Postpartum Exercise

Cayuga Pilates Postpartum Exercise

Let’s be honest. Most women’s bodies change dramatically during pregnancy and some women’s expectations of how to recover after delivery run high. Some women try to resume to their pre-pregnancy exercise routines too soon or ineffectively after delivery. Unfortunately, the media gives women the impression that fitting into your pre-pregnancy jeans and having flat abs is what’s expected of many women. My motto is, it took your body 40 weeks to deliver a baby and despite what women may want to hear, it can take 40 weeks or longer post-delivery in a regular exercise program to regain your prior fitness level. This often takes into account your strength and fitness level prior to pregnancy, if you exercised during pregnancy and your birth experience.

Postnatal Pilates-based exercise will focus on safely strengthening your core and your entire body after your delivery. Joyce has trained with leaders in the field of prenatal/postnatal exercise. As a Postpartum Exercise Specialist, she will teach you safe and effective exercise techniques to strengthen your entire body after delivery and help you meet the demands of motherhood.

In 5 sessions, you will learn:

  • Exercises to activate your deepest abdominal muscle, the transverse abdominis, and the pelvic floor muscles, two of the primary muscles known as your “core”. These muscles are cued before movement and this is why Pilates is an ideal exercise regimen postpartum.
  • Safe and appropriate exercises after vaginal birth or Cesarean section.
  • Exercises to strengthen your back and the rest of your body which are necessary and essential to the demands of motherhood.
  • Prenatal and postnatal exercises that are ideal to perform with a diastasis and those that are essential to the healing of a DR.
  • Proper body mechanics during activities of daily living and when feeding and lifting your baby to prevent further abdominal muscle separation.

What is a Diastasis Recti (DR)?

“Diastasis” means separation and “recti” refers to your abdominal muscles also called the “rectus abdominis.” These abdominal muscles (also known as the “six pack”), which run lengthwise down your abdomen, stretch to accommodate the growing fetus during pregnancy. Stretching of these muscles, in conjunction with pregnancy hormones that relax connective tissue allow for the birth of your baby. A midline separation (at your belly button) of more than 2 finger widths is considered a diastasis.

Screen Shot 2015-02-18 at 10.58.12 AMResearchers have found that nearly one-third of all pregnant women will have a DR in their second trimester and by some estimates, the majority of women will have a diastasis by the third trimester. Immediately postpartum, 53% of these women continued to have a DR and 36% remained abnormally wide at 5-7 weeks after giving birth.

In many cases, a diastasis will close naturally on its own. For those women who do not have a natural closure of their abdominal muscles, it can have mild to severe consequences including: low back pain, pelvic floor dysfunction, urinary incontinence, or hernia.

Who is at risk?

Women:

  • With prior pregnancies.
  • Expecting more than one baby.
  • Over the age of 35.
  • Who are petite.
  • With high birth weight babies.
  • With poor abdominal muscle tone prior to pregnancy.

Genetics also plays a big role. For some women, its simply how their bodies respond to pregnancy.

Screen Shot 2015-02-18 at 11.00.08 AMDiastasis Recti Self Test:

  • Lie on your back with your knees bent and feet flat on floor.
  • Place one hand behind your head and the other hand on your abdomen, with fingertips pointing downward into your abdomen at the level of your belly button.
  • Relax your abdominal muscles while slowly lifting your head off the floor into a “crunch”, making sure your ribs move closer to your hips.
  • Move the fingertips on your abdomen back and forth sideways (laterally) while pressing into your abdominal midline feeling for the right and left sides of your rectus abdominis muscle.
  •  Measurement of the width of separation is determined by the number of fingertips that can fit within the space between the left and right recti muscles. Separation of 2 fingertip widths or more is the determining factor for diagnosing diastasis recti.
  • Repeat to test for separation above and below belly button.

Signs of a Diastasis Recti/Abdominal Separation:

  • A gap of 2 or more finger widths.
  • The gap does not shrink when you contract your abdominal wall.
  • You see a small mound protruding from your abdomen.

It is allows recommended to verify this self-test with your health care provider to accurately diagnose a diastasis recti.

Movement to Avoid with a Diastasis:

  • Trunk twisting motions.
  • Lifting and carrying heavy objects.
  • Any exercises that require lifting of the head including: crunches, oblique curls, and exercises that require lifting head off of the mat which put the spine into flexion. Also, straight double leg lowering, dipping the toes with both legs elevated, single leg stretches, the 100.
  • Yoga postures that stretch the abdominals including “cow pose”, “up dog”, “triangle pose”, and backbends.
  • Exercises on all fours without controlled activation of the deep abdominal muscles.
  • Coughing, sneezing or blowing your nose without deep abdominal muscle contraction.
  • Anything that requires “jackknifing”, going from lying flat to sitting up straight  position. Women with a diastasis need to learn to “log roll” (See “How to Log Roll”  below)  rolling onto  your side and activating your deep abdominals,  to sit up from a lying position.
  • Exercises that flex or bend the upper spine forward should be done sparingly, if at all during and after pregnancy. This action buckles or separates the recti muscles.

How To Log Roll

To protect your mid line during pregnancy and postpartum if you have a diastasis, always use the “log roll” maneuver when rising from the floor or out of bed. With your torso and head aligned, engage your deep core abdominal muscle, roll over onto your side, then use your arms to help push yourself up to a sitting position.

 My Postpartum Experience

When I delivered my first child in 1997, there was little information available on how to exercise safely during or after pregnancy. During my pregnancy, I developed the common physical discomforts but after the birth of my son, I was left with hip and back pain and a large abdominal diastasis recti or a split in my abdominal muscles. Hoping that my old self would soon return, I resumed my pre-pregnancy exercise routine without much thought as to whether it was safe or appropriate for my post-pregnancy body.

My first experience with Pilates was in this postpartum time. Upon hearing that Pilates could help me get back into shape, I started using a Mari Windsor VHS tape (yes, that’s all there was back then!). I followed the routine and started to feel “different”. But all was short-lived after, as a busy mom, I stopped the workout for a 3 week period.  My hip and back pain immediately returned. Slowly using Pilates and a variety of other exercise means, I got back in shape with eventual resolution of my hip and back pain. Until, in 2002, I got pregnant again….

Following my second pregnancy, and now faced with minor hip surgery, a physical therapist directed me to a private Pilates teacher, now as a means of therapeutic rehabilitative exercise. Working one-on-one with a trained Pilates teacher (not a VHS tape) is when the Pilates light bulb truly went on for me. The instructor taught me how to do the exercises safely and  effectively for my body type (which I wasn’t doing with a videotape!). With consistent practice, I realized the results in my body faster and the healing movement of Pilates. I have since utilized Pilates not only for general fitness but for rehabilitating from hip surgery and recovery after a ruptured vertebral disc.

Following my formal Pilates education, I pursued advanced Pilates pre/postnatal education with leaders in the Pilates and physical therapy field so that I could help other women after pregnancy realize the benefits of the Pilates Method.  As I had experienced, Pilates is not only a great part of a fitness regimen but has far reaching therapeutic benefits. This is why dancers discovered Pilates after Joseph Pilates introduced it to them in New York City. Well-known dancers such as George Balanchine and Martha Graham became devotees and regularly sent their students to the Pilates for training and rehabilitation. Now many people are experiencing the benefits of Pilates including everyone from seniors to Olympic athletes to new moms, aging baby boomers, college students and even school children.

Postpartum Pilates Benefits

After your baby is born, most moms are anxious to get their old body back. Although celebrities and models make it seem like it’s a piece of cake to get your figure back instantly after you give birth, the truth is its a lot of hard work and it takes time. But, Pilates can help in many ways.

1. Strengthening Your Abs & Core

Pilates is a great exercise to strengthen your abs and core after pregnancy and slowly get you back into the routine of working out.

2. Beating incontinence and pelvic organ prolapse

Abdominal and pelvic floor muscles which expanded and may have weakened during pregnancy and delivery need to be strengthened. Strengthening these muscles aids in a faster recovery from childbirth and can prevent pelvic organ prolapse as well as urinary and fecal incontinence. Although many mothers are thinking only of recovering their bodies and caring for their babies after delivery, few are thinking about incontinence.

According to a 2005 study published in the Australian and New Zealand Journal of Obstetrics and Gynecology, 30 percent of women report postnatal incontinence, while women who suffered from leaks before pregnancy were more likely to suffer the problem after giving birth. A study published in the April 2010 issue of theInternational Urogynecology Journal showed that a Pilates exercise program strengthens the muscles in the pelvis that are responsible for incontinence.

3. Building strength

Being a mom is hard work. It’s not just emotionally taxing, but the physical burdens are immense. Building strength training into your post pregnancy exercise routine is necessary because you now have to lift and carry a baby (as well as a car seat and often diaper bags and a playpen) with you wherever you go! This is all part of the joys of motherhood, but it’s much easier to deal with if you’re physically fit.

Because Pilates is a strength-building exercise that tones your core AND your entire body, you can prepare yourself for strenuous lifting with this workout. Few people know that Pilates is ALSO equipment-based  and the body is strengthened using a variety of spring-loaded apparatus which create resistance on the muscles. Pilates is a low-impact exercise that requires you to work on muscles you may have never knew existed in your body!

4. Counters postural habits

 The center of gravity shift that occurs with pregnancy combined with the physical demands of new motherhood (cradling and lifting your baby, carrying his/her car seat and diaper bag, pushing a stroller) can greatly affect a new mom’s posture. Pilates focuses on strengthening back and core muscles essential to restoring a more ideal, neutral posture after pregnancy. 

5. Increases energy

Fatigue is one of the hallmarks of new motherhood. Regular exercise can help improve energy levels and build endurance and stamina needed when caring for a new baby.

6. Promotes faster recovery from delivery 

Multiple medical studies show women who exercise recover faster and more completely during their postpartum period. See the ACOG recommendation for postpartum exercise below.

The ACOG Recommendation for Exercise in thePostpartum Period

The American College of Obstetricians and Gynecologists (ACOG) Committee Opinion issued December, 2015, states, “Resuming exercise activities or incorporating new exercise routines after delivery is important in supporting lifelong healthy habits. Exercise routines may be resumed gradually after pregnancy as soon as medically safe, depending on the mode of delivery, vaginal or cesarean, and the presence or absence of medical or surgical complications. Some women are capable of resuming physical activities within days of delivery. In the absence of medical or surgical complications, rapid resumption of these activities has not been found to result in adverse effects. Pelvic floor exercises could be initiated in the immediate postpartum period”.

Note: Please consult your health care provider for medical approval to begin this or any exercise program following the birth of your baby.

What happened to my body, how will Pilates help & why can’t I just go back to my pre-pregnancy workout?

Birthing a baby is one of the greatest joys that a woman can experience. But, the diagram below illustrates what typically happens to a woman’s posture and her muscles during pregnancy. PrenatalPostnatalPilatesAll of these muscles were important for support and stability of your core during your pregnancy and assisted in the delivery of your baby. But weakened or tight muscles don’t result in an efficient or tight muscles don’t result in an efficient or well functioning body.

The Postnatal Fitness & Birth Recovery

The Cayuga Pilates Postnatal Fitness & Birth recovery is a full body, core and pelvic floor strengthening program for women following delivery. Once you have medical clearance to begin exercise, this progressive Postnatal Recovery program will: help reduce the size of your diastasis recti (see “Diastasis Recovery” page for more information), allow faster return to your pre-pregnant body, and give you the stamina to deal with the physical demands of motherhood.

All too often, women either don’t return to exercise after delivery or return inappropriately doing:

  • abdominal curls  – yes, most women think this is the best way to get flat abs right after delivery but this may actually WORSEN a  diastasis recti (split in your abdominal wall which more than two-thirds of postpartum moms have).
  • running or other high impact exercise (a weakened pelvic floor + high impact exercises = risk for pelvic organ prolapse).
  • lifting weights (also not appropriate unless your core muscles and your pelvic floor muscles have been adequately strengthened).      In the Postnatal Recovery program, you will learn how to strengthen your muscles to resume your prior exercise routine and recover from pregnancy faster so that you can handle the physical demands of motherhood with ease. At Cayuga Pilates, exercises are tailored for each woman depending on what you are experiencing in your body after the delivery of your baby. In private or semi-private sessions, you can opt for a 60-minute or 30-minute session. These sessions, done solo or with a friend, are carefully constructed using props and Pilates equipment and will leave you feeling challenged, stronger, energized and ready for motherhood!