Postpartum Fitness - Where to begin?
The first thing we need to start with is Postpartum and what that means. Postpartum is the period of time after birth. This means that any individual who has given birth is in Postpartum from that point on. So, whether you are 6 weeks postpartum, 12 weeks, 2 years, or 20 years, your body has gone through a major physical and emotional life changing event.
We all know that having a baby can effect us mentally, emotionally, and spiritually. However, what isn't talked about enough is the physical stress that your body endures throughout pregnancy and birth. Whether you've had a c-section or a vaginal birth, the strength of your abdominal and pelvic floor muscles has been altered.
What muscles consist of the pelvic floor? If you were to sit on the saddle of a horse, your pelvic floor are all of the areas that touch the saddle. Starting from your public bone, back to your rectum, and your inner thigh muscles - left to right. Your pelvic floor is also part of your core muscles. Think of your core muscles like a canister. The top of the canister is the diaphragm, the side is your abdominal muscles and back, the bottom is your pelvic floor. This visualization will be helpful later on.
So, why are these two things so important? Because if they are not functioning properly, you can actually do more harm than good by jumping right back into working out like you did pre-pregnancy. Carrying a human inside of you for 9 months, plus birthing that child (whether vaginally or abdominally) causes a lot of stress on all of those muscles and can create Pelvic Floor Dysfunction, as well as Diastasis Recti.
Pelvic Floor Dysfunction is the result of excess intra-abdominal pressure. Which basically means, too much pressure in your abdomen. There are two types of PFD:
Stress Incontinence: Accidental leakage (urinary and fecal) during sudden movements like coughing, laughing, sneezing, or during exercise.
Pelvic Organ Prolapse: When one or more of the pelvic organs (bladder, rectum, or uterus) descends lower than its normal position. It can sometimes manifest as a heavy "bowling ball" feeling between the legs.
Diastasis Recti: A "wider than usual" separation of the left and right sides of rectus abdmoninis (6-pack muscles), about 2 fingers widths or greater apart. This can happen in anyone - not just pregnant individuals. It is a result of EXCESSIVE intra-abdominal pressure. It can be caused from alignment shifts in your body (anterior pelvis tilt - your pelvis tilting forward), holding your breath upon exertion, insufficient core strength, and performing "traditional" core exercises too late into pregnancy. DR is a pressure management problem. You often see this problem in "very fit" athletes as well. If you were to google a picture of a body builder, you would notice that there is a major space between their 6-pack muscles. This is often a result of them holding their breath while lifting heavy weights above their head. The same separation can happen when lifting a child, groceries, or carrying heavy furniture/objects throughout the house (carrying a carseat, lifting a stroller out of your trunk, pushing a stroller, etc)
So. What does this all mean? How do we prevent these issues from happening? How do we start working out?
You need to start at the beginning. No matter what type of birth you had, no matter if you're an Olympic gold medalist, an amateur runner, or a professional dancer, you need to start at the beginning. And where is that?
Probably not the answer you were hoping for. But this is EXTREMELY important. Breathing improperly will affect your core and pelvic floor muscles as a result of, you guessed it, too much intra-abdominal pressure. Not only do you need to breath properly when exercising, you need to breathe properly when preforming normal everyday activities of daily living. Picking up the baby from the crib, rocking the baby to sleep, getting up and down from the ground with baby or toddler in hand. You need to be breathing properly to do all of these things. If you can't breathe properly while doing ADLs, you won't breathe properly while running, lifting, or any other type of exercise. And if you're not breathing properly, you can cause DR or PFD (as stated above).
Place your hands on your waistline. You should be able to feel the bottom of your ribcage. Take a deep breath in and feel your ribs and belly expand. Please note to be aware of your shoulders and chest. They should only rise SLIGHTY. If your ribs and chest are lifting really high (to your ears) as you breathe in, you are not breathing correctly. The majority of the action should be in your belly and ribcage (your diaphragm and lungs). As you exhale, feel your belly come back in. Repeat this type of breathing over and over again until it becomes a habit that you do not have to think about. I promise you'll get there.
Practice breathing upright in neutral alignment. If you are sitting, you want your ears, shoulder, and hips to be in line with one another. You should be able to connect them all with a straight line. If you're standing, connect your ears, shoulders, hips, knees and ankles. Neutral alignment is important because it not only improves your posture, but it helps you breathe properly and minimize injury when exercising and performing activities of daily living. Being aware of your alignment also helps correct your anterior pelvic tilt. Every pregnant person's pelvis begins to tilt forward as the baby grows. Not only does this weaken your core and pelvic floor muscles, it also can cause lower back pain during pregnancy. Pay attention to how you are sitting and standing right now. Is your pelvis leaning forward? If so, fix your alignment so that you can begin to strengthen the muscles that support that area. Breathing in neutral alignment also helps prevent DR so that you learn to carry a carseat properly - by standing or walking upright without holding your breath or leaning to one side.
Core and pelvic floor activation: To breathe properly, you want to make sure you are connecting your pelvic floor with the action of breathing. Remember, the pelvic floor is a part of your core canister. Start by practicing your breathing with your proper inhale/exhale. Do this several times until you notice what your pelvic floor is doing. As you breathe in, your pelvic floor should be expanding and loosening. As you inhale, your pelvic floor should be contracting and rising. Think of either a flower opening and closing, or your vagina dropping and picking up a blueberry, as you inhale and exhale. Open the flower on the inhale, close the flower on the exhale. Drop the blueberry on the inhale, pickup the blueberry on the exhale. This process is important because it prevents intra-abdominal pressure. If you breathe the opposite way, you will in fact cause pressure on your core and pelvic floor muscles. This causes them to weaken and separate, resulting in bladder incontinence, rectal incontinence and the separation of your core muscles.
These 3 steps are the first exercises you should start with when getting back into your workout routines. By now you are probably thinking to yourself that these aren't exercises. Oh, but they are. And they are key to making sure that your body rebuilds strength and recovers in the area that has dealt with the most stress.
Breathing properly helps make sure that you aren't causing more pressure inside your abdomen that could damage your muscles. Practicing this breathing technique will not only help you make sure you don't injure yourself during high intensity workouts, it will also prevent you from injuring yourself during activities of daily living. Exhale on the exertion. Exhale on the exertion. Exhale on the exertion. Drill this into your brain. Do not inhale or hold your breath on the exertion.
Neutral alignment helps your posture, helps strengthen your core and pelvic floor muscles, reduces stress placed on your body from pregnancy, and helps you with performing everyday ADLs safely.
Core and pelvic floor activations rebuild your muscle strength. It's important to do these exercises and NOT just kegels. In fact, kegels actually do more damage than good. People often mistake kegels as an important way to strengthen your pelvic floor but, they don't actually strengthen the muscles. Kegels tighten the muscles. But a tight muscles is not a strong muscle. On the contrary, a tight muscle is often a week muscle. When the pelvic floor muscles are weak, there is a tendency to keep the muscles in a chronically contracted state. For example, imagine your bicep as the pelvic floor. When you perform bicep curls, you work through a full range of motion - lengthening your arm all the way down and curling it all the way up. Working through this full range of motion is what helps develop a strong, well-balanced muscle that can respond to various loads, including heavy weights. Now, imagine holding a heavy weight in a flexed position and never moving it. After a while, the bicep being in this shortened hypertonic state would likely not be able to hold an object much heavier than a phone. The same is true of your pelvic floor. If the muscles are held in a chronically shortened position, they will not be able to respond when needing to control larger amounts of force (like the force generated from sneezing, coughing, or jumping). So think of the core and pelvic floor activations I gave you, with your breathing technique, as a bicep curl - a full range of motion for your pelvic floor. Opening the flower, closing the flower. Dropping the blueberry, picking up the blueberry. Full. Range. Of motion.
How long should your practice this for before adding more excercise? AND what exercises do you start with next? Ideally you should be practicing these exercises until you do not have to consciously think so hard about them and they begin to come to you naturally. Do it every day. Every. Single. Day.
6-12 weeks postpartum you should be focusing on core/pelvic floor activations, breathing, and neutral alignment.
12-24 weeks postpartum - all of the above but start to add in LIGHT exercises. Cat-cows, Chair get-up (literally get up from sitting - sounds silly but, you'd be surprised), Split squats, Down-dogs, bridges, and more. ALL of these exercises should be performed slowly, while consciously and simultaneously performing your breathing techniques and pelvic floor activations. Sound difficult? It may be at first but, it'll be so worth it in the end. Now would be a good time to reintroduce or start yoga.
1 year+ postpartum - all of the above and start progressive building of strength and conditioning exercises. Slowly introduce high-intensity pre-pregnancy activities and exercises.
If you're looking for specific workout routines, I will be announcing my programs and pricing in the coming months. For now, start at the beginning with these main 3 exercises.
And lastly, the most important thing about reintroducing exercise after pregnancy and birth is your mental health space. If your goal is to fit into pre-pregnancy clothes, to be a certain weight or to look a certain way, stop and ask yourself why. Take a moment to journal this out and/or talk it over with a trusted friend, Doula or therapist. Explore why you feel this way and why you have a strong urge to JUMP into things as quickly as possible. A healthy mental space is hard to achieve when it comes to fitness. It's really really fucking hard. If you feel yourself obsessing and stressing over it, stop before you get started or go too far. Society puts huge expectations on us when it comes to body image and it can be daunting. You do not need to do any of this alone.
Remember to have grace for yourself. You carried a human for 9 months and brought them into this world. That's really fucking awesome. Your body is bad ass and can do amazing things. You are loved. Don't forget to love yourself too.