The Pregnant Body Editorial

by Stephanie Ondrack

When we are pregnant, our focus often dwells on the discomforts and deprivations associated with the condition: Our aching back, our puffy ankles, our cravings for cabernet, or camembert. Sometimes we look down on our swollen belly, our stretch marks, our sore calves with bemusement or even antipathy. How did I get like this? Can this really be my body?

The pregnant body seems to have a mind and will of its own. It infuses us with a unique incursion of hormones that alters our physiology: our shape, our circulation, our very constitution. Our body expands and morphs to accommodate the pregnancy, shifting in shape and texture before our eyes and under our fingertips. Pregnant in the SpringNo part of us is immune to alteration: our skin, our brain, our hair, our thirst, our feet, our breasts, our appetites, our energy, our libido, our joints and muscles, our moods, and of course our ever-expanding belly. Do we even recognize ourselves within this altered body? Have we been taken over, reformed, according to alien specifications?

Historically, we are told, and still in non-industrial societies, the pregnant body is revered as the most beautiful womanly shape, an ideal form of femininity radiating fertility, maternity, strength, and good health. Here, we tend to equate largeness with being overweight, even when our intellects know that pregnancy and obesity are as unrelated as apples and beach balls. Do we luxuriate in our pregnant body, admiring our new curves, and appreciating our new contours? Or do we count the days until we can fit back into our ‘normal’ clothes?

Despite our ambiguous feelings about inhabiting this temporary body, we know that it provides a medium for our growing progeny. As strange and unfamiliar as we may feel about it, our body is, quite literally, essential to our baby. The pregnant body’s changes, fluctuations, and bizarre new habits are all helping baby form and develop. It is an enormous feat, growing, cultivating, and nourishing a whole new human being; This triumph is not to be undervalued. The pregnant body is a body of transition; a miracle of nature, an achievement of evolution, a non-illusive magic trick. From one of you, to two of you: A whole new human emerges.

In this issue we look at some common pregnant body considerations. And then we indulge in an account of why we were pregnant in the first place, the fruit of the labour: a birth story in which a mother tunes into her pregnant body’s intuitions to make decisions to support her labour. So like most pregnant women, we will linger for a while in the mundane effects of pregnancy, but also acknowledge the incredible fact of the pregnant body: it grows a brand new person. From scratch. Wow.

 

Fitness Dos and Don’ts for Pregnancy

By Ben Stanford

There are a lot of misconceptions out there about how physically active pregnant women can and should be.

As a soon-to-be mama, you might be a little worried to go full tilt on your normal fitness routine – you’re carrying precious cargo, after all!

Below, we spell it out simply, and offer some guidelines for staying fit & healthy while pregnant.

DO work out!

Unlike days of yore, you’re not likely to see any kind of physician who suggests that a woman stop being active simply because they’re with child. These days, unless you have a specific condition that demands bed rest, pregnant women can continue to do cardiovascular and weight training – within reason.

If you’re an active person, no need to stop your activities of choice. Just be aware that some provisions may need to be made as your pregnancy progresses, and be sure to talk to your doctor, midwife, coach, or trainer. Also, listen to your body – if something feels quite uncomfortable or painful, stop. You know better than anyone what works and what doesn’t.

If you’ve never been much of fitness person, now might be a great time to start incorporating a little more movement into your life. A healthy mother typically equals a healthy baby, so consider working a few longer walks into your week, or try a similarly low-impact kind of exercise.

DON’T try kickboxing for the first time

All of that being said, now is NOT the time to try new, high-impact, high-intensity workouts. Never been a runner? Don’t start training for your first marathon. Afraid of the gym? Not the best time to think about getting into fitness competitions.

Anything that’s going to seriously deplete you or put stress on your little one as they grow is something you may want to avoid, particularly if you haven’t yet developed the skill or strength to do them safely.

That being said, if you are a high-intensity athlete, there are ways to continue your favorite sports safely – again, just talk to your personal trainer.

DO watch your heartrate

Again, if you were a fit, active person before getting pregnant, your heart rate isn’t likely to be much of an issue when pregnant.

If you’re trying to get more active because of your pregnancy, most sources agree that employing the “talk test” is the best way to ensure your heart rate stays in the optimal zone for cardiovascular health: if you can carry on a normally paced conversation while working out, your heart is likely doing just fine.

Bonus: if you’re conversing while working out, it means you’ve brought a friend along, which is an excellent tactic for motivation!

DON’T go crazy with the flexibility

Prenatal yoga is a great way to get ready for labour, but one thing you’ll notice if you attend a dedicated prenatal class is that there’s less of an emphasis placed on stretching and lengthening your muscles.

When you’re pregnant, your body generates the hormone relaxin. Relaxin isn’t just a clever name – it relaxes the muscles, tendons and tissues in a pregnant body, preparing it to open during labour.

One side effect of relaxin production is that your body will feel much, much more flexible than it actually is. Because the relaxin is also effectively weakening your muscles, you lose the integrity you need to stretch safely – and run the risk of some seriously pulled muscles.

Keep this in mind in a yoga class, but also while at the gym, and even while running – form will be super important during this period.

DO try classes tailored to your condition

We live in a wonderful modern world, where pregnant women have access to literally hundreds of options if they want to get fit or stay fit.

Check out your local rec centre or gym – chances are they have at least one or two classes tailored to prenatal fitness. These classes are great because they’ll keep you safe without making you feel weak or disempowered.

Our conclusion? Don’t be afraid to move while pregnant! It’ll keep you happy and healthy, which is a huge benefit to your wee one as they develop.

Keep this in mind in a yoga studio, but also while at the gym, and even while running – form will be super important during this period.

Growing up in Hope, BC, Ben Stanford from Physiotherapy Victoria, has been connected with Sport and Massage Therapy since his high school years. With a passion for the healing attributions of the human body and alternative medicine, he has worked his way towards a greater learning of integrated health principles.

Chiropractic Care for Discomfort in Pregnancy

Dr. Stephanie Bonn, BSc,BPHE,DC

More and more women are discovering the many benefits associated with chiropractic care in pregnancy, with the most common complaint being low back pain. In a recent study, 84% of patients who received chiropractic adjustments reported relief of back pain during pregnancy and significantly less back labour. As more women utilize chiropractic care they are noticing additional benefits for pregnancy-related discomfort.

Over the 40+ weeks of pregnancy, the body is changing every day with hormonal fluctuations, increase in fetal weight and shift of the mother’s centre of gravity. As well, many women have pre-existing conditions prior to pregnancy such as postural or repetitive strain from poor workstation ergonomics, and previous injuries from motor vehicle accidents or sports injuries.

The pregnancy hormones, especially relaxin towards the end of the pregnancy, make the ligaments of the body more lax or less stable. This is required to allow the pelvis to widen to make room for the developing fetus, but can contribute to further strain on the lumbar spine in the lower back. The additional weight can also stress the spine along with the imbalance in weight distribution as the baby develops. Gentle and safe chiropractic adjustments will decrease the low back strain as well as improve the alignment for optimal fetal positioning and a more comfortable pregnancy, as well as facilitate an easier labour and birth. After 32 weeks of gestation, if the baby isn’t in the occiput anterior head down position, the chiropractic Webster Technique can help encourage the baby to turn prior to the onset of labour.

Specific exercises, icing therapy, Epsom salt baths, and ergonomic modifications at work and while sleeping can also help alleviate prenatal strain. An exercise ball is ideal to sit on while pregnant as it keeps the pelvis and low back moving when you have to be stationary at a computer. Many workplaces are also incorporating standing desks which prevent you from having to sit for long periods of time. Ideal types of exercise during pregnancy include swimming and yoga, both of which encourage proper fetal positioning and decrease the strain on the spine. Pillow support while sleeping, especially between the legs while on your side, will stabilize the pelvis. Icing at twenty minute intervals, ideal at the end of the day, will decrease inflammation, and Epsom salt baths will ease muscular tension and reduce the swelling in the hands and feet that can occur in the third trimester.

Other prenatal aches and pains that can be helped with chiropractic care include headaches, heartburn, and carpal tunnel symptoms. Because chiropractic also affects the nervous system, it can neurologically reduce the stress on the spinal nerves that are being irritated from pregnancy. Pressure on certain nerves in the neck can cause headaches, in the upper back can lead to heartburn and in the neck and wrist, numbness and tingling in the hands.

Pregnancy is an exciting time full of physical and emotional changes and challenges. Chiropractic is a natural type of health care for both yourself and your baby, to aid in the sometimes unavoidable aches and pains of pregnancy.

Dr.Stephanie Bonn & Familiy
Dr. Stephanie Bonn is dedicated towards helping families have healthy pregnancies and births. As a mother of three following doula and midwifery-assisted homebirths, she supports attachment-parenting and helps families through the challenges of breastfeeding, co-sleeping and baby-wearing. She has an integrative approach, incorporating exercise and nutritional recommendations for optimal health.

 

Through chiropractic, infants and children are assisted naturally through their milestones for optimal growth and development. As an advocate for holistic healing, Dr. Stephanie helps clients surpass their health goals. Whether they suffer from pain, have a colicky baby or just want a spinal wellness assessment, chiropractic is the natural option.

For more information, contact Dr. Stephanie Bonn at Bonn Chiropractic Wellness,120-1020 Mainland St., Vancouver, BC, 604.688.5437, info@bonnchiro.com

Trusting My Instincts

by Jocelyn Wagner

mom and breech newborn

 

Our labour/birth journey of our first child was not what I originally imagined. I originally envisioned labouring and giving birth naturally at home with our midwives, ideally using a birthing pool, unless things got unsafe or I needed pain relief. However, the “home birth” part of this dream was modified quite early, around 30 weeks, when we found out that our babe was sitting in the frank breech position.

We tried everything to turn her but she ultimately remained head up. Because of this, our midwife had to transfer care of delivery to an OB. And because I really wanted to go into labour naturally, not to mention give birth naturally, we spent the remainder of the pregnancy doing everything to ripen my cervix and naturally induce labour. Which finally happened on the morning of January 3!

That morning I was having a bath to ease the “pressure” I woke up with in my pelvis. This pressure was a new sensation in my pregnancy, so my spidey-sense was tingling that something was up. Around 11:00 am I felt a “pop” in my pelvic area and the release of fluid into the bath. Phil, my husband/birth partner and baby’s father, made a quick call to the doula and midwife to confirm that my water had indeed broke! And, oh boy, there was a lot of meconium from our bum-down baby! I called my mom (who we had planned to join us from the Comox Valley for labour and birth) and we packed up the car and headed to BC Women’s Hospital to meet our midwife and doula and get admitted.

I remember driving to the hospital taking in the snow-covered mountains, blue bid sky and uncharacteristically cold Vancouver air. I remember thinking, “After so much of my life wondering who my baby will be, I finally get to meet them. I’d never felt such a combination of peace and anticipation as I did in that moment. Later, Phil said the same thing — “We may have been calm on the surface, but we were terrified and super excited on the inside!”

Our arrival at the hospital felt rehearsed, maybe because we had done the very same drop off a few weeks early when we attempted an ECV, an external version, an obstetric procedure to turn a breech baby. Except this time, it was go time. And speaking of time — from the moment we arrived at hospital, time became fluid. I remember looking at the clock a bit throughout labour, but it could’ve said anything. Time no longer meant anything. I was just in it!

In the admitting area, my contractions intensified as baby’s heart rate and my contractions were monitored by a variety of machines that went “bing!” I was hooked up to an IV. Phil and our doula accompanied me through the waves of pressure in my pelvis. We strapped a TENS unit to my lower back and I used the “toning” technique almost religiously to live into these intense sensations.dad with newborn

After about an hour or so, once the hospital staff was convinced I was indeed progressing, I was moved up by wheelchair to a private labouring room. The privacy and intimacy of the room was glorious! I could tell from the few windows that the daylight had already faded. The lights were kept very low. The nurse was gentle, informative and attentive. The machines were not invasive but reassuring. A couple comfy chairs and a cot welcomed my family. I felt like I was in a safe cocoon.

Contractions were now full on and I was using the TENS machine throughout every contraction. I had my team members providing counter pressure to my hips during each contraction. (I have the bruise to prove how hard I was asking them to push against me!) As much as it hurt during each contraction, at no point did pain relief cross my mind. I got up regularly to relieve my bladder and bowels, often experiencing contractions on the toilet, leaning into Phil so much that I almost pushed him over, and then curled back up on the hospital bed, sucking on sweet popsicles, sipping water and relentlessly applying chapstick to my lips.

My parents arrived in the late evening. The frequency of the contractions, and the intensity at their peak, made me yearn for my mom like I was a child again. I was very relieved when she arrived. My dad sweetly lingered on the vicinity, getting Phil a coffee and sleeping in the car so as not to be too far away. With their presence, and the care I was receiving from the hospital staff and my midwife, doula and husband, I again felt insulated; protected. My intuition felt encouraged and trusted.

After 13 hours of this pattern, I still hadn’t dilated more than two centimetres. Babe just wouldn’t descend! Oxytocin was suggested to augment labour, but that would intensify the contractions. This reality check made me distressed and I felt panicked. I really wanted to do the best for my baby and for me, but I was tired and a bit weary of more intense and frequent contractions. I also felt strongly that I hadn’t yet exhausted all options for a natural delivery. Then someone said, “I think you should consider an epidural” and it was like my body didn’t give my brain a chance to consider – I immediately accepted!

Tnewbornhe epidural, though a bit patchy, brought me physical relief and a chance to rest while the oxytocin attempted to get baby to descend. However, after another five hours, I still didn’t dilate. Babe still hadn’t dropped. And I was now 18 hours into labour, six hours away from a higher chance of infection due to my water having already broken.

My options were now: 1) keep trying the same thing for a couple more hours or 2) have a cesarean. Although my midwife and OBs felt that Option 1 wouldn’t make a difference, and although I deeply valued their knowledge and experience, it was my intuition that ultimately made the decision. I believed our baby was strong (the fetal heart rate monitor told me the same thing) and I believed baby’s reasons for being breech and not descending were not for me to question or to force. So I opted for birth by cesarean.

Within what felt like half an hour I was in the OR getting prepared for surgery. Within what felt like minutes after that, my baby was out of me. Between those moments, I experienced several intense things – I shook uncontrollably due to the spinal block, so much that I had to hold on to poles on either side of me and worried I would shatter my teeth; I was freaked out by not being able to feel or control my legs; and it was 7:00 am – shift change for all the nurses – so I didn’t recognize anyone behind their hats and face masks. But, I got through it, many thanks to my doula, midwife and husband for reminding me of my courage. And I am so grateful for the anesthetist, with his tall height and willingness to take Phil’s phone from our doula and stand above the barrier to capture photos of my baby being removed from me.

As per our wishes, Phil was prompted by the OBs to announce the sex to the room (we didn’t know until then what we were having!) and my daughter was put on my chest within seconds. I will never forget that moment when I saw her face for the first time. On one hand, I had no idea who she would be. On the other, she was exactly who I expected. I am so grateful for this immediate connection I had with her. And I am so grateful for the photos of these moments captured by my doula.

Dawn, as we came to name our daughter, was a bit wheezy because of the mucus in her system, but her eyes were open and she stared at me as her skin turned from blue to pink. She had very little vernix on her – this confirmed my intuition that she had been ready (and adamant) to be born that day! And as she lay on my chest, her outstretched legs brought her sweet little feet to my chin. It was surreal. It was elating. It was a dream come true.new family

Phil followed Dawn and the paediatrician to have her checked out. He trimmed the umbilical cord and was able to hold her skin to skin while I was stitched up. We were into the recovery area by sometime after 8:00 am and then into a postpartum room sometime after that. Again, time was not a something I tracked but instead lived in!

We spent the next two days recovering in the Dogwood ward, learning lots from the nurses, and being visited by the OBs, the anesthetists, our midwife and our close family and friends. It was a magical (somewhat drug-induced!) time of learning to breastfeed, learning to trust that she was breathing when she was in the bassinet, and accepting help. It was incredibly humbling. I’ve never felt so vulnerable, nor so human.


Jocelyn Wagner is a communications strategist who believes in the power of framing all birth stories positively. She found the act of writing her own story to be an important exercise in processing the many emotions, facts and milestones of her experience and she hopes that other new and expectant mamas may be encouraged to do the same. She currently lives in East Vancouver with her husband, Phil, and their newborn baby girl, Dawn.

Battling the Aches and Pains of Pregnancy

by Trish Gipson RPT

While for some of us pregnancy can be a glorious time where we feel better than we have ever felt, for the majority of us it is a time of back pain, calf cramps, rib pain, difficulty breathing, and the dreaded pregnancy waddle. Because of our growing bellies, we tend to shift our ribcage back in space to counterbalance the change in our center of mass. This causes increased muscle tension in the back and hip muscles, which can lead to back pain, rib pain, and sacroiliac joint pain. But by focusing on our posture and maintaining mobility in our muscles and joints, we can help to minimize the aches and pains associated with being pregnant.

Good posture
Good posture
Poor posture
Poor posture

It is important to be aware of our posture and alignment throughout our pregnancy. Try to keep your weight evenly distributed between your toes and your heels, keep the knees soft (ie: don’t lock them in hyperextension), carry your pelvis over your heels and stack your ribcage over your pelvis. Also think of floating your shoulders up very slightly (I cue people to imagine a helium balloon under their armpits; this prevents the shoulder blades from getting pulled down and back which can contribute to back and rib pain as well as neck pain and tingling in the hands). And last but not least, lengthen the back of your neck so that the head hovers at the top of your spine rather than poking your chin forward (I cue people to imagine strings attached to their ears pulling them up). In this position, you should be able to take an unrestricted, deep breath into your abdomen and lower ribs.

Here are a few stretches that can be helpful to release some of the tension that builds up from pregnancy-related posture changes:

Chest Stretch

Chest stretch

laying on your back on the floor with a rolled up bath towel underneath you along your spine (you can also do this laying against a yoga ball if laying flat on your back is uncomfortable). Open your arms out to the sides to feel a gentle stretch across your chest. Relax in this position for a few minutes each day.

Deep hip stretch

Deep hip stretch

lay on your back, knees bent, feet flat on the floor. Cross your right ankle over your left knee. Pull your right knee towards your left shoulder with the left hand; stop at the midline. Allow your left knee to fall out, causing a greater rotation at the right hip, therefore a bigger stretch. Hold 30 seconds. Repeat on the other side.

Hip flexor stretch plus overhead reach

 

Hip flexor stretch

kneel with your left knee down in a low lunge position, right leg forward. Activate abdominals so that your low back doesn’t arch. Press the hips forward to feel a stretch in the front of your left hip. Reach the left arm up overhead and lean slightly toward the right side, to feel increased lengthening along the left side of your torso and the front of the hip. Hold 30 seconds and repeat other side.

Rolldown

 

Rolldown

Standing in front of a chair, bring the chin down to the chest and flex the thoracic spine vertebrae by vertebrae. When your hands can reach the chair, support yourself and “pour” yourself into your hands. Return to starting position, moving vertebra by vertebra. Repeat 10 times.

Happy Baby

happy baby

Lay on your back, feet in the air, knees bent. Loop a belt around your feet and pull your feet towards you. Relax your tailbone down to the floor to feel a stretch in the hips and pelvic floor. Hold for up to a minute.

Supported Deep Squat

Supported deep squat

Come down into a deep squat, with a small stool or roll under your buttocks for support. Keep the knees over your toes (don’t let the knees fall in). Press out gently into the knees with your elbows. Rest in this position for a minute or so.

As our posture changes our diaphragm tends to adopt a more flattened position, and the lower ribcage widens or is held in an “open” position. This position makes it more difficult to get air into the lower lungs and is tied to increased tension in our backs in the kidney area. It is a good idea to take a few minutes throughout the day to practice diaphragmatic breathing (I call it umbrella breathing), to help release tension in the back and obliques, to maintain mobility in the ribcage, and to move air into the lower lobes of the lungs.

Umbrella Breath

Laying on your back, knees bent and feet flat on the floor (prop yourself up with 2-3 pillows if laying on your back is uncomfortable). Breathe in through your nose and feel the belly rise and your ribcage widen in the front, back and sides (imagine an umbrella opening at the bottom of your ribcage). Exhale passively without squeezing the air out. Practice this for a few minutes each day.

As we near the end of the pregnancy, the joints of the pelvis starts to widen, stretching the ligaments of the pubic symphysis (where the pelvis meets in the front) and sacroiliac joints (where the pelvis meets the base of the spine in the back) which can contribute to pelvic pain. Sometimes a pelvic torsion or twist (often what people describe as their pelvis being “out”) can result from muscle imbalances and asymmetrical standing posture.

It is very important to get in the habit of standing with weight equal on both feet. Shifting to one side and jutting the hip out contributes to muscle imbalance and can force the pelvis into a torsion.

If you do feel that your pelvis is “out” or you are getting severe pain in the hip or SI joint with weightbearing, the following is a self-mobilization exercise that you can do to correct the torsion.

Self-correction for Pelvic Torsion

Self correction for pelvic torsion (R leg)

Laying on your back, knees bent, feet flat on the ground (if laying on your back is uncomfortable, prop yourself up with 2-3 pillows). Press the heel of the painful leg/hip/SI joint into the floor as if you are trying to pull your heel toward your buttock (but there should be no movement). Hold for 3 seconds then relax. Repeat 5 times then stand up and walk around and see if the pain is improved. Repeat again as needed.

 

If your aches and pains are minor you can try these above exercises. However, if your pain is severe and cannot be managed with exercise, it is important to seek the help of a physiotherapist. Sometimes manual release, massage, or other hands-on techniques are necessary to restore proper movement to the joints and tissues which will then allow you to use these exercises to manage the discomfort.

You can find a women’s health physiotherapist in your area by clicking on the “Find A Physio” tab on the Physiotherapy Association of BC website (http://bcphysio.org/) or feel free to contact myself at trish@envisionphysio.com.

Trish GibsonTrish Gipson graduated from SFU with a Bachelors Degree in Kinesiology, and from McMaster University with a Masters Degree in Rehabilitation Sciences (Physiotherapy). She completed her Advanced Diploma of Manual and Manipulative therapy, and has taken post-graduate courses in manual therapy, acupuncture, pre- and post-natal care, pelvic and perineal re-education, and running injuries, and is a trained Pilates instructor. She has experience working with people of all ages and fitness abilities but has a special interest in treating pelvic floor disorders and working with new moms and moms-to-be. Trish has completed numerous half and full marathons, and has also laced up her hiking boots to walk the Inca Trail in Peru and climb Mount Kilimanjaro in Tanzania.

ASK CHILDBEARING: During this pregnancy I’ve been experiencing pain….?

Q: During this pregnancy I’ve been experiencing pain on one side of my lower back, between the hip and spine. It makes walking quite painful. What’s causing it and what can I do about it?

A: It sounds as if you might have a misalignment of the sacroiliac(SI) joint.

SI Joint pain

This is the place where the “wing” of the pelvis (Ilium) meets the lower spine (sacrum). As your body prepares for birth the hormones progesterone and relaxin loosen the ligaments of the pelvis to allow the baby to pass through. Unfortunately this makes the pelvis more prone to dislocation.
Massage, acupuncture or acupressure and chiropractic techniques can be very useful in relieving the immediate pain and adjusting the alignment of the pelvis. However, once you have found a treatment that allieviates the pain, you need to help prevent recurrence.
The way to compensate for relaxed ligaments is by increasing your muscular strength in the pelvic girdle area: the abdominals, buttocks, and pelvic floor muscles. Strengthening these key muscles will help keep your pelvis and spine in good alignment and prevent further dislocation. Good posture both standing and sitting will also help. Many of the exercises in the Healthy Pregnancy Course target these muscles, and you can refer to our Parents’ Handbook for illustrations. (If you missed the Healthy Pregnancy Classes ask your instructor during the Labour, Birth and Postpartum
Classes).
For an assessment of your muscle strength and pelvic alignment you can see a physiotherapist, who can also recommend exercises to improve muscle strength and posture. The physio may also suggest an elastic brace worn around the hips to help support your SI joint.

Jennifer Landels is a Childbearing Society alumnus. After many years of teaching childbirth classes and supporting new families, she now teaches mounted combat and publishes fiction.

Exercise after baby; Where to Start

by Trish Gipson, Registered Physiotherapist at Envision Physiotherapy

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One of the main reasons new mothers come to see me at the clinic is because they are eager to get back to some sort of exercise or sport but want to do it safely.

Usually women are given the “go-ahead” by their health care provider to return to activity around six weeks post-partum. But what does this mean? Is it safe to start running? Boot camp? Playing volleyball?

The truth is it depends on the individual. Not all pregnancies are the same, not all deliveries are the same, and not all bodies are the same.

So how do you know when and how to get back to your desired level of activity?

The first thing to consider is your level of activity during pregnancy. Most women decrease their activity level over the course of their pregnancy and, as a result, some deconditioning likely occurs. So jumping back into pre-pregnancy activities at that six-week mark may be a bit overzealous and may put you at risk of an overuse injury.

Secondly, you need to consider your delivery. Tearing of the pelvic floor can affect the ability of the core muscles (the pelvic floor, the diaphragm and the deep abdominal and back muscles) to function improperly which can lead to hip, back, knee, or pelvic pain if not properly rehabilitated. These symptoms may not become evident until the load is increased, such as with exercise. A caesarean is a major surgery, and must be treated as such; you wouldn’t start skiing again right after a knee surgery without at least a few months of rehabilitation, so I would suggest the same diligence with rehabbing after a C-section.

Also important to consider is the amount of change that a woman’s body goes through over the course of a pregnancy. Her posture changes, her movement patterns change, certain muscles get more active and other muscles tend to atrophy. These changes don’t revert as soon as she gives birth; her body has taken forty (give or take) weeks to adapt to the growing baby and is going to take time to readjust. And sometimes our bodies need a bit of help along the way.

That’s where a women’s health physiotherapist comes in. I recommend that all women who have delivered a baby see a women’s health physiotherapist six weeks after giving birth. Your physio will assess your posture, your movement patterns, your abdominal wall and your pelvic floor to determine if all is functioning as it should or if there are any areas that need attention.

Because every situation is different, there is no “cookie-cutter” approach for getting back to exercise or sport post-partum. But here are some guidelines to follow:

  1. For the first six weeks, honour your body and what it’s just been through. Consider that tissue that has been torn or cut takes at least six weeks to heal; over stressing it too early could compromise that healing process, but not moving at all can be equally detrimental.
  2. Diaphragmatic breathing, very gentle pelvic floor contractions and deep abdominal contractions help with recovery; see a women’s health physio to learn how to properly perform each of these.
  3. As soon as you feel comfortable doing so, start doing some daily walks. They don’t need to be fast, they don’t need to be far, but bundle baby up and get outside. Gradually increase your speed and distance as tolerated, and vary the terrain (concrete, track, grass, hills, etc).
  4. Once you’ve hit the six week mark (and you’ve already made your appointment to see your physio, of course), seek out classes or instructors that cater to new moms; yoga, stroller fitness, etc. Have a chat with the instructor so that they know the circumstances of your delivery and where your body is in its recovery. If anything doesn’t feel comfortable to you, then perhaps it is not appropriate for where your body is right now.
  5. Increase your activity level slowly and steadily. The six week mark is a very common time for pelvic organ prolapse (which is when one or more of the pelvic organs descend and remain sitting lower than they should) to occur because many women rapidly increase the load before their tissues and the muscular support systems (the pelvic floor and deep abdominals) are ready. However, if you gradually increase your activity level and the intensity of exercise over time, your body will adapt to match the increased load.

Your body has ways of telling you that you need to slow down. Listen to it. The following are some signs that your body may not be ready for whatever activity you are doing:

  • bleeding increases or resumes
  • pain anywhere in the body
  • leaking urine, feces, or gas (even a little bit!)
  • heaviness in the pelvis or on the pelvic floor
  • bulging of the abdomen with certain exercises or movements
  • something “just doesn’t feel right”
  • excess fatigue

If you experience any of these things it doesn’t mean you can’t ever do that activity, just not yet. It may just take time, or you may need to seek the help of a health care practitioner.

Remember that movement, specifically exercise, is an integral part of our health and well-being. But remember that, as a new mom, it is imperative to give your body time to recover, heal, adapt to the changing load, and get strong. Growing a baby is a process, as is returning to your desired level of activity. Be patient, set goals along the way for motivation, and don’t be too hard on yourself. You just grew a human, super-mama!

 

 

Trish Gipson, BHKin, MScPT, FCAMT, CAFCI.

trishgibson

Trish graduated from SFU with a Bachelors Degree in Kinesiology, and from McMaster University with a Masters Degree in Rehabilitation Sciences (Physiotherapy). She is certified as a Fellow of the Canadian Academy of Manipulative Physiotherapy, and has taken post-graduate courses in acupuncture, pre- and post-natal care, pelvic and perineal re-education, and running injuries. She has also completed the Clinical Mentorship in the Integrated Systems Model with Diane Lee. She has experience working with people of all ages and fitness abilities but has a special interest in treating pelvic floor disorders, and working with new moms and moms-to-be. In her spare time Trish enjoys running, biking, playing volleyball, doing yoga and snowboarding, and spending time with her family. Trish has completed numerous half and full marathons, and has also laced up her hiking boots to walk the Inca Trail in Peru and climb Mount Kilimanjaro in Tanzania. You can reach her at www.envisionphysio.com.

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