they may come through a completely um
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you know non-complicated vaginal birth and are going to be ready to roll really early compared to our other wahine who
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may have quite complicated births with significant tearing and
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injury of the pelvic floor potentially even a prolapse so my guidance here is
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just to have a lot of empathy for yourself and for each other and if there
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is wahine in your workplace that are like far out what are you up to you know i was back playing touch after six weeks
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and every birth and pregnancy is so different so don't measure yourself on
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anybody else and don't judge anybody else if they're taking longer than you to recover
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birth injuries are usually caused by the position of the baby having a large baby
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having a long labor having a short labor having a small or unusually shaped pelvis and it's quite hard to know you
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know what the effects of birthing are going to be until we're in there and for people that are on you know their second
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or third births you know the every every birth is completely different and we want to treat our
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bodies relevant to what what else is going on and you know so we may experience minor
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damage or we may experience quite extensive damage so it's just a matter of working really closely with our lead
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maternity carer um you know the medical officers once we get back to work our pelvic health physiotherapist and once
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we start getting back into exercising you know slowly working with our physios and eris
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another point that i wanted to bring up here is acc is now covers birth injuries which is
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going to be relevant to you know if you decide to leave the new zealand defence force that you know these birth injuries
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will be covered and they're still really working through you know what are covered and what aren't covered at the moment but that's really good news for
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um wahine who often go through a pretty traumatic physical and often emotional
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ordeal as well and to have this covered by the government is really is really a step in the right direction
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uh one in four of our wahine are going to have a cesarean section either
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emergency or elective uh caesarean section and recovery from
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this is quite significantly different from our normal sort of vaginal births and it's going to take at least sort of
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six to ten weeks for the wound part to heal and quite a bit longer until we
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feel well enough to get out and do activity so we can do
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you know we can complete the walking and start the pelvic floor exercises and deep core exercises but really check
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with your women's health physio and lmc before commencing any resistance training and ask them about specific
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treatment for cesarean section scar pain or numbness if this is relevant to you
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for most people you know we will bounce back from these cesarean sections but some people do have quite a lot of
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ongoing pain and if you're in um you know if this
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is relevant to you to really seek out and seek out the help from the your lead maternity carer from the medical officer
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from the women's health physiotherapy and those support networks around you
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so what do we want to do in those first sort of two to six weeks and if you've had a caesar or had you know some pretty
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significant birth injuries you're probably not wanting to do too much so just listen to your body and get back
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into activity as you feel comfortable to do so continue to walk and do deep core
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exercises and pelvic floor exercises if you feel well enough to do so and for some people low impact
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activities such as the cycle or cross trainer can be added in if you're feeling well enough to do so for those
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non complicated births during weeks two to four same again if
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you're feeling well enough to do so you can start doing some bodyweight squats and bridging activities but noting that
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in this stage we really just want to recover and if you want to do activity
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cool but the the main aim is to just get our bodies right and look after baby
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the one of the important parts in this area is really reconnecting with our breath and you know it's been sort of 20
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weeks since we've been able to lie on our back comfortably and we've had you know
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a big old uh basketball in front of us which has been squishing all of our organs so in this
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period of our training we really want to do some breath connect and start getting back into that deep diaphragmatic
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breathing exercises such as lying on your back and breathing are recommended to coordinate
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the pelvic floor and diaphragm to work better and in this stage it's vital that
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emphasis is placed on healing and strengthening the pelvic floor muscles to reduce the long term to reduce the
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chance of having long-term pelvic floor dysfunction uh after childbirth it's normal to feel
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pretty beaten up but in this table here it talks about what is normal and what is not normal so you know
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when to reach out and seek help so it's pretty normal to be sore but it's not normal to
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be so sore that you can't look after baby and do your activities of daily living so
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if you're so sore you know make sure that you do reach out and let the lead maternity carer know
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hemorrhoids is pretty common after childbirth and same again this is normal but if it's so painful that it's making
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you cry and unable to you know and it's getting affecting the way that you're looking after your baby you know reach
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out and get the treatment required it's normal to feel overwhelmed but if
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you're feeling so upset and overwhelmed and thinking about um
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harm definitely reach out because there's some really good and important networks out
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there in one of the sections we'll talk about at the end uh postnatal depression
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is um you know there's a percentage that will get this during pregnancy and even higher percentage
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afterwards so if you are feeling so upset tired fatigued that you're
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starting to have you know thoughts that you know aren't healthy and are going to affect
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your safety and safety of your child make sure that you get those support networks around you
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it's normal to be pretty sore after a tear or episiotomy or after having a c-section
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but if you get any redness over the wound or it's starting to smell funny or
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that there is worsening pain this may mean that you've got an infection so yeah pain is normal but if it's starting
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to be red and yucky and horrible and spreading make sure we get on top of
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that it's normal to bleed after
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after having a baby but this should stop after six weeks and so if it continues
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on make sure that your lmc knows about this and if you're needing to change pads you
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know multiple times in an hour and bleeding increases instead of decreasing make sure that that's um you know that
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your medical professionals around you are aware of that cramping it's normal for cramps to come
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and go as the body uh gets used to i guess sort of being non-pregnant
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but if there's constant significant pain that's not normal
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leaking urine at the end of pregnancy and a few weeks after birth is well i
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wouldn't say normal but common because there's been so much pressure put on the pelvic floor but if this continues after
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that six weeks period you know make sure that we get that sorted
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through referral to a pelvic health physiotherapist
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if there's pain with peeing and pulling it's going to be a little bit sore initially but if it really starts to
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sting or burn we've got to make sure that there's no infection there nipple pain when we
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first start breastfeeding it's going to be pretty sore but if there's red streaks lumps
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uh you know latching issue bleeding or pus you know make sure that we use the
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you know touch base with the lmc and if we need to you know there may be an infection or we may need some
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additional support with breastfeeding stuff doming coning and a gap between
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abdominal muscles and so in the first part of this booklet we talk about abdominal separation being
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or stretching being a normal part of pregnancy and it should return to normal
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in the first six months but if it's still there following the six months we want to do a little bit
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more specific stuff for the core bulging and pressure everything might
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feel pretty uncomfortable after childbirth but if it's still there three months afterwards there may be a bulge
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or a prolapse that we definitely want to get sorted seek medical advice if you experience
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any birth complications listed in the right column so it's just a bit of a yeah a bit of a table as to yeah we're
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going to feel sore we're going to feel tired we're going to feel terrible well terrible is probably not the right word
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we're going to feel overwhelmed but if it's to a point that it's affecting our ability to look after baby we need to
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talk to a medical professional and get the support in place that we need
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and then there's just a bit of a checklist there and the main things that we want to do in that zero to six period
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is connect with the breath and getting our pelvic floor and deep core
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working and functional again we want to get out and walk get some fresh air um you know start taking
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some you know getting some fresh air and getting out of the house we want to talk about postnatal depression with friends with different
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health lines and if we need to get a referral to the um you know from the defense health centre let's do that to
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make sure that we've got plenty of support around us and purchase a good supportive sports bra the
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with breastfeeding everything's going to feel pretty engorged and if we're out
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walking we want to make sure that we're well supported there in the next part of this zero to six
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uh section we have got a couple of uh example exercise programs that you
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can start and so in this first one we want to get into some breath connect we want to
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start reconnecting with the pelvic floor with the deep core muscles and we can also start some bridging exercises
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we have attached a video here which i will bring up
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just to give you an idea of yeah i mean what we've got and so you can see
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our fitness model here working through the different sort of exercises so that's the first one with our breath
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connect when you know that big basketball is no longer there we want to get back into
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that diaphragmatic breathing when we get back into our pelvic floor
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stuff the easiest way to do this is lying on our back there's different cues that we use to
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get this pelvic floor contracting and working well and we also want to work the fast twitch fibers of
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these muscles as well the transversus abdominis is our deep
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core and once we've had baby we want to make sure that that deep core is um strong
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and functional we can start getting into some glute bridges and working that posterior chain
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of the body
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this one's quite a nice way of getting the deep core working with a little bit of movement as well so we know that we
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can get the decor firing during different movements of the body
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and then the last one here just working our stabilizers so everything working in and around the
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hips and that's an example of the pelvic
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floor and core exercises
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moving on to right and that's um what we want to be doing in that zero to six so we want to
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be out walking and doing pelvic floor and core
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moving into the next section of our postpartum journey from week seven to
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twelve and at that six week period we have a catch up with our lead maternity carer
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and we you know if the lead maternity carer is happy with how we're going
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potentially we're going to get discharged from their care and this discharge from lmc care is more
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around sort of wound healing and specific pregnancy related stuff some people take this as cool i'm good you
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know i've been discharged from the midwife i can get back in and start smashing everything so um yes maybe your
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wounds have healed but it's not a time to get back into everything if your body's
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not quite ready ensure you get a postnatal or on a fitness check or you know potentially
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longer to check pelvic floor muscle damage and strength it's also important
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that the pelvic health physiotherapist confirms that you're doing the exercises correctly
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and they'll also have a look at that diastasis recti which is the normal sort of separation of the abdominal muscles
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and make sure that everything is okay there give you some exercises to help there they'll look at posture core
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strength and check to enable a safe return to exercise
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our contracted physiotherapists in the new zealand defence force camps are apm physio and if you want to catch up
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with so you can request a referral either from the defense health centre or
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directly through apm physio
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keeping in touch days as you are probably aware we can return to work for apps up to 64
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hours on the discretion of our commander manager when we're on um parental leave
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and you know we can apply for some of these keeping and touch days to
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you know go and catch up with the dhc and you know report how we're feeling if we need any special referrals out for
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example if we're having a bit of a hard time and need some more support around that postnatal depression stuff if we
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need a referral out to a pelvic health physiotherapist you know we can use these hours to get in sometimes our
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wahine if they've taken for example 12 months maternity leave and you know won't step back and camp for that time
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and that's fine but i guess the point that i'm trying to make here is that we do have the ability and our health
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services do want to support us during the time i could use some of these hours to touch space with the camp medical officer at
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the dhc or catch up with the women's health physiotherapist campbell-based physiotherapist or exercise
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rehabilitation instructor to start an exercise program
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on this page here we talk a little bit more about a self-check for diastasis recti and
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during pregnancy we have a natural sort of thinning and separation of the abdominal muscles which should over six
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months just heal return and repair itself as time goes on and that's a nice way to just
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check to see if um if you've got a diastasis recti and need to be doing
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some specific additional core stuff to help in the healing there
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what sort of exercise is recommended in the seven to twelve period uh if our
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wounds have healed and bleeding has stopped you know potentially we can return to swimming uh cycling or spin classes if this is
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comfortable for you to do so resistance training can progress to either light bands or weights if comfortable
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to do so uh if we've gained quite a bit of weight during pregnancy definitely
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don't attempt to run until your bmi is back under 30 because that extra weight
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is going to put extra weight on the pelvic floor and our pelvic floor is pretty important to us
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for uh peeing pooping sexual function and uh you know holding all our organs
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in so we want to make sure that we're looking with that we're really looking after that pelvic floor and sometimes
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you know sometimes we'll have problems at the time but sometimes these postpartum problems
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won't i guess sort of really here until one years five years after and sometimes
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even into menopause so even if you are feeling cool like i'm ready to smash it
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really go back to that concept of um you know
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could i versus should i and we start talking about the return to
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running from 12 weeks and this is based on some
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pretty robust uh evidence and the the references there if you want to do
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further reading about it let's talk about breastfeeding bras and
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exercises exercise so if you have chosen to breastfeed your baby there are no
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medical reasons why you can't return to exercise following medical clearance
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but however you may need to alter the type of training that you're doing the type of clothing that you're wearing to ensure exercise can be completed
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comfortably uh if you've got um engorgement
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uh pain from breastfeeding or even mystitis acknowledged that you know you
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probably don't want to get out and do exercise and that's fine like as we've talked about we want to get back into it
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as the body is ready to do so relaxing levels do not return to normal
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until three months after breastfeeding so just keep that in your mind
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that you know the joints ligaments are more lacks more flexible so if we feel
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like going out and playing touch rugby we are going to be more at
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risk of injuries that was a bad example we obviously don't want to go back to running until at least 12 weeks because
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we know that everything has healed up but that's the point that i'm trying to make there is you know whilst we're
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breastfeeding there's still going to be a high level of relaxin and hormones within the blood
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uh to make exercise more comfortable we can consider feeding baby prior to exercising you know to ensure that
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you're not overly full or babies not really hungry while you're out exercising
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and then we want to make sure that we have a really good supportive sports bra
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breastfeeding hydration and nutrition moderate to vigorous exercise does not
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affect or does not impact your milk quality
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or your ability to provide all the nutrients required by your babe from
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your baby uh however you do need to drink a lot more during this time
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because you know the body is working so hard to produce uh you know milk and nutrients for the baby
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while breastfeeding your body does need an additional 400 calories per day above what your
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normal energy requirements are to produce this woman who are overweight can safely diet
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during breastfeeding if they choose to do so and monitor the impact of their diet change on milk production
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let's talk about some of the exercises that we can do in that seven to twelve week period
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in that zero to six we're relying on our backs and in this one we just want to progress it and make it a little bit
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harder so these ones are done in our four-point kneeling position i'll take us through to that um video again
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so these ones are the same exercises that we've done in the zero to six and just in a position that challenges the
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body a little bit more so we're in that four point kneeling position we're working the pelvic floor both the slow
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twitch fibers and the fast switch fibers which is a quick flick of 10 for those fast finish
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we want to continue working that transverses abdominis so at that underlying we just want to pull in one
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centimeter to get that deep core firing
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and this one we're going to start working that posterior chain the glutes the hemis the low back and if any of
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these exercises are sore uncomfortable just skip them out these are just
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suggested exercises but as we talked about everyone's going to recover so differently so if your body
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doesn't like these ones um this one works the stabilizer muscles so
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we're just preparing the body in the deep core as we get back to exercise
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and we can also get into our strengths training here and same again i'll just pull up our
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video and the sort of stuff that we are pretty happy doing in that seven to
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12 weeks so we're just going to start training
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our press ups but we can just do this in a standing position
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or if you feel like you need a little bit more we can do them in a kneeling position
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we want to start working all the stabilizing exercises in and around the shoulder blades so when we do go back to
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[Music]
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an initial sort of squat exercise some calf raises to prepare us for the
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next stage which is our return to running stuff
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a deadlift exercise same again we just want to prepare that single leg standing out balance before
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we get back into running to make sure that when we do get back into running our body's really strict for it
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and this is one to work our core so just a little bit harder than our sort of big core exercises now we've got the decor
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working with movement
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and then let's talk about what that postpartum week's 12 plus look like running is a high impact activity
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which puts a lot of pressure on the pelvic floor core and organs return to running is not advised prior to three
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months postnatal or longer if you've had a caesar or birth trauma so
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for this 12 months for most people they should be ready to return to that
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running in this guide it's just a guide so with use this guide
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in you know with a close relationship with your physiotherapist pelvic health
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physiotherapist eri and they will take you through um exercises for you that are suitable for
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where at so even though it says cool you know i'm 12 weeks postpartum i'm allowed to run as of today it's going to be
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different for everyone for some people it might be a little bit earlier but you know just make sure that
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you're cleared by the pelvic health physiotherapist so you know that your pelvic floor is strong so you know that your core is good and you're not putting
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yourself at risk of injury because it's not a race we want to play the long game for this yes we want to get back to work
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full fitness and operational deployability but not at the detriment of injuring ourselves or having
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long-term problems with pelvic floor or prolapses or incontinence because that's going to
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accelerate our you know exit from the new zealand defence force really quickly we don't
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want to do that your exercise recovery will be easier if you start light as soon as you feel
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ready and ease your way back into training rather than going sort of full handy when you've got to that specific
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time frame there's a really good document that was written in 2019 by
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goomb and donnelly and that's set up as a hyperlink as well so
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if you want more information about specific research of when to return to different things
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that's a really good and robust research article about that
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before we return to running we need to make sure that we can balance for 30 seconds we need to make sure that we can do a single leg squat that we can jog on
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the spot for a minute that we can do bounds that we can hop and that we've got enough strength in our calves so
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this is a pretty good measure of am i ready to go back to running can i do all these things and if you are and you
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don't have any problems then it means that cool you know you're ready to start getting back into running which is
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awesome uh exercise programs when in that zero to six we were on our
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back in the seven to twelve we were in a four point kneeling position by 13
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plus weeks we want to be able to do this pelvic floor and deep core work uh while
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standing whilst walking around whilst doing the dishes peeling the carrots that sort of things brushing our teeth
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so by this time we want those brain muscle contractions to feel to be really
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good and strong that we can put it into our everyday activities and then on this one we've also added in
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single leg balance to prepare us for running and also some more advanced glute stuff let's have a look
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at that video
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so this video isn't overly exciting because it's just someone standing there but what you can't see is what's going
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on in the inside so they are working their pelvic floor and doing that lift and squeeze with this one holding for 10
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seconds and as we've talked about previously it's only that pelvic health physiotherapist that's able to tell us
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if we are doing these exercises correctly they the pelvic health physiotherapists
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do an internal examination with your consent but it's really worth getting
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that examination to know that you're doing everything well and properly before you get back into your running and resistance training
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got a single leg balance there
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and some bridgewater
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on our next page we are progressing our resistance training
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again and this one is specifically for our return to run stuff let's pull up the video and
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watch the exercises that are recommended in that 13 plus
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so we're starting to get a little bit more functional and adding in sort of opposite arm opposite leg stuff
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we've got to press up with the bird dog there
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we want to make sure that we're really strong and through the shoulder blade stabilizers
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might be a little bit uncomfortable if you are still breastfeeding and fighting board so as you say just skip out those
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exercises if they're not happy only get into these leaking ones if you have
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been cleared by your pelvic house physiotherapist
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because this is our real sort of return to run strengthening program
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and we want to make sure that we've got much strong cards
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so we know we don't have any injury problems same again only do these leaping ones if you have been cleared
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and we know that that pelvic floor is strong enough and we're not having any um urinary
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works the stabilizer muscles
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good
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with our return to running one of the programs that
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is really highly used and well written is the uk national health service couch to 5k
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training plan so if you're looking for something sort of online that you can start straight away or you can go in and catch
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up with your exercise rehabilitation instructor and they'll be able to write a program specifically for you
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as we talked about continue to ask yourself um you know should i be doing this not can i be
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doing this going uphill will reduce the pressure on the pelvic
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floor but going downhill is going to increase it so if we can just sort of stick to the flat initially that will be
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important for us uh start each exercise with a bit of a warm-up ideally a fast walk and we want
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to increase the running tolerance not speed
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combine the running program with the strength training
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if you are so running with a pram alters the way that we run and so if we can return to
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running without the pram that's ideal but this baby is probably going to be with us 24 7 and our partners are not
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always going to be home or maybe we don't have partners so our baby's going to be with us so if we run with our pram
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we just want to make sure that the pram is set up in uh so we're using a pram that's designed
36:15
for running start with a two-handed hold on the buggy even though this is going to feel pretty uncomfortable on our
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shoulder hair our shoulder blades and um so start with two-handed hold on
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the buggy is this position is where your body behaves closest to that of normal running compared to the
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you know one hand out in front
36:39
returning to work so as you are aware members of the nzdf are
36:44
entitled to 26 weeks paid parental leave which you may split up with your your partner
36:52
when you return to work book in with the defence health centre who will review
36:57
your medical grading which will take into account breastfeeding birth injury and any postnatal complications
37:03
you will be exempt from fitness testing contact sports formal fitness classes uh
37:09
for 12 months but if you want to get back into this sooner then just make sure you're
37:15
cleared and that your public health physiotherapist is happy that you return
37:20
and that your manager is on board with where you're at and the you know that you've been cleared
37:27
medically so there's these you know policy there to protect you however if you are
37:34
ready to go back to these things earlier then that's cool as well but just make sure that you're cleared to do so
37:41
every individual is different every pregnancy is different every birth is different and so it's really important
37:47
that you work with your physiotherapist and eri and manager to manage your training
37:52
and liaise directly with the mo with any questions concerning your return to work return to training and fitness training
38:00
courses promotions seniority and nominations so if you want to do a course you can if you don't want to do a
38:06
course you don't have to in that first 12 months if you want to do the course but can't do
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the sort of the physical components then there's you're not going to be discriminated
38:18
against however it's really again that really clear communications between your
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manager the course manager your medical officer so you make sure that
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you're keeping those communications nice and open and we've just got the reference there
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to dfo part 12 chapter 10 for further information about this
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fitness testing so we've got 12 months until we're required to do fitness testing however if you want to do it
38:48
before that you can providing that you're cleared or if you need longer then you can get an extension through
38:54
the medical officer so this is a line in the sand for i guess sort of something
39:00
that it's realistic that you can aim for if you've had a non-complicated pregnancy
39:06
however if you're for example manager or commander says
39:12
you know like it's 12 months since the birth of the baby you are to do a fitness test no that's incorrect if and
39:18
you need to make sure that you've been you know that you've got good correspondence with the defense health
39:23
centre with your medical officer and that if you have had complications you know we need to extend that out to
39:30
make sure that you're not putting yourself at risk of further injury so 12 months is um
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i guess sort of what's written in the falls but it may be sooner or it may be longer for you
39:44
ensure you talk to the mo about your situation ensure your manager is aware of your updated
39:49
time frames and training program progression so they're able to provide you support
39:54
during your recovery and back to full fitness there's just a bit of a checklist there
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the sort of things that we want to do in that final sort of stage
40:06
and postnatal for life this one's really important so complications and side effects from
40:12
pregnancy and birth may arise immediately after childbirth or sometime following pregnancy and birth and
40:18
sometimes signs of pelvic floor damage or prolapse are not detected until menopause and at this time
40:26
yeah you know we want to be able to go to the defense health center and get that support
40:32
and treatment that we need and similarly you know if there's people around you
40:37
that you're like oh you know i pee when i'm jumping on the trampoline or skipping or running just because it's
40:44
common it doesn't mean that it's normal um there is a lot that can be done to
40:49
prevent injuries improve injuries help you return to full fitness without symptoms when you listen to your body
40:55
and get the right support you can be stronger and fitter than before having children and it's never too late
41:01
hey that concludes the main part of our exercise and postpartum there is a lot
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of information there but hopefully with the movies and videos in there it's able to make it a little bit more clear for you
41:15
with uh as always these are just examples of safe exercise during
41:20
postpartum but you know make sure that you touch base with your pelvic health physiotherapist with the apm physio with
41:27
the eri you know to make sure that you're doing the exercises correctly and if there's any that uncomfortable or
41:34
painful don't just do them because they're in the booklet and you know catch up with someone to find out
41:40
exactly what's going on i'll just flick through the the annexes really quickly
41:45
so you can get an idea of the other stuff that is included in the booklet so there's a page there of how to do a
41:52
pelvic floor self-examination a little bit of information about miscarriage in
41:59
that one about stillbirth and about postnatal depression and the different support networks that are available for
42:06
you if you experience any of these things uh cultural support and making sure that
42:12
the um so everybody has a right to um
42:19
you know be treated you know culture with cultural respect
42:24
and making sure that you're linking in with you know what's important to you and for
42:30
maori and many other populations in new zealand the standard ways of delivering social and health services do not align
42:36
with the concept of whanau ewe and community and there is
42:42
a lot of support out there for maori pacific islanders um asian populations
42:48
in the different way that they may choose to go through birth childhood and um you know particularly that fourth
42:54
trimester there's a checklist in here for commanders and if you are ever in the
43:00
position that you're feeling forced to go you know back into the field or on
43:05
course or back to fitness training there's you know there's really good clear
43:12
policy to support you and you know once the commanders are able to get their hands on this as well this is going to
43:18
support them through this process also and then finally just a bit of directory
43:24
of key contacts that may help you if you are feeling that you need more support you
43:30
know particularly in those that time uh after childbirth when
43:36
everything feels pretty crazy there's some really nice helplines that are available 24 7 for you to talk to for
43:44
you know if you need help with breastfeeding latching feeling overwhelmed depressed um
43:50
and there's lots of phone numbers and email addresses there
43:57
that can help
44:03
and that concludes the presentation on exercise pt and training for a postpartum
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and we definitely want to listen to our bodies
44:14
and just do what we can and slowly ease back into it with the aim of returning
44:19
to full work duties full fitness and operational deployability good luck