pelvic floor

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!

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 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!

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 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!

What Is a Maternal Pelvic Health Specialist?

Last week a patient asked me a very good question...

"Who should I speak with about staying active and exercise during pregnancy...because I don't feel comfortable doing that with my OB?"

I thought this was a very valid question, since she is not pregnant yet and is hoping to conceive in the near future. But then again, I must have failed at my job, for not educating her enough on what physical therapists, i.e. I do.

So here's the answer to her question: a women's health physical therapist.

Why? Physical therapists are specifically trained to:

  • understand the musculoskeletal system and our structure
  • knows the mechanics of the joints
  • how the muscles function together
  • how the nervous system plays a role in our function
  • what our mobility is suppose to look like
  • how to test for imbalances, weakness, dysfunction, tissue tension and much more related to our structure
  • distinguish best practice for diagnoses and problems to reach our patients goals with the most conservative path as possible
  • know what exercises are appropriate for certain diagnoses and problems [and which ones will do harm]
  • apply manual therapy techniques when appropriate to enhance the exercises needed to reach desired goals

Really the list can go on and on!!!

OBs and other medical doctors (not including physiatrists and DO) are not trained as in depth on the musculoskeletal system and certainly not on how to treat structural and mobility issues.  They are highly trained on knowing how to treat ailments related to the reproductive system and maternal care (or whatever the specialty is).

But their profession as a whole is lacking in knowledge about how to stay active, structurally pain free, and what exercises or manual therapy treatments are necessary for certain problems.

That is what physical therapists do!

More specifically when you are experiencing problems during pregnancy like:

  • back or pelvic pain [really any form of pain not related to the baby or reproductive organs]
    • Because really most aches and pains during pregnancy are related to our changing posture and joint instability causing tight and imbalanced muscles
  • want to stay active, but don't know how
  • pelvic floor dysfunction...incontinence, constipation, etc
    • Which may only get worse after birth
  • want more information about preparing your body for labor and delivery
  • nausea, swelling, headaches

...and want to do everything possible after birth to support your body in recovery

Then a women's health physical therapist, especially one who has been trained in maternal care and even better one who also has a deeper understanding of the fascial system and core cylinder is the BEST provider to go to of all your concerns about your body during pregnancy.

I've said it before, this country is well behind others in supporting expecting and new moms with the structural changes that occur in our bodies.  It's time to change that and offer moms the choice to see a physical therapist during all stages of pregnancy, regardless of specific diagnoses.  Because let's face it, even if we feel great, there is always something we can learn about our body that will benefit us in the long run (me included!)

a women's health physical therapist, especially one who has been trained in maternal care and even better one who also has a deeper understanding of the fascial system and core cylinder is the BEST provider to go to of all your concerns about your body during pregnancy.

To be clear my job is really to help all moms reach her greatest physical potential, it's not just to be a physical therapist.  So pass the word on to all moms [in all stages] you know, that I can bring the best out of their body!!