prolapse

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!

What You Were Not Told About Birth: Part 3

Once the swelling and inflammation has gone down. Tearing or incisions have closed and superficially healed. The tissue has to continue going through a healing process which includes relearning how to function.

To better understand the long term effects we need to understand the roles of the pelvic floor.

The pelvic floor has four main functions...

  • To keep pee and poop in
  • To let pee and poop out
  • Sexual
  • Structural

These functions are influenced by the flexibility, contractility and coordination of the muscles and tissues of the pelvic floor. But they are also influenced by what is happening above and below the pelvis, daily movement patterns, and your habits.

A vaginal delivery not only stretches the pelvic tissues of the pelvic floor, but also widens our hips and pelvic joints changing how the forces travel through the body.

The pelvic muscles and tissues are attached to and support these joints. Your pelvic joints are affected by positioning, external forces from people pulling on your legs, or your inability to feel how hard your pushing from an epidural. So if your pelvic joints are injured the tissues that are attached to them can also be injured or guard to protect.

These changes can have lasting affects on the structure of your pelvic bowl and may alter the strength-tension relationship in the muscles supporting the joints and organs, most importantly the pelvic floor. The body needs to compensate by shifting your posture or you may unconsciously alter how you perform a task.

This results in changing forces within our trunk and pelvis.

When this occurs the functions listed above can be altered resulting in

  • Urine or fecal leakage
  • Urine or fecal urgency
  • Pelvic pain - front or back
  • Back pain - anywhere in the back
  • Painful sex
  • Reduced sexual arousal
  • Constipation, etc.
  • Prolapse

The longer the body compensates, guards, moves in less than desirable patterns the more the tissues will tighten, weaken and become imbalanced.

Resulting in:

  • That pesky twinge with sex now being a sharp chronic pain with sex.
  • No leakage with coughing or sneezing to every time you have a cold you have to wear a pad.
  • Once your baby starts to grow and get heavier your back aches or you can't bend over to lift the babe up because it hurts your pelvis so much.
  • Whenever you lift your leg to go up the stairs or get dressed you have pain in the front of the pelvis.

Really the list can go on and on.

The contractility and flexibility of the pelvic floor muscles in particular are most influenced by a vaginal birth and just like the short term risks, medical intervention can result in more dysfunction.

For example, an episiotomy rips more resulting in a fourth degree tear. This means the laceration affects all the muscles and tissue between the vagina and rectum, including a large junction point of pelvic floor muscles and ligaments. When this happens not only is the scar going to be bigger, which may cause increased adhesions and reduced flexibility and guarding in the tissues and muscles, but also weakness in the anal sphincter.  Resulting in increased risk of uncontrollable gas loss or fecal incontinence. On top of pelvic pain, prolapse and urine incontinence.

These issue will not be helped with just Kegels, ladies!

On a more global scale, the length of pushing during birth, regardless of medical intervention can increase the risk of pelvic floor dysfunction.

As I mentioned in Part 2, a short labor may not allow the time for the tissues of the pelvic floor to relax and stretch to expand for baby.  On the other hand a long labor and pushing can overstretch the tissues.

Not being able to relax may cause tearing, resulting in scarring. Leading to pain or inability to contract or relax the pelvic floor muscles.

Either of these can mean muscle guarding, muscle weakness, muscle spasm - which can all lead to incontinence and pain.

Over stretching the tissues also means increased risk of prolapse. What this means is your pelvic tissues are unable to support your pelvic organs and either your bladder drops into the vaginal canal, cervix or uterus drop into the vaginal canal or the rectum drops into the vaginal canal.

Prolapse is highly influenced by the support you are able to provide to the pelvis through muscular, fascial tensioning and proper pressures. This is really where the weakness of the core, pregnancy posture and any other trauma that occurs to the pelvis from vaginal delivery is be highlighted as a problem.

Another injury that is rarely spoken of is nerve damage. This can be caused by:

  • The amount of force placed into the pelvis during pushing
  • The position of the baby
  • The position of mom
  • Any external forces on mom (think partner holding onto one leg and nurse holding on the other leg while moms on her back)
  • Medicalization such as epidural so mom can't feel how hard she's pushing, or instruments.

It takes a long time for nerves to heal and if the surrounding tissues have also been injured, posture is altered, pelvic congestion or there are imbalances in tissues causing tension or guarding squeezing the nerve it'll take even longer.

The nerves that run through the pelvis not only control the pelvic organs and tissues but also the legs!

Ever wonder why it's hard to lift your leg or why your foot is numb after birth?

To recap:

Long term effects of a vaginal birth on pelvic health are:

  • Incontinence
  • Pain
  • Prolapse

These are influenced by:

  • Scarring (tearing, episiotomy)
  • Injury from vacuum, forceps
  • Length of labor and pushing
  • Ability to relax the pelvic floor during birth
  • Awareness and health of the pelvis prior to pregnancy
  • Nerve damage
  • Any other pelvic injury during birth

The good news is all of these are treatable in some way, with care from a pelvic health PT!

The sooner you are able to speak up and seek care the better.

The more women who do speak up about it and find out that these effects are not normal results of childbirth the women who will be able to live a fuller life!!

What You Were Not Told About Birth: Part 1

So I can't tell you how many times I have been chatting with a client and she says

Why didn't they [meaning her OB or midwife] tell me that?

And I can never really give a good answer, because I don't know why providers don't inform expecting moms what may or will happen to her body after birth.

To me, this should be common practice, so that moms can make the best decisions while preparing for birth and recovery. If we are unaware of what to expect how can we prepare?

This creates more of a reactionary mindset, which is typically more defensive.  Rather than a proactive mindset, which is typically more offensive.

So I've decided to delve into the issues that aren't brought up. The changes, birth injuries and short and long term problems that arise from pregnancy and birth.

To begin, I want to talk about a podcast I listened to this morning on the way to work.  It was called Risky Birth-ness from The Longest Shortest Time.

It was brought to my attention by a past client, who thought I'd enjoy the topic, being about the risks of vaginal births.

In the episode the host, Hillary interviews Kiera Butler who wrote What the Expect: Why aren't we talking about the surprising number of women injured by childbirth?  for the magazine Mother Jones.

[You may subscribe to the magazine for free here]

After downloading the podcast I couldn't wait to listen to it!!

I am such an advocate for women who experience childbirth injuries so I was excited to hear what Kiera had to say.

So I was shocked to feel less than satisfied by the conversation. Which you can listen to here.

Hillary and Kiera spoke some specific birth traumas that can occur from vaginal birth and how the prevalence of birth traumas are on the rise.  How Doctors are required by law to inform women the risks of  C-section but aren't required to discuss the risks of vaginal birth.

They also discussed certain interventions that may occur during vaginal birth, such as epidural, vacuum, episiotomy, and how the risks of these interventions are not addressed. And how vaginal birth can leads to short term and long term injury. Kiera went into a little more detail around these, stating short term injury is tearing or episiotomy and long term can be prolapse and stress incontinence. [I will go into more detail to these later].

But to me, this episode sounds almost like an anti-vaginal birth discussion until the very end.  I do not believe that was the intent; however I feel there was information lacking about the comparison in risks between C-section and vaginal, not just stating there are risks with C-section as well because it is major surgery.

Here's my insight on the risks of vaginal birth - 

Vaginal birth is the most natural way to deliver; however there are circumstances that can reduce a woman's ability to birth vaginally, so in those cases C-section is necessary.

Just because vaginal birth is the most natural doesn't mean there are no risks to your body.

There needs to be more education upfront about how to birth, including positioning, respecting the bodies innate pushing reflex. This includes the providers involved doing every effort to use these practices rather than the default lying on the back and telling moms to push.

Providers need to have more training on the muscular on the pelvis or to at least have it become standard practice to have expecting moms see a physical therapist trained in pelvic floor and prenatal care.  This gives expecting moms the best opportunity to bring awareness to the proper muscles that are the most involved or injured during birth, regardless of method.

Even though the risk of stress incontinence and prolapse is twice as likely for those women who have vaginal births compared to C-section and may lead to surgery in the long run. These are still risks of C-section in addition to other complications like abdominal pain, back pain, painful sex...

Medical interventions should be the last resort based on an individual basis, because there are other risks that are involved, such as epidural migraines, lack of body awareness to feel a natural push (which can lead to tearing), trauma to infant from vacuum or forceps, etc.

Hospitals and birthing centers need to be more open about it being the woman's decision for birth method and the experience she is looking for. Meaning she should not feel pressured or shamed into either method, but treated with respect.

Care does not end after birth. There needs to be more education around recovery, what to expect, what could happen and how to be proactive. I like how Kiera brought up recovery in France includes PT! [I have to listen to the podcast about pelvic floor PT].

And never, I mean never, tell a mom "At least you have a healthy baby" when she expresses a discontent with the birth experience because it diminishes her feelings.

Each birth experience is different because each woman is different, so every women should have the opportunity to be able to make an informed decision about that experience, without feeling pressured by society, medical community, friends, family or other moms. The only way we can make informed decisions is by being educated by those who have the information.  If birth trauma is not discussed, normalized or dismissed, then woman won't know to ask. So providers need to be the first to bring it up. Especially since, pregnancy books don't talk about birth trauma.

After listening to this podcast I was worried I was over reacting, but was pleasantly reassured by other's comments that I was not the only one who felt that this episode left me wanting more.  As one woman pointed out in the comments - there was nothing said about vaginal injuries being linked to the birth environment, including medical professionals you've never met, machines, IV, other sounds, etc, which may affect the moms mindset around birth. As I mentioned in another post, when a mom feels uncomfortable with a situation during labor the body responses by slowing or stalling progression. This can lead to intervention and possible injury.  So I'm glad someone brought this up in the comments.  That yes, there can be birth trauma and injury but what percentage of this trauma was caused by or within less than desirable environments.

I know I may stir up some conversation about this topic and I'd love to hear from you.  Tell me about your birth experiences. That is the only way we can learn from each other and figure out the best way to educate other woman about the birthing process.

Look for part 2 of this series as I get more in depth with some of the issues brought up in the podcast like stress incontinence, pain, prolapse and more.