December 3, 2019

By Carolyn Yates, PT, DPT

Hey mama! Congratulations. You successfully created a human and that is rad!

You’ve probably been given a fair amount of information on what to do with the babe but what about your body? Having a baby is beautiful and natural and has been happening for thousands of years. Women have also been suffering (mostly in silence) from the physical repercussions of childbearing for thousands of years; incontinence, pain with intercourse, prolapse...to name a few. These repercussions have been accepted as “normal” and basically just part of the territory. Well, they don’t have to be! Common does NOT mean normal. Just because you have had a baby does not mean that you have to pee your pants or that you have to have uncomfortable intercourse for the rest of your life. But, you do have to be proactive and devote some time to yourself which is difficult in the early postpartum time. Just remember that it is easier to be the mom you want to be when you are feeling 100% physically and mentally. So, take a little sliver of you-time to help your body rehabilitate. Your body and mind will thank you!

Exercises for the first four weeks postpartum

Belly Breathing

Belly breathing is such a great exercise to maintain mobility of the abdominals and pelvic floor muscles. Your abdominal muscles have been slowly being stretched out over the past nine months. After childbirth, the stretch is alleviated over a much shorter amount of time and this can cause tightness and painful trigger points in the muscles. Belly breathing encourages normal mobility back into the muscles.

• Lying on your back with your hands on your belly, take a deep breath in for a count of 5 seconds and feel your belly rising.
• Exhale the air out for 5 seconds and feel your belly falling back down.
• In addition to belly movement, feel your pelvic floor lengthening or “bulging” down slightly as you inhale, and then feel it rise back up as you exhale. You can add a pelvic floor contraction as you exhale when your pelvic floor soreness has subsided by 70%.
• Do this exercise every day for 1 minute in the morning and 1 minute in the evening.

Hypopressives

Hypopressives utilize a negative pressure system to encourage re-engagement of the core muscles and a “suctioning” up of our pelvic organs. We are, in a sense, encouraging the upward pull of the pelvic organs with hypopressives which is hypothesized to help decrease incontinence and prolapse symptoms. These are not very functional (mimicking your usual movements) exercises because they involve breath holding, but when implemented properly they can help immensely in the early postpartum time.

• Lying on your back, take a deep belly breath in (hands on your belly and really feel the upward motion of your belly) then exhale fully. Once you have exhaled all of your air, hold your breath, plug your nose, and suck up-and-in even more. Think Arnold Schwarzenegger when he was posing. He would suck his belly up and in and try to pull his lower ribs out. You are trying to do that and hold for 6 seconds. At the end of the 6 seconds take a deep belly breath in again. You should really feel the extreme change of abdominal position. You’re going from a strong upward-and-in abdominal contraction to relaxation and stretch.
• For an added bonus, as you are holding your breath, try to pull up-and-in at your pelvic floor. Imagine you have a marble at the opening of your vagina and you are picking it up and holding it tight as you hold your breath.
• Do this exercise every day, with one set of 5 in the morning and one set of 5 in the evening.

Cat-Cow

Cat-cow is an excellent exercise to improve mobility of your back, alleviate stress, and work on engaging and strengthening your core and pelvic floor in a different position. It uses your breath to guide the movement and encourages muscle engagement as well as stretching and relaxation.

• On all fours, take a deep breath in as you gently arch your back and look up. Reverse the motion; exhale as your round your back up.
• As you are exhaling and rounding up into cat position, imagine you are “zippering-up” your pelvic floor and core muscles up-and-in.
• As you are inhaling and arching your back into cow position, relax your belly and pelvic floor.
• Do this exercise every day, with 10 repetitions in the morning and 10 repetitions in the evening.

These three exercises are gentle enough to do immediately postpartum but also effective enough to start you on the road to muscle recovery. The quicker you regain strength and mobility of your pelvic floor and abdominal muscles, the better. These are the muscles that help you hold your pee, stretch to have enjoyable intercourse, hold up organs and so much more! Give them some extra attention and they will thank you!

Is it safe to exercise immediately postpartum?

Yes! The word “exercise” is being used in the most gentle way possible. These “exercises” are meant to help gently re-engage the muscles that have been slowly stretched out over the past 9 months. Gently moving your body and engaging your muscles will help to prevent prolonged urinary incontinence and prolapse.

What are functional exercises?

Functional exercises are exercises that mimic real-life situations. For example, squats are functional exercises because we squat to sit down and stand up all day long. Hypopressives, which involve holding your breath and sucking your belly up and in, are not functional because they do not mimic something we do regularly. All three of the exercises help rebuild strength in your pelvic floor, but functional exercises have the extra benefit of training your muscles to safely do everyday activities.

When can I start running again?

It is strongly recommended that you wait until 12 weeks postpartum to start impact activities again. If you start back to impact activities and have not rehabilitated your muscles and given your organs a timely chance to return to their proper position then you put yourself at risk for injury. The kicker is that sometimes these injuries that happen from returning to impact activities too soon do not manifest in pain or dysfunction until months or years later. Do your body a favor and wait until 12 weeks postpartum to start the gradual return-to-impact process. You future self will thank you!

If you are reading this and are really confused, then please reach out to your local pelvic floor specialist and make an appointment. Your body and future self will thank you!

Carolyn Yates, PT, DPT is a Colorado State licensed Physical Therapist with a pelvic floor rehabilitation specialty. She received a Doctorate of Physical Therapy (DPT) from Belmont University School of Physical Therapy and is the owner and head physical therapist of Verity Physical Therapy & Wellness in Boulder, CO.