Postpartum Wellness

38 weeks pregnant- Photo by Lilly Ann Photography

Two and a half years ago, my pregnancy journey came to an end and life truly began with Hudson. Looking back now though, I wish I had of known more about what the women’s body goes through during pregnancy, preventative benefits of physiotherapy, and returning to fitness safely postpartum. With so many ladies in my life announcing pregnancy or recently giving birth, I thought it would be worthwhile to share some knowledge from an expert on the topic. I’ve teamed up with my friend Lauren Browne, a Pelvic Health Physiotherapist and Certified Strength and Conditioning Specialist to share a candid Q&A of my experiences as well as best practices for those pregnant, planning on pregnancy, or on the postpartum journey.

Hi Lauren. Let’s start off with the basics. What is pelvic floor physiotherapy?

Pelvic floor physio is the prevention and treatment of pelvic floor dysfunctions by a physiotherapist who has undergone specialized training in this area. The pelvic floor is a basket of muscles that sit in the bottom of your pelvis like a sling. They hold your internal organs up against gravity, help to control bowel, bladder and sexual function and work with the rest of your core to keep you strong and stable. The pelvic floor muscles act like any other muscle in your body. They can become tight and painful, weak and painful, overused, underused and any combination of the above.

What are the most common issues you see and treat in the postpartum population?

1. Urinary incontinence (peeing your pants when you cough, laugh, sneeze, run, jump). This is very common and often joked about as being part of having children, but it’s actually not normal and can be easily treated.

2. Any type of pelvic pain–hip pain, low back pain, pubic symphysis pain, sacroiliac joint pain, pelvic pain, pain with sex, bladder pain

3. C-section rehab–rebuilding abdominal strength, scar work, abdominal pain, diastasis recti, the dreaded “mummy tummy”

4. Any other bladder or bowel issues–increased frequency and/or urgency of going to the washroom, digestive issues, constipation.

I ended up having a C-section after a week of being induced and never considered following up with pelvic floor physiotherapy. Unfortunately it was just never brought to my attention by my healthcare providers. What are some misconceptions around pelvic floor health?

• That it is all about kegels, and it is SO much more than just kegels. Kegels refer to squeezing and lifting your vagina muscles as if stopping yourself mid stream on the toilet, and are often done incorrectly. A lot of women actually hold too much tension in their pelvic floor. This can contribute to a lot of pain and can actually cause incontinence (leakage) as well.  Learning to relax and let go of your pelvic floor is just as important as strengthening it (for some even more important!). The only way to truly determine where your pelvic floor is at is with an assessment from a qualified pelvic floor physiotherapist.
• Another big misconception is around c-sections. Most women think because they haven’t had a vaginal delivery that their pelvic floor isn’t affected.  This isn’t the case. It is not uncommon to see a lot of women with a very tight pelvic floor after a caesarian. A tight pelvic floor can actually weaken your abdominals and also contribute to painful sex. A caesarian requires cutting through your lower abdominals. Your lower abdominals and pelvic floor work hand in hand together. Scar tissue can develop and of course weakness. If you don’t rebuild this area appropriately it can lead to issues down the road.

One week postpartum, after a long 4 days of being cooped up in a hospital room I remember wanting desperately to go outside and get things moving. Rather than taking a light walk, I wanted to distance the neighbourhood while pushing the stroller. In the months to follow, I put extra pressure on myself to “bounce back”. In hindsight I feel foolish for putting this strain on myself mentally and physically. What is your advice for women returning to fitness postpartum?

• Go slow and LISTEN to your body. When you think you’re going slow, go slower! Our bodies are very good at telling us what they need. It’s just whether we choose to listen to them or not is what it often comes down to.
• Your body has undergone so much change during pregnancy. Your muscles, ligaments and joints have stretched. Your posture has changed. Your hormones are fluctuating. And you have lost muscle strength no matter how active you were able to stay during pregnancy.
• If you are breastfeeding, you won’t be able to re-gain strength or recover as quickly due to the hormone changes and the potential nutrient deficiencies.
• You will be sleep deprived. This will also affect your strength and recovery time.
• Go easy on yourself mentally. Don’t rush into losing that baby weight as fast as you can. You want your progress to be sustainable. Remind yourself of the AMAZING feat your body has gone through to bring a child into this world.  
• Don’t compare yourself to others. Just like no two babies are the same, no two mom’s are either!

What are some general guidelines for women looking to slowly engage the functionality of the abdomen area and prepare for another pregnancy?

• Specific core exercises will vary greatly woman to woman. It’s important to get assessed by a pelvic floor Physio or work with someone who specializes in postpartum rehabilitation to determine what level of abdominal exercises you should begin at. The general principle is to first learn how to turn on your pelvic floor and abdominal muscles, and then combine them with breathing and moving. Static core exercises like planks often encourage tightening and breath holding which is not an effective core strengthening strategy.
• Think of your baseline as what your fitness and strength was at before getting pregnant, and then add the 9 pregnant months of gradual stress, stretching and weakening. At the very least, it could take you at least the same amount of time of consistent core strengthening to return to baseline. Some women may bounce back faster, some may take much longer.
• Once the core is more developed again, moms planning for another pregnancy should first and foremost remember the importance of maintaining balance. Life becomes busy and stressful with a young baby or kids running around, so it’s important to stay active in balanced moderation. You don’t want to only do yoga, or only run, or only do weightlifting. It’s as important to partake in stress relieving activities as it is working out. A happy mind means a happy body! 

After spending some time with Lauren, it became clear that working with a pelvic Physiotherapist during pregnancy is essential for assistance with labour, delivery and what to do immediately postpartum. Our bodies undergo tremendous change during pregnancy and it is an extremely taxing and traumatic process on our muscles, joints and connective tissue. You wouldn’t think twice about rehabbing after a trauma like a car accident or surgery so why should childbirth be any different?

If you are in the Victoria area and interested in booking an appointment with Lauren-registered in-home physiotherapist-contact her here.