Here are some guidelines for the last month of pregnancy – look at which ones suit your lifestyle and start to incorporate them!
Preparation at this stage can increase the chance of a birth with minimal intervention and tissue damage and help to facilitate your recovery, including bonding with your baby and your ability to breastfeed.
Optimal foetal positioning:
- Avoid bucket seat positions where your pelvis tips under – especially be mindful when driving, at work or when relaxing at home. Try to keep your hips higher than your knees – sit on your birthing ball where possible!
- Sleep on your left side – don’t worry if you move, just start out on your left
- Pelvic mobility exercises in different positions – standing, leaning, on all 4s or on birthing ball. Sways, rocks, tilts, circles, figures of eight
- Exercises I’ve shown you in class to encourage baby into the most favourable position
- Move daily, preferably outdoors
Preparing the pelvic floor and cervix:
- Perineal massage
- Kegels especially focussing on the relaxation phase. You can also try J breathing to help
- Eutonia – sitting on the noodle daily!!
- Intercourse with deep ejaculation (semen softens cervix)
Mental and emotional preparation:
- Visualize your perfect birth – in as much detail as you can, the positions you take, who’s there, how it goes
- Don’t watch/listen to birth horror stories – no One Born Every Minute for now!
- Watch beautiful birth videos (YouTube)
- Verbalize fears – write them down – then work through them
- Read affirmations – eg. “I look forward to meeting my baby”, “I trust my body to birth my baby”, “contractions help to bring my baby to my arms”, “my baby is happy and healthy”. Read more examples on the app In Shape Moms (affirmations are free). Try to write your own!
Prepare tissues and systems with nutrition:
- Avoid processed foods and just eat real food!
- Eat an anti-inflammatory diet – avoid wheat, sugar, dairy, processed foods
- Add more gluten-free carbs to your diet – sweet potato, rice
- Add good fats – coconut milk/oil, avocado, fish, nuts
- Eat foods high in iron – green veg, walnuts, almonds, meat
- Take probiotics
- Eat 4 dates per day – this helps to keep the waters intact which in turn can lessen the pain of contractions
- Stop taking multi-vitamins especially those containing iron – inhibits prostaglandins which help soften cervix
- Stay hydrated – can include raspberry leaf tea now which may help contractions
- Try to establish a regular sleep cycle – this helps regulate hormones
- Take naps where possible
- Reduce stress – use your breathing, soften your face, avoid stressful situations
- Limit social agenda – don’t try to fit everything in
- Prepare for the postnatal period – try to enlist other people’s help for household tasks or else build up a bank of frozen homecooked meals
- Spend time outdoors, preferably in the sun (!!)
- Favour activities that make you happy and so increases oxytocin – massage, music, sex, cuddling
Do what preparation you can beforehand and then when it all starts know that you and your baby are fully prepared for what’s to come – don’t try to control it, go with it!
And your first piece of advice is – feel free to ignore this advice. As a new mum you are likely to get a lot of advice in the next few weeks, most of it unasked for and much of it unwanted. The biggest thing you can do is take courage, forge your own path and not worry what anyone else thinks. If there was only one way of doing things then there would be only one parenting book…
The right way to parent
Having said that, here’s some things that helped my mums – many of the same things came up with everyone so hopefully it will be of some use to you as well:
- Breastfeeding – oh this may well be a blog post in itself… It is not necessarily easy and doesn’t always come naturally and it’s not always for everyone. Like learning to dance, both partners need to know what they’re doing and sometimes baby just doesn’t get it! Seek help early on – don’t wait until you’re struggling. There is a telephone service at Stepping Hill, clinics at local children’s centres, national breastfeeding helpline, local breastfeeding groups. I had an amazing midwife who helped me postnatally – I think without her I would have given up and that would’ve sent me over the edge. We tried loads of different positions – for me lying down helped the most until we got it. But I also felt the difference between my two babies – they fed so differently at first, so it’s definitely a two-way thing! Just know that it does stop hurting and becomes a lovely experience. And in the meantime, there is always Lanisoh cream!
- Let go of the guilt! There are many ways to raise a happy baby so be confident in your choices, do what works for you and don’t compare yourself to others. Things often don’t go the way you plan, from your birth experience, through to your feeding and sleeping choices. It’s all ok – whatever gets you through.
- It’s hard! I spent a lot of the early days in tears – lack of sleep, pain, struggling to feed, not knowing what I was doing, hormones, railing against the change in myself. It wasn’t all loveliness by any means and that’s fine – no-one enjoys the feeling that they have no idea what they are doing. It’s a new job and you wouldn’t expect to know everything on your first day. I eventually accepted my new role, worked on the feeding and began to gain confidence. I would say though I probably should have talked to someone – if you feel sad more often than you feel happy then it would be worth mentioning this to your doctor/midwife.
- Sleep deprivation is torture. Do everything you can to sleep when you can.
- You have no life in the early days – you’re just a feeding machine. My baby didn’t feed well and seemed to stay latched on for an hour but also wanted to feed every hour. So I was rooted to the spot. Make sure you have plenty to amuse you and plenty of food/drink – use the time to relax and recover rather than feeling like its stopping you from doing what you want/need to. Ask for help when needed – all those visitors need to earn their cuddles. Farm out the washing, cooking and shopping to others.
- Everything changes! It’s such a steep learning curve in the early days and just when you think you’ve got it cracked along comes some new event in your babies life. But for every new challenge there is also new joy in your baby. It’s hard being a mummy and knowing you’re responsible for how your kid turns out. But I can honestly say it’s still the best thing you’ll do – so stay strong and trust yourself. This too will pass. So many difficult stages feel like they’ve lasted forever when it’s only been a few days and will last only a few more
- Get out of the house every day – it will make you feel better and it’s good for the baby. Start with short walks and simple tasks – get milk, a treat etc. (chocolate was mentioned…)
- Always fill the change bag as soon as you get home, so it’s one less thing to worry about or delay you when you are trying to leave the house
- Don’t feel you need to entertain your baby all the time – sometimes they just need to sleep
- Try batch cooking so there are meals to hand when you have no energy. I wish I had done this – we ate a lot of sandwiches in the early days… Even better – get someone else to batch cook for you!
And my final bit of advice came from Lucy…
“After your 6 week check, get out to Mums, Tums & Buggies/Pilates with Sarah ;)”
I’ll see you then!
I have already talked about pain in the front and back of the pelvis and the hips – Pelvic Girdle Pain (PGP) – caused by the hormone relaxin during pregnancy. You can read the original post here. Now here’s another pain in the bum!
Piriformis Syndrome can occur in anyone but it is particularly prevalent in pregnancy. The piriformis is a muscle that connects the thigh bone (femur) to the spine at the sacrum. It also blends into the pelvic floor so can affect the function of the pelvic floor too. It’s quite a small muscle that can be overused and quite tight. Because the sciatic nerve runs through/near it, a tight and spasming piriformis can press on it causing sciatic symptoms – such as pain in the bum and down the leg.
Posture (as ever!) has a lot to do with it. If you walk/stand with your feet facing outwards the piriformis muscle is continually switched on. Try to have your feet facing forwards instead.
Another postural problem is having your bum tucked under constantly. Instead think of your bum sticking out when standing – easier if you’re not pushing your weight into your toes. In seated position try to sit upright on your sit bones instead of slouching back. This is essential in pregnancy anyway, to help keep the pelvic bowl open, creating lots of space for baby. And try not to sit too much – take regular standing breaks if possible.
To ease off the muscle there are a number of stretches you can do. The main one is the figure of 4 stretch. Sit on the edge of a chair, up on your sit bones, feet flat on the floor under your knees. Lift one leg up and place the ankle on top of opposite knee. Allow knee of top leg to rotate down gently. Try to keep ankle straight – having the foot flexed helps. Hold and breathe for a few seconds and then switch legs. This could also be done sat on the floor or lying on your back with the bottom leg up the wall
Sitting on a tennis ball – not suitable in pregnancy. Place a tennis ball under one bum cheek – you can go right on the source of discomfort if it’s not too intense, otherwise place just above or below the trigger point. From there you can just sit and breathe until the discomfort eases or you can make small circles. Also from a seated position with feet flat on the floor allow one knee to drop out slowly then draw back in.
One we often do in Pregnancy Pilates Relaxation class is a hip hinge with feet in a t shape. Place one foot in front of the other so that the instep of the front foot is next to the toes of the back foot. In this position, push the hips back, keeping the back straight. You should feel the stretch in the bum cheek of the front leg.
Just as important as the releases, you also need to strengthen the bum – squats, hip lifts, hip hinges all help. These are key movements in all my classes as a strong bum will also help with posture and strength as well as looks good!!
November was national incontinence and bladder health awareness month in the U.S. As lots of the training resources I use come from there it seemed an ideal time for me to bang on about my favourite subject again!
I’ve already covered stress incontinence, which is the most prevalent
But there are other types as well. And bear in mind incontinence isn’t just urine, it can also be faecal
- Stress – leaking due to a change in pressure on the bladder eg jumping, running, sneezing, laughing
- Urge – a sudden and overwhelming urge to go. Leaking before have chance to get to the loo
- Overflow/dribble – bladder doesn’t empty fully so leaking occurs without necessarily having had an urge to wee
Incontinence is not an unavoidable consequence of ageing and childbirth. Things can be done to prevent it and/or improve it. It’s always worth seeing a doctor and getting a referral to a women’s health physiotherapist. Instead of masking the problem with pads etc – you need to find the reason and make a lifestyle change!
Things that can affect the pressure within the pelvis:
- Posture – try to keep your ribs stacked up over your pelvis when standing and sitting
- Clothing – too tight clothing can compress and move your organs. High heels will make you tilt your pelvis in order to be able to stand upright
- Diet – avoid foods/drinks that irritate the bladder or cause gas
- Exercise – move more, sit less
Exercise needs to be functional, so that you’re using movements you need in everyday life – squats, lunges in all directions, hip hinges. Exercise can also have a negative effect if the exercise you’re doing is too much for the pelvic floor to withstand. Any exercise that makes you hold your breath, bear down, shake, really clench, lose postural cues or leak needs to be avoided for now.
Another useful part of your life to look at is your toilet habits as straining can cause huge problems.
- Wee every 3-4 hours – try to avoid going ‘just in case’. You just need to relax to wee so don’t hover above the seat. Rocking the hips a little at the end can help if you feel like you haven’t emptied fully.
- Poo when you feel the urge – don’t hold it in as this can cause compaction. Knees should be higher than your hips – feet up on a kids stool or just use 2 loo rolls. Don’t strain. If the pelvic floor won’t relax you can help by vocalising – try a grrr or ssss now and see which one makes you feel like your pelvic floor relaxes. Then use that sound when on the loo.
And finally – keep practising the knack
Just over 10 years ago I took my one year old daughter to a family event at Reddish Vale Technology College (RVTC). I hadn’t really gone back to work at the gym since I’d had her – I’d covered one class and did too much too soon. From then on I didn’t really feel like I belonged any more. Plus I wanted to carry on spending time with my girl.
I got chatting to people who worked for the extended schools programme at RVTC. They wanted to offer fitness classes at the school in the evenings. It was something I had considered doing for years but I’m a terrible procrastinator!! Anyway, they persuaded me and on Thursday 17th November 2005 I began teaching Bums, Tums and Wobbly Bits and Pilates in their performing arts centre.
Now here I am 10 years later, based in Christ Church, Reddish with 15 classes on the timetable and a great community of women that I have the pleasure to serve. It has always been their desire for more that has allowed me to teach additional classes and develop my specialities.
Massive thanks to you for your loyalty to me through the years, enabling me to keep doing a job I love whilst still getting to spend time with my family. And thanks too to Reddish Vale for getting me started on this journey!
There’s been a few people in my classes recovering from injuries and minor operations recently. Then of course there’s the mums who are recovering from childbirth – considered a trauma whatever experience they have had! But despite the range of severity and site of injuries, there seems to be a six week rule – no returning to exercise until after six weeks . What’s so special about six weeks?
Stages of Wound Healing
The answer lies in the four stages of wound healing. Tissue is the same no matter who you are or what has happened and it will go through the same process every time.
- Haemostasis – this is all about stopping the bleeding and forming a clot. It happens immediately
- Inflammation – this is the stage of fighting infection and keeping the wound clean. There is increased blood flow to the wound – resulting in redness and heat. There is likely to be pain, swelling and possibly pus. This lasts for 4-6 days.
- Proliferation – new skin is formed over the surface, whilst tissue is rebuilding underneath. This pulls the wound closer. This starts after 3-5 days and can last for 2-3 weeks
- Remodelling – changes to the tissue strength and number of blood vessels serving it. This is when a scar starts to go paler and flatter. The process starts 2-3 weeks after injury, once the wound has closed, and can last up to 2 years!
These stages are not distinct but instead overlap, so there is some variation in healing times. 6 weeks means that all the early stages have completed and the remodelling phase is well under way.
However, it will take up to a year and possibly longer to return to full strength and function. And scar tissue is only 80% as strong as the original tissue. This is worth bearing in mind when you are returning to exercise after an injury and after childbirth. At 6 weeks healing is not completed, so you need to begin gradually and listen to your body – don’t try to get back to your previous level straight away!
So last week a blog was doing the rounds on some of the Facebook pages I follow. It was talking about the incidence of urinary incontinence in exercising women.
There are various types of incontinence. Stress incontinence is the most common (1 in 3 women) and is where you leak urine when exercising but also when laughing or coughing. It’s due to the weakened pelvic floor not being able to withstand an increase in intra-abdominal pressure.
What I found particularly interesting in this write-up was the percentage who had a problem in very high impact sports – up to 80% of women. This figure included younger women and also those who hadn’t experienced childbirth.
This is the reason why I keep impact out of all my classes. This wasn’t always the case – jumping jacks was a favourite of mine in aerobics. But without fail there was always someone who left the studio to use the loo…
So it’s advisable if you are experiencing any symptoms that you also avoid high impact exercises. Doesn’t necessarily mean you will never be able to do the things you love, it is just a sign to cut back for now.
There are a number of other lifestyle habits you may want to adopt that can help if you are experiencing stress incontinence:
- Drink plenty of water – cutting down may seem like a good idea but actually it will create stronger urine which will irritate the bladder more
- Don’t go ‘ just in case’ – this can de- train the bladder. You should be able to last for 3-4 hours between toilet trips. And you shouldn’t have to go in the night.
- Strengthen the pelvic floor – My Pilates classes can help with this. I have had marathon runners in my class who used to have to wear pads when racing that are now dry. It may be worth seeing a women’s health physiotherapist as well – 50% of women do kegels wrong, bearing down instead of lifting. And some women’s pelvic floor will be too tight, in which case kegels is completely the wrong exercise to do!
- Try to pre-brace the pelvic floor before sneezing, coughing etc if at all possible. Weirdly, lifting one leg when you sneeze can also help.
- Practice the Knack!
Foods/drinks to avoid if you are experiencing urinary incontinence:
- Spicy foods – can be irritating to a sensitive bladder
- Cranberry juice – fights off bladder infections but it can also increase the symptoms of an overactive bladder
- Caffeine – it’s a diuretic and bladder irritant. Bear in mind that chocolate also contains caffeine
- Carbonated drinks – carbonation can irritate the bladder
- Acidic food – includes fruits (especially citrus fruits), vegetables (tomatoes) and drinks such as juices
- Sugar – real or artificial can worsen symptoms of overactive balladeer for some. Even ‘healthy’ sugars such as honey can cause problems
- MSG – mono sodium glutamate has been found to be a trigger for some
I was also sent this picture (I know, I dread to think what my browsing history looks like!).
The gap that you can see is unique to women. It is the urogenital hiatus – a gap in the pelvic floor muscles that allows for childbirth. It is also the reason why women suffer from prolapse more than men. If your pelvic floor is strong, the hiatus stays narrow and this keeps the pelvic organs lifted. If you are experiencing leaks this is a sign that there is a weakness in the pelvic floor. So it’s definitely worth being mindful of this gap and not putting undue pressure through your pelvic floor and risking prolapse
So don’t ignore leaking – it’s common but it’s not normal and can be improved.
There is more to successful c-section recovery than just stopping driving and no hovering! Do try to get as much help as possible in the early days – I know we always want to do everything but you have just had major abdominal surgery. So even if you feel ok you still need to take it easy otherwise recovery can take much longer. A general rule of thumb is to not lift or push anything heavier than your baby for the first 6 weeks – this includes the pushchair.
Other considerations are:
- Continue to roll over to get out of bed – and reverse the action to lie down. Check out my video here. Some people find gently pressing a pillow on to their incision helps when rolling over and when standing up.
- Remember to lift the pelvic floor and breathe out as you stand up – read about it here. You need to use the same technique when lifting baby and during any exertion.
- Be aware of your posture, especially when lifting holding your baby.
- Make sure you are well hydrated and try to eat nutritious food instead of junk – more about healing nutrition here
- After doctor’s clearance at 6 weeks, introduce scar massage to prevent adhesions.
Adhesions are tiny ropes of tissue (collagen) that bind together to help with healing after surgery and also after infection, inflammation, radiation therapy and trauma. It is an important and necessary part of the healing process but unfortunately there seems to be no stop button. This means the adhesions can remain and continue to grow for life – so even if you are way postnatal this may still be something that could help.
Something else to consider, especially for those of you who are way post surgery, is that NeuroKinetic Therapy proposes that other pain can also come from a stuck scar. Scars are neutrally dense which means they receive all the messages from the brain instead of other parts of the body e.g. the abdominal muscles. This could lead to pain and a lack of strength in other muscles – which may mean you don’t get the results from strengthening exercises that you think you should. Deactivating the scar could make a huge difference – think I’m going to have to start practising what I preach!
Although you need to rest in the early days, movement is an important part of your recovery. It improves the blood circulation helping to nourish your body, keep muscles healthy and prevent stiffness and constipation – gentle walks are perfect!
When you do consider a return to exercise after a C-section (at least 8-12 weeks later) you need to be aware of any pain/tenderness you experience. A painful scar is a good indication that you need to ease off a little. And it goes without saying – NO CRUNCHES!
I’m always being asked about exercises to flatten the abs so I should explain why I don’t do crunches in my classes.
One of the main things to bear in mind is the saying that abs are made in the kitchen – it’s more about nutrition than anything else. You cannot choose an exercise to reduce fat in a certain area and according to Men’s Health Magazine it would take over 22,000 crunches to burn 1lb of fat. And for us women, the stomach is where we mostly accumulate fat. So watching what you eat is going to be the main way to get your desired result.
Back to those crunches… Most people know you have to stop doing them when you’re pregnant. But it’s one of the first exercises women think of returning to once they’ve had their baby in a bid to get rid of the mummy tummy. In fact they’re a huge no-no as the pressure they create in the abdomen will push out on the stomach muscles and may prevent any diastasis from healing.
But it’s not just pre and post natal women that need to avoid this exercise. And here’s why:
1. They don’t work – most people’s stomachs push up as they do the exercise, training the muscle to be domed, not flat.
2. They put pressure on the spine – the spine is loaded more than is healthy and the discs are compressed. This could lead to back problems and will exacerbate any existing back pain.
3. They reinforce an unhealthy posture – due to our daily habits most of us have rounded shoulders, a chin that pokes forward and tucked under pelvises. When you do a crunch you mimic these same movements. In fact, one sure fire way to achieve a flatter stomach is to improve your posture.
4. They put a huge amount of pressure on your pelvic floor – I saw a graphic video showing this and wanted to post it. But either it’s been removed or my parental filters are too strong! Either way, every crunch forces pressure down on the pelvic floor. With 50% of all women who’ve given birth going on to prolapse and 1 in 3 women have urinary incontinence, I think it’s worth protecting our pelvic floors! So what’s the best thing for a flatter stomach?
- improve your posture – Pilates is ideal for this. Also sit less and walk more
- nutrition – eat real food, and try to avoid sugar and alcohol particularly
- functional whole body exercises – I’m a great fan of all fours work and squats and lunges and include them in all my classes!
Pelvic girdle pain (PGP), sometimes known as Symphysis Pubis Dysfunction (SPD) or SI Joint Pain – can be felt in the back, bum, legs and front of pelvis.
It’s a common problem in pregnancy – 20% of pregnant women get it, although it can be as much as 50%. But remember common does not mean normal – so you don’t have to just put up with it!
The good news is that it does tend to clear up after pregnancy – only 7-8% women still have a problem postnatally. But how you deal with it in pregnancy will have a bearing on your recovery
There are various risk factors for the condition including:
- pelvic girdle pain in previous pregnancy
- gaining excessive weight during pregnancy
- lack of core strength
- poor posture
- pelvic misalignment or history of trauma to the pelvis
- hypermobility, connective tissue disorders or laxity in the joints
- expecting a large baby or multiples
- baby’s position
There is also a range in the severity of pain felt and different activities can affect differently – some movements may cause no pain in some women but be excruciating for others. For instance, the classic going up stairs was not a problem for me but turning over in bed was always painful. The general rule of thumb is – if it hurts, don’t do it! There is no benefit in pushing through the pain and you’re more likely to make it worse.
Here are a few ideas to try which may help out with day to day activities:
- Walking – take smaller steps and go slower. Be aware that if you have a small child or a dog pulling on you that will also exacerbate it. Otherwise walking is a great exercise and should be continued as much as possible
- Sitting – don’t cross your legs – either at the ankles or the knees. Sit upright and with both feet on the floor – an upright chair or birthing ball is helpful rather than the sofa. Click here to go to my YouTube channel where there are videos instructions on sitting, standing up and getting up from the floor or bed. Using the Knack on movement will also help.
- In bed – turning over is usually the issue. Keep a pillow between your knees then squeeze your knees, perform the Knack and try to keep your hips stacked as you roll. This can be aided by having a duvet under the bottom sheet. Also reducing friction to turning can help – using silk sheets, a snoozle slide sheet or if you’re desperate, a bin bag!
- In the car – getting in and out is a challenge. Think 1950s and keep your legs still and swivel round! You don’t want the knees to move inwards past hip width, so again a pillow between the knees (or a yoga block) and squeeze and perform the Knack as you swivel. A plastic bag on the chair can help. Also when in the car try sitting on a rolled up towel so that your hips are more in line with your knees.
- Avoid one legged positions – sit down to get dressed and walk upstairs by bringing the second leg up to meet the first before you take the next step. Think of stepping upwards with each step rather than forwards. You may also want to avoid carrying things upstairs. If you need to get down to the floor try to use a squat position and onto all fours instead of a lunge.
- Avoid wide legged positions – anything wider than hip width apart will either cause pain or risk pulling the pubic bones further apart. This also applies to your birthing position – safest position is actually on your side.
- Avoid heavy lifting and pushing – this means vacuuming and shopping trolleys are not good idea. Time to get help where possible.
- Work on your posture and try to keep your pelvis in alignment – get a referral to see a women’s health physiotherapist or a chiropractor for an assessment. They will be able to give you manual therapy and may advise a support belt to help.
- Exercise – it’s important to keep moving if possible. Gentle walking and swimming are good – but avoid breaststroke legs. Pelvic floor and deep abdominal exercises are essential – my pregnancy Pilates classes are ideal for this. Other key exercises we do are those that work on keeping the pelvis both stable and mobile. Try to practice these at home regularly.
Also, make sure it’s written in your notes – mine wasn’t and I ended up in stirrups with a forceps delivery. I was kept in that position a long time after birth too and this made my postnatal recovery from PGP much harder.
For more information the best website to use is
www.pelvicpartnership.org.uk – loads of information there.
If you need any more help feel free to contact me and remember I can always teach you exercises in class that you can use at home.