Recovering Your Pre-Pregnancy Shape
Congratulations on becoming a mom!
As the euphoria settles down, you may be wondering what you can do to get your body back to where it was 9+ months ago. To help you on your way, we asked two specialists from Sino United Health for advice: Kristin Volmer, Consultant Senior Physiotherapist, and Corrine Ouzeau, a French midwife specialising in postnatal perineal rehabilitation.
The key, they say, is to take things gently, and start by building up strength in your pelvic floor.
What is my pelvic floor?
Most people are completely unaware of the existence of their pelvic floor until they attend childbirth preparation classes.
Your perineum, or pelvic floor, is a hammock-shaped group of muscles that are attached from your front to your back, and crosswise to each of your pelvis's bones. It goes underneath the bladder, the uterus and the bowel, and it surrounds your urethra (=bladder opening), vagina and anus.
To identify these muscles, you can use a test that in French is called "stop pipi":
While sitting on the toilet, start passing urine. Then try to stop the flow midstream, before relaxing and allowing your bladder to empty. The muscles used to stop the urine midstream are those located in your pelvic floor.
Why does it need strengthening?
Your pelvic floor is involved in all bodily movements – because hormonal changes in pregnancy and pressure of the enlarging uterus cause your pelvic floor muscles to soften and relax, it takes time after birth to improve the weakened muscle and pelvic floor. Pelvic floor reduction and stretching can cause many risks down the line in pregnancy and childbirth.
During pregnancy, regular muscle tightening practices can prevent or reduce small leakages of urine when you cough, laugh or sneeze (called "stress incontinence"), and can also help to better prepare your body for birth.
Loss of tone in the pelvic floor muscles, and/or damage from a prolonged vaginal delivery, can lead to stress incontinence, prolapse and/or pain during intercourse (called dyspareunia).
Is this common?
It is so common that in France, where Corrine is from, perinea therapy is required and is in fact a part of standard postnatal care; at the 6-8 weeks postnatal check-up, many patients are referred to a midwife or physiotherapist for 10 sessions of pelvic floor rehabilitation. Due to the lack of this service in Shanghai, this has become one Corrine's main activities here.
What should I do?
In the immediate postpartum period, you need to be careful so as to allow your uterus and internal organs to return to their original place in your pelvis. It is usually not recommended to restart sexual activity before your six-week check-up, in order to avoid putting pressure on your perineum, which may create problems or pain in the future. Until then, focus on your pelvic floor with exercises you can do yourself, like kegels and abdominal breathing. Click here for instructions.
If you experience extreme pain whilst doing these exercises or if there were complications during labor, please consult your midwife or doctor first. The goal is to strengthen vaginal walls after birth, so as to prevent incontinence, and other gynaecological health hazards that come with age.
What if I need more help?
Pelvic floor rehabilitation aims to restore proper function of the perinea musculature through pelvic muscle education and/or re-education using manual techniques, postural gymnastics, biofeedback and electrical stimulation (the techniques used will depend on the practitioner's therapeutic background, training and experience). Patients need to practise these exercises both with the practitioner and at home, which is why motivation is key to success.
Pelvic floor rehabilitation begins with an in-depth evaluation of a patient's need for it (based on patient and family history, and a series of tests), an introduction to pelvic floor physiology and anatomy, and a review about the basics of bladder control.
A tailored program is then established, often consisting of:
• Exercises and feed-back on the spot, enabling the patient to feel the correct muscle to contract and release.
• Kegel exercises - teaching the patient how to practice in daily life
• Teaching perinea blockage before stress or straining occurs; pelvic floor muscles must be contracted before causing any kind of abdominal pressure.
• Postural exercises that may help to reinforce the pelvic floor muscles by avoiding excessive downwards pressure. This also increases the patient's awareness of the correct posture to use in daily life to further protect this area. For example, while standing it is best to tilt the pelvis.
• Breathing techniques, in particular abdominal breathing. For example, it helps to expire prior to and during increased pelvic floor activity.
See here for instructions that you can already follow at home.
For how long do I need to take care of my pelvic floor?
Pelvic floor exercises should be done regularly by all women throughout their life. You can do them anywhere and at any time – nobody will know! It is about more than postnatal rehabilitation, it is also about taking care of yourself as a beautiful woman, and not just a mom.
How will I know if my pelvic floor needs strengthening?
Here are some ways you can tell, though you might not experience all of them or any at all and still need some help:
- If your vagina is still open when lying down on your back, or you have a "wide" feeling.
- If you are experiencing lower back pain.
- If you urinate when laughing, coughing and sneezing.
- If you feel heavy or loose in the pelvic area.
- If you can't feel when your bladder is full, or if you find it difficult to stop urinating midstream. (Please note that you should only do this as a test, not as an exercise)
Pelvic floor rehabilitation could be recommended by your doctor at any time in your life if you have problems of incontinence, prolapse, downward sliding pelvic organs, or difficulty or pain during intercourse. Depending on the problem, pelvic floor exercises may not be enough and surgery your only option. However, if you keep up your exercises and address any problems as soon as they present themselves, surgery can be avoided.
What else can I do to help recover my pre-pregnancy shape?
Going for walks every day is the easiest and simplest way to start exercise after giving birth; it is good for both mom and baby. However it's important not to push yourself too hard at first and increase intensity little by little. Also, it's better to go for a walk a couple of times a day, so that you feel happy about your increased mobility.
For those of you who had a C-section there will be about 6-8 weeks before you can start doing abdominal muscle strengthening; it takes longer for the uterus to recover from degeneration. To eliminate a scar from forming after a C-Section you should start with the healing process as soon as possible. Your midwife or doctor will advise you on when it's time for you to start exercising.
What about my weight?
For those of you who are breast-feeding, please don't concentrate on your weight. Good nutrition and being active is more important than counting calories.
How soon can I exercise?
Start your pelvic floor exercises right after giving birth. Stomach muscle training starts about 6-8 weeks after birth for the oblique muscles, and 8-10 weeks for the rectus abdominal muscle. Before you begin abdominal exercises, check for diastasis, which is the gap in your abdominal muscles. Please see here for instructions.
If you were very active before giving birth, you will have an easier time getting back to your exercises. For comfort, remember to breastfeed before exercising.
After 8-10 weeks you can start with "light" sports, i.e. Nordic walking, Tai Chi, Yoga, and swimming. Do not swim before 6 weeks as there is still the possibility of contracting an infection. Running, football, basketball and other "jumping" sports should be avoided until your pelvic floor is fully recovered and strong enough for intense physical activity (normally around three months). For the golfers out there you can start to play as soon as you feel well and you can walk without any struggles, using a golf cart makes it even easier.
Don't forget to take care of yourself, as well as your relationship with your partner/husband after such a big change in your life. Try to find time for yourself every day, and remember to rest when you can. Having a baby can be very stressful, especially with frequent visits from family and friends, lack of sleep, etc. so don't overstrain you body, drink enough water and eat healthily. Read this news article for other tips on postnatal wellness.
Here are some more exercise ideas Kristin recommends that you try:
General Advice: do the exercises slowly and with full control! 10 reps is the goal, but less is also good if you manage to do them every day. At the end of the day it is your fitness levels that will determine how many reps you can manage.
There are three things you should know before you get started:
1. Keep Your Knees Up
When you are doing crunches, make sure that your knees are bent and your feet are flat on the floor. Make sure that your knees are centered and pointed upward. Keep them centered and up, not leaning to one side. If you drop your knees to one side, you will be compressing your vertebrae, which can lead to a painful back injury.
2. Avoid Straight Leg Lift
This is a traditional "stomach exercise" that should be avoided. This exercise actually works the lower back more than any muscles in the midsection. Using this exercise can put strain on your back, and possibly lead to injury.
3. Do not do traditional Sit-Ups
Traditional sit-ups actually do very little for the abdominal muscles, but can cause great injury to your neck and pelvic vertebrae and to your shoulder muscles. Even when done properly, the strain is mostly on the hip muscles and neck muscles.
Here are the exercises:
1) Begin by lying on your back on a mat on the floor with both feet flat on the floor as well. Keep both arms laid flat on the floor by your sides. Start this exercise by having one hand reach to touch your heel on its same side. The motion will be similar to a regular crunch. Repeat this step on the opposite side for as many repetitions as you can. This exercise is designed to target your oblique muscles.
2) Lie on your back and keep your feet flat on the floor. Place your hands behind your head. Curl up and bring your left elbow and shoulder across your body while bringing your right knee in toward your left shoulder at the same time. You can either do one side for all your reps, then switch to the other side or alternate sides. Hold the position for a second (each day one second more until 10) and don't forget to breath.
3) Pelvic tilt: this is another good exercise for strengthening your abdominal muscles. Lie on your back with your knees bent and your feet flat on the floor. Inhale than exhale when lifting your pelvic toward your navel. At the top of your tilt, tighten your buttocks, than release.
4) These side planks work the muscles at the side of your waist and your abdominals: Lie on your side, propped on your elbow with your legs and hip resting on the floor. Resting the weight on your forearm, lift your hip off the floor, breathing out. Keep your tummy muscles engaged and lower back down. Repeat as many times as possible, than switch to the other side. If you want more challenge, hold your top arm straight, with a dumbbell in your hand.
As you feel stronger and less sleep deprived — usually from four to six weeks postpartum on — you can add sets and do more repetitions to increase the level of difficulty, or you may want to try more advanced exercises.
Remember that pain is a signal from your body to stop doing the exercise. Don't over do it the first few months after giving birth; your body needs time to heal and adjust to the new situation. Above all, enjoy your newborn, and remember that what took you nine months to put on, won't go away just like that!
The information and images contained in this article were provided by two consultants from Sino United Health: Kristin Volmer, Consultant Senior Physiotherapist, and Corrine Ouzeau, a French midwife specialising in postnatal perineal rehabilitation.
Please note that you should consult with your doctor or midwife before commencing an exercise program. Stop immediately if you feel pain, light-headed or dizzy and contact your health practitioner. Bumps & Babes Co. Limited cannot be held responsible for any exercise program undertaken after reading this article.
You might also be interested in the following notes from past talks: