postpartum recovery

Flat Butt Posture

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As you can see, during pregnancy, my pelvis wants to tuck under to balance the weight of the growing baby and uterus (picture on the left).  If I were to move around with this posture throughout pregnancy, it could contribute to the flat booty and pelvic floor issues many mommas experience post-baby.  UNFORTUNATELY, this week I have noticed my butt is, SADLY, looking more flabby than it has in the past.  Time to focus on how this momma is holding herself up during the day!!!  Time to make sure I am practicing what I preach and focus on posture in the right picture. 

I need make a conscious effort now, for the next few weeks, to keep my posture in proper alignment and keep my pelvic untucked.  It is so important for postpartum recovery and what I preach daily! 

With my postpartum women, I am usually discussing how tucked butt posture causes misalignment of the ribs and pelvic floor, which can increase pelvic pain, leaking, pressure in vagina, hip pain and much more.  And this isn't just for women!  For example, my hubby just got a stand up desk at work and has been complaining of hip pain.  When looking at his posture, this is how he is standing during his work day.  Men do it too ladies!  

When tucking our butt under, our initial thought might be that I am clenching my butt so I must be making it stronger, but actually you aren't.  You are making it more weak by turning off the glutes from stabilizing you and you end up clenching more pelvic floor. A weak butt can increase pelvic floor dysfunction and make your postpartum recovery even harder because you don't have a strong butt for picking baby up properly or lugging the car seat around etc. 

So, start practicing better aligned posture in standing and while carrying/ lifting babies, groceries etc You body will thank you!!  

Sex After Baby

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Sex.  This can be a scary thing for women who have had a cesarean birth, who have torn vaginally, or who have had an episiotomy (or some kind of traumatic birth...or even just birthed a baby).  For one, some women find it hard to look at their cesarean scar, think their vagina appearance has changed or have a difficult time letting their partner look at them postpartum because they have lost muscle tone, have a stretched out belly, stretch marks etc.  

The scar tissue from the cesarean delivery and vaginal delivery (with a 3rd/ 4th degree tear and episiotomy) is still healing at your 6 week check up and will continue to heal for 6-12+ months, even if you are released at your 6 weeks check up and were told your incision was healed.  

Remember, sex should not be painful, but if it is, it would be wise to see a pelvic floor physical therapist to assess your scar tissue (vaginal or abdominal) and see if it might be causing some of your pain.  Most OBGYNs and Midwives recommend waiting until after your 6 week appointment to start engaging in sex again.  If your doctor has cleared you for intercourse, it is fine to start. There are many factors during pregnancy and delivery that can cause pain with sex.  Remember, painful sex is common and not normal.  Speak with your doctor about your pain and see a pelvic floor physical therapist to help improve your symptoms.  A pelvic floor physical therapist can evaluate your pelvic floor muscles for tightness, poor coordination and assess your scar tissue (cesarean or vaginal) to help address your pain.

If you are experiencing pain with sex, here are some things you can try:

  1. Water-based lubricant

    Hormone fluctuations can decrease the amount of lubricant your body produces, especially if you are breastfeeding. Trying a lubricant that is water based is likely to last longer. Here are some options (In no particular order) :

    1. Slippery Stuff

    2. SYLK lubricants

    3. Good Clean Love lubricants

    4. YES lubricants

2. Longer foreplay with deep belly breathing

-It may take a little longer to increase your arousal.  Adding in some belly breathing with foreplay can help calm down the tissues and get them ready for the fun!

3. Switch it up!

-A position that used to be comfortable, may not be anymore.  Try a new position out and see if that does the trick.  For example, on your back might be uncomfortable, but on top might cause less discomfort.

If pain continues, please seek the help of a pelvic floor physical therapist and your healthcare provider.

What You Need To Know About Pelvic Health

As women, we live in this one body, yet, we still have a difficult time bringing awareness to the pelvic floor muscles and learning how to contract and relax these muscles. This is a topic that surprisingly, not a lot of women are well educated on. I love addressing the pelvic floor muscles, their roles in our health and how they can change with pregnancy and birth.  

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The pelvic floor muscles offer many functions to our bodies: they are supportive to our organs, they help pump/ circulate fluid in as we breathe in and out, they aide in sexual function, they control opening and closing of our openings and stabilize our SI joint, pelvis, hip joints and lumbosacral joints. The muscles run from the front of the pelvis at the pubic bone, to the sits bones and attach to the SI/ tailbone area.  When functioning properly, the pelvic floor muscles should fire prior to movement of lifting children, laundry, jogging, grabbing a glass of water etc. So it is important to continue to focus on your pelvic floor muscles through all phases of life.

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Your "core" is made up of your diaphragm, pelvic floor muscles, transversus abdominus and your mulitidus muscles in your low back.  So, as you can see, doing abdominal exercises for your "6-pack" muscles, will not target the true core. 

With life, we generally create habits.  Even within our bodies, we tend to do things the same way most of the time.  For example, we tend to carry our children or purse on the same side of our body.  This can create compensations to certain tissues and joints, especially during pregnancy and postpartum.  For instance, during pregnancy we may stand with our bum tucked under, our abdominals stretched and tightness in our backs to hold us up with our growing belly/ uterus.  After birth, our bodies stay in a similar posture, with weakened tissue and we start moving throughout the day making new compensations with carrying an infant or a toddler.   Seeing a pelvic floor physical therapist can help you fire and re-train your core the proper way to improve your core support during pregnancy and postpartum. 

One day, I hope it becomes a natural thing for a women to be seen at least once during her pregnancy and then get an automatic referral to a pelvic floor physical therapist postpartum to check on how the pelvic floor is functioning prior to beginning an exercise routine.  I believe many women would benefit on a prenatal visit with a pelvic floor physical therapist, to figure out how to make their pelvic floor muscles function properly and then what posture and body mechanics would be beneficial to avoid to promote a healthy pelvic floor.  Then postpartum, addressing women's pelvic floor strength, endurance, coordination and any areas related to pelvic floor dysfunction, diastasis recti or scarring from cesarean birth or perineal tearing.  I think so many women are doing too much too soon instead of giving their bodies enough time to heal postpartum prior to jumping back on the exercise train.  Remember, it took your body 9 months to grow that baby (ies), so give it grace with healing.  You will be glad your took your time and were smart with your healing and exercise, instead of rushing back into things.  

What Happens During a Cesarean Birth?

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This is an area that as women, even those of us who have HAD a cesarean birth,  we know little about.  Cesarean births can be planned or unplanned.  Planned are scheduled ahead of time and unplanned can happen after pushing for long periods, or when needing to deliver baby quickly, like in my first delivery.  There are lots of different reasons for an unplanned cesarean.  

During the cesarean delivery, the doctor makes an incision into your skin, through your fat cells, connective tissue and into the abdominal cavity.

The abdominal muscles are spread apart and the bladder is moved so the doctor can get to the uterus.  An incision is made into the uterus and the baby is guided out.  After the placenta is removed, then the uterus is stitched up, the bladder is put back, the connective tissue and abdominals, and then the skin is stitched up.  A lot of layers of sutures within the tissues so scar tissue develops as you heal.

Please note, your abdominal muscles are not cut through during a cesarean birth, but your connective tissue is.  This is important to understand why we need recovery programs after birth, not just “sit ups” and running as soon as we feel like it.  

 

"I had a csection, so why do I need to heal my pelvic floor?"

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Google Image

This is a question I seem to get quite often. "I had a csection, so why do I need to heal my pelvic floor?"

During pregnancy, your pelvic floor muscles are compromised and stretched with weight of growing baby and uterus.  This can cause the pelvic floor muscles to be more lax than normal.  Changes in posture during pregnancy, also cause changes to pelvic floor muscles.  For example, standing with your butt tucked under to accommodate growing belly, can cause tightness and change in tone in your pelvic floor muscles.  This can lead to pelvic floor dysfunction (urgency, frequency, leaking of urine, pelvic pain). 

Pelvic floor muscles are also involved if you pushed prior to cesarean birth.  Also, cesarean scars can cause issues with nerve function to the pelvic floor, where you might develop pelvic pain with sex, urethral burning, or feeling of needing to pee all the time.  It is important to get the pelvic floor muscles to function properly with your “core” after birth.  See a pelvic floor physical therapist to re-train your pelvic floor muscles and core to function properly again as you care for your family at home or during an exercise routine.  

Seeing a pelvic floor physical therapist postpartum is ideal.  If you are looking for someone in your area and would like a recommendation, just let me know!!  

Should We See A Pelvic Floor Physical Therapist Postpartum?

Image from Google Images 

Image from Google Images 

Just a little food for thought.  Delivering a baby, vaginally or cesarean, is a difficult job for our body.  I hate to say it, but birth is traumatic to our tissues.  The muscles are stretched during childbirth, some are torn or even cut through, in order to do what is best to get baby out safely.  As a pelvic floor physical therapist, I have often wondered, why are these women missing out on opportunities to improve the function of their pelvic floor and abdominal muscles after delivering a child?  In all other areas of muscle injury (strain) or rupture/ tearing, patients are usually advised to seek the help of a physical therapist for regaining muscle control, range of motion, strength, flexibility, stability and overall function.  For instance, someone might have a whiplash injury (similar to a childbirth with minimal or no tearing), they would see a physical therapist to stretch tight muscles and strengthen weak muscles.  If someone tore their Rotator Cuff, they may have surgery to fix the muscles (similar to repairing pelvic floor muscles or abdominal muscles after delivering a baby(ies)), then they would seek the help of a physical therapist to stretch the tight muscles, regain coordination of the muscles, teach the brain how to connect with the muscles again, and go through a program of improving range of motion and strength/ endurance of the muscles.  

I think we are missing this with our new moms.  Think about it.  Women are pregnant for approximately 9 months (posture changes, back muscles tighten, abdominal muscles weaken etc) and then they go thru delivery (with tearing or not) and their body's are expected to bounce right back while taking care of a rapidly growing new born.

What I see with my patients are poor postural stances of weakened and stretched abdominal muscles, tight and short low back muscles, sometimes tucked bums or ribs thrusts with carrying and lifting baby/ children/ car seat etc.  I think it would benefit so many new moms to be referred to a pelvic floor physical therapist postpartum.  Every new mom could come in for a screen to see if they are having any issues and if there are any things a new mom should be working on in the first couple of months.  I personally think, it would be beneficial to see a pelvic floor physical therapist for a screen PRIOR to getting back into an exercise program.  A pelvic floor physical therapist can evaluate women for diastasis recti, pelvic pain, pelvic organ prolapse, urinary incontinence and proper postural and body mechanics.  Hopefully with seeing  pelvic floor physical therapist, this would prevent more pelvic floor risks and issues in the future. 

So...see a pelvic floor physical therapist today, even for a screen, to see if you would benefit from starting a pelvic floor home exercise program.  Why not support your tissues for a stronger future?