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Prenatal and Postpartum Exercise

EXERCISE DURING PREGNANCY AND POSTPARTUM
BY CHRISTINA MCGEE PT, DPT – SULLIVAN PHYSICAL THERAPY


Important Terms

Diastasis Recti: a separation of the abdominal musculature, specifically the rectus abdominus lengthwise down the center of the abdomen at a line of fascia, called the linea alba. This often results from the stretching of the abdomen during pregnancy. Your practitioner may or may not check this for you. Make sure you ask!

A diastasis recti can impair spinal and pelvic stability, give your belly a pooched or bloated appearance, and potentially cause pain. Modifications need to be made to exercise routines in order to prevent worsening and to help healing.

Pelvic Floor: a bowl-like set of muscles under your pelvic organs that support posture and organs while acting as the “gatekeepers.” A well-functioning pelvic floor controls passing urine, gas, and bowel movements, and further, allows penetration  during sexual activity, exams, and tampon use. The pelvic floor withstands challenges in order to support different pressures and weights during pregnancy and is stretched to an extreme during vaginal childbirth.

Impaired pelvic floor musculature can result in compromised bladder and bowel functioning, including difficulty emptying, leakage, painful intercourse, tailbone pain, pain in the genitals/rectum, and discomfort and even pain with sitting.

Prolapse: a lowering of pelvic organs – bladder, rectum, or uterus – due to abdominal pressures, often from pregnancy and childbirth, but also brought on by straining with constipation or heavy lifting.

A weakened, lengthened pelvic floor can lessen the support structure under these organs and lead to or perpetuate prolapse. Often, women with prolapse will describe a heaviness, feeling like organs are falling, feeling like they’re always wearing a tampon, or feeling a bulge at the vaginal opening.


FAQs and Important Information

Is it safe to do core work while pregnant?
With the changing weights and postures during pregnancy, it is important that the spine is supported by the core. However, exercises that look like sit ups and crunches are not a good fit and should generally be avoided during pregnancy. Exercises that engage the abdominals in a static position to help support the spine are a better idea.

After giving birth, when can I start exercise again?
It is important to allow your body time to rest and heal postpartum. The first three weeks after labor should be spent in or near the bed, bonding with your baby. Avoid lifting, straining, and prolonged standing. You should not lift anything heavier than your baby- keep in mind laundry, a grocery bag, and a vacuum are all heavier than your baby and should be avoided during these early weeks. This period of rest allows your tissues and organs to heal appropriately and return to the proper lengths and positions. Trying to push through what would ordinarily be simple chores, errands, or exercise can cause a great deal of harm.

Around three-weeks postpartum, assess your healing and listen to your body. Progress very slowly back to exercise and discontinue immediately if you’re feeling any pain, heaviness, or excessive fatigue, or if you see an increase in bleeding or sense anything that doesn’t feel quite right.

After giving birth, what core work can I do?
Similar to during core work during pregnancy, anything that looks like a crunch or sit up can cause strain to the abdomen and high pressures at the pelvic floor and therefore, should be avoided. For the first six weeks postpartum, you should also avoid anything that requires elevated hips such as bridges.

Get checked by a provider for a diastasis recti before returning to core strengthening, and see a physical therapist if you want to return to higher-level workouts, similar to those performed prior to pregnancy.

Should I do kegels?
Yikes! Big question. Although this is a common practice, kegels do not help restore every postpartum body. Kegels, or contractions of the pelvic floor (like you’re holding back urine and gas), are only appropriate for some patients. They might be a good fit for you but could be the absolute wrong fit for your body. A large percentage of people perform them incorrectly.

Please seek assessment by a pelvic floor physical therapist before starting this practice. They should never be recommended in a broad sense during pregnancy or postpartum as a simple, general healing practice.

It’s important to be assessed by a physical therapist:
In other countries, it is the standard of care for everyone to see a pelvic floor physical therapist following delivery- whether it be vaginal or cesarean- to assess muscle and tissue healing, to address any complaints, and to give recommendations for safe return to exercise.

It is NOT normal during pregnancy or postpartum to pain in the abdomen, genitals, back, or hips; to feel pain during intercourse; to experience urine or fecal leakage; to experience feelings of heaviness in the pelvis; or to suffer from significant problems with constipation. If you experience any of these problems, get assessed and get help.

Your birth provider will typically clear you for an internal exam with a pelvic floor physical therapist after your six-week checkup.

How do I get an appointment?
In the state of Texas, a referral from a doctor, physician’s assistant, nurse midwife or chiropractor is required. Once you have your referral, give us a call to make an appointment – (512) 335-9300!

Post Author
Christina McGee

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