Pelvic Floor Considerations in Pregnancy

Pelvic floor care during pregnancy is a bit more complex than just “do your kegels”. It is important to understand the changes that are happening in our bodies throughout pregnancy, and how to best care for ourselves so as to minimize the stress on an already stressed system.

Some of the changes that occur during pregnancy that may affect our pelvic floor muscles include: a growing belly, relaxing & stretching of ligaments/joints, weight gain, gastro-intestinal issues (such as constipation), form & posture changes, and stress/tension.

While certain things are out of our control (genetics, hormones, baby size & position) there are a few things that we can do to minimize the stress on the pelvic floor.

  1. Breath work – learning how to coordinate breath with pelvic floor contraction. This can be done anywhere, anytime, and in any position. Begin by taking a slow breath in, and at the same time relax your belly & pelvic floor. As you start to exhale (also slowly), GENTLY engage your abdominal muscles & “lift” your pelvic floor (think kegel, but not forcefully). Continue to coordinate the timing of your breath with your contraction & relaxation of the abdominals & pelvic floor.
  2. Breath + movement – using the breath technique above & incorporating it into exercise and daily activities. As a basic rule of thumb, you want to exhale as you complete the more challenging part of a movement (the lift of a heavy object, standing up from a squat/seated position, pushing something, etc.) Each person may have different tendencies, however (such as “bearing down” when breathing aka creating extra pressure down through the pelvic floor and/or out through the belly), and it’s important to check your form and breathing tendencies with a women’s health physical therapist and/or a pregnancy & postpartum coach.
  3. Exercise modifications – knowing when to make adjustments to training mode, intensity, form, etc. Your body is going through major changes throughout pregnancy, and the load on your pelvic floor increases as pregnancy progresses. Some indications that it’s time to adjust your training include pain anywhere in the body, pressure in the vagina, leaking of any kind, and the inability to maintain proper form throughout an exercise. The first thing you can try is to slow down the movement and check in with your breath, to see if you can still do the exercise with more control. Next, try decreasing the load/weight and range of motion. If you are still experiencing any symptoms, it might be time to choose a different exercise altogether. Remember that pregnancy is temporary, and consider the long term risk vs. reward of doing an exercise that may or may not be serving you at this time.

Final thoughts: I always recommend pregnant and postpartum athletes (and I believe that if you move your body, you’re an athlete!) should meet with a Women’s Health Physical Therapist both during pregnancy and postpartum. Pregnancy and Postpartum Athleticism coaches are also amazing resources if you need guidance with movement and exercise. Please don’t hesitate to reach out to me if you need guidance and/or a referral!

8 Postpartum Exercises for New Moms

*Always consult your doctor before beginning any exercise program*

You’ve just had a baby (for the first time or not), your whole world has been flipped upside now (in mostly good ways), and you barely recognize your body right now.

Regardless of your birth experience, your body (and brain) has been through a lot of trauma, and you should take at least a few weeks to rest and recover. Let your body heal, eat nourishing foods, bond with your baby, and please, let people help you around the house.

Each person’s birth and recovery will look different, so you cannot follow generalized timelines as to when you should be doing what, and definitely DO NOT compare your experience with anyone else’s! Early postpartum typically comes with a lot of new aches and pains, and tightness and weakness in places you’ve never felt before. Read this blog post about my tips for early postpartum. At whatever point you feel like your body needs a little movement, I’ve chosen some exercises that can be helpful in those early weeks.

I will never claim for any movement to be “diastasis safe” or “pelvic floor friendly”, as everyone has different needs. If you feel any discomfort at all doing any exercise, consult your doctor, and seek out help from a Pelvic Floor PT.

1. Breath Work – It is important to understand how breathing is connected to the core and pelvic floor. Basic breathing technique involves relaxing your abdominals & pelvic floor as you inhale, then gently contracting your abs and lifting your pelvic floor as you exhale. Check out this video for a more detailed explanation!

2. Tummy Time Breathing – Laying on the floor on your stomach, head supported with hands or a comfortable surface, arms and legs relaxed, focus on breathing. Think about inhaling “into the floor” (let stomach expand), and then contracting abdominals on your exhale. Do this for several minutes.

3. All Fours Rock – This is a great place to gently activate core stability, while also working the upper body (it’s a perfect progression for push-ups!). Begin on hands & knees, with hands under shoulders and knees under hips. Gently rock forward and back, moving with your breath, and increase your range of motion as you are able. Click here for video demonstration.

4. Bird Dog – Beginning in the same position as the All Fours Rock, slowly lift your opposite arm & leg off the ground and straight out. This can be much more challenging for the core, and requires balance, so the key is to move with your breath (lift as you exhale), and only lift as high as you can without disrupting your straight spine. If it’s too much of a challenge to lift both arm & leg at the same time, begin with just one arm at a time, followed by one leg at a time. Video here for reference!

5. Lying Marches – Here is a very gentle way to engage your abdominals and hip flexors. Laying flat on your back, knees bent & arms at your side, lift one leg off the floor while keeping your knee bent. Alternate legs (like a march) and move with your breath (exhale lift, inhale lower). Check out the video here.

6. Glute Bridges – Glute muscles (aka the booty) are important to strengthen to help with back pain. Bridges are a gentle way to engage the glutes, and can be easily progressed as you get stronger. Beginning in the same position as the Lying Marches, gently lift your hips to the ceiling until you feel your glutes work. Lift with your exhale, and lower with your inhale. If you feel pressure in your lower back, don’t lift your hips as high, and try to engage your abs by slightly pulling your rib cage down. Click here for video.

7. Kneeling Hip Hinge – The hip hinge is an important part of a lot of major exercises, such as squatting, lifting off the ground (deadlifts), swinging (kettlebells), jumping, and Olympic lifts (cleans & snatches). Beginning in the kneeling position is a gentle way to begin practicing this movement and training proper form. Start by sitting on your knees with the tops of your feet on the ground & your bottom on your heels. Moving with your breath, as you exhale, press your hips forward until you are fully extended in the tall kneeling position. Return to start as you inhale. Video here for demo.

8. Squats – One of the most basic movements of our every day lives, squatting can and should be incorporated early on (as long as it doesn’t cause pain). Squatting to a surface (chair, couch, bench, etc.) is helpful to support weakened and tight muscles. The higher the surface, the easier the movement will be. Make sure to keep your feet flat on the floor, and try to have your knees follow above your toes. Keep your back straight throughout the movement, and exhale as you stand. Click here for video!

CrossFit and Pregnancy – Is it Safe?

*Always consult your doctor before participating in any exercise program*

I’ve been in the CrossFit world for over 5 years, as both a coach and an athlete, so I am very familiar with the workouts typical of a gym (aka “box”). I am also familiar with the reputation CrossFit has, especially among people who are on the outside.

“CrossFit is too intense!” “It’s only for competitive people…” “You will definitely get hurt if you go to CrossFit.” “CrossFit will make you bulky…” “I’m not fit enough for CrossFit.”

While I don’t always agree with the CrossFit programming, I believe it can be made for everyone, with the appropriate modifications and the right coaching. The basic premise behind CrossFit is to be “ready for anything”, which is an idea I can totally support.

Can I get hurt doing CrossFit? Of course you can, but you can get hurt doing literally anything. I think it’s up to the coaches (and the people who hire & train them) to ensure that people are moving appropriately. There are good and bad CrossFit coaches and programs, just as there are good and bad trainers, gyms, and coaches in other places.

What about CrossFit and pregnancy?

First, I want to say I never recommend beginning anything new in pregnancy. But if you have been doing CrossFit for a while, and you want to continue as long as you can because you enjoy it, here are some things to consider:

  • Tell your coach about your pregnancy as soon as you feel comfortable. He/she should be understanding about your need to modify workouts, and should not push you to do more than you feel comfortable doing. Also, they could potentially be trained in coaching pregnant woman, or know someone who they can refer you to!
  • Be mindful of your exercise intensity. CrossFit is known for its intense workouts and competitive nature. Pregnancy is not the time to compete (against yourself or anyone else) or to attain personal records. Work at your own pace, pay attention to symptoms, and be sure you can still carry on a conversation throughout your workout.
  • Know what symptoms to look out for. Diastasis recti (abdominal “separation”), pelvic organ prolapse (heaviness, fullness, or pressure in the pelvic area), and incontinence (leaking/urinating) are some more obvious symptoms that can arise during pregnancy. If you notice any of these symptoms, DON’T FREAK OUT, they can be managed/improved, but please find a Pelvic Floor Physical Therapist (here) who can help you. Some less obvious symptoms are minor pain, cramping, or if something “just doesn’t feel quite right”. If any of these symptoms arise, take a rest, make sure you are properly hydrated, and adjust your form and/or breathing to see if it passes. If the symptom persists, decrease your intensity, or stop that particular exercise for now. A Pregnancy & Postpartum Athleticism Coach can help you with how to adjust your workouts. Find the directory of coaches here.
  • Exercises to avoid. There are a few things I recommend every person stay away from when CrossFitting while pregnant. These would be exercises that put you at risk for falling, such as rope climbs, box jumps, muscle ups, and handstand work.
  • Other modifications: Finally, other CrossFit-specific movements that you will likely have to modify at some point during your pregnancy are olympic lifts (snatch and clean + jerk), impact exercises (running, jumping rope, burpees), and anything that requires a lot of core involvement (abdominal exercises, push-ups, pull-ups, other overhead movements). Stay tuned for my follow-up post on specific exercise modifications in CrossFit!

Final thoughts – CrossFit CAN be safe during pregnancy, depending on a variety of factors. Training specifics will look different for each person, because everyone’s experiences and considerations are different. The important thing to remember is that you should be training throughout your pregnancy because you enjoy it and it feels good, and not because you are afraid to lose anything or want to prove something. Also, ask for help when and where you need it!

I Have Been Cleared By My Doctor – Now What?

Typically around 6 weeks postpartum you will get the “all clear” to return to activity. Some doctors/midwives will give you detailed guidelines as to what exactly this means, and others will just tell you that you’re good to go.

Regardless of your health and experience, it can be overwhelming to figure out how to return to exercise after baby. Your body has been through major changes (and traumas), your life demands are extremely different, and emotions are all over the place.

Each person will have different concerns, and I recommend everyone find a professional to help guide you, but I’ve put together a few tips to get you started:

1. Find a Women’s Health Physical Therapist – It is important to get checked out by someone who specializes in pregnancy/postpartum health. These PTs are trained in the management of pelvic floor and core dysfunctions, and they can guide you on how to properly strengthen these areas after having given birth.

Who are these people and where can I find one? First, ask your doctor/midwife if they have a recommendation for you. If you still need help finding one, check out this directory here and search in your area.

2. Find a Pregnancy & Postpartum Athleticism Coach – The next step would be to find someone who can help you return to your sport of choice – and yes, motherhood is a sport! These coaches are trained in all of the considerations of a postpartum athlete – physical, mental, environmental, emotional – and how to work with each person’s individual needs. Everyone’s body, health, pregnancy, and birth experience is different, and so there is no one correct way to recover and train postpartum!

To find a P&PA coach in your area, check out the directory here

3. Some things you can do on your own if you just need to get moving:*

Walk – and get out of the house if you can! The fresh air + movement is like instant therapy for the mental and physical drain of new motherhood. If the weather isn’t cooperating, or if you don’t have easy access to a walking path, find a local mall and go walk around during the times when it won’t be crowded (because, germs). Just remember to take it easy, gradually work up the distance, and BREATHE.

Breath work – speaking of breathing…one thing you can begin doing right away is to work on coordinating breathing with pelvic floor & core engagement.

INHALE = relax your belly/abs + relax your pelvic floor

EXHALE = gently contract your abs + lift your pelvic floor

Be sure not to overly “squeeze” anything, and relax just as much as you contract. This is where a Women’s Health PT is extremely beneficial in helping you connect to your core & pelvic floor!

Gentle stretching & bodyweight movements – Back pain and hip tightness is no joke in the first few weeks/months postpartum, due to lots of sitting & baby-holding with less-than-ideal posture. Try doing stretches that are the opposite movement of what you do all day, like this chest opener , this yoga move, and this hip flexor stretch

Check out this blog with exercise recommendations for early postpartum!

FINAL THOUGHTS: Your body just went through major trauma, no matter what your birth experience was like. Please give yourself time to recover! Rest as much as you can, sleep whenever the baby allows you to, and eat all the food!

Start slowly, and progress slowly. You will not be ready right away to jump back into what you were doing before you had your baby, and that’s okay! Use this opportunity to rebuild a stronger baseline that you can continue to build upon.

You might not have any interest right now in doing what you did before – and that’s okay too! This is such a short period of time in your life, so spend it how it serves you.

*Consult your doctor before beginning any exercise program.