Tag Archives: postnatal

How you can help your pelvic floor

I was asked by someone this week about rehabbing the pelvic floor post birth, in preparation for getting back to running.  I was so pleased that she was aware of the importance of taking her time – things keep popping up in my timeline about postnatal classes where people are running with buggies, skipping and even doing jumping jacks! All of this can have a deleterious effect on the pelvic floor and continuing to overstress a weakened pelvic floor can lead to prolapse.

However taking your time, making a few lifestyle changes and building up core strength can mean that even if you’re currently experiencing pelvic floor dysfunction (any leaking, back pain, heaviness in the pelvis) you may be able to get back to your previous exercise routine.

I prolapsed after my first child and was given very little advice about it other than being told I would probably need a hysterectomy when I go through menopause.  Because of this experience I have spent my time learning more and applying it to my own life as well as in my work with others.

First thing I implemented was no impact.

As someone who wasn’t a runner, this wasn’t a big change.  But I did have to stop jumping around in my aerobics classes and also give my trampette a wide berth…!  I can now run for the bus without worrying and I played rounders in the summer where I was sprinting for quite a while with no effect.  So I could probably run now if I wanted to but I’m still choosing to stay low impact most of the time.

Second thing was no crunches

The downward pressure created by crunches/sit-ups will push on the pelvic floor.  Full planks and press-ups and exercises with both legs lifted also creates a lot of pressure and so I avoided them.  However there are alternatives – for example in press-ups performing them on an incline, plus incorporating crunchless core exercises – so there is no reason to stop exercising, just make a few changes.  Bear in mind that sitting straight up in bed is also a crunch (and how many times do you do that a night?) – I roll over to get out of bed instead.

It’s not all about what you shouldn’t do though. There are things that I needed to start doing:

  • alignment/posture

particularly the with respect to the pelvis.  Try tucking your tailbone under and bringing your hips towards your ribs.  Lift the pelvic floor now.  Then take your hips away from your ribs, allowing your lower back to arch more, then lift the pelvic floor.  Then bring yourself to a neutral pelvis where your level through the front and the back of the pelvis (think of it like a bowl) – the pelvic floor lift should feel easier in this position.  Pelvic floor works best when we are in alignment, with the head, shoulders, rib cage, pelvis and heels all stacked up in line

  • breathing

both looking at how you breathe during exercise and from day to day.  During exercises you need to breathe out on the effort and lift pelvic floor at the same time.  This also applies when you are lifting a weight – baby, shopping etc. – and also when you go from seated to standing (The knack – as you go from sit to stand but vice versa too).  The other aspect of breathing is to stop breath holding and sucking your stomach in.  When you breathe in your stomach should actually swell not suck in.  I see so many people who’s stomachs stay still when breathing and instead their shoulders lift.  Try lying on your back with your knees bent, feet flat on the floor.  Put one hand on your chest and one hand on your stomach.  As you breathe in you should feel your chest move first then your stomach.  Your stomach lowers as you breathe out and then your chest.

All these changes I’ve made have meant that my prolapse has improved and I’m hoping to avoid that hysterectomy!  I know that there’s still work to do and I’m currently learning more about another part of the puzzle:

  • relaxation

stress can affect the pelvic floor, there’s also some evidence that lower limb injuries and back injuries will impact the pelvic floor too, even years after healing or the pain has stopped. There may also be scar tissue from episiotomies or tears.  I’ve just learnt some trigger point release for that – sitting on one of the spiky balls!  It’s uncomfortable but definitely has an effect – I will let you know how that goes!  And it’s also helped to introduce deep breathing, mindfulness and relaxation practices into my daily life.

 

So when looking at rehabbing the pelvic floor, it’s not just about a list of exercises to do – we need to think of the body as a whole and the pelvis at the centre of that, and looking at improving in all these areas

Is postnatal exercise just for YOU?

I saw an advert for a postnatal exercise class the other day that had a line about how mums were deciding to be selfish and take time for themselves.  Now I’m all for me-time as an essential part of a mums postnatal recovery and don’t see that as being selfish at all – in fact, if anything, mums aren’t selfish enough and always seem to put themselves at the bottom of the to do list.

But in addition to mums deserving to do something that benefits them, I also see so much benefit to the babies coming along to exercise classes too.

The NHS states that babies should be encouraged to be active throughout the day and avoid being sedentary for long periods of time – in car seats, pushchairs, bouncers etc.  This is why in my buggy class we tend to exercise in one area so that the babies can be let out on to the floor whenever possible!  And in Pilates, unless they’re sleeping, babies can get over an hour of play on the mat – giving them loads of room to roll, rock or for tummy time.

Babies getting the chance to be active along with their mums is good for two reasons:  first, they’ll see exercise as a normal and fun thing to do and secondly, they learn by copying.  Being active also helps the brain to develop.

There is some degree of sensory play in class as well – the balls, bands, mats and dumbbells are all a source of fascination.  One baby’s first crawl was because she wanted to get to the dumbbells!!  Outdoors the leaves and grass give vital feedback about their surroundings – and help their immune system too.  The fresh air is good for them and as an added bonus may help them sleep better!

The social aspect of the classes is also key – I know my daughter first started walking because she clocked an older child doing so.  I watched her watching him and as soon as she got home she grabbed hold of the high chair and off she went!!  There is also a lot of enjoyment in just watching their mums – I’ve a few video clips of babies laughing at the exercise!  And in Pilates there is often a very chilled feeling to the start of the class as the babies watch the flowing movement – they sometimes seem mesmerised!!

There have been lots of developmental firsts in my classes, from first rolling and crawling to first standing unaided and first steps.  Given time and space and a great example from mum gives the babies lots of opportunity to develop – so turns out class is as good for them as it is for you!!

Click here for a great pdf on physical activity guidelines for under 5s from the NHS

5 tips for preventing back pain when caring for children

As I was walking home from class yesterday a father and his toddler walked past me.  The dad was taking tiny baby steps in time with his son, was crouching in a squat position to be at his son’s level and was leaning over to one side in order to hold his hand.  This reminded me of how Becky used to love to hold my finger as she walked – up until her hand was big enough to hold mine.  And how it hurt my back let alone nearly dislocated my finger!!!

The trouble with having bad posture when you’re caring for children is that you’re going to repeat that same position over and over again each day and this will take it’s toll on your body.  And because of the interconnectedness of our body parts, that pain could show up anywhere, with the back often being the prime suspect.

Here’s my 5 top positions to be aware of your posture:

  1. Bending over to change nappies and other jobs at waist height – stay in close, hinge from the hips and keep the upper back in alignment. You’re trying not to just round your shoulders and hang from your ribs.  If the task is lower down, bend at the knees into a squat or lunge
  2. Getting out of bed – roll over onto your side and push yourself up. Try not to just sit straight up – this causes pressure through your stomach and could prevent diastasis from improving as well affecting your pelvic floor and back.  I demonstrate this on video here
  3. Pushing the pushchair/shopping trolley – stand upright, not too far away, with your arms slightly bent and think of powering through your legs, it’s a great bum work out!  Don’t rest your weight on the pushchair and don’t think of it as pushing with your arms – your whole body is doing the job.  Applies even more so when going uphill!!
  4. Picking baby up from the floor – bend at the knees into a squat or lunge keeping your back in alignment, pull baby in close, exhale as stand up (using the knack).   The same with car seats – and it’s better if you can carry them close with both hands when baby is small.  Picking up from the cot you need to stay in close and again bend at the knees and hips
  5. Carrying baby – try not to lean back to rest baby on your chest.  Drop your ribs down and keep them in alignment with your hips – you will feel your core tire quicker but that will just remind you to change positions.  Try and keep baby high and in the centre.  If you carry to one side keep them high and let their head rest on your shoulder – try not to push your hip out and try to vary sides rather than always favouring one

Bear in mind that any continuing pregnancy conditions need to be assessed – pelvic girdle pain, piriformis/sciatica, diastasis, pelvic floor dysfunction.  These can all contribute to back pain as well.

 

C-Section Recovery

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!

8 Ways To Lose Your Mummy Tummy

There was an article this week that showed Zara Phillips/Tyndall out for the day, dressed up, enjoying herself.  The photo showed off a bit of a bump so people were assuming she was pregnant again.  She then had to issue a statement that she wasn’t.  I must admit, I felt a bit sorry for her – nothing worse than being asked when baby’s due when you’re not even pregnant…

Anyway, the article went on to assume that Zara had diastasis recti.  This is a possibility as 36% of women have it past 8 weeks postnatal.  At this stage it’s done all it’s going to do on it’s own and from then on requires a bit of help!

So what is diastasis recti?  Basically the two bellies of abdominal muscle are connected in between by the linea alba. During pregnancy this thins and stretches in order to create space for baby.  There then appears to be a gap, often seen as a doming when trying to sit up   It is thought that all pregnant women in their 3rd trimester have a diastasis recti.

Postnatally, the linea alba needs to shorten and strengthen for the stomach muscles to resume their normal distance apart (1-2 fingers) and feel firm underneath.  There are many issues to look at to help this process along.

Things to avoid:
  1. Inappropriate abdominal exercises – like crunches/sit ups and full planks.  If you have to hold your breath, strain, are shaking or your stomach pushes outwards, the exercise is not for you at this time;
  2. Getting straight up out of bed – that’s just like doing a sit-up every time you get up to do a feed.  You need to roll out of bed,  same as you did in pregnancy;
  3. Sitting for long periods – everything compresses down.  Hard when you’ve got a new-born that needs feeding all the time!  But try and stand up when you can and fit in a daily walk;
  4. Straining – especially when lifting. Don’t hold your breath – exhale on the exertion – and try and engage the pelvic floor when lifting (as taught in the knack).
Things to do:
  1. Posture – you need to be mindful of posture when seated and standing. Try to keep your hips in line with your heels, rather than your weight pressing over your toes and make sure you’re not lifting the ribs up.
  2. Breathing – need to avoid breathing into the belly but use the diaphragm and ribs instead.  Linking this with pelvic floor recruitment will also benefit. Click here to see my video of how the diaphragm initiates your breath and how the pelvic floor works in tandem with the diaphragm.
  3. Exercises – to improve core strength but also to release tight muscles.
  4. Nutrition – especially water and protein (doesn’t have to be animal based).  I wrote a more in-depth article about postnatal nutrition – you can read it here.

It’s also worth bearing in mind during pregnancy.  You’re not trying to prevent the stretching of the linea alba, as this is what gives space to your growing baby.  But by following the steps above you will be able to put less pressure through your mid-section, protect your back and prepare you for the postnatal period.

no shame

No blame, no shame - own your birth story

No blame, no shame – own your birth story

I posted a link to a blog on Facebook this week giving another perspective on mums who’ve had C-sections – taking pride in them instead of feeling shame.  It had struck a cord with me as I had felt such a failure when I didn’t get the home birth I wanted and ended up having the most medicalised birth possible. Seems it struck a cord with other people too, as it became my most liked, shared and viewed post! Here’s the link if you want to read it for yourself.

Question is, why was it so well received? Do so many women feel bad about themselves? And of course the answer is yes, because this is what society seems to be about at the moment. As mums, we’re made to feel bad if we give birth the wrong way, feed the wrong way, if we choose to stay at home or if we go back to full time work. And it’s not just our parenting skills that are questioned. Fat shaming, slut shaming – the fact there are words for it shows how prevalent it’s become.

I’m proud that in my classes people feel welcomed and not judged in any way – there is a real community feel where we support one another.  I have always been a proponent of exercise for health and fitness, so I don’t expect people to look a certain way before they can attend, I just want everyone to get the benefits that exercise affords. In my classes I have people of all ages, fitness abilities, health history and size. And they all get something out of the classes.  And I hope that when we feel good about ourselves we therefore don’t feel the need to diminish others to make us feel better.Today take another look at all you’ve achieved and take pride in it.

Mother’s Day

A Mother's Day Love Letter

A Mother’s Day Love Letter

I’m often wary about mentioning Mother’s Day as it has different connotations for many. I’m particularly mindful of it following some of the conversations and emails I’ve had this week. But that has made me more grateful this year than usual, for my own mum and the sacrifices she made and also for how lucky I am to have my girls.

Sometimes being a mum is just so hard and thankless. There’s a never ending list of stuff that needs to get done. There’s our bodies which have irreparably changed in so many ways. There’s the scariness of being responsible for another human being and having to get it right. It’s a steep learning curve and just when you think you’ve got the hang of it, something new comes along…

But there are two people who at the minute think I’m the centre of their world. I’ve never known love like I felt for them the moment I set eyes on them.

In the words of Eden Ahbez “The greatest thing you’ll ever learn is just to love and be loved in return.” My girls have given me this and I’m so thankful for it.

Happy Mother’s Day

Nutrition for the postnatal period

When it comes to optimal nutrition for the postnatal period, there is more to consider than just regular healthy eating advice.  For sure cutting out processed foods, refined carbs and sugar and limiting the intake of alcohol and caffeine is good advice for us all.  But there are also a few other factors to consider postnatally – the body has to gone through trauma, whatever the birth experience, and the postnatal body needs to heal and be renourished.

Nutrients to include in your healthy eating plan:

Vitamin A – low levels of this can delay healing of wounds and can leave you open to infection.  Having avoided classic foods rich in vitamin A throughout pregnancy, the postnatal body may already have low stores.  Found in cheese, eggs and yoghurt and in very high amounts in liver and pate (NHS advice is to only eat one portion a week), it is also converted from yellow and orange vegetables – sweet potato, carrots, peppers, green leafy vegetables and yellow fruit – mango, apricots, melon.

Iron – again, low levels can delay healing.  Blood loss during the birth may leave the postnatal body deficient.  Found in liver, meat, nuts, wholegrains, spinach and eggs.

Glutamine – intake of this amino acid is essential when a body is severely wounded, for example after a caesarean section.  Good sources of glutamine are eggs, pork and chicken, yoghurt and milk, ricotta and cottage cheese, spinach and cabbage

Water – dehydration can reduce the efficiency of blood circulation, meaning impaired supply of oxygen and nutrients to the wound site

Vitamin C – helps wound healing, maintains healthy connective tissue and helps to prevent infection. Found in a wide variety of fruit and veg.

Protein – essential for healing, helps in repairing tissue

Part of the healing process involves inflammation around the wound site.  In order to help the body to continue to heal we need to be eating anti-inflammatory foods – good fats , whole fruit, berries and veg, most  fish and seafood, nuts, ginger, garlic and turmeric

It’s very difficult to think about healthy eating in the early postnatal period – sometimes getting any food into you is a bonus! And later on our focus can sometimes be more towards losing the baby weight.  But instead, try to see your food intake as a way to nourish yourself and heal from the inside.

when can I return to exercise after having a baby?

With the rise of the yummy mummy and celebrities pinging back into their size 0 figures with seemingly little effort, there is immense pressure on the modern mum to follow suit.  Some will take drastic measures with their diet and some will try to fit straight back into their exercise routine.  That may have been suitable pre-pregnancy but is it now?  When is it ok to return to exercise after having a baby and what type of exercise is most appropriate?

There are a number of issues to consider when deciding which exercise routine is right for you and when:

  • Relaxin.  The hormone that enables your muscles, ligaments and joints to relax and soften allowing room for your baby to grow and be born.  The effects of this hormone can continue for up to 6 months postnatally, affecting all your joints, leaving them unstable and more susceptible to injury.
  • Our amazing pelvic floors that did all the carrying and then pushing are severely weakened.  This is true even if you had a caesarean.  They need to repair and strengthen so they can continue to support the internal organs.  Exercising too hard or too soon can increase the likelihood of prolapse and incontinence.  According to the National Institute for Health and Clinical Excellence, 25-45% of women suffer from urinary incontinence.  The NHS says that up to half of all postnatal women are affected by some degree of pelvic floor prolapse.  If you had multiple births, ventouse or forceps, spent over 1 hour in the second stage of labour, severe perineal tearing or had a baby over 4kg you may be more at risk of pelvic floor problems.
  • The stomach muscles have stretched massively to allow for the growth of your baby. For up to 60% of us, our stomach muscles will have split.  These will need to come back together so that our backs are supported and additional pressure is not put on the pelvic floor.  One study reported that 66% of women with diastasis rectus (split in the stomach) had support-related pelvic floor dysfunction as well i.e. incontinence and pelvic floor prolapse (Spitznagle et al, 2007).  Any traditional abdominal work and twisting moves done whilst the stomach muscles are separated can cause these muscles to stay apart and can lead to doming of the abdominal muscles, making the mum still look pregnant.
  • Any pregnancy-related conditions you experienced can continue postnatally – pelvic girdle pain, carpal tunnel and sciatica.  These may also affect your exercise choice.

So given these considerations, when can you get back to exercise?  Most health professionals will require you to have had your doctor’s check before you can resume an exercise program – 6-8 week check for vaginal birth, 10-12 weeks for a caesarean.  This time is given to allow the uterus to shrink, stomach muscles to heal, ensure bleeding has stopped and the perineum is healing. Stitches may need to be removed and cases of anaemia dealt with.  Once you’ve had your check-up, this does not necessarily mean you are ready to start where you left off.  Given that every woman’s pregnancy and birth are different, there can be no hard and fast rules, merely guidelines.  You need to listen to your own body – it has gone through a lot physically and emotionally.  Determine which of the factors listed are still applicable and therefore what is appropriate for your postnatal body – it can be 6-12 months before you’re ready to resume your previous exercise intensity.

You need to avoid the following exercises before your check-up and only gradually add them to your exercise repertoire once your pelvic floor is strengthened and any diastasis is healed:

  1. Running and impact exercises
  2. Sit-ups/crunches
  3. Oblique twists
  4. Plank

In the meantime, there are some exercises that you can do soon after having your baby which will help to repair the pelvic floor and abdominal muscles.  These can (and should) all be done in a variety of positions – standing, sitting, side-lying and lying on your back.  Try to avoid kneeling on all fours to do the exercises in the first 6 weeks:

  1. PELVIC FLOOR FIRST – working the pelvic floor will also help to flatten the abs.  It brings blood supply to the perineum so is good for healing even if you’re still feeling sore.

Pelvic floor lifts – quick pulses and long holds.  Working from your back passage to the front, lift and release.  Try and maintain a good posture, no tucking the bum under or squeezing it; don’t hold your breath.

  1. Pelvic tilt – from a neutral position, tuck your bum under, drawing the hip bones towards the ribcage.  You should feel your lower back flatten and your stomach muscles start to engage.  Try not to squeeze the bum and concentrate on the pelvis only moving.
  2. Abdominal bracing – keeping your body in a good posture, think of drawing your hip bones towards each other.  Don’t tilt the pelvis, don’t suck in or hold your breath.  It is a small movement where you should feel your stomach muscles start to tighten, but no change in your back muscles.

You can also target the pelvic floor in the last 2 exercises by breathing out and drawing up the pelvic floor just before you start the movement.

By starting slowly and targeting key muscles first, you should be well on the way back to your regular exercise routine.