THE POSTPARTUM STRUGGLE IS REAL
For some Moms returning to their previous exercises and activities after having a baby in the postpartum period becomes one of their top priorities. Some Moms are chomping at the bit to get back into the gym. Those can include the CrossFit Moms who want to prove to themselves they can still crush it. Other Moms just want to keep up with their kiddos and get back into shape while gaining some strength along the way.
Some Moms relate to their previous activities as a part of their identity. When they are given the green light by their doctor at the 6 week check up to resume their previous exercises, the thought of holding back doesn’t exist. They want to go all in!
However…just because you are given the green light by the doctor does not mean your body is fully recovered. It can take up to a year and a half for our body to recover after having a baby. Breastfeeding also makes a difference in that hormones that make our joints and ligaments lax from pregnancy are still present, making Moms susceptible to injury if they push themselves too hard.
Just because you were an athlete in the gym before getting pregnant does NOT automatically mean you are going to “bounce back” into shape better than the next Mom after delivery. During pregnancy you still had your abdominal muscles stretched and vaginal pressure from carrying the baby for months which can stretch and strain the pelvic floor muscles. Not to mention the stretching of the pelvic floor muscles with a vaginal delivery, or a C-section incision to your abdominal muscles which impacts core stability and control of your pelvic floor.
So what advice for returning back to exercise is out there for Moms? Unfortunately not enough……
Overall awareness of the importance of Moms seeking guidance with safe return to exercise in the postpartum period is growing, but still not where it should be.
ADVICE FOR MY POSTPARTUM MOMS
Here is some advice I share with my Moms that are dying to get back to the gym or want the hit payment running right after having their baby….
- This time after giving birth is just a temporary phase. It is just a small period of time. There is no need to rush back into anything too quick and risk injury to yourself. There will be time to kick butt again in the gym later when your body is stronger and ready to take on those higher demands.
- Recovery after baby does not just include exercise. You need your rest, especially those first few months when baby comes home. So if you feel the need to skip that exercise class and take a nap instead, please give yourself permission to do so.
- What we eat is important with the recovery process. Getting enough protein helps with the collagen repair with a diastasis recti (when there is separation in the abdominal muscles) or when ligaments have been stretched as with a prolapse. This is when our bladder can be shifted a bit into the vaginal wall, and we may have feelings of pressure along the perineum or vagina. Soups made with bone broth can also be beneficial in boosting collagen. Here is an excellent resource for nutrition both during the Pregnancy and Postpartum periods. Home – Lily Nichols RDN
- Try and keep your stress levels low. Having a new baby is HARD work and can be EXTREMELY stressful! No one can really prepare us for those first few months. Please accept help when you can and delegate tasks to be done around the house. High levels of the hormone cortisol as a result of stress can interfere with the healing process. Put Hubby or your partner in charge of laundry or let a family member take care of it.
- You CAN get back to what you want to do, in most cases, but there needs to be a progression to get you there safely along with some modifications along the way.
We hear the expression “listen to your body” sometimes in regards to exercise. If I’m doing too much I will know right? Not always… You may not know what you are actually listening for….
As a new Mom you need to make informed decisions as to the best way to recover and stay healthy after having a baby.
Doing too much too soon could potentially lead to pelvic floor issues such as prolapse symptoms, incontinence issues and pain
You have to ask yourself is it worth it to do those burpees, planks, lifting heavy amounts of weights when you are just 6 weeks postpartum? Or is it better to advance at a slower pace so you can progressively get stronger and learn techniques that will protect you in the long run??
So once you begin an exercise program, how do you know if an exercise is appropriate and safe to do and or when you can advance….
This is where the “Three P’s” come into play…
SIGNS EXERCISE IS A NO GO POSTPARTUM, FOR NOW
PEEING– If you are peeing while running, jumping or while lifting weight for example, it is a sign that your body is not quite ready for that exercise. This can be for any woman no matter if you had babies or not. This could be as a result of weak pelvic floor muscles, or perhaps a strategy you are doing while exercising that may be contributing to intra-abdominal pressure “down there” placing extra stress on your bladder.
Adjusting your posture, avoid holding your breath, and exhaling with a pelvic floor contraction along with core recruitment during the resistive part of the exercise may help prevent leakage. It can also be a sign that the pelvic floor muscles are getting fatigued with that activity.
Leakage can be common among women, but should never be considered “normal” or acceptable. Having a women’s health Physical Therapist complete a vaginal exam to make sure you are able to contract the pelvic floor muscles the correct way can be helpful. Awareness of both contracting and relaxing the pelvic floor is key when performing your exercises so that you are doing them correctly. A Therapist can also look at techniques while exercising or reinacting your symptoms with your day to day activites, to see what else could be “tweaked” to minimize or eliminate leakage.
PRESSURE- This pressure refers to either pressure we may feel through our abdomen as with a diastasis recti, or vaginal pressure as with a prolapse. You may be able to see the pressure through the abdominal wall as with “doming” in the middle of the abs when changing position such as sitting up on the side of the bed. You may see this with sit ups and wonder what the bulge is. This can be as a result of decreased muscle integrity along the linea alba, where the rectus abdominis muscles have been stretched from carrying a baby. If you observe this “doming” along the abs with certain exercises, then it’s a sign you may need to stop the exercise or tweak your strategy.
Retraining some of the deeper muscles can help distribute this intra-abdominal pressure so there is not as much pressure pushing outward. Exercising with this doming will not change anything for the better, and could make the diastasis recti worse overtime. A women’s health Physical Therapist can assess for the presence of a Diastasis as well as help give cues on how to activate the muscles to strengthen the core.
Feelings of pressure along the perineum or vagina can be from intra-abdominal pressure that is pushing downward during exercise or from just life itself. Some women may feel this pressure if they are on their feet for long periods of time, and may worsen as the day goes on. If you are performing certain exercises which promote this pressure overtime it could make the prolapse worse. This can result from lifting heavy weights while holding your breath and pressure goes down along the bladder and pelvic floor. You may feel this running as well since running involves a lot of impact with our body making the pressure more intense along the pelvic floor muscles.
Anytime you feel pressure “down there” while exercising it’s a sign that you need to stop. Sometimes changing your posture, position or breathing pattern during the exercise can help. Being on a good exercise program that incorporates the pelvic floor and core will help improve these symptoms and in turn help provide support as well.
Learning good strategies can help you not just at the gym, but with other activities such as lifting a stroller, the car seat, the kiddos etc. If you have a job that involves a lot of lifting on a regular basis, or you are a committed CrossFitter and having symptoms, you may want to consider a pessary. One type of pessary is shaped like a disc and inserted into the vagina. It gives the bladder support while doing more strenuous activities. Modifications are still needed with technique during exercise to help minimize intra-abdominal pressure.
Of course there may be cases where even wearing a pessary along with modifications may not be appropriate. Always ask yourself, is the risk worth the reward? Or could I potentially be setting myself back in the long run…
PAIN- The expression “no pain no gain” is NOT the rule with new Moms or any woman exercising for that matter. While there may be muscle soreness after working out, pain in most cases is a red flag our body is not ready for that exercise. A perfect example is when a new Mom attempts planks or burpees, and then have back pain either during the exercise or may feel it afterward. The stretched abdominal muscles from the baby just can’t tolerate that much strain, and so the back as a result may pay for it.
Runners may experience pain during a run or afterward. This could be perhaps from a weak core or having a diastasis which could potentially lead to back pain. I see a lot of runners with complaints of pelvic girdle pain try and start running too soon. This is why a progression with an exercise program is so important, so we can help Moms get stronger and then add those harder exercises in when ready and appropriate.
So do not think leaking, experiencing pain or feeling pressure “down below” during exercise or life in general is the “new norm” after having a baby!! Please take the time for yourself and make yourself a priority to resolve issues earlier rather than later!
You can download a free e-book here that goes into more details on how Moms’ bodies change after baby as well as beginner exercises to start once cleared at the 6 week check up.
I love working with Moms and advocate for all Moms to be assessed by a women’s health PT after they have their babies! Even if it’s been a while since you had your kiddo. Doesn’t matter if your baby is 6 weeks or 16!
Same goes for women who have not had any children. Any of the symptoms discussed here can be helped! Please help me spread the word and share this info with someone who needs it! Check out my website for more info www.indywomenpt.com
Please call me if you would like to talk. I do offer free 15 minute phone consults.
317-689-0073 or email Camille@indywomenpt.com
Cheers!
Dr. Camille Fenwick, DPT
Owner of Indy Women Physical Therapy
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