People who are pregnant or postpartum are not getting enough out of daily walks or "core strengthening". Information online and services that are offered either is far too general or inaccessible. Changes in the standard of care and resources available need to be made.
You most likely know someone who has given birth in their lifetime or may have it in their plans. Despite studies that prove that pregnant people who exercise regularly have healthier babies, the information on how to prepare for childbirth, including how much exercise is appropriate, can be scarce or even misleading. (1,2) One solution may be to increase access to the right, individualized information that will promote the health of mothers and individuals. (4)
Assuming all things go well, the nine months prior to childbirth are but a small wrinkle in time compared to the healing that follows. Pregnancy proves to be a tremendous, altering moment in a person's life and the physiology of someone who has given birth changes drastically. Thus, the term "postpartum" may be interpreted any time after childbirth whether that is two days or twenty years.
Across the population of individuals who go through pregnancy and childbirth, pelvic floor disorders (which encompasses a variety of symptoms) are common. (3,7) The prevalence of these issues do not dissipate with time. Pelvic organ prolapse, for instance, has about one third (if not more) chance of recurring after surgery, especially with age. (3,5,6) The statistics do not necessarily address what health outcomes may look like with more well-rounded approach to training and the recovery process.
Pelvic floor health, something that can so directly impact our physical wellbeing and indirectly influence our mental state, is inadequately addressed across the health and fitness industry.
A note to the reader seeking postpartum solutions:
Here, I will oversimplify how to break down the training or recovery process into several parts at which the person in recovery reaches milestones in physical fitness. Oversimplification helps to dilute the material for a general scope, but does a poor job detailing specifics of where individuals may need to direct intentions when it comes to specific fitness goals, muscular imbalances, or other movement patterns. To this point, let this be a guide to where you might start training and the path you can expect during the recovery process; when it comes to training and execution, be mindful of seeking a healthcare professional who will listen to the symptoms you present and direct you to someone who can best serve you.
Part one: In And Out (sorry, not the food joint) Focus on breathing because proper breathing is most likely not what you've been taught.
Slap dab in the middle of our bodies, our diaphragm not only separates compartments within us, but serves as a connection between our core, pelvic floor, and larger muscles that dictate the positioning of our spine and hips (thereby affecting our knees and ankles and feet, or our shoulders, neck, and so forth).
The importance of a stable core is stressed in academic literature as much as the terms have been thrown without regard by self proclaimed health and fitness experts in the saturated digital space. So what does it really mean to be intentional about core strengthening and why do we care to do it through breathwork?
The diaphragm is a muscle that contracts to allow an inhale and relaxes as we exhale. Think of it as a parachute that connects to lower back and the ribs or sternum. Now imagine how pregnancy may bring the ribs out into a more open position and the low back into more arch than normal. Just as tight muscles or dysfunctional movement patterns may influence the position of our joints, the dramatic change in this positioning and of our posture will influence our breathing patterns.
Posture during pregnancy and postpartum encourage shallow breathing patterns, left unchecked the result may attenuate movement dysfunction.
When influencers and practitioners alike talk about core, the overarching idea is that deep abdominal muscles hold the spine (particularly the low back) stable so that the rest of the torso and the hip can functionally move--safely and pain free.
Belly breathing may be a good cue to suggest deeper diaphragmatic breath but underestimates the individual's ability to execute a true full breath that expands the rib cage 360°.
When it comes to coaching the mechanics, coaches tend to fall into old habits, likely overlooking a larger portion of their clientele than they'd like to believe. The core does not limit to the abdominal wall, it is held above and below by the diaphragm and the pelvic floor, respectively. When we limit the expansion outward, the pressure will move towards less resistance and press either up or down instead. If the pelvic floor does not move functionally, this may encourage dysfunction (or larger issues such as POP, pelvic organ prolapse).
Drawing "navel to spine" may provide stability in some ways, but it promotes a shallow breathing pattern and limits how we can move functionally.
The first line of defense when it comes to recovery or getting back to life and all the activities missed is breathwork. Since people may recover or progress with different timelines, there are a few things I would suggest: incorporate back breathing into warm ups and get the ribs a bit more mobile, work on thoracic (mid-back) mobility to relieve stress from the low back, and start strengthening the core using supine movements (i.e., deadbug variations and glute bridges or hip thrusts). Some of these suggestions may be more readily applied while others take some time to work towards.
New and old mama's and folks out there getting back into the groove or reclaiming your health, be patient. You've got time. Hope these tips help!
1. Encourage back-breathing with a foam roller
2. Mobilizing the midback: sidelying midback rotation with breathwork focus
3. Dead Bugs: focusing on abdominal bracing and "marches" first
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Sources for the nerds:
Chen, Yanting, et al. "Effects of maternal exercise during pregnancy on perinatal growth and childhood obesity outcomes: a meta-analysis and meta-regression." Sports Medicine 51.11 (2021): 2329-2347.
Hayman, Melanie, et al. "What exercise advice are women receiving from their healthcare practitioners during pregnancy?." Women and Birth 33.4 (2020): e357-e362.
Memon HU, Handa VL. Vaginal childbirth and pelvic floor disorders. Womens Health (Lond). 2013 May;9(3):265-77; quiz 276-7. doi: 10.2217/whe.13.17. PMID: 23638782; PMCID: PMC3877300.
Rajah, Amina Suleiman, et al. "Perceived Benefits and Barriers to Prenatal and Postpartum Exercises among Child Bearing Women in Kano, Nigeria." International Journal of Childbirth 11.2 (2021): 37-46.
Fleischer, K., and G. Thiagamoorthy. "Pelvic organ prolapse management." Post Reproductive Health 26.2 (2020): 79-85.
Barber, Matthew D., et al. "Defining success after surgery for pelvic organ prolapse." Obstetrics and gynecology 114.3 (2009): 600.
Mazi B, Kaddour O, Al-Badr A. Depression symptoms in women with pelvic floor dysfunction: a case-control study. Int J Womens Health. 2019 Feb 22;11:143-148. doi: 10.2147/IJWH.S187417. PMID: 30863189; PMCID: PMC6390859.
Szczygieł, Elżbieta, et al. "Biomechanical influences on head posture and the respiratory movements of the chest." Acta of bioengineering and biomechanics 17.2 (2015).
Laframboise, Faith C., Rebecca A. Schlaff, and Meghan Baruth. "Postpartum exercise intervention targeting diastasis recti abdominis." International journal of exercise science 14.3 (2021): 400.
Ahmed, Afaf, Samia Ibrahim Hassan, and Howaida Amin Elsaba. "Effect of Four-Square Breathing Exercise on After Pains, Initiation of Breastfeeding, and Satisfaction with Intervention among Postpartum Mothers." Assiut Scientific Nursing Journal 10.29 (2022): 11-22.
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Written by:
Judith Wang
Founder, Project Green Beard
UCSC Banana Slug