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What Your Doctor Doesn’t Tell You At Your 6 Week Check.

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The 6 week postnatal check- that’s when you get the all clear and it’s back to business as usual, right?

That’s how I remember feeling anyway, and from my experience training new mums, I know I’m not alone.

I remember sitting there and asking, “So I’m ok to go back to exercise now?”

And I got lucky, because my GP said yes, but advised that giving birth means my body had been through some big changes, and 3 months would be better, to really have time to recover.

That, plus having a baby who didn’t sleep well, plus geting mastitis at 3 months postpartum, meant that I didn’t get back to training as quickly as I had planned. Which probably saved me from doing myself some harm.

Because although I’d been a personal trainer for 7 years, I didn’t have any postnatal qualifications at that point, and the general message I’d absorbed from the media is that if you’re in good shape you should ‘bounce back’.

And I was fit, so I should be fine. In fact, because I worked in the fitness industry I felt I should be seen to recover and get my fitness back quickly, and I was very fortunate to have a doctor who gave me some good advice (and to be too exhausted to argue with it)!

Because The 6 Week Postnatal Check Does Not Mean You’re Ready To Exercise!

However, this hinges upon what your definition of ‘exercise’ is. Because I could also say you don’t need to wait 6 weeks before you exercise.

The problem I come across is that many doctors aren’t specific about what they mean by exercise. So while they’re thinking a few walks and pelvic floor exercises would be good, I know a lot of women will be thinking ‘back to my old workout routine.”

What Happens If You Do Too Much Too Soon.

Even though you might feel ok at your 6 week check, it takes so much longer than we realise to recover from childbirth. Then there’s the pregnancy hormones, lack of sleep and breastfeeding to consider. I’ve written here about postnatal recovery already, and the potential consequences of too much exercise too soon, and this blog is a must-read example of what happened to one mum when she returned to exercise too quickly.

Your Pelvic Floor

The pelvic floor is the area that often pays the price if you overdo it, and unfortunately this is one of the things your doctor probably doesn’t tell you.

Pelvic Organ Prolapse is when 1 or more of your pelvic organs (bladder, rectum, uterus, intestines even) move out of place, and prolapse down into the wall of the vagina. I had 2 children, did my ante and post natal exercise qualification, and still hadn’t heard of this. (I’ve since studied both pregnancy and postnatal exercise to a higher level to rectify the gaps in the fitness industry’s basic training!)

And I really wish GPs, or even the hospital/ homebirth team, would give new mums some information on this AS STANDARD! Because prolapse can have such a huge impact on your life, I’m sure a little information would lead to a lot of mums making far more sensible decisions.

Diastasis Recti

This is something else that I really wish GPs would check, but generally they don’t. I can count on 1 hand the number of mums I’ve met (out of 100s) who have had their diastasis checked at their 6 week appointment. For more information about what exactly diastasis recti is, read this blog, but it’s another biggie in that if it isn’t healed, you’re at a higher risk of injury or pelvic floor problems if you do too much too soon.

doctor 2In fact, I don’t know about you, but my 6 week checks have been a quick blood pressure check and then asking what contraception I was using. In case the 6 week baby wasn’t enough!

In many cases the check up is more about the baby than the mum, and even though one of mine was a seperate appointment than the baby check, it still didn’t go anywhere near as deep as it should. The only way to know for sure what’s happening with your pelvic floor is too see a Women’s Health Physio (if you’re local to me I recommend some here).

So What Can I Do?

I said before that you don’t have to wait for 6 weeks until you exercise, and you don’t. But I’m talking about exercise so gentle you may not even think of it as exercise.

You’re advised to start your pelvic floor exercises (kegels) as soon as you’ve had baby, and you can start doing some gentle deep core connection work after a few days. Even with a c-section, you can do these from around 7-14 days. I do this with clients and mums doing Restore My Core, as there can be a loss of responsiveness in those muscles, which needs to be restored.

Following on from this, progressing to glute exercises to promote pelvis and hip stability is also beneficial. This, plus some gentle walking when you feel up to it (and I’d advise a few weeks rather than a few days for that) can help in a number of ways:

Faster Recovery Post Birth

The pelvic floor exercises will increase circulation to the area, helping to heal any tears, and both the core and floor work will help your nervous system to re-connect to these muscles.

Healing Diastasis and Preventing Incontinence

The right exercises, especially those that involve the deep transversus abdominis and pelvic floor, will help to heal diastasis recti. And pelvic floor exercises will help you regain control if you’re suffering from any leaking post-birth.

Reduced Pain

Having a stronger core will help take the pressure off your back muscles, which have to pick up the slack when the rest of the core isn’t functioning properly. Some gentle stretching and release work can help with this too.

The best course of action is to follow a specific post natal restorative programme, such as Restore My Core, but to learn more now you can download my 10 Tips for getting into shape after baby. And remember- the most important thing in the early postnatal period is rest, and when you do start exercising it should make you feel better, not worse. If you feel fatigued after you may have over done it. Listen to your body, and take it slowly.

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Think You’re Ready To Run? Read This First!

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So, you’re ready to get started. You’ve read my last blog about how long you should wait before running after baby, and it’s time to run.

Running is a great form of exercise- it’s free, and anyone can do it, anywhere. But it’s an advanced exercise. Your feet will hit the floor about 1500 times per mile: that’s your body weight plus the extra g-force, and if you’re carrying any extra pounds then that’s pretty intense.

I can’t remember where I heard this (I definitely stole it from somewhere!), but it’s so true:

training running

So Let’s Make Sure You’re Ready!

I don’t just mean make sure you’ve recovered from giving birth. I mean let’s get your body ready to cope with the stress, and get better results when you do run. Here are 5 tips to get you ready.

1. Incline Walks.

I know, I know. You want to work. Really feel like you’ve built up a sweat, get that kick that only running gives. And you will. Seriously. Hiking up a steep hill is hard work, and it’s perfect for preparing to run.

More so than walking on a flat surface, a good hill will get you using your arms and rotating your body, just like you do when you run. This will help your running technique. It requires loading and control on one leg, like running, but without the impact. And all this means you’re integrating your core and building the strength needed to run.

So if you haven’t yet, spend some time doing hill hikes before you start the running regime.

2. Build Your Butt!

The bum, or glute, muscles, are important for a number of reasons: they help maintain posture, play an important role in reducing the risk of injury (underactive or weak glutes mean more strain on the back, hips and knees), and they help to balance the pelvic floor by keeping the pelvis in alignment.

Those hill walks will do a great job of getting your butt working, and here are a few exercises you can start doing right now to work on your glute strength. Click here to find out where to buy the minibands.

Kickbacks.

I love these because you’re standing up and on 1 leg, so it engages your core too. This exercise really focuses on making sure you get a good extension behind your body. So many runners just fall forwards from one leg to the other, rather than using their glutes to propel themselves forwards.

Side Steps.

These work the butt muscles at the side of the pelvis, so help to keep it stable when you’re on 1 leg. Having strong muscles on the outside of your hip helps to keep your knees in line and prevent injury.

1 Leg Miniband Squats.

A lot of people struggle to keep their knee in line when they stand on 1 leg and it moves inwards instead of staying in line with their toes. This is a corrective exercise where you use the band to pull on the working knee: the muscles on the outside of your hip have to work harder to fight this pull and keep your knee from moving in, thereby getting  better at doing this, even when the band isn’t there.

3. Breathing

How you breathe has a huge impact on your core and pelvic floor. I explain how in more detail here, but essentially your diaphragm (your main breathing muscle) and your pelvic floor work together, along with your core. If this system isn’t functioning properly you increase your risk of incontinence when you run.

A really important point here is to make sure you’re not tensing or pulling your tummy in while you run. It’s not always easy to do- when you’re working hard it’s difficult to stay relaxed. I see a lot of runners with tense shoulders, jaws or fists, and tummies can tense up too. This interferes with the natural movement of the core as you breathe and puts more pressure on your pelvic floor.

4. Alignment

This links to your breath- you need to keep your ribs over your pelvis so that your diaphragm and pelvic floor are in their strongest positions. ribs over pelvis

You also need to keep your pelvis in what’s called a neutral position. This means your bum shouldn’t be tucked under and your back flat (more about this here), but untucked so there’s a slight curve in your low back. If your bum is tucked under then your pelvic floor is left in a weak position and you’re at risk of- you’ve guessed it!- leaks. The butt exercises above will help with this too.

5. Reduce The Impact.

As with anything, build up slowly. Start with slow, short jogs or intervals, where you jog then walk, jog then walk. This gives your body time to adapt and get stronger, so you’re less likely to suffer the result of your pelvic floor giving way as a result of too much, too soon.

Other key things to bear in mind when planning your run:

Running surface.

Grass, gravel and sand will all reduce the impact on your joints and pelvic floor. Try to avoid alwasy running on the pavement.

Reduce your stride length.

A long stride will lead to a heavier landing on your heel, and more impact. Take smaller strides and land with your foot under your body, rather than out in front.

Avoid downhill running.

Downhill running tends to result in a heavier landing and more impact, so try to stick to flat surfaces, or walk down hills.

Vary your workouts.

Include other forms of exercise in your routine to give your body a break. Cycling and swimming are great pelvic floor safe cardiovascular workouts, and a good resistance programme will complement your running, as will yoga or pilates.

If you still feel you need help getting fit to run then personal training can help, giving you a programme to build up to running again, or to complement your existing running routine. If you’d just like a chat about where to go next with your training, or what help you might need, then get in touch here.

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Running Postpartum – How Long Should You Wait?

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Running after baby pelvic floor postnatal

I get asked this question a lot, so I think it deserves a blog!

Unfortunately there is no simple answer, because EVERYBODY’S DIFFERENT! So you need to start listening to those motivational memes on Facebook telling you not to compare yourself to others- it doesn’t matter that your friend was back running 3 months after giving birth. Someone who was fit before and during her pregnancy, and had a quick labour with no tearing will recover a lot faster than someone who isn’t a regular exerciser and/or had a difficult labour. This is about what’s right for you.

It Takes Longer to Heal Than We Realise

postnatal recovery

I have seen it advised that it takes at least a year for the pelvic floor to return to full strength , and if you look at the graphic above, you can see why that is! Connective tissues, such as tendons and ligaments, have a slower healing rate than muscle, and there’s a lot of this within the pelvic basin.

This doesn’t necessarily mean you can’t run for a year though!

Here are some guidelines to help you decide whether to start running yet, and signs that you need to slow down.

We’ll start with a hormone called relaxin which is released into your system in the early stages of your pregnancy. Its job is to relax your ligaments to help prepare your pelvis for childbirth, but relaxin doesn’t just affect your pelvis, it affects every joint in your body. And it stays in your system for up to 6 months after birth, or until you stop breastfeeding.

As a result your joints aren’t as stable as they once were. When you run, your entire body weight lands on 1 leg with a G-force of 2-3. So there’s a lot of impact going through those unstable joints. Plus, for those of you who no longer have relaxin circulating: I’ve assessed a lot of clients over the years, and most people have poor alignment in a 1 leg stance. If you wobble when standing on 1 leg, how well will you cope with impact?

Next up is your pelvic floor.

If hasn’t recovered yet, chances are, you’ll wee yourself the first time you go out for a run, and could do yourself some everlasting damage. Even if you don’t suffer any incontinence, if you feel a heaviness down there: stop.

Unfortunately incontinence is accepted as normal by many women. Common, yes, but not normal, even if you just leak a “little bit” when you sneeze or jump. In the majority of cases it can be resolved, so if you have any doubts about your pelvic floor see a Women’s Health Physio and follow an appropriate exercise routine. And no running! If you place pressure on a dysfunctional pelvic floor it’s never going to heal.

Do you still have diastasis recti?

Your abdominal wall forms a sort of pressure system with your pelvic floor, low back muscles and diaphragm. And if you have diastasis, there is a weakness in that system, which means your back is going to be less supported while you run, and potentially there’s going to be more pressure on your pelvic floor too. So focus on restorative core exercises before starting anything high impact.

I know the idea of no running can be hard.

For many it’s not just the physical side (although it does feel good to go for a good run and feel like you’ve worked) but the mental side, as it relieves stress and gives you time to yourself. But remember: this is a phase of your life. It will pass, and it is so small compared to the bigger picture. At some point you will be able to run and jump again, just as long as you don’t rush things now.

Jenny Burrell of Burrell Education explains this brilliantly: You brush your teeth every day, even though you could get dentures implants if all your teeth fell out, but there is no replacement for your pelvic floor!

So, you can start running again, if:

  1.  Your pelvic floor is in check.
  2. Your diastasis recti is healed.
  3.  You’ve done a couple of months’ worth of work on restorative core exercises, and some whole body strengthening.
  4. You’re at least 4, if not 6, months post partum. This is a minimum- some will need longer.
  5. You’ve invested in a good sports bra (always a must with impact exercise, but especially when breastfeeding!)

What if you’re not yet ready to run?

I have a few blogs to get you started- this one has training tips to get you fit to run, and this blog has my top 5 postnatal core exercises. You can also download my top 10 tips for getting in shape after having a baby here.

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No Housework And Regular Massage: Postnatal Traditions From Around The World.

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postnatal traditions recovery fitness

I have some vivid and precious memories from the first few months after my sons were born, despite being in a bit of a daze at the time. It’s such a special time, and one of enormous transition: physically there’s a lot of healing needs to take place, there are hormonal changes, bonding, learning to breastfeed, and relationships adjust.

And I can’t help but feel we don’t honour this time as we should. We’re pretty good about pregnancy, but once baby arrives, the mum doesn’t always get so much attention anymore. And with paediatrician appointments,  endless nappies to change, baby clothes to wash and visitors to see baby, self-care can take a back seat.

 postnatal recovery traditions

But is this good for our recovery?

In a word: no. Which made me wonder- do other cultures take better care of new mums than we do?

Confinement.

Many countries have confinement practices where the new mum stays at home, with no visitors except close family until the confinement period is over. For Malaysian women this usually lasts for 42 to 44 days, for an Indian mum, it’s about 40.

Wouldn’t it be wonderful if we could follow a similar practise in the UK, treating the postpartum period as a time to cherish and give mum extra care? Unfortunately it is just not practical for most of us: how many have family members who can tend to us for that long? There is the option of hiring a doula though, who often provide support beyond the birth itself and can advise on self-care and even help with household chores, or postnatal support from someone like Karen at Parents & Co, who can provide overnight care too.

No washing your hair!

This is a Chinese one, and linked to an overall practise of staying warm, because loss of blood and energy is thought to make mum ‘cold’: in Vietnam they practise nam lua (‘mother-roasting) where a fire keeps the mother warm for a month.

Other warming practises include bathing in warm, herb infused water- I don’t think any of us want cold baths or showers, so this one is pretty easy to follow!

postnatal traditions

Is this a valid concern though? Apparently so! One study found people who dipped their feet in icy water for 20 minutes were more likely to develop a cold than those who didn’t.

Given that new mums often experience increased sweating (getting rid of the extra water retained during pregnancy) these warming traditions do seem like a good idea!

No TV or reading!

Ok, I would have struggled with this one. I get the reasoning- strain on the eyes and potentially tiring- but I’m not sure I could stay in the house for that long without books. Unless I ran up a MAHOOSIVE bill at audible.com. Is it acceptable to ask for itunes vouchers instead of baby clothes as a gift?

Other activities considered to be stressful and avoided include shouting, crying, and too much conversation. I may have struggled with the crying (hormones!), however talking to fewer people may have helped…

No housework

Awesome. Also, no bending at the waist to prevent back injuries. In India new mums are sometimes helped by a dia (or even a maid) who will help with cooking, laundry, and bathing the baby.

In some cases, where the birth has been particularly difficult and there may be problems such as a prolapse, this is great advice. In others, it may feel impractical: bending over baby to play, for example.

Also, whilst I’m all for rest, some exercise, such as gentle walking, can be really beneficial in encouraging the core to repair. It will increase circulation which will increase the nutrients being delivered to mums muscles, aiding her at a cellular level.

However, there’s something else that aids circulation…

Massage.

postpartum traditions healing massage

Also awesome. In India the dia will do this too (maybe even daily), or in Malaysia a bidan massages the abdomen. Pregnancy and the strains of a new baby can leave mum with tight areas, and  a tight spot pulling you out of alignment can affect posture, and therefore abdominal healing (diastasis recti).

Release work doesn’t have to be done with massage, I give clients techniques they can use at home for this, but massage would be my method of choice!

Abdominal binding.

Many cultures practise some form of belly wrapping to aid with healing the core. In Malaysia they use a special postnatal corset (bengkung), and India a long cloth to bind it. They can give extra support to weakened abdominal muscles, reduce postnatal swelling, and encourage them to close back together.

In the UK Physiotherapists can recommend abdominal support for women who are having trouble healing. But whereas across the pond in France new mums see a Women’s Health Physio as standard, subsidised by the government, here you have to be referred by your GP if, or search for a private one. The difference this would make to recovery, and incidences of pelvic floor disorders such as incontinence and prolapse, is immense.

Diet: warming ginger, good; windy onion, bad.

The keeping warm theme continues here, as in many countries (including China, India and Malaysia) some foods, such as ginger, are believed to promote better blood circulation and strengthen the joints, while other cooling foods are avoided. Cucumber, cabbage, young coconut and pineapple fall into this catagory, the ‘cooling’ elements thought to cause rheumatism, arthritis and weak joints in a mother.

I’m not at all convinced by this, and would have recommended pineapple myself, as the enzyme bromelain in it is thought to aid digestion! However other advise I came across, such avoiding ‘windy’ foods like as onions and jackfruit, seems pretty wise! And bone broth/ soup is a staple of the postpartum diet in many cultures, which is great for recovery.

nutrition postpartum tradition soup

Not all these practises are followed rigidly; even for the confinement, some mums will end early if they feel they need to. I don’t think I would: the prospect of a month of massage and having my meals cooked is almost enough to make me want another baby!

If you’re struggling with your diastasis recti find out about my postnatal personal training packages here.

References

http://www.hyphenmagazine.com/magazine/issue-23-bittersweet/motherhood-rooted

http://www.babycenter.com.my/a1021145/confinement-practices-an-overview
http://www.babycenter.com.my/a1042118/indian-confinement-practices#ixzz3ZlkB5GUy

http://www.babycenter.com/0_postpartum-sweating_11720.bc

 

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What Do Ab Curls REALLY Do To Your Postnatal Tummy?

Should postnatal mums do ab curls?

I’ve talked a lot on social media about crunches and sit-ups being a no-no when you’re postnatal, but a video I shared on my Facebook page recently seemed to really hit the mark. Aside from the comments and shares, I had quite a few mums tell me how clear it made things for them.

So I thought it was about time I wrote a blog on this. Unfortunately there’s a lot of bad advice out there when it comes to postnatal exercise, and many new mums do crunches to try and flatten their tummies, so we need to keep spreading the word that IT DOESN’T WORK!

Before I carry on, here’s the video:

 

Sit-ups, or any variation of this movement that works the six pack muscle, can cause more harm than good.

So, if you’ve recently had a baby and you’re doing sit-ups, STOP them immediately!

During pregnancy the first thing your six-pack muscle (Rectus Abdominis) does is lengthen, vertically. Then, as your pregnancy develops, and your baby grows and your bump gets bigger, this muscle starts to separate around your belly button.  This is referred to as Diastasis Recti. The abdominals can take time to re-align after your baby has been born, so for several weeks and indeed months (or for some, years) after birth, your six-pack muscle remains in a lengthened, separated state.

The first thing we need to do regarding this area is actually focus on connecting to your pelvic floor which is a bit like a sling of muscles supporting you from underneath, and the deep abdominal muscles which lie under your six-pack muscle.  This deep muscle is known as the Transversus Abdominis (TVA).

Strengthening the abdominals after birth, and specifically the TVA and pelvic floor, is a bit like building a house.

If your house has a solid framework and foundations, it will always be strong.  If you work on strengthening the deepest muscles first, then focus on the next layer, then the next layer after that, then your abdominals will re-align to their original structure.

What do crunches do?  They strengthen and work the six-pack muscle.  During pregnancy, we know that this muscle has lengthened and separated.  If you don’t have a solid foundation underneath this six-pack muscle before you work it (I’m talking about your core and pelvic floor here), then by doing crunches, you’re actually going to make your separation worse.  In other words, any separation you had after birth, will now be wider, because you’re forcing the muscle to strengthen, when it’s still in a weakened, separated state.  The amount of abdominal pressure placed on the six-pack muscle when performing a sit-up, forces it to separate further apart. As shown in my video.

And here’s what the pressure can do to your pelvic floor:

 

I follow a system with postnatal clients which involves locating the TVA first.  We connect to and strengthen that, along with lots of focus on the pelvic floor.  Once function in these muscle groups has been gained, then strength work can be done.

So, I hear you ask: “Why do people do sit-ups?”.  Well, in most cases, people do sit-ups in the hope that they will get themselves a toned, flat stomach and a noticeable six-pack.  I’m here to tell you that doing sit-ups AREN’T going to help you (as a postnatal woman), or anyone you know, male or female, get a six-pack.  Your body needs to be extremely lean to do this, which has nothing to do with sit-ups! (See this blog for my thoughts on having visible abs as a fitness goal.)

As a final point: I don’t even use sit-ups for clients who don’t have diastasis recti. As explained on athletic coach Eric Cressey’s website here:

“World-renowned low-back researcher Dr. Stuart McGill says that we have a finite number of flexion/extension cycles in our back until injury is caused. That number is different for every person, but the bottom line is that by performing exercises like crunches and sit-ups, you’re increasing your risk for injury with every rep!”

Plus, they’re promoting a rounded posture, which is the very one I’m usually trying to get clients out of, after too much time sat at a desk!

I do sometimes use crunches, but never in the early postnatal phase, and doing a crunch where you are engaging your transverse abdominis is very different to an uncontrolled crunch. So I recommend having a professional (physio, trainer) teach you how to do one properly, and also assess whether you need to do them.

Please share this blog and forward it to anyone you think might find it useful, as unfortunately I still see a lot of ab dominant work recommended for postnatal women- this myth needs busting!

For help with your postnatal fitness click here to find out more about my next Restore My Core course, or get my 10 Tips for getting back in shape here. You can also read what core exercises ARE safe and effective when you’re postnatal here.

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