Physical Therapy versus Personal Trainer During Postpartum Healing

After my class the other day I was approached my one of the moms who wanted to know what the next step for her should be during her postpartum healing. She was feeling disconnected and “wrecked” after her third baby and really wanted to do more for herself.

She’s taken several of my classes over the years but nothing consistent due to life (on both our ends).

Needless to say she knows that I’m a PT who helps new moms. But she still wasn’t sure if she needed to see a PT or go to a personal trainer.

This opened my eyes up to see that even those moms who I think are aware of the benefits of postpartum PT and how important it is, STILL, question if it’s necessary.

Then as if the universe was telling me to help moms understand more an Instragram feed I follow posted a quick list of differences between postpartum core rehab and personal training.

I took this as a sign to go deeper.

So if you have ever questioned if postpartum PT is right for you versus seeing a personal trainer here are the top 6 differences.

Assessment

A physical therapist has been extensively trained to perform a whole body physical evaluation. This includes not only testing your strength and flexibility, but joint function, pain assessment, motor function, mobility, posture and alignment, and when necessary an internal pelvic exam. This evaluation is based on your history, current complaint and goals.

This provides you and the PT a more in depth look at what your body needs during your one-on-one care and home program.

Manual Care

What this means is if your body has muscle spasm, fascial restrictions, muscle trigger points, joint hypomobility and other musculoskeletal issues that really benefit from hands on manipulation a PT can perform special manual therapy techniques to help.

There are many different types of manual therapy and some PTs specialize in one or a few techniques. By performing these it helps your body reduce inflammation & pain, improve flexibility & motor control, organ functioning and overall well being.

Inside - Out

When you work with a pelvic floor PT for postnatal core rehab we focus on the deep muscles first. You know those muscles that influence and are most effected by pregnancy, birth and postpartum.

The deep core four!

The pelvic floor, transversus abdominus, multifidus and respiratory diaphragm.

These muscles need to be addressed first before moving on to the big ones surrounding them. This is because they provide the stability to your organs, pelvis and spine joints. They help manage the forces and pressures within your trunk to reduce strain on your body during activity.

Focus inside then out!

Fascial Functioning

The fascial system is a network of tissue this is interwoven into every fiber in your body. This tissue influences every other fiber and function around it. When it becomes injured and dehydrated it can cause dysfunction like diastasis recti (abdominal separation) and pain, among other problems.

A PT can help you manage your fascia through nourishing myofascial release and fascial stretching.

Home Program

I believe one of the most important aspects of PT is the home program. The instruction of what to do when you are on your own. Not only the exercises, but the habits, body mechanics, lifestyle modifications and self care necessary to reach your goals.

Functional Training

Exercises will only get you so far, especially when healing from a birth and taking care of a baby. That’s where functional training can up level any exercise routine. A PT builds upon your strength, flexibility, posture, balance, fascial and mobility exercises and reflects it in how you perform your daily tasks.

Meaning you learn how to move safely and efficiently while caring for yourself, your baby and the rest of your life. These new movement patterns are enhanced and through exercise and mindfulness. Both of which are harnessed through a home program.

Remember, these are only the top 6 differences between PT and a personal trainer for postpartum core [really all healing] rehab.

In other words, seeking help with a highly trained postpartum PT after giving birth is the first step to recovery. Then once you have reconnected to your body and addressed any dysfunction seeking the more longer term assistance of a personal trainer can help you reach other fitness or lifestyle goals you may have.

Curious how postpartum PT can help you? Let’s chat. Schedule a FREE informational consult call with me now to build your knowledge for life long pelvic health.

You’ve got this!

How to uplevel your healing during postpartum recovery.

You just had a baby and feeling blissed out by meeting this new little human(s).

But you are also sore and don't recognize your body. Your body doesn't respond to your commands and is uncomfortable to do basic functions.

This is totally normal those first few weeks after birth.

You're body just went through the quickest physical change it will ever naturally go through.

Then what?

Bruised and injured tissue are nourished and heal. Your uterus shrinks and other organs slowly shift to normal position. Your body finds its way to regular functioning through mind-body connection. And much more.

This is happens while caring for your new baby and moving your body in new ways; creating new habits and movement patterns.

What happens when you're having a hard time healing and reconnecting to your body?

You are not alone mama!

This is very common and why it takes time to feel "normal" again.

It's also why resting and asking for help is so important after birth.

But who do you ask for help to bring balance to your mom body?

A pelvic floor physical therapist who specializes in postpartum care.

But how soon after birth should you ask for help?

It's not enough to wait until your 6 week visit.

Ideally you will find an amazing PT during pregnancy who will follow you through birth into postpartum.

But if you didn't, you can see a PT as early as 2 weeks postpartum!

That's right there are things you can do before you see your birth provider that are safe and very effective to help you recover from pregnancy and birth.

Some of these things, like core breath coordination can start within hours of giving birth.

Most importantly you will learn how to work with your healing body. You need to rest yes but when you are not snuggling up with baby you will be moving around to care for baby and yourself.

Figuring out safe ways to move in and out of bed, traverse stairs, lifting and carrying baby, breastfeeding positions, what exercises to reduce muscle tension from breastfeeding, and much more.

You can also begin manual nourishment of your healing tissues. Myofascial release and visceral mobilization are only two techniques that work wonders after birth to improve circulation, reduce inflammation, and assist organs in healing.

Then after 6 weeks we can take your care a step further by assessing the pelvic floor internally. Testing for weakness, scar adhesions, pain, coordination, pelvic organ position and more.

So not only will you know how to work on what you can see but also those super important internal bits that you can't!

Guidance by a PT will help make the most impact on your healing body and ensure safe reconnecting and avoidance of those undesirable pelvic floor problems!

But don't worry if you're past the 6 weeks postpartum, it's not too late to start your pelvic health postpartum healing journey.

Should you use a Postpartum Belly Binder?

I'm asked a lot about the use of abdominal binders and braces after having a baby.

Maybe you're considering using a belly binder after having your baby or you heard belly binding is good for a diastasis recti.

Before you rush out to purchase a binder, here are a few things to consider first.

Belly binding has been used for hundreds of years after having a baby. Typically a binder is used within a few days of birth for 2-6 weeks.  There are special cases that a binder is used longer for more severe abdominal separation, but should always be addressed with a postpartum physical therapist first.

Here are some benefits for belly binding*:

  • Provides postural support for the torso and organs as they return to pre-pregnancy position

  • Supports and assists abdominal wall healing and diastasis recti recovery

  • Supports the body's natural spine and posture realignment post birth

  • Constant pressure on the torso and abdomen hastens healing by reducing water, fat and air in the tissue and cells

  • Stabilizes loose ligaments

  • Helps to prevent and relieve lower back aches and strains

  • Prevents slouching while feeding or holding your child

Your goal after having baby should be returning to optimal movement and function in your body. So when does belly binding no longer promote healing and return to function but cause problems instead?

1. A belly binder is only meant for short periods of time.

If worn for longer than 6 weeks (unless directed by a specialist practitioner) it starts to replace the function of our core muscles. Which means the muscles no longer need to build strength to do the job they are meant to do...support your posture and organs, and stabilize your spine for movement. Your body will rely on the binder, which not a long term solution.

2. Cinching can cause too much compression.

When pulled too tight the compression around your waist alters the natural pressure system without your trunk. Instead of even pressure, it is now pushed upward into your chest and downward into your pelvis. This can lead to hernias and pelvis organ prolapse, which nobody wants.

3. It alters your breathing pattern

When you breath your trunk expands in all directions, up, down, front, back, and to the sides. The abdomen is meant to rise and fall as your trunk and pelvis expand with every inhale. If your abdomen is compressed, as your respiratory diaphragm contracts and pulls down while you inhale there is no place for the lungs to go except just into the chest. This causes shallow breathing, leading to an increase in cortisol levels and perpetual fight or flight mode.

4. Your core may establish bad habits

There are two ways this may happen. One, the core may stay contracted. The constant compression triggers a perpetual contraction of the abdominal muscles. This is like always holding your shoulders up to your ears. Eventually those muscles  become tight and unresponsive to proper movement. The core needs to relax to function properly. Part of the core's job is to let go to allow you to go to the bathroom or to have sex. If the muscles are in a state of contraction this cannot happen! A tight muscle can no longer provide stability for movement, which may lead to [more] pain and dysfunction.

Two, the core may push out when it contracts. Having a binder wrapped around our waist gives the body something to push into. When someone pushes your shoulder, what do you want to naturally do? Push back.

For some (like myself) this is what can happen when wearing a belly binder. When you brace against the binder it creates internal pressure, again leading to hernias and prolapse, and bad form for an abdominal separation. You may not even realize you're doing it.

In the end, do I think belly binders are bad?

No.

I think they are beneficial for immediately after having a baby when you are mindful of how your body is responding to wearing one.

You need to be aware of how you body feels when you take it off. Are you paying attention to your movement patterns or just relying on the binder? Do you have a game plan for weaning off the binder?

These are all relevant and important things to consider before you use a binder.

*https://www.thewombwellnesscenter.com/postpartum-bengkung-belly-binding.html

This one thing may delay you feeling "normal" again after baby.

After having a baby there is all the talk about getting back to normal.

What is normal really?

Why is it so important to get back to anyway?

After having two children and working with countless new moms I'm here to tell you,

You're never going to normal again, and it's okay!

Normal is over rated.

Normal can be boring.

You, mama, are anything but over rated and boring.

You are wonderfully unique!

Let's embrace your non-normalcy.

If what you seek; however is feeling connected and in control of your body after having your baby, then that is a WHOLE other story.

Pregnancy and birth can be a joyous, unpredictable, whirlwind of a time. Your body changes so much that it can be hard for your systems to keep up.

Leaving you feeling disconnected and out of control of basic functions, like holding in pee when you sneeze.

I get it if that is what you mean by normal.

Of course you want to feel in control of you body again.

And over the next year after baby is born your body will naturally find it's way through healing and for the most part you'll feel normal.

Unfortunately, this is not the case for every mom, for various reasons.

Birth injury, medical interventions, csection, episiotomy, epiderals, long labors and pushing, really quick labors, these different factors play a role in how long your body will heal.

Not to mention all your past injuries and habits.

But the one thing that I've seen as a common thread despite the type of birth, injuries etc is breastfeeding.

After delivery your estrogen levels plummet. Then remain low if you breastfeed.

Why does this matter?

Estrogen plays a large role is tissue function, especially in your nether regions.

Just think a mini menopause after delivery, dry, thin, weak, itchy vagina (though really your vulva but you get the idea).

When this happens the pelvic floor doesn't function 100%.

And this can last the whole time you breastfeed.

I experienced it with my daughter. I breastfeed for 2 years, about 3-4 months after stopping, I felt like a different woman.

Now, I'm not telling you to stop breastfeeding, heck my little guy is nurse sleeping as I type. Only you and your baby can set the timeline.

But be aware that some of what you are experiencing with pelvic floor dysfunction or how your feeling may be partially due to low estrogen from breastfeeding.

Once I tell my patients this I usually see a wave of relief. That no you aren't crazy, yes you're doing everything you can do to mitigate the symptoms your having.

So I ask again, what is normal? Do you really want to be normal or just in control again of your body?

If you want help finding your normal reach out to me by setting up a free consult call. We'll figure out your next step together!

Reconnect to your Body like a Baby

As my son becomes more active and works really hard to crawl [forward] I can see how similar movement patterns in babies are like those I use with my moms.

Most of us can picture the stages of gross motor development in infants. They start off as blobs not able to move much and when they do move they expend a tremendous amount of energy. Gradually being able to pick up their head, lift their arms and legs while on their back, push up while on their belly, roll, and so on.

There are similar movement patterns that we look for in all babies, but how they achieve those goals and how long it takes them may be slightly different for each baby.

Typically they can't move on to the next skill until they've mastered the one before. And even when the skill has been mastered, they may relapse a little when they are working on the next skill.

Babies have very little core strength to start with and need to build it up through movements that start in positions where gravity has no influence on their core. These positions are on their back, stomach and side.

Then they are able to gradually work into a sitting position. Then kneeling, hands and knees, and eventually standing. Standing takes the most amount of effort to stabilize the body against gravity before they start to move in a standing position. Even in each position babies pause to find stability and balance...like rocking on hands and knees before crawling.

There is a reason why babies work through different stages to find and build core strength. They have to create stability in the trunk before they gain mobility in the limbs. The further away an object from their center of gravity the harder it is to control. Think lever arms from physics - even a light object can feel heavy is you hold it away from your body.

Remember when you were a kid on a see-saw (teeter-tauter) and if you were evenly balanced with the opposite kid you would either have to had another kid which ever side was lighter or the heavier kid could move closer to the center.

We are hard wired to work on being stable around our center of gravity [belly button/low back area] then work outward.

This is why when your core is weak after having a baby reconnecting to your core LIKE a baby makes the most sense.

Finding balance through very little movement in positions that don't require work against gravity and working to more dynamic movement that require work against gravity.

The big difference between your body and baby is your body as the influence of years of other habits and patterns intertwined into the weak core. Tight muscles, poor posture, joint position, injured tissue [scarring], uncoordinated muscles etc.

These all influence how your body will reconnect.

So simply doing "core" exercises on your back may not be enough.

Recognizing the influencers, using props and modifying the movements to reduce the effect they have on your body, then working through the natural progression of movement will help you achieve the most connection to your core.

And just like your baby, it will take you time, you may relapse a little on a past movement when you move on the next step, you may get frustrated when you can't do what your mind is telling you to do and you'll be super excited when you do achieve your goal.

You may THINK lying on your back and doing breathing exercises or arm raises are super easy. But when you have to incorporate your alignment, good posture, stability and breath, it's not so easy at first.

So when you resume core exercise after having a baby, think of it this way, simple to complex movements are the way to go.

This is how I work with my clients and how the way I progress the core exercises in my almost complete 4th Trimester program in Expecting Pelvic Fitness.

If you're ready to start reconnecting to your core but don't know how to work through the different positions let's chat!

Or head over to Expecting Pelvic Fitness to learn more about the almost finished but still available to purchase 4th Trimester program!

 

What to know about healing from a C-section

I've never had a csection, so I can't speak to the healing process through a personal stand point. But I have worked with some amazing moms who had 1 or multiple csections with incredible results!

I'm going to share some of my insights from what I've learned over the years when working with these moms.

Start early

You can start reconnecting to your body in the hospital. When you aren't napping or taking care of baby doing some simple body movement is totally safe.

The focus of these movements are to keep you from becoming super stiff from laying in bed.

Movements like raising your arms over your head with an inhale.

Sliding your heels along the bed with an exhale.

Practicing the following sequence using an exhale every time you move, pausing between each segment.

  • Rolling from back to side
  • Sitting up from your side
  • Standing up
  • The reversing

These are movements you will be doing anyway, so why not become more mindful with some extra practice.

Starting to become mindful and reconnecting to your body while in the hospital sets the stage for your whole healing process!

Wear the right panties

Even though an incision from a csection is low, it can still be under direct pressure from clothes, especially underwear.

The solution?

The C-panty.

A high waist, gel lined panty designed specifically for csection recovery.

These are amazing and can be purchased at a ton of different locations. I just linked directly to the main website so you can check them out for yourself (no affiliation).

Go check them out, enough said.

Be gentle

You [just] had major abdominal surgery.

Be gentle on yourself. Don't feel like you have to do it all immediately or ever.

As for help. Get your family and friends to help you out. Or work with a postpartum doula!

Realize that your body will not be able to respond to your commands the way it used to.

You'll be sore and tired and may not want to do much other than sleep and care for you baby.

And that's OK.

Give yourself time

It takes time to heal from a surgery.

It takes time to heal from a pregnancy.

It takes time to reconnect to your new body.

It takes time!

Give yourself the space to have time. To slow down and heal. To allow your body to get nourishment and the time it needs to go through a proper healing process.

Then give yourself time to not have a pregnant body anymore. Your body just went through a the fastest physical change it ever will. It took 9 months (give or take) to grow your baby. Within that time frame your body had to morph into the mama powerhouse that it is. Then in minutes it is no longer pregnant.

Your body needs time to resume a non pregnant form again, which doesn't happen over night, especially after a csection.

It'll take at least 1 year (more if your breastfeeding) to regain some sense of normalcy in your body.

Give yourself that.

Learn how to open up

An incision from a csection has come a long way. No longer is it a large vertical cut but a few inch horizontal cut that is barely visible sometimes once healed.

The thing about csections [and really any abdominal surgery] is that your body will respond in a similar way no matter the size.

Your body will want to protect that area while it heals.

To do this your body will do the only thing it knows how to do to protect itself.

Create armor.

To do this it contracts muscles to guard against pain and it turns inward [into a flexed position] to reduce stretch on the sore tissue.

This is ok, to some extent, but not ideal for optimal healing.

What happens if we let the body take over is the muscles that are guarding become tight and shortened and the hunched position becomes habit causing an imbalance in posture, stability and pain.

This is compounded by breastfeeding in a hunched position.

What can help?

Learning how to open up the front of your body!

Allowing your body to safely go into extension to get your body to find a balanced state again.

You can still have pelvic floor problems

A common misconception about csection births are you are immune to pelvic floor problems because you didn't birth vaginally.

While there is a reduced risk of incontinence, you can still have pelvic floor problems like peeing your pants, painful sex, and prolapse.

This is because your pelvic floor was just holding up the extra weight of baby for 9 months and which weakened and stretched it out.

Your pelvic floor works with your abdominal muscles, mainly the transverse abdominus, to coordinate against forces placed on the body that may cause urine leakage and stability issues.

Your abdomen was stretched and weakened from pregnancy plus you have the added incision scarring to heal from.

So regardless of birth, pelvic floor problems can happen.

Find yourself an amazing pelvic floor PT

It's not easy caring for yourself and your baby after a csection.

Getting all the help you can get is not a fail. It's a win!

You just said F - this  to "you just had a baby so deal with it."  You just said "I'm not going to settle for half rate care that doesn't give me all the information necessary to fully heal from pregnancy and birth."

You're committing to your own self care because you know how much it'll help your entire family in the long run.

And a pelvic floor PT is the person who will help you create your self care path.

They'll become your partner in figuring out exactly what YOU need for healing.

They will make sure you can reconnect to your body, you can open up and find proper posture, will ease tight, painful tissue, will give you exercises that are appropriate for your stage of healing, and teach you all you need to know about using your new mom body to avoid future injury.

It's not just a "do your Kegels" kind of care. It's a whole body, whole life kind of care that will revolutionize how you live, new body and all.

So if you had a csection years ago or have one scheduled in a few months. Find where you are in your healing journey and start there.

If you're ready to commit to self care check this out to learn more!

 

Running after Birth: How to Safely Run with Baby

Running with baby can be a great way to get your endurance exercise on without having to carve out time away from baby.

However, there are many factors that need to be considered when running with baby to make sure you are supporting your body as it continues to heal from birth.

Factor 1

You have been cleared by your OB/Midwife to exercise. Even if you ran prior to and during pregnancy you'll want to discuss returning to exercise with your birth practitioner.

Your body just went through tremendous change, quickly. Whether you had a natural vaginal delivery, a csection, episiotomy, tearing, or other trauma your body has to heal.

Much of your tissue healing will occur in the first 6-8 weeks after delivery. But this doesn't mean you're fully healed. But it does give your birth practitioner an idea of how well your body is healing and when you may be ready to return to more rigorous exercise.

Factor 2

Be screened for a diastasis recti. Most women have some form of abdominal separation during pregnancy, which should heal on it's own over the next year after birth.

For those with a diagnosed diastasis recti, it takes more support to regain full functioning of the abdominal wall.

Running takes a lot of core activation to support your joints and pelvic organs. If your abdominal wall is not up to coordinating with the rest of your deep core to withstand the forces placed on the body, it can cause imbalance in the intra-abdominal pressure. This can lead to incontinence, pelvic organ prolapse, low back or pelvic pain, or a hernia.

Factor 3

Make sure you can do a proper pelvic floor contraction.

If you have never had a pelvic floor assessment, testing what your pelvic floor awareness and control is, this is a must after birth.

It gives you a chance to deepen your understanding and awareness of the pelvic floor. Find out how pregnancy and birth affected your pelvic floor, even if you had a csection.

Your pelvic floor has to do A LOT of heavy lifting when running.

Every time your foot hits the pavement the pelvic floor contracts to protect your organs, joints and prevent any unwanted pee or poo escaping.

If you don't know how to voluntarily contract the pelvic floor, your body won't know how to do it on demand.

Leaving yourself at risk for causing [more] damage to your pelvic floor leading to incontinence and prolapse.

Factor 4

Timing your run to avoid breast issues.

When you breastfeed running can be a challenge for many reasons.

One, your breasts need more support.

Two, baby may want to eat in the middle of a run.

When breastfeeding your breast tissue is more susceptible to damage. The force placed on the breast tissue when running is tremendous and unfortunately you can't just contract your pectoral muscles to keep your breasts stable.

Side note: yes, having strong pecs will help with breast support, but typically these muscles are tight in postpartum, so don't over do the chest presses.

The best way to support your breasts is to double up your sports bar. You want to make sure there is no to very little movement of your breast tissue as you run. But also not be too squeezed that you are cutting off blood supply. This will reduce the shearing that can occur on the ligaments and milk ducts, as well as reduce friction on the nipples, while keeping proper nourishment to the tissues.

The second thing you'll want to do is time your run to just after a feeding. This reduces the size of your breasts prior to running, so less needs to be supported, but also making sure you don't get engorged while running. Avoiding the risk of blocked milk ducts and blips.

Factor 5

Start off slow [even if you ran before and during your pregnancy] and always warm up.

Warm up with some dynamic stretches like knee lifts, leg swings and arm circles.

Then begin with intervals. Walk 5 minutes to get your blood flowing then run for 1 minute. Really focus on proper form during that 1 minute versus going as fast as possible. Gage what feels right in your body [which will be different for everyone], my stride will be different than yours which will change my pace. Going too slow will also be awkward. 

Doing intervals will give you time to really tune into your body as you build your endurance and stability for longer run periods.

Then to avoid tight, achy muscles afterward. Cool down with some static stretches or rolling out your fascia.

Factor 6

Lastly, don't be a robot.

Allow your trunk to twist when you run. Just a little rotation through your spine and pelvis is necessary to run in proper form. It gets your abs and hips really working and improves your overall spine mobility.

This can be challenging when you are holding onto a stroller, so you can do one of two things [unless you figure out another safe way!].

One, hold the stroller with one hand allowing yourself the freedom of movement through the other arm. This is helpful if you have less than optimal shoulder mobility, which is common in postpartum from breastfeeding and carrying baby. There are two caveats to using one arm...you want to switch it up and it's harder to control.

You will want to change which arm holds the stroller, so you aren't always using one arm. This will ensure you are building up strength in both arms and allowing both sides of your body to be mobile.

Plus, using one arm may be harder to control the stroller, especially if you are on uneven pavement or surface.

Two, improve your shoulder mobility, so you can twist with anchored arms. Doing exercises that increase your shoulder/rib disassociation is ideal in postpartum, not only for running but for other tasks through out the day. One of my favorites is a kneading action (bending the elbows) through the arms while on all fours.

There you have it!

The major factors you should be considering before running with your baby [or running in general]!

If you've checked all these factors and feel ready to run...have fun!

If you don't know where to begin, comment below or send me a message, we'll figure it out together!

When Breastfeeding Becomes a Pain in Your Neck

Breastfeeding is one of those things you're told is great for baby.

It improves your bond, it increases baby's immunity, it provides nourishment and nutrients, it helps with baby's gut health and so much more.

Breastfeeding isn't always easy though.

It can take a while for baby to figure out how to latch, causing nipple pain.

You may worry if baby is getting enough to eat.

Your breasts may become engorged leading to blocked ducts or mastitis.

These are things that are typically mentioned if you see a lactation consultant or at least chat with a friend whose breastfed.

But what about how breastfeeding affects the rest of your body?

Yes, breastfeeding can help you slim down from the pregnancy weight. And it can prolong the return of your period.

What you may not have known is it also keeps estrogen and progesterone circulating in your body longer, which means your tissues are softer longer and more susceptible to injury or dysfunction.

This means:

  • your pelvic floor muscles may be strong but you still leak when running.
  • your sacroiliac joint (that joint that connects your sacrum and your pelvis) may continue to be problematic because it's hasn't regained it's support.

What breastfeeding also means for your body is neck and back aches and pains. Holding your baby to breastfeed can take a lot of effort. For a healing body that is already weak, this means compensations and bad habits form.

You may slouch to bring the breast to baby instead of propping up with a pillow.

You may twist or cross your legs.

You're sitting more.

If you nurse lying down you may jut out your ribs to bring your breast to baby.

You're constantly looking down at baby. Because really who doesn't want to stare at baby 24/7?

All this adds up to pain.

So how can you avoid getting a pain in your neck or back while breastfeeding?

1. Posture

Be mindful of your posture. First you need to make sure you are in good posture alignment. This means finding pelvic neutral, where your sitting on your sit bones , your ribs are centered over your pelvis and your spine is long with the natural curves. If the surface you are sitting on is inhibiting this then change where you are sitting or use props. Put pillows behind your, sit on a harder surface, anything that will help. Then use pillows, cushions, blankets, anything  except your body to prop baby up to reach your breast.

When you nurse on your side you want to consider the same thing. You want to make sure your body is in a neutral position. If you twist, make sure it's more of a log roll twist and put a pillow behind you. Make sure your head is supported and your shoulders are away from your ears.

2. Stretch

Stretching tight muscles after nursing is a great way to reduce aches and pains. And over time you'll maintain soft supple tissues rather than dehydrated tissue that will cause even more problems.

Doing simple stretches like:

  • neck rolls
  • reaching your head up and away to the side as you reach your opposite arm down and away
  • looking down to your arm pit
  • bringing your arms up and behind your head to open your chest
  • clasping your hands low behind your chest and reaching back
  • lying on your back and doing snow angles with your arms
  • rib twists
  • side bending
  • cat/cow
  • lunge stretches
  • taylor sit (criss cross applesauce) and bending forward from the hips then switching legs

These are all super simple stretches that you can hold for 30 seconds after nursing. And mix it up, you don't need to do all of them each time.

3. Strengthen Your Core

Reconnecting with your core after birth can take a while. But breastfeeding is a great time to start. Taking a moment to focus on your breathing and tuning in to the movement of the pelvic floor - out on inhale, in on exhale - is the first step. Then start to energize the pelvic floor on exhale, zippering up through the abs, while keeping your bony structure soft and in good posture.

Then when you start to feel up to doing more exercise, starting with basic core connecting exercises is the safest. This is where seeing a maternal health PT is helpful, so you can make sure you are doing the exercises correctly, and there isn't anything else going on that may become problematic.

Breastfeeding is a magical experience that can do wonders for your baby's health. Let it be a time you focus on yourself too!

 

 

After Birth Care for Your Pelvic Floor

I've given birth twice now.

Each experiences has shaped how I view birth and my ability to reach deep down to the inner strength with in.

However, each birth resulted in different recovery needs.

My first delivery I needed to push for at least an hour, if not longer, I really can't remember. The umbilical cord was wrapped around my daughter's neck and every time I pushed the cord pulled tight and prevented her from descending. Then when I "relaxed" between contractions all the progress I made with the previous contraction was lost.

It wasn't until my midwives flipped me on my back and said "push" did I realize something may be wrong.

So I dug down and pushed with all I had left. This delivered her head. My midwife cut the umbilical cord then I was able to birth the rest of her body.

That push that birthed her head resulted in a grade 2 tear. I wasn't focusing on relaxing the pelvic floor as I had been previously I was just focusing on delivering my babe.

The tear needed a few stitches. It was uncomfortable to sit. It was uncomfortable to poop. It was uncomfortable to wear pants with a seam down the middle. I wore padscicles for several weeks around the house. I tried to reconnect with my pelvic floor the next day and couldn't feel much. And once I was feeling ready to be intimate with my husband again, there was a spot of pain.

My second birth was vastly different. I pushed twice to deliver my babe, taking only 8 minutes. I was swollen but did not tear. It was only uncomfortable to sit when I was transitioning from stand to sit to the reverse. I could wear jeans without discomfort. I successfully reconnected to my pelvic floor within 12 hours of delivery. And only being 3 weeks from birth I can't compare intimacy yet.

Looking back, even though I had prepared pretty much in the same way as the first birth, I trusted my body more the second time around. I followed the signals it gave me rather than what I thought I should do based on what I learned in class or what the midwives were telling me.

The result of each birth and recovery has effected how my pelvic floor functions. After my first birth, there was pain effecting my pelvic floor's role in bowel movements and sex. After my second birth, my pelvic floor is functioning properly, thus far!

Giving birth has been said to equate to a marathon or an Olympic event.

I can't agree more. However, there are some major differences.

After a marathon or Olympic event (if all goes well) you come out of not much different than when you started. All the training you did pays off and your body will be tired, but otherwise unscathed.

After birth, even a natural, unremarkable birth, your body is not immediately the same.

There are so many variables that effect the outcome of birth and recovery. Your body is different from mine, your baby is different from mine, your medical history, location and pain tolerance are different from mine. These variables and others make each birth and recovery unique.

However, there are similarities that can be addressed in similar ways to get the same outcome during recovery....a healthy pelvic floor that functions properly for you for the rest of your life.

Here is what I did to recover from my births. Remember some of these things every mom should do and others are more of an individual basis.

1. Afterease

I took an herbal tincture made by my midwife specific for after birth cramps. These cramps are caused by your uterus contracting and shrinking back to pre-pregnancy size and are usually most intense while nursing. This can cause some significant pain.

After my first birth, even though the after birth pain was intense, I didn't not take anything. I didn't want to take any over the counter medication if I could avoid it, since I was breastfeeding, though there are some medications that are safe to take. Being a first time mom, I wanted to avoid everything. And I didn't know about an herbal tincture that could help.

Taking something appropriate for after birth pain, will greatly improve how you feel while recovering.

2. Peri Bottle

After giving birth wiping with toilet paper can be rough and uncomfortable. Especially if you are swollen or tore.

So using a peri bottle to rinse off your perineum will keep you clean and the cool water will sooth the area too.

3. Herb Sitz Bath

A sitz bath is a great way to reduce inflammation and promote healing of swollen, bruised or torn/cut pelvic floor tissue.

Adding in healing herbs like Lavender or Epsom salts boosts the healing power of the sitz bath.

There are some great herb mixes specific to postpartum sitz baths, like Earth Mama or you can look on Etsy or you can make up your own. Here's a good recipe!

These mixes can also be brewed and added to the peri bottle or to padscicles instead of witch hazel.

4. Padscicle

These are frozen menstrual pad. You add either witch hazel or an herb ticture to saturate the pad, then pop it in the freezer.  After birth wearing a padscicle is a great way to sooth a hot, swollen or injured pelvic floor and speed recovery.

Some hospitals give you an ice pack specific for post birth swelling.  These are great, but I'd suggest making up padscicles as well to add the extra healing power of the witch hazel or herb tincture.

5. Adult Diapers

Adult diapers are a necessary evil after birth. You will continue to bleed as the uterus losses the endometrial lining that protected baby. Diapers are much easier to use and provide more protection than pads immediately after birth.

6. Menuca Honey

Honey has antibacteria and antifungal properties that help promote healing. It's like a natural version of Neosporin, but safe for your pelvic floor.

Dabbing a tiny amount on the perineum goes a long way!

7. Lymphatic Massage

After my second birth I had a good deal of swelling. So during my sitz bath I would do lymphatic massage to promote movement of the inflammation. 

Lymphatic massage is a very light massage to very specific areas in the body directed toward the heart. It is a safe and very effective massage to reduce swelling when performed properly!

8. Pelvic Stretches

In addition to lymphatic massage to reduce swelling I did pelvic stretches after my sitz bath. Stretching out tight muscles around the pelvis, like hip flexors and adductors gives more space for the swelling to move out of the area.

9. Breathing Exercises

The last thing I did after giving birth to promote healing was to reconnect with my core. I did this through breathing exercises while I nursed.

Every time I inhaled I took a full diaphragm breath filling my trunk. Then as I exhaled I would follow the natural movement of my core inward, feeling my tummy and pelvic floor drawing inward.

By reconnecting and activating my core muscles I created a muscle pump. This pump improves circulation to the area, flushing out the inflammation and bringing in healing nutrients with each contraction.

I also found that this breathing helped me get through the after birth pains.

Since I gave birth vaginally my after birth care looks different from a mom who gave birth with a csection. However, initially there are only a few differences. For examples padscicles may not be necessary. But scar care is added.

I go more in depth for immediate after birth care and progressive care in my signature program for pelvic health, 4th Trimester Expecting Pelvic Fitness.

By taking care of your pelvis after birth you are encouraging not only short term relief but long term pelvic health.

Pubic bone pain stopping you in your tracks?

During my second pregnancy I have experienced pubic bone pain more often and with more severity than during my first pregnancy.

There have been several times that it was so intense I could barely walk.

If you've had pubic bone pain you'll know what I'm talking about. The sensation that the front of your pelvis is grinding together and ripping apart. It's not pleasant.

But why do some of us experience pubic bone pain during pregnancy and sometimes even into postpartum?

Pubic bone pain is a very common pain syndrome during pregnancy. It is associated with Symphysis Pubis Dysfunction. The symphysis pubis is the joint that connects the two halves of the pelvis in the front. Your abdominal muscles, pelvic floor muscles and inner thigh muscles attach to the pubic bones.

There are four main causes of pubic bone pain, these can happen exclusively or more commonly in combination:

1. Posture

Your spine and pelvis is designed to be held in a particular position in relation to each other.

You have natural curves through the spine that allow forces to be translated efficiently and safely through the joints.

During pregnancy your posture tends to alter these natural curves because of your growing belly shifting your center of gravity forward and a stretched & weaker core.

When this happens your lower back curve increases and your pelvis tips forward, in standing. Or while sitting we tend to slouch into curved position. With a weakened core it's harder to pull out of this position.

This puts more weight on the symphysis pubis, that it is not meant to have to bear, straining the joint.

2. Alignment

Our pelvic joints go together likes puzzle pieces. There is one way they fit together, any other way is like jamming the pieces together.

Picture how painful that could be.

This is more commonly considered Pelvic Girdle Pain. Issues in the sacroiliac joints (back of the pelvis) that translates to the symphysis pubis.

Your joints are more susceptible to not fitting well during pregnancy and during recovery because of relaxin, estrogen and progesterone, which soften the ligaments and connective tissue that support and stabilize the joints.

When your joints are not "put together" they no longer efficiently manage forces, putting more strain on them.

3. Muscle trigger points or spasms

Trigger points and muscle spasms are locked up, dehydrated, sometimes over-worked muscle fibers. They tend to get stuck in a pain cycle of communication until "unlocked."

During pregnancy and  postpartum, with weaker core muscles, other muscles work harder to stabilize the pelvis and spine.

When muscles repeatedly work harder they form trigger points and muscle spasms.

These trigger points and muscle spasms can effect the joints they are attached to, referring pain  or causing imbalances in the joints.

4. Weak core

Without being extremely mindful as well as diligent with corrective exercises your core muscles will weaken, loose natural reflexes and disorganize function.

When this happens they no longer support and stabilize your joints and body.

So every time you move, like getting up from sitting or rolling in bed. Your joint are able to manage the forces going through them and your body responds with pain.

For me it has been a combination of old injuries causing alignment issues and trigger points reducing my body's core coordination. This all happened after two incidences:

One while lifting and moving too many boxes and furniture without asking for help.

The other after slipping on wet leaves covering my shed's ramp while doing yard clean up after a big storm. The caused me to tense up to avoid a full on split.

Both certainly not my finest hour, but I was able to get resolve pain fairly quickly with self care I've learned over my pelvic health years that I know work for my body.

If you answer "yes" to the following questions then it's time to listen to your body and ask for the help you deserve....

1. Do you experience pubic bone pain when you role or shift in bed?

2. Do you get pubic bone pain when you walk?

3. Are you several months postpartum and your pubic bone is on fire?

4. Do you want to have a natural birth and wonder how you'll manage because of your pubic bone pain?

There are simple tips and tricks to reduce your pubic bone pain.

Top tips....

Take smaller steps while walking...

Stand and sit tall keeping your pelvis and spine in neutral...

Warm up your pelvis with pelvic tilts before standing up...

Keep your legs together and roll like a log when moving in bed...

And lastly....

Set up a breakthrough call to learn what your body needs.

Breastfeeding...Tips to Reduce Upper Back Ache

My first experience breastfeeding was in an ER.

My delivery was pretty by the book. I went into labor Friday night, I was able to sleep between the contractions, we were up by around 7:00 am and two hours later I was to the point I couldn't stay home anymore.  We arrived at the independent Birth Center by 9:00 am.

I tried the tub...man was that hot and not for me...even though I LOVE water.

But clearly my body was saying, nope and I respected that.

Instead I climbed into the queen sized bed and pushed on my hands and knees.

Everything was going well, as far as I could tell...even though I joke with my husband that I only dropped the f-bomb once, he chuckles and says if you say so.

But even though I was in pain I was riding the waves of it, resting in between and in a total state of euphoria.

It was REALLY hard work, but I have a hard time describing just how painful and hard of work it was even just 3 years later.

Mostly, I remember things being in a haze around me, the midwives encouraging me, my husband by my side, my mom helping me stay hydrated.

But then, everything changed.

The midwives had me flip onto my back. They insisted I get my baby out.

So after a few pushes her head emerged.

This is when things really get blurry.

Apparently, unlike other circumstances when the umbilical cord is wrapped around a newborns neck it can be removed or does so on it's own during decent.

This was not the case for our little one.

I was strangling her with every push and if I had kept going she may not be here with us today.

This is why the midwives think it took me as long as it did to actually get her head out.

So instead of being able to keep her cord connected as long as possible, as my plan intended, they needed to cut it even before she was fully delivered.

I had 30 SECONDS to get her out after they cut the cord!

Well let me tell you there was no amount of time you could have told me to get my baby out if I knew her life was on the line.

Needless to say with that last push, she was born and I tore.

They placed her on my belly and told my husband and I to rub her vigorously to try to get her to cry.

This didn't work.

They removed her from my belly and had to perform rescue breathing on her to get her to breath.

It has been 3 years and I still tear up thinking about how our vivacious, head strong, wonderful daughter may not be with us, if my awesome midwives hadn't been on the ball.

Within minutes the ambulance came to pick her up and bring her to the hospital.

I was not able to go with her because I tore and needed stitches before I left.

So last I saw her was partially limp, but breathing on  the bed next to me.

My husband followed the ambulance and my mom stayed with me as I was cleaned up.

When I arrived at the hospital, the nurse at the ER desk didn't seem very concerned that there was a newborn infant waiting for her mother in one of the rooms and it felt like eternity to get me back to her.

My midwife was not impressed and rather cross.

When we finally arrived, my husband had our daughter all bundled up and was letting her suck on his finger with sugar water.

The whole time I was being cleaned up and driven over to the hospital and then waiting to be reunited, I was petrified that I wouldn't be able to breastfeed because we had been away from each other too long.

I climbed into an ER bed, in a dark room tucked away from the hustle and bustle of the other goings on and my daughter was handled to me.

When I held her to my breast, it felt so awkward and she seemed so tiny that I was fumbling. But my midwives again encouraged me my daughter latched.

It was a miracle.

We were fortunate that we had no issues nursing, after I was so terrified that I wouldn't be able to.

We went on an nursed for 2 years.

I can't say that through those 2 years it was all sunshine and roses though.

Hello teething!!!

She never really bit, but holy cow her suck became so strong to sooth those tender gums.

But the trickiest part for me was finding positions that wouldn't hurt my neck and back.

She was a nurse to sleep kind of girl.

And sometimes, she would stay nestled in my arms for hours and any time I moved she would scream.

So if I wanted her to nap, I needed to stay put in my rocker.

Fortunately, we found a super comfy glider, rocker combo with ottoman, but even that wasn't enough.

I had pillows galore and would stuff them in all the crevices to get me from slouching down to meet her.

This helped, but still my muscles would ache.

Of course being the physical therapist that I am, I was determined to stop the ache.

This meant not only making sure my posture was in good alignment or that I switched up the position I was in so I wasn't always using the same muscles but I stretched.

I stretched my neck, chest, upper back, hips and buttocks after every feeding.

But stretching isn't enough to make sure you don't slouch. Our core plays a HUGE roll in our posture. After pregnancy and birth our core muscles have to heal, shrink, and remind themselves what their roll is.

Most of the time, they need our help.

This meant when I was sitting or lying down or standing while nursing I did sets of pelvic floor and core exercises.

Some of you may question me when I say exercise, when I not breaking a sweat.

But exercising a muscle does not always require us to be jumping around or moving our whole body to gain benefit.

Actually, in the postpartum period smaller, slower, more intimate exercises will help you heal and get back to those more intense, vigorous exercises without long term issues.

So to recap my tips:

  1. Make sure you are in good posture while breastfeeding. This means if you are sitting - not sitting on your tailbone, bringing the baby to your breast and supporting with as many pillows as necessary. If you are lying down try to switch up the sides you lay on and again prop baby until she is big enough to not need support. If you are standing, the easiest way to breastfeed a newborn without a carrier is in football hold.
  2. Stretch. Tight muscles will lock in the chemicals that help our muscles to work, but over time this build up and constant shortening and pulling on the joints will cause pain. So balance out your muscle by stretching those that are most shortened while nursing. Try out these!
  3. Work on your Core. Starting simple and easy with breathing exercises is the best way to reacquaint yourself with your core. If you had pelvic floor trauma or a cesarean this reconnection may take longer and you may need help from a specialist to figure out what muscles your are targeting and if there is anything may be inhibiting your reconnection, like scar adhesions. Check this video out!

To find out more about proper nursing postures, postpartum stretches and reconnecting to you core sign up here for your free consultation with a maternal pelvic health specialist.

What You Were Not Told About Birth: Part 4

As we all know birth does not always happen vaginally.  Many babies are born through mom's belly.

Moms who have a cesarean have many of the similar factors to consider as moms who birth vaginally.  These factors are centered around all moms were pregnant before birthing and the pregnancy itself alters our body.

However, moms who birth through cesarean have the added factor of an abdominal surgery.

Let's consider the two paths moms may on before a cesarean.

The first path is mom is laboring and pushing, but for what ever reason baby is not progressing or another medical complication occurs and for the best interest of mom and baby a cesarean is performed.

The second path is mom is scheduled for a cesarean and does not labor and push.

Each of these paths have it's own implications on the mom's body.

In the first path, the pelvis is primed for a vaginal birth, the tissues and muscles of the pelvis are stretching and widening, the uterus is contracting.  Mom may have been laboring naturally, induced or with pain medication. She may have tried multiple positions to help baby out and may have pushed for hours. For some baby is in an asymmetrical position or breech which puts strain on moms tissues where we don't want the extra strain. Baby may have been pushing into and stuck on the pubic bone.

Whatever the scenario, when mom has labored and pushed before a cesarean her pelvis has gone through a partial vaginal birth.  This means that she is at risk of long term pelvic floor dysfunction, similar but not as high of a risk to those who delivered vaginally.

A reminder of these problems are incontinence, pelvic pain, and prolapse, which Part 3 goes over in more depth.

In the second path, moms body has started prepping for a vaginal birth, but typically a cesarean is scheduled at least a week or 2 before the due date.  This is to reduce the chances of mom going into labor.

For these moms, they have the least risk of pelvic floor dysfunction.  This is a no judgement zone and I believe cesareans are absolutely needed when medically necessary, but don't let the reduced risk of pelvic floor dysfunction lull you into a false sense of security.

Cesareans are a major abdominal surgery.

Without getting into the medical component of a cesarean, which you can read more about the that in my blog post Vaginal vs Cesarean, I'm going to cover how an abdominal surgery alters the body.

Unlike cesareans of the past, the abdominal muscles should no longer be cut, however they spread and separated from the connective tissue.  So after 9 months of being stretched out they are further stretched and traumatized, regardless of how gentle the OBs are.

Especially during an emergency cesarean, OBs want to get baby out fast, so moms tissues may be bruised and have extra micro trauma that has to heal.

If you think of any other major surgery, most of us don't assume the person will bounce right back from it.  Usually there is a recovery time and rehab, sometimes A LOT of it.

When your abdominal muscles are retracted and organs are shifted some more to remove baby, the fascia and connective tissue that is interwoven through the abdomen down into the pelvic floor is involved. This means that even though baby was not born vaginally, there is still a risk of pelvic floor dysfunction, because of the interplay of tissue.

What are the major implications though of the incision?

A cesarean incision is a scar. A scar is an interruption in the normal tissue fiber, which is weaker and sometimes unpredictable.  The scar for a cesarean is multi-layered and can vary from mom to mom based on the OBs technique and how mom heals.

Some moms heal beautifully without complication and others may have extra scar tissue, infection or added complications that prolong the healing process.

In turn, a scar may visually looked healed but tactically be numb, bumpy, tight or painful.

There are two major implications that result from the scar.

  1. Pelvic weakness, mainly the abdomen.
  2. Pain, mainly abdominal or pelvic.

Let's take a look at each these more closely.

When any muscle is traumatized by injury or insult, such as a surgery it is weakened at a micro level.  Plus nerves are also involved causing numbness and reduced sensation in the abdomen. Combine this with weakened and stretched out abdominal muscle from pregnancy, moms with a cesarean are at a higher risk of longer lasting abdominal weakness and a harder time tuning into the Abs.

This is perpetuated by the fact that most OBs don't want mom to perform any form of exercise for 8 weeks to make sure the incision is healed, which is fair enough. However, with the guidance and expertise of a maternal pelvic health specialist there are safe exercises that can help with healing.

Abdominal weakness can lead to

  • back pain
  • constipation
  • prolapse
  • poor posture

But as I stated before the fascia that is woven through the abdomen reaches into the pelvic floor, which can result in some pelvic floor dysfunction as well and as we all know (now, from reading the series) it's not all about Kegels for pelvic floor dysfunction. So we want functional Abs too!

On the other hand the scar can cause pain. When a scar is formed the body arbitrarily adds connective tissue to the area.  Then over time the body comes back and straightens it up to match the force vectors in the tissue.

Some bodies aren't as efficient at this process or are overly efficient, meaning they don't straighten it up very well leaving nodules or bumps or extra scar tissue is created and may adhere to surrounding organs or tissues.

This disorganization or adhesions can result in pain receptors saying something is wrong, thus abdominal or pelvic pain.

For many moms this is most noticeable with activity, bowel movements, a full bladder, sex, and menses (once they start).

Long term implications if not addressed as be increased severity of symptoms, "sudden" start of symptoms that may seem out of the blue but stemming from the cesarean or complications in later births.

So as you can see there are risks for all forms of birth and we as women need to research, ask questions and feel in control of the decisions we make regarding birth.

Knowing that you are not alone, there are people who can support you through your birth and your healing after birth. There are treatments for these complications and ways to help reduce these risks. All it takes is reaching out.

We'd love to hear your birth experience. Comment below.

The Low Down on Diastasis Recti

Let me start by saying.... YOU ARE BEAUTIFUL, mommy tummy or no.

That being said, there can be more to a mommy tummy than meets the eye.

Our bodies are amazing. They are able to stretch, contract, contort, rebound, over and over again.

As woman we are able to expand enough to grow a baby in our womb!  This takes a lot of STRETCH of the surrounding tissues.

There is a healthy amount of stretch and rebound that the body can handle. And there is an unhealthy amount of repetitive stretch or frequency of stretch positioning that puts our tissues at risk for injury.

During pregnancy our abdominal tissues go through an incredible amount of stretch.  I can't tell you how many times I thought "I can't get any bigger" but I did.  I could literally feel my tissues stretching after my daughter had a growth spurt in the womb.

This stretch is very healthy and is meant to happen to provide space for the growing baby.

However if the tissues being stretched were already under unbalanced loads prior to pregnancy, they may be at risk for injury.

This injury of the abdomen or symptom of unbalanced mechanics in our body is commonly known as Diastasis Recti (DRA) or abdominal separation.

I would like to clear a few things up about Diastasis Recti, and I'm going to channel Katy Bowman, a biomechanist who wrote a phenomenal book about DRA which gets to the heart of how I have been working with my patients for years.

DRA is typically the result of years of stress on the connective tissue of the abdominals, called the Linea Alba. Our abdominals expand and contract for gut function, respiratory function, structural support, reproductive health and much more.  It is when the abdominals are used over and over again in a posture, or are placed under unbalanced forces frequently that cause the weakest point of the abdomen, being the connective tissue to give.

Then there comes a point when the weakest point just cannot take it any more and stretches or separates past the point of natural.

We all have different widths of linea alba, which can change after pregnancy, but still be normal.

In our modern day society, for many of us these unbalanced forces are sitting in a slouched posture all day at a computer, holding our breath while performing heavy lifting or extreme dynamic exercise, or driving leaned off to one side. These are just examples, there are so many other ways we repeatedly and frequently stress our body.

What we need to take into consideration is DRA is not just an abdominal problem, but a whole body problem.  The way we sit can either help or hinder our ability to properly engage our abs. Try it...sit slouched and see where your belly goes.  Then sit upright so you feel you are sitting on top of the two bones in your bum and see what your belly does. Is it easier to contract them in one of these positions versus the other?

Our trunks are pressure chambers and when we are honoring the natural curves of our spine and neutral positioning of our joints, these chambers are stacked, all the parts insides are in place and the container (bones, muscles, skin, etc) are not distorted.

When we don't honor neutral these chambers are not stacked, the parts insides are displaced and the container has to distort.  It is when we repeatedly dishonor neutral that this becomes a problem.

Imagine a woven shirt, if you repeatedly stretch it, the fibers will eventually start to break down and the seams, being the weakest point will tear.

This is what happens with the linea alba. However, for most woman the tissue doesn't actually tear, it just gets really thin and weak.

99% of expectant women have a DRA, based on the measurable definition of abdominal separation. However, it doesn't become a problem unless the abs are pulled past an unnatural state of stretch during pregnancy and then is not addressed post birth.

Again, DRA is a symptom of unbalanced forces in the body putting strain on the connective tissue of the abs that results in back pain, pelvic pain, abdominal pain, gut & digestive issues, and pelvic floor dysfunction.

66% of women tested with DRA had at least 1 support-related pelvic floor dysfunction diagnosis.

The good news is there is a way to help correct this problem. And it doesn't mean just closing the gap or having a flat tummy.

Here's a little inside into my life...I had a DRA after my pregnancy.  I was very fit before and during pregnancy. I was doing prenatal yoga & Pilates and I ran until I was 8 months pregnant.  But I have past injuries and compensations that my body found challenging to withstand the forces placed on it.

I have worked hard to create a functioning abdominal wall again, and I still have what some would consider a separation.

BUT, my abdominal muscles all work properly, there is proper fascial tensioning in my linea alba, I can close the gap, I do not have any pelvic floor dysfunction, gut issues or pain issues.

What does this mean? By addressing the issues of unbalanced forces in my body, through bad posture, tight muscles or fascia, repetitive movement patterns and the like I put less strain on my belly.

You can too! The first step is recognizing what unbalanced forces you are creating in your body then taking the time to recalibrate how your body responds by creating healthy movement patterns!

Sex After Birth...Is it Normal to Hurt?

Okay ladies, let's talk about sex. Not just sex, but sex after having a baby. You've just labored, pushed and birthed a baby either vaginally or cesarean and your body is forever changed.

So now you have to reacquaint yourself to your new body...."Hello mama body, how are you feeling today? Tired? Sore?"

No wonder the thought of having sex for most of us is the last activity we'd chose to do with our new body.

So why is sex after baby painful?

Statistics range from 9 out of 10 women experiencing pain the first time after birth, falling to one quarter of women suffering long-term painful sex. Other studies find 45% of women experience pain during sex after birth

Nearly one in ten women who had an episiotomy, tear or other forms of intervention during childbirth suffer from painful post-birth sex – that’s over 35,000 women a year!

Here are the tops reasons sex is painful after baby:

  1. Shy about our new bodies
  2. Breastfeeding
  3. Hormones & the thyroid
  4. Scarring
  5. Injured pelvic floor muscles

For many women the changes that occur to our bodies make us self conscious of how we look...stretch marks, soft tummies, wider vagina. Even though a women's body is beautiful after having a baby, many of us just aren't comfortable with these changes.

Breastfeeding changes the natural mucosal lining of the vagina and reduces the lubricant produced by the body when aroused.  This in combination with unbalanced estrogen levels from the body readjusting from pregnancy can cause the vagina to feel dry....leading to major friction during sex.

These on top of being sleep deprived and focusing 24/7 on a new baby can really reduce the sex drive we may once had.

Scarring occurs in tissue when it has been cut or torn.  So for those who tore during delivery, had an episiotomy or a cesarean the risk of painful sex is increased.  Why is this...because when scar tissue is less flexible or elastic than the surrounding tissue.  This becomes even more apparent when the scar does not heal properly and creates more scar tissue than necessary or binds down neighboring muscle.  So then when you go to stretch the scar it doesn't want to give and creates a pain response.

No matter how you delivered, your pelvic floor has been forever changed from pregnancy.  The weight it supported during pregnancy, the strain it felt during labor and the stretch it went through during delivery all play a role. "I had a c-section" you may say.  You're pelvic floor can still be affected depending on if you pushed before your transition to the c-section.  If you had a scheduled cesarian your risks are more linked to scarring, hormones, and past history of pelvic floor dysfunction.

This does not mean you can avoid painful sex by having a c-section!  There are more risks that come along with having major surgery, so please let this decision be medically based.  That is a whole different post...I have worked with many moms who never delivered vaginally but had horrific pain during sex.

So what can you do about it now?

First listen to your body...if it is painful, slow down, adjust your position, or just stop.  You don't want your body to associate pain with sex..this creates muscle guarding and increased anxiety....which are easily avoidable.

Then try some lubricant. Natural oils like coconut and olive oil can help boost the bodies natural moisture, but if you go with store bought always go with water based.  If you have sensitive skin, you may want to stick with organic brands like Sliquid.

Massage, massage, massage!!!

So think of yourself as an athlete returning to your sport after an injury.  [Not that I consider birthing an injury...it is a natural process for the female body] but bare with me.  An athlete with ice, heat, get a targeted massage, do targeted exercises for the injured area.  These help the body heal!  So why wouldn't you help your body heal by using targeted massage and exercises?

Take out that coconut or olive oil and gently massage your perineum (that tissue between the vagina and anus), especially if you have a scar.  If you have a c-section scar gently massage it and the surrounding tissue.

*Always wait for the scar to be fully closed before doing any massage*

Stretches and targeted pelvic floor awareness exercises helps your muscles find their groove again.  Because of the strain and stretch these tissues experience they loose some of their natural function to contract and may end of tightening up or weakening.

Reacquanting yourself to this area with breathing exercises to synchronize your diaphragms and create a new muscle memory will help bring back the sexual function of the pelvic floor.

Be aware though that KEGELS should not be done if you have tight pelvic floor muscles...this will only lead to more tension and more pain.

My best advice is to assessed by a women's health physical therapist who is trained in postnatal and pelvic floor care.  That way you will know exactly what your body needs!! No point in guessing when there are experts who can help!

Too many moms I have worked with waited months and even years experiencing pain with sex.  Don't wait, soreness and tenderness is totally normal the first few times you try.  But persistent, sharp, stabbing, burning, (I could go on here) is not!

Do yourself and your partner a favor and mention it the next time you see your provider. Or better yet find a local women's health PT near you..did I mention NH is a direct access state, so you can see a PT without a referral.  How cool is that!

Remember the only sensations you should be feeling during sex are pleasurable ones!