What happens at a 'mummy MOT' and what are they for
Until you’ve had a baby, nothing can ever truly prepare you for how you’ll feel afterwards –or at least, that’s what I found when I gave birth in July 2021.
My body was mine but not as I knew it. On one hand, I was in awe of it, marvelling at what it was capable of. On the other, it felt completely alien. My bump had been replaced by an empty, rippling stomach that I was nervous to touch. Due to stitches, every step twinged, and even sitting down took practice. Used to stomping and striding, I was reduced to hobbling, living on a frustrating - albeit temporary, luckily - go-slow.
“Our bodies change dramatically during pregnancy and childbirth,” says Emma Brockwell, a pelvic health physiotherapist and author of Why Did No One Tell Me? How to Protect, Heal and Nurture Your Body Through Motherhood. “Even if women have a low-risk pregnancy and straight-forward delivery, the changes that have occurred will have undoubtedly weakened and compromised certain parts of their bodies.
These changes could, over time, cause a variety of preventable symptoms, including aches and pains, plus pelvic floor issues, such as urinary leakage and pelvic organ prolapse. These symptoms can significantly affect a woman’s physical and mental health, and be a key barrier to exercise, something we should all be engaging in more due to the long-term benefits it offers us.”
The cherry on top of my recovery came in the form of my pelvic floor, which shrieked into action after a lifetime of peaceful lurking.
Worst of all was the ‘everything falling out’ sensation - the feeling that if you take one more step, your organs are, almost certainly, about to start dropping out. There was no rhyme or reason to it, and I could go days at a time without it happening, which lulled me into the false sense of security that it had cured itself. This 'falling out' sensation can be indicative of a weakened pelvic floor or, in more serious cases, a prolapse of some variety. It’s incredibly common after birth yet knowing that everyone else experiences it wasn’t really much comfort.
A slew of odd sensations drove me to consult the ever-reliable Dr Google, which was quick to diagnose me with everything from a prolapsed bladder to piles. It’s worth noting that I actually had neither.
What is a 'Mummy MOT?'
Following a six-week check-up with my GP so brief it could be measured in seconds, I eventually checked myself in for a private ‘mummy MOT’ with a brilliant physiotherapist who assessed my pelvic floor, looked at my tummy muscles and, all in all, put my mind at ease. However, not every woman has the option to fork out for this kind of reassurance.
For the uninitiated, the ‘mummy MOT’ is a postnatal physio check, which sees a new mum’s pelvic floor and tummy muscles examined to ascertain what help she might need to aid her recovery. Searching for ‘mummy MOT near me’ on Google should bring up local results, while TheMummyMOT.com also offers consultations across the UK. I booked mine at Bodyworks Physio, which was recommended to me by a friend.
I had my post-natal MOT around eight weeks after I’d given birth (it’s recommended to be at least six weeks post-birth). Slightly nervous, I was quickly put at ease as I answered questions about my pregnancy, the birth and my recovery, before the physio asked me to lie down on the couch.
She checked my pelvic floor, which involved tightening my muscles and holding them while she felt for weakness and measured duration. She also gently felt my stomach to ascertain what condition the muscles were in. The experience was incredibly reassuring and very sensitively carried out.
I walked in feeling utterly terrified of what I was about to discover; I walked away feeling confident in my body and its recovery. I had the reassurance I needed that I had none of the dreaded prolapses that my 3am Googling kept leading me to, but that said, there were still improvements I could make to my stomach muscles. I was given practical exercises to carry out at home, as well as instructions for monitoring my progress.
The MOT taught me the importance of Kegels as a means to ‘tighten up’ the pelvic floor, with the physio advising they be carried out throughout the day, when sitting, standing and walking.
'After pregnancy and childbirth, women should be rehabilitated just as we would with a sporting injury,' explains Brockwell. 'The NHS Long Term Plan has pledged to offer postnatal physiotherapy to as many women as possible - a step in the right direction - but this is likely to be delayed due to Covid pressures. In an ideal world, every woman would be offered the service to ensure preventative, as well as reactive, treatment options.'
Is a mummy MOT helpful?
In my opinion, yes, a post-natal MOT is an incredibly useful appointment to book yourself, and it’s a shame that it isn’t accessible for all women as a matter of course. Sure, some women are absolutely fine and don’t need the insight or support that the MOT can offer. But for those who are doubting every sensation or are mortified by their pelvic floors, it can be incredibly reassuring to get expert advice that’s specific to your body as it is, right now. Even if it’s not good news, it’s the first step of the journey towards getting your body feeling better.
What are some common post-birth side effects?
Post-birth side effects vary hugely from woman to woman, and can include:
- A weakened pelvic floor
- Urinary and/or fecal incontinence
- Pelvic organ prolapse
- Diastasis recti
- Constipation (caused by iron tablets and/or a fear of bursting stitches) and piles
- Postpartum hair loss due to a drop in oestrogen as your hormones return to normal
Outside of the obvious, such as wound recovery and bleeding, there’s no predicting what you’ll encounter after birth. With that in mind, it can be helpful to be aware of some of the common - yet little discussed - side effects you might encounter during your fourth trimester.
Pelvic organ prolapse
A post-birth prolapse is caused by one of the pelvic organs - your bladder, bowel and uterus - slipping out of place and pressing into the vagina. They can typically occur after long, difficult labours with large babies, or after an assisted delivery. Symptoms of vaginal prolapses, rectoceles (rectal prolapses) and cystocele (bladder prolapses) can include:
- A bulging sensation
- Feeling and/or seeing a lump protruding from your vagina
- Discomfort during sex
- Urinary issues, including incontinence
'There are a number of treatment options,' says Dr Swati Jha, Chair of British Society of Urogynaecology and spokesperson for the Royal College of Obstetricians and Gynaecologists. 'These range from weight loss and pelvic floor exercises to having a vaginal pessary inserted, which will hold the prolapsed organ in place. In severe cases, and where women don’t respond to non-invasive methods, surgery may be recommended.'
It’s worth noting that not all prolapses require intervention but if your quality of life is being negatively affected, seek help.
'The best way to minimise the risk of developing a prolapse or other pelvic floor conditions is to begin pelvic floor muscle training prior to birth,' advises Demetri Panayi, Consultant Obstetrician and Gynaecologist at The Lister Hospital. 'It’s recommended women begin in the middle of their first pregnancy and continue afterward for life. The majority do not develop permanent prolapse problems after childbirth as long as they persist with the training alongside the natural recovery of their pelvic floor, which can take up to a year post-delivery.'
Diastasis recti (tummy gap)
Diastasis recti is the separation of the muscles in a woman’s stomach, caused by her uterus forcing them apart during pregnancy. The tell-tale signs are a ‘doming, coning or deep gully along the midline of the abdominal wall’, advises Emma.
'Every woman will experience a tummy gap during their pregnancy,” she explains. “It’s normal and has to happen for the baby to grow. For two-thirds of postnatal women, this will heal within eight weeks.'
You can check on your tummy gap at home and if it’s not showing signs of improvement by eight weeks, seek advice from a pelvic health physio or qualified fitness instructor.
A weakened pelvic floor
The muscles in your pelvic floor support your bladder and bowel, giving you control over urination and excretion. However, it’s the lack of control post-birth that will probably first bring them to your attention, with a degree of temporary incontinence likely for many women following the trauma of delivery.
'Immediately after birth, it’s common to experience some leakage when coughing or sneezing, or a feeling of needing to rush to the toilet,' says Panayi. 'As the pelvic floor recovers, these symptoms typically improve, especially if a woman undertakes pelvic floor training.'
Which exercises can help?
Kegel exercises can be undertaken when you feel strong enough. But how do you do them?
'Get comfortable, whether sitting, lying or standing,' says Emma. 'Squeeze your anus as if you’re trying to stop yourself from passing wind. Hold this squeeze for a few seconds and then let go and relax. As you’re holding this squeeze, don’t hold your breath. Repeat this 10 times, working up to holding each squeeze for 10 seconds. Make sure that you slowly release and relax between each squeeze.'
Emma advises trying this once or twice a day for at least six weeks. If you don’t begin to see an improvement, ask your GP for a referral to a pelvic health physiotherapist.
Dr Jha also recommends incorporating ‘fast squeezes’ into your Kegels regime. 'Tighten your muscles [as above] but stronger and faster,' she suggests. 'Then release straight away. Aim to do 10 of these in a row.'
If you had a C-section, your pelvic floor can still be weaker than it was pre-pregnancy. 'Some degree of strain will occur, especially towards the end of the pregnancy,' says Panayi. 'However, vaginal childbirth is strongly associated due to the passage of the baby through the vagina and any associated trauma to the perineum.'
Bowel incontinence can also affect some women, notably those who experienced third or fourth degree tears as a result of delivery. Whilst the prospect of discussing it - whether with a friend or a healthcare professional - might feel mortifying, don’t suffer in silence.
'A lot of the side-effects of birth - urinary incontinence, faecal incontinence and pelvic organ prolapse - are incredibly common but often considered taboo,' says Brockwell. 'Women are often embarrassed to discuss them and because they aren’t life-threatening, they’re dismissed. But the narrative is beginning to change. Celebrities and influencers are increasingly discussing their own experiences and more women are being educated about the importance of pelvic health. Knowledge is power, and it's important to keep the conversation going.'
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