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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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Can Babywearing Stop Your Diastasis From Healing?

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I love babywearing. Unfortunately, I’m a bit crap at it. I gaze longingly at the amazing mamas with their beautiful wraps (especially Oscha Roses. I want the roses), but I never managed to get the hang of them. In a way this may have been a good thing: having seen the size of some of the stashes out there, I think it’s a slippery slope to wrap addiction…

I managed a stretchy wrap with my second when he was teeny, then moved on to a soft structured carrier (SSC) for back carries as soon as I could (4 months). I got to keep him close, while staying hands free to play with big brother (and do household chores and stuff. But I won’t pretend any of that got done very often).

babywearing and diastasis recti

Back carry with the Boba!

And after starting out in the dreaded Baby Bjorn (more about why the ‘dreaded’ part later), big brother progressed to a toddler SSC too.

But what was happening to my diastasis recti while I was strapping baby to my back for hours every day?

There are 2 aspects I want to look at here: the core itself, and what the pressure of a strap around the tummy is doing to it; and posture, and how baby wearing can affect that.

The reason I’m so keen to do this is that, if done incorrectly, babywearing could hinder the recovery of your core and pelvic floor. However, I don’t believe this needs to be the case, and I have seen advice out there warning mothers to stay away from front carries until diastasis has healed, or questioning if it’s ok after c-section. And I don’t want anyone to be scared off. BECAUSE BABYWEARING IS AMAZING. Did I mention that?

The Core

I’m going to start with the core itself. And perhaps not the core as you think of it, because for many of us, core means ‘abs’. The ‘Core 4’ that I want to focus on are the diaphragm, the transversus abdominis (TVA), multifidis (low back muscles), and the pelvic floor. This video from physiotherapist Julie Wiebe explains it brilliantly:

So, as you can see, pressure from wrapping too tightly around the tummy is going to put a lot of strain on the diaphragm and the pelvic floor. Plus the first step in post natal recovery is training the breath, and this can interfere with that big time!

 This was my mistake.

 I wanted baby as high up on my back as I could get him. I was advised to have the strap up on my ribs, but I couldn’t get it to stay there, it would slip down. So I strapped it as high up on my tummy as I could, and it felt like if I didn’t have him strapped tight he would drop down and the strap at the front ride up. So I would pull the strap firm, pulling my tummy in with it. This is over utilising that TVA muscle, and tiring for my low back. After 3 hours of this (he went through stages of having MEGA naps back there!) it would feel pretty achy!

It also had the effect of giving me some rib flare (or at least exaggerating some that may have been there as a result of my pregnancy).

So should I babywear if I have diastasis recti?

I have seen the advice that front loading carriers should not be used until any diastasis is closed, to avoid pressure on the abdomen. This advice was accompanied by a picture of a front facing out Baby Bjorn. Just like this lovely holiday photo of me with baby number 1.

e56a76_2477ba12b2f7426987abf3657bebd7aa

Is a forward facing front carry bad for postnatal abdominal seperation?

BB carriers don’t get such a deep seat for baby as SSC or wraps (you can see my little one’s legs dangling in this picture, rather than being in a hip healthier ‘froggy’ position), and the facing out position is often not advised anyway. Plus, BB is the worst culprit for pulling the shoulders forward into hyper kyphosis (see below). So with regards to this particular carrier, I agree. But others?

Certainly, increased abdominal pressure could worsen diastasis.

And because babywering is usually done for a fairly long period of time (up to an hour+, compared to picking up a buggy or a short time carrying baby in your arms) then comparitavely it is likely to put more pressure on your pelvic floor.

Making sure you engage your core and floor while you babywear is important, and ideally seeing a Women’s Health Physio will make sure you’re doing this correctly, and assess how much babywearing your pelvic floor can cope with.

But you’re going to be carrying baby anyway, and a good fitting wrap or carrier will keep baby snug and closer to your centre of gravity, so easier to carry. And it should also be easier to correct your posture using a carrier, compared to having baby in your arms. In fact, a wrap can make baby feel even lighter, as it spreads the weight. So babywearing won’t necessarily delay healing, or increase abdominal pressure.

But you need to consider duration.

How long will you babywear for? You may need to start with short periods of babywearing and build up as you get stronger. Again, having your pelvic floor assessed for endurance by a WH Physio is the best way to know what’s suitable.

And you need to have the right posture.

You could be doing excellent work on rehabilitating your core, but if you stand in poor alignment all day you will be undoing all that work.

After having a baby you are left with a weakened core- the transverse abdominis, multifidis, pelvic floor and diaphragm work together to maintain stability as a unit, and your TVA and pelvic floor have just had a hard few months! So many women have postural problems after birth as it is. A poor wrap or fitting carrier will not help this.

If you’re not in alignment some muscles may not activate as effectively, while others overwork. Let’s look at what good posture should look like first.

posture postnatal abdominal seperation

How aignment affects diastasis recti

The cues you’re looking for are:

Ribs over hips with a slight arch in the lower back, tall upper spine, and chin tucked in (as opposed to head sticking out like a turtle).

Neutral pelvis. If you fully tilt your pelvic forwards (think glamour model back arch), then tuck your bum right under, neutral is roughly in the middle of these two extremes. The two most prominent points on your pelvis should be level with your pubic bone, forming a tripod.

For more detail here’s another video talking about rib position:

What does poor posture look like?

Imagine you’re standing with your fly undone. If your bum is tucked under (posterior pelvic tilt) or tilted forward (anterior pelvic tilt) the fly is more likely to gape. Same thing with diastasis, and your pelvic floor will not be in optimum alignment with your diaphragm. Regardless of whether you babywear, if you stand like this all day then DR is less likely to heal.

The problem is babywearing can exaggerate these postures.

Hyper-kyphosis is the ‘bell rung down’ position Julie Weibe talks about in the video above. It looks like slouching, and as well as hindering healing, it is a risk factor for pelvic organ prolapse (Altmen et al 2008).

Then there’s a sway back, which is quite common when carrying a baby- sticking out the tummy whilst leaning back to support baby up on your chest. The result- weakened core muscles, prevention of abdominal healing, and possibly low back and hip pain.

What about after C-Section?

I have seen the advice to avoid post c-section, but again, if you’ve recovered enough to lift your baby, I can’t see why you wouldn’t be able to wear him. My main concern would be pressure on the scar, and a stretchy or ring sling should sit much higher than that. I’ll discuss all the options below, along with guidelines to follow, but see here for one sling consultant’s experiences with various wraps post section.

Which carrier is best?

This is a bit like having to decide which flavour ice cream, is best, it depends who you ask! (Oh dear, I’ve got Craig David’s What’s Your Flavour in my head now.)

Stretchy Wrap

As the name suggests. It’s stretchy! Simply a length of material, but the stretch means you can pre wrap and slip baby in. Weight is distributed all over the shoulders and waist, and the stretch makes it really comfy.

Woven

A stretchy without the stretch, it takes a bit more getting used to these, but as baby gets heavier he will need more support, so this is the next step. There are multiple multiple ways to wrap with a woven, so there is loads of versatility to find a style comfortable for you, and that spreads the weight in an easy way to maintain good alignment.

Ring Sling

A sling that goes over one shoulder, you can do hip carries with an older baby, or a froggy position with a newborn. The downside is that the pressure is all on one shoulder (although it is spread over the shoulder) so keeping upright can become challenging after a bit. I struggled with more than 20 minutes with mine as it made my shoulder sore, but they were both large by this point and I was unused to the carry. The plus side is they’re quick to use, there’s no pressure on the waist itself, and newborns are light.

Soft Structured Carrier/ buckles

A panel, with a buckle at the waist and for the arm straps. Easy to use, and they come with different degrees of padding, so find the one you find comfiest and fits your shape best, so as to distribute weight as evenly as possible.

Mei Tai

Like a SSC but instead of buckles you tie the straps.

Are you wearing correctly?

Here are some tips-

  • Follow the TICKS guidelines. Having baby close enough to kiss in particular will help with posture.

  • Get help at your local sling library to make sure you’re wearing correctly, if you have one. Also try out a few different wraps to see what works best. There are online stores that rent slings, in the event there isn’t a library near you. For those local to me, Stork and the Bees are in Herts, there’s Harrow Sling Library or the Chiltern Sling Library are the nearest

  • BUY ALL THE WRAPS! Well, maybe not all, but owning a selection of carriers means you can vary the pressure on your body, kind of the same way it’s good to wear a variety of shoes for your foot health.

  • Take a break. If you do find yourself struggling with posture, or with a large DR, if possible try not to wear for long periods at a time, to give your body a rest. Also, getting dad to wear when he’s there gives you a break. And who doesn’t love a babywearing daddy?

And remember, if you get good posture to start, you’ll get stronger and it will get easier to maintain with time.

Babywearing can feel like a lifesaver if you have a clingy baby, and I wouldn’t want any mum to feel that she couldn’t do it. Plus, I see plenty of mums pushing buggies in poor alignment too.

Get it right and it’s a wonderful way to carry your baby, bond with your baby, and help build your own strength.

If you’re unsure about your alignment and how’s it’s affecting your recovery, it’s a big component of my Restore My Core programme. Click here to learn more and grab a spot on the next course.

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Do You Have Diastasis Recti?

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Maybe my first question should be have you heard of it? Because unfortunately many mums haven’t. But you know that poochy tummy some women are left with after having a baby? This can be the cause.

And those who have heard of diastasis tend to focus on closing the gap thinking then all will be well, but there’s a bit more to it than that, so read on to learn more…

What is Diastasis Rectus Abdominis?

The six-pack muscle (rectus abdominis) runs from your breast bone to your pubic bone and is joined together with a strong fibrous sheath called the linea alba.  In some pregnancies, the linea alba becomes a little darker in colour and is visible on your stomach. This is called linea negra which simply means “dark line”.

You may have heard people talk about your abdominal muscles “splitting”.  Your muscles don’t “split” because they’re already in a separated state and held together by the linea alba.  A split muscle is like a torn muscle, so if you’ve ever torn your hamstring, for example, you’ll know what this pain is like!  What happens to the abdominal muscles during pregnancy is completely painless, you aren’t aware of it, and I like to refer to it simply as abdominal “separation”.

The rectus abdominis stretches vertically (up and down your stomach) to accommodate your growing baby, and when it can’t stretch any further up and down it starts to separate horizontally (from left to right).

diastasis recti

I guess it’s a little bit like the linea alba is heavy duty cling film stretching apart. And when you’re growing a baby in there, it will stretch apart! When this happens, it’s called Diastasis Rectus Abdominis. It’s not clear how many women get this in pregnancy, as there isn’t a huge amount of reseach to go on. The latest research suggests that 100% of women develop it, but as Physical Therapist Julie Wiebe explains here, there are flaws in this study. Another one found that 66% of women had diastasis in the third trimester, and 53% continued to have it immedietely postpartum (read more here).

It should heal on its own by 8 weeks post partum, (Coldron et al 2008) but if it doesn’t don’t worry, this is far from uncommon! It just means you need to work out why it isn’t healing, and do a few restorative exercises to help.

If you don’t and your DRA remains, your body will be forced to rely on other muscles to stabilize the pelvis, which can lead to:

– Back pain

– Pelvic pain

– Incontinence

– Pelvic organ prolapse

– A tummy pooch that never goes away

It’s not just about closing the gap

In fact you can have a diastasis and still be functional. I have about a finger’s gap there still! You also need to consider the tension of the midline: there is a big difference between having a firm and functional gap, and a gap that is soft with lots of give.

You need to consider WHY the gap is there. Yes, you grew a baby (again well done for that! I never fail to be amazed by how awesome it is that we can do that!)

But it should heal in the first few months after giving birth. If it doesn’t, this is down to too much pressure in the abdomen which then pushes out on your tummy or down on your pelvic floor. This happens when your core isn’t functioning as it should, so it isn’t managing to control the pressure.

What to avoid

Any exercise that puts repeated forward pressure on your abdomen could very well be making your diastasis worse.

This means avoiding many common exercises such as crunches, sit-ups, and conventional planks. I discuss this in more detail in this blog.

Diastasis can also be worsened by poor posture and an imbalance in the muscles of the core.

So what do you need to do?

It’s about connecting with your core to recruit the right muscles, and this starts with how you breath. Which sounds too simple but it’s SOOO important, and where I start with all my clients. You can read more about this here.

And you can’t look at your core in isolation. Your alignment, nutrition and stress all affect your diastasis recti. And you have to do the exercises RIGHT (we look at all of this in my Restore My Core programme).

It sounds odd, but one of the hardest things for me is getting clients to back off: the exercises are subtle, and no way as hard as what you are probably used to doing. I struggled to get my head round it. I spent years working in gyms taking abs classes and pushing through that burn. But contracting the deep transversus abdominis muscle is subtle, and until you have connected and it is happening naturally you risk just engaging the abs and obliques and having them take over. Then they pull on the midline and stop your diastasis from healing. This blog has some diastasis safe exercises to get you started.

To learn how to test for diastasis recti sign up to my free Restore My Core mini course.

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No Time For A Workout? The Busy Mum’s Guide To Staying In Shape

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As a Fitpro, I HATE the #noexcuses hashtag. Because, as any mum will telll you, there are excuses. (Other people have excuses too, but I’m focusing on mum ones here.) This attitude does not inspire me, and I’ve written about it before here.

I love working out. It used to be a big part of my life, and it took a while for me to accept the fact that, post-baby, I just didn’t have that much time for it any more. And that’s cool. One day the kids will be bigger and I can get to the gym again: this is just a phase of my life. And it’s a phase where I have other priorities, like looking after the children, cooking dinner, and work.

Also, maybe you just don’t want to look like that! Hell, some people could have all the time in the world and they still wouldn’t spend it down the gym sculpting themselves into whatever shape the media has decided we should aspire to.

So no, you don’t need an excuse not to be at the gym getting super fit. BUT, being healthy and being fit are different things.

Having priorities other than the gym doesn’t mean my fitness has to suffer. I may not be as fit as I used to be, but I’m fit enough, and for now that’s fine with me.

Quite frankly there’s a limit to how much I can balance. Which brings me to my tips on how to stay fit and healthy when your time is monopolised by small people.

Soft play and playgrounds.

Yes, I realise other people’s children in an enclosed space with the fragrance of sweaty socks floating through the air may closely resemble hell for some of you. But if you’re there anyway, make the most of it.

GET MOVING! Chase, throw, roll with and generally play with your child. They will love you for it, and there are health benefits to any movement.

My favourite isn’t a soft play centre, but toddler time at a local leisure centre.

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Try carrying an 18mo through that bouncy castle course 5 times! And when it’s quiet runningup the slide at the end is more fun and effective than a treadmill any day. Then repeat for 2 hours.

Similar thing for playgrounds in general- climbing frames, tunnels, monkey bars. Want a leg workout? Try pushing off on a see-saw against someone less than half your weight.

Walking.

Any walking. Just leave the car at home. I’ll save banging on about the benefits of it for another post, but I honestly think it is one of the BEST forms of exercise. For added challenge find some good hills. I was in Winchester a few weeks back and climbed up and down this one:

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And I was carrying the toddler for added ‘ow’ factor. But, as before, much more fun than the treadmill or stairclimber!

Hanging.

This is a basic skill we should all have, but few do. So good for upper body strength, it helps with scapular (shoulder blade) stabilisation (and I see many people who struggle with this) and is great for shoulder mobility.

Even if you can do full pull ups, I’d recommend some hanging work. See here for a beginners guide and here for more advanced challenges.

I use my chin up bar and Olympic Rings at home (although as you can see I have to wait my turn):

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But again, the beauty is you can throw in some hangs when you’re at the park with the kids. (Yes, I do get the odd funny look.)

Home workouts.

They don’t even have to be long. My youngest doesn’t sleep very well, so any intense workout is liable to be interrupted, even in the evening. Plus, I’m flipping knackered by that time anyway, so can’t usually face anything mega.

I have a few little routines that I can do in 10 or so minutes. Sometimes I just work through some dynamic mobility, to maintain flexibility, and because I feel good after. I can increase or decrease the intensity to make it challenging to my strength too, and it gets my heart rate up a bit.

Deep squats.

Ok, so these alone won’t get you fit. But the ‘potty squat’ is another basic movement we should all be able to do, yet many can’t. It’s good for mobility, strength, even just sitting in it is beneficial.

Again, I could do a whole post on the squat. But it’s already been done, so head here for more benefits and beginners tips. I’m just pointing out that by squatting to pick up the hundreds of toys strewn across the floor, instead of bending over and straining your back, you can cram a LOT of reps into your day, whilst simultaneously cleaning. Hooray! Which reminds me…

Cleaning.

Yeah, I don’t do this one much. But apparently  it’s a great calorie burner.

Playing.

Yeah I know, I kind of cover this on soft play. But, for anyone a bit more advanced, locomotion is a great way to goof around with the kids, doing animal walks, while getting strong at the same time! Hip hip hooray! See here for a beginners routine. Just don’t be fooled by the inclusion of the word ‘beginner’ (some of this is quite advanced and should NOT be attempted by anyone who has given birth recently, or who is not already in pretty good shape).

Also, this isn’t really playing, but since some of those are a bit hardcore anyway, single leg squats can be done pretty much anywhere- think standing around while the kids are playing. Don’t waste time standing! Single leg squat!

Okay, I think I’m done. Hopefully these are some useful tips for getting more movement into your life when time is not your friend.

P.s. I know this is for busy mums, but if you’ve just had a baby or still have any core or pelvic floor problems some of these suggestions won’t be suitable. Remember, you are post-natal FOREVER and even if you measure your child’s age in years, not months, you could still have weaknesses resulting from pregnancy if you haven’t gone through a good restorative core programme.

If you’re interested in getting a personalised home workout designed so you can fit exercise in to your life more easily, contact me to find out about personal training.

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Postnatal Exercise Advice: The Good, The Bad, and The Ugly.

There’s no shortage of advice on what exercises you should be doing to get your ‘pre-baby body’ back. Problem is, not all of it’s good advice.

postnatal exercise advice

First off, I hate the ‘get your pre-baby body back’ thing. It is not a race to see who can shift their pregnancy weight fastest, and it encourages mums to throw themselves into exercise and dieting to do so. Not healthy.

And whilst it’s fine (not vain) to want to change how you look, you shouldn’t have to feel ashamed of your post-baby body. You need to take it slowly and be gentle on yourself, take time out and be a little selfish (except it’s not really selfish- happy mum means happy baby).

But back to the advice itself.

The Good.

Let’s start with some exercises you CAN do. I’m going to link to someone else’s website here, so you don’t have to just take my word for it!

Marianne Ryan is a top Womem’s Health Physio, and I’ve shared this blog of hers with clients before, to reiterate what we’ve talked about in the session. It includes safe, effective exercises, that I use with personal training clients and in Restore My Core.

Good advice is about how to connect to your deep core. Training the breath and pelvic floor. Click here for Marianne’s advice on how to get a flat tummy.

The Bad.

Here’s a blog with ‘4 Moves to Target Your Mummy Tummy.’

However it’s more like 4 exercises to make your mummy tummy worse!

While this article does say to check with your GP if you have diastasis recti, it’s misleading in saying these exercises are how you should get a flat tummy post partum.

I’m not saying never do planks or crunches (although crunches would never be my exercise of choice to get a flat belly, postnatal or not), but you have to go through a progressive restorative programme first.

Any exercise that creates a lot of abdominal pressure, like these, runs a big risk of pushing your tummy out, not giving you a flat stable core. For example, the strain of the double leg lifts could lead to the low back arching, or pushing it into the ground to compensate, both of which put the pelvis in a non-optimal position for the transverse abdoninis and pelvic floor muscles. And the rectus abdominis and obliques can end up taking over, placing strain on a weakened linea alba.

Bad advice involves ab exercises, feeling the burn and anything that leaves you straining while you train.

The Ugly.

This one is actually part ugly, part good. But then I wouldn’t have had a nifty blog title, so I just went with ugly.

The first link mentioned girdles, and I want to talk about that some more. Are they a good idea postpartum?

Waist training has been in the news a lot recently, in large part thanks to the Kardashians making social media posts like this:

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And because this was after giving birth (although over a year later), women can see it as a good way to get their tummy down. But wearing a supportive garment after having a baby is completely different to waist training, so please don’t confuse the two.

To start with I wouldn’t recommend this type of waist training. If you squeeze your tummy in like that, where do you think all your organs are going? Where is the pressure going?

Up or down is where. And pressure down on your pelvic floor is not a good idea, ever. Especially not when postnatal. It is going to put you at huge risk of pelvic organ prolapse.

And pressure up on the diaphragm? Hiatus hernia anyone?

On top of  which you will actually be preventing your core from functioning properly. Here’s a video from Women’s Health Physio Julie Weibe that explains this beautifully.

But a supportive belt postpartum is different. They provide support spread around the torso, rather than just squeezing one area. This can give extra support to weakened abdominal muscles, reduce postnatal swelling, and encourage them to close back together whilst regaining tension.

Because it isn’t just the gap between the muscles that’s the issue. It’s the ability to create tension along the linea alba, which is the tissue in that gap. And if you close the gap without restoring function, your core still won’t be able to do it’s job properly, and any symptoms you may be having, like pelvic girdle pain, low back pain, or incontinence, will likely remain. You need to relearn how to use the deep core muscles and address your alignment.

If you do have abdominal separation and are considering a belt, I really recommend you see a Women’s Health Physio first. They can make sure the belt is fitted correctly and address any underlying issues with a tailored programme.

You can be referred by your GP, or you can find one to see privately here, just make sure you pick Women’s Health from the drop down menu.

Anyone local to me, I recommend www.beckyastonphysiotherapy.co.uk, having seen her myself.

I hope this article helps give you a bit more confidence in being able to distinguish between the fitness advice that’s worth following, and that which is best ignored. And as a mum, I trust you’re pretty good at listening to bad advice, nodding along, then going along on your way whilst ignoring it completely!

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