Postpartum Rehabilitation and Exercise

by Crystal Jancovic, LAc, LMT

After spending three quarters of a year growing a baby inside and preparing for labor; rehabilitation and exercise after birth are rarely planned out ahead of time. It is never too late to take care of your body postpartum but the sooner the better for a faster recovery. Preparing the body for healing even before the baby is born is highly recommended. Gaining knowledge during the pregnancy on ways to regain function and strength can greatly increase the chance of using these skills and more importantly, using them correctly. There are many schools of thought surrounding exercise especially regarding what type, when, how soon after birth and to what intensity. Here is a brief article on a collaboration of some of the leading experts in the field from their presentations at the Birth Healing Summit 2017. To research further, feel free to explore the information of the women listed in the references section at the end of this article.

You have given birth to your baby, now what? Where do you start? Simply go for a walk. Slow and steady wins the race. Not only will this be good for your body’s alignment, but it is crucial for your mental health to get some fresh air postpartum. Do not push a stroller for the first four to six weeks because that puts your body in a different posture and causes strain on different muscles. Be mindfully aware of how you move, focus on the breath. Noticing your posture, how am I sitting? How am I standing? Bring baby to your breast while feeding. Do not hunch over the baby while feeding or at the changing table. Sit high on your sits bones with your rib cage and pelvis facing each other and not tilting forward or behind. Do not sit on your sacrum. Squat down to your baby to lift them out of their crib instead of back bending. Protect the back and pelvic floor by sucking the belly button up and into the heart. Carry babies and diaper bags on both sides of the body to help with asymmetries. Keep your arms tucked in (wings in) and your head up. Aligning the body in a healthy posture is crucial for the healing of tissues, relaxation of taxed muscles and rebuilding of weakened systems.

It is recommended to do recovery exercises (even before your six week postpartum checkup). Three muscle groups to address are the pelvic floor, transverse abdominals and deep core muscles. Activating these areas can be done correctly with a pelvic floor physiotherapist. Call your local physical therapy office and ask if there is someone who specializes in pelvic floor and core dysfunction during and after pregnancy or ask your ObGyn for recommendations of experts in the area.

To connect with the pelvic floor muscles, sit on an exercise ball to be able to feel them contract. Contract from back to front, starting at the anus and working forward. Lay down to feel them better if the exercise ball isn’t working. In that position lying down, draw the belly button in slightly. These pelvic floor muscles are best contracted when the body is in neutral so make sure you aren’t doing any type of pelvic tilt. Just connect with this area. Get used to movement again through the breath. When using the breath, activate and bring up the pelvic floor muscles while exhaling. Then let the perineum expand and relax with inhalation. With any exercise make sure to exhale first before doing the movement (blow, then go). Do not hold your breath or suck in or tense up your tummy. This causes unnecessary pressure on the pelvic floor.

What about kegels? Kegels are not the magical cure-all for strengthening your pelvic floor muscles. In fact, there are substantial reasons not to do kegels. For example, kegels should not be done if you have scar tissue, had a cesarean birth, have a prolapsed bladder causing incontinence or are experiencing any sexual pain.

Core strengthening is recommended to do for around eight weeks before moving into any exercises. Making sure your center is balanced and strong will prevent future injuries and hopefully make you stronger than you were before your pregnancy.

What if I’m exhausted and don’t have the energy to work out? Unless you are getting at least six hours of sleep in a row, do not increase to 80% workout intensity. Increasing without proper amounts of sleep, will start depleting your postnatal energy. If you are pushing it too hard physically without replenishing your reserves with some restful sleep you increase your chances of injury and of slowing down your body’s natural healing process. When we are bordering on adrenal fatigue our bodies go into protective mode and they hold onto fat causing weight gains, regardless of how much calorie burning we are doing at the gym or with the baby and me stroller group.

Do not make exercise goals in the first three to six months and understand that you will most likely have to take steps slowly. For example, your two steps forward in a good week may become one step backwards when you have a bad week with the baby being very fussy or sick.

What happens if I do too much, too soon? Doing too much, too soon can lead to bladder, uterus or rectal prolapse at which is Stage 4 prolapse, these organs fall out of the woman’s vagina. Over-exercise without building strength and function first can lead to urinary incontinence, prolonged uterine bleeding, back pain, hip or pelvic dysfunction, etc.

The worst exercises in the postnatal period are those of high intensity, high repetitions and heavy weights. Crunches, cross-over crunches and planks with a weak core only further exacerbate symptoms especially if diastasis recti is present. Running is very hard on pelvic health after birth. It is important not to put big loads through the pelvis so switching to riding a bike can decrease impact. If you feel any heaviness or unusual discomfort while working out, back it off. Listen to your body, pain is the body’s alarm system to tell you something is wrong. Reflecting on the exercise you are doing now in regards to your long-term pelvic health and asking yourself, “How will this affect me in a decade? In 5 decades?” Knowing what you can do, opposed to what you choose to do for your long term health and longevity can be very beneficial. “I can move this crib by myself. I choose not to.”

All in all, the postpartum period can be very intense as you adjust into your new life and your new body. Accept your postpartum body. Don’t compare it to other mother’s bodies or to past pregnancies. Love yourself in the moment for who you are and what you look like. Be proud of your body bringing another being into the world. For those days that are hard and you find yourself judging yourself more harshly or feeling like you are not enough; put your hand on your heart and say, “This is a moment of suffering. May I be kind to myself, may I be gentle with myself and from here may I walk forward with a vision of positivity.”


References:

Birth Healing Summit 2017 (online). instituteforbirthhealing.com/summit-2017/

Led by Lynn Marie Schulte. 16 presenters and their presentation topics included:

  • Relieving Pelvic Pain After Birth by Isa Herrera, PT
  • Pelvic Organ Prolapse: What Every Postpartum Woman Needs to Know by Christine Kent
  • Exercising after Birth: the When and How’s by Lorraine Scapens
  • Born to Fall in Love:  Healing and Resolving Birth Trauma by Chanti Smith
  • Hypopressives- A Completely Different Core workout by Trista Zinn
  • Understanding and Avoiding Mama Shame by Amanda Ogden, IBCLC
  • Healing Diastasis Recti and a weak core by Kelly Dean, PT
  • Problems Your Body is Still being Effected from Pregnancy/Childbirth by Lynn Schulte, PT
  • Real Life Optimal Nourishment for Post Natal Recovery by Jenny Burrell
  • Mommy and Bootcamp Don’t Belong in the Same Sentence by Kim Vopni
  • Ayuvedic Healing by Dr. Bharat Vaidya
  • Self Massage by Carole Osborne, LMT
  • Perinatal Ceremonies and Birth Trauma by Gena McCarthy
  • Core and Pelvic Health by Lauren Ohayon
  • 6 Principles of Trauma Informed Care by Dr. Kathleen Kendall Tackett
  • Health after a Baby by Annie Brees

Michelle Astringer
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