Postpartum recovery is a tricky issue for many mothers in Singapore, much less those who delivered twins and triplets. The physical toll of pregnancy and childbirth leaves mothers grappling with a myriad of challenges, including healing from any tears or incisions, managing pain, and adjusting to hormonal fluctuations. Moreover, the emotional and mental adjustments postpartum can be just as demanding as the physical ones. Today, we are thrilled to have physiotherapist Dr Claire Low with us. Having given birth to her first child naturally and triplets via C-section, combined with her physiotherapy expertise as well pilates training, we believe she's the perfect person to share tips and advice on postpartum healing. Let's jump right in!
Hi Dr Claire! We’re so excited to interview you today as a fellow triplet mum in Singapore. Could you please provide a brief introduction about your background and expertise, and if you have any special area of interest?
Hello everyone! I am a musculoskeletal physiotherapist, with a sub-special in Lymphoedema management. Simply put, I treat people with musculoskeletal conditions like body aches, pains and sprains, sports injuries as well as do pre- and post-operative rehabilitation. In the field of Lymphoedema, I treat patients with swelling from cancer treatment, or congenital reasons. Managing scars and manual lymph drainage are also part of my work scope. Having spent more than a decade working in a public hospital, I moved to a private clinic, Milestone Physiotherapy, after having triplets.
Aside from physiotherapy, I am also trained and certified in pilates rehabilitation.
In comparison to your first singleton pregnancy, how did the physical demands of carrying and delivering triplets impact your own well-being?
With my firstborn, he was induced as he was nearing 42 weeks gestation. Thankfully, I managed to deliver him vaginally even though he was a big baby at 3.68kg. I was walking independently and could even shower myself within hours after giving birth.
As for the triplets, they were delivered via c-section nearing 35 weeks, weighing 2182g, 2280g, and 2070g.
The pain post-op was excruciating for me. It was sharp in nature and located right above my stomach, near my sternum. There was also a visible bulge at my abdomen. It was later confirmed by my gynaecologist that my intestines had herniated due to the separation of my abdominal walls (also known as diastasis recti).
The road to recovery from my triplet pregnancy and the c-section delivery was long and hard. Two days after the surgery, I could hardly walk. I remember seeing all the other mothers on the ward floor getting out of bed by the next day post-op, but I was struggling even just to turn in bed.
Returning home to a toddler and having to pump and getting out of a non-hospital automated bed was also very difficult. I wore a binder diligently for a good 3-4 months.
As a physiotherapist, what advice do you have for expectant mothers in terms of maintaining their physical health and comfort during pregnancy?
As with every task in life, the capability of your muscles and joints needs to meet the demands of the task required in order to minimise the risk of injury. Unfortunately, many of us do not regularly exercise nor maintain an active lifestyle prior to pregnancy. Thankfully, the human body is adaptable, and exercising once deemed safe by your provider, as long as it is done with gradual loading, will help in all aspects of pregnancy, childbirth, and the demands of looking after your baby.
I would advise mothers-to-be to continue to be physically active throughout their pregnancy. This does not necessarily mean starting a new exercise regime. It can be as simple as continuing to do your functional tasks like light housework or walking out to buy food during mealtimes. Do all these while listening to the limits of your body.
Twins and triplets often result in a more demanding postpartum period. What were some key aspects of your postpartum recovery, and how did you manage the physical challenges?
My diastasis recti with the triplets was naturally way more severe than with my singleton. My gap started out at 6.5cm, and I decided to seek professional help this time round. Despite being a physiotherapist myself, I wanted to accelerate my healing as it started to affect my function.
I sought help from Orchard Clinic and underwent ultrasound, high-intensity focused electromagnetic therapy (HIPEM), and shockwave therapy to help with closing my gap. Together with simple exercises, I managed to close my gap and complete the treatment program in 6 months.
As a physiotherapist, what exercises or rehabilitation strategies do you recommend for mothers of multiples during the postpartum period to aid recovery?
Firstly, wearing your binder/corset is imperative for regaining core control and improving your function.
I used mine for nearly 4 months postpartum. Initially, I wore the 3-panel Dale binder as my tummy was still very big after surgery. As it flattened, I moved on to my 3-piece binder with metal pieces and more elastic for better lumbar support and compression. As I regained core strength and awareness, I switched to supportive undergarments, recommending those from Plié.
There are many exercises you can find online that helps with your core, but I am going to break it down to the top few that personally worked for me as a busy mom of triplets and a toddler:
Deep Breathing Exercises:
One of the first things you will notice after giving birth is your lack of core strength. A simple way to re-engage your core is by doing deep breathing exercises. Start by lying on your back, sliding your legs one by one into a bent knee position. Place your hands on your belly button and apply gentle pressure. Breathe in through your nose, pushing your hands away and filling your abdomen with air. As you exhale, imagine your hands sinking into the back of your spine. Repeat this 10 times.
Pelvic Tilts and Double Leg Bridging:
Begin in the bent knee position again. Rock your pelvis forward and backward. As you rock your pelvis backward, you will feel your lower back imprint on the bed/floor. As you rock your pelvis forward, you will feel your lower back arch away from the bed/floor. Do this around 10 times. After 10 pelvic tilts, continue by lifting your buttocks as high as you can, aiming for 10 repetitions.
Double Leg Squats:
Squats are a great way to improve your lower leg strength. Begin by placing both hands on your hips. As you squat, lean your body forward and stick out your backside as if descending onto a toilet bowl. If this is difficult, practice sitting and standing repeatedly from a chair.
Are there any specific techniques or practices that you find particularly beneficial for enhancing the healing process of C-section scars?
If you are currently pregnant and expecting a C-section delivery, I would suggest purchasing your wound dressing before your scheduled surgery. I recommend Mepiform scar dressing in 4 x 30 cm (available online or in hospital pharmacies) or Smith & Nephew Cica-Care Scar Treatment Gel Sheet (available online or in retail pharmacies). These wound dressings may be expensive but they can be washed and reused multiple times until they lose their adhesiveness.
First, massage the wound in a zig-zag manner using oil/cream/gel (such as Bio-oil) to break up the scar tissue at the sides of the wound. Apply the wound dressing during the day after your shower and do the scar tissue massage at night, after clearance from your doctor during your first postnatal check-up.
Given the busy schedules of parents, how do you recommend integrating physical activity into daily life for both parents and children?
For many of us in Singapore, increasing physical activity must be deliberate and mindful. We live in a society where modern amenities are at our disposal, and many things are within our reach. Most of the advice I give my clients regarding physical activity often begins with those that are free and convenient.
One simple way to begin increasing physical activity postpartum is to take your babies out for walks. Somewhere after the fourth trimester, an infant grows increasingly more aware and fussy. This is also a great time physically for mothers to increase their physical activity. Taking walks with your baby is an easy way to increase cardiovascular endurance, which would take a hit during your maternity leave as you are more likely to be at home more often. It would also help satiate your baby’s newfound curiosity, so I think it is a win-win situation for everyone.
For parents of older kids, take them outdoors frequently. My son never tires of the playgrounds and parks in our estate. We spend many weekend afternoons doing things like raking sand with fallen twigs, which may seem mindless but is a wonderful activity from the perspective of child development.
We hear that many parents and grandparents injure themselves while carrying out caregiving duties. How can caregivers ensure that they are not putting undue strain on their bodies while attending to the needs of the children?
This is a common issue I encounter in my line of work, especially with postpartum care. As mentioned earlier, injuries usually result from our muscles and/or ligaments being exposed to tasks that exceed their capabilities. Common injuries I see are “mummy’s hand” and mid-back pain from breastfeeding, lower back pain from repeatedly bending over the crib, and even nerve-related pain from baby-carrying.
It is important to seek professional help to see if there are ways to rectify the source and cause of the issue. As a physiotherapist, I take time not only to understand my client’s pain but also the contributing factors. Many times, I work with them to seek out alternative methods to do the same task, in the hope of reducing injury rates/severity. Also, gradual graded loading of muscles is important for the long term.
Any last words of advice or encouragement?
Just like how your body made space for a growing, tiny human gradually in 9-10 months, our muscles can similarly adapt with gradual loading in exercise. Our bodies are often stronger than we think. You’ve got this, mamas (and papas)!
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Thank you Dr Claire for generously sharing the above with us. To all the mothers out there: Wishing you all the best on your postpartum healing journey!
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