By Debbie Cohen, PT, MS, CSCS, COMT, WCS


www.pelvicwellnesspt.com

The first few weeks after giving birth can be a tumultuous time in many ways. Everyone’s schedules are up in the air, there’s a newborn needing to be fed and changed every couple of hours, and perhaps other children and family members trying to adjust to the new family configuration. Add on top of that the fact that the new mom is not exhausted and overwhelmed, but her body has completely transformed into something totally foreign. Vital parts are not where they used to be, and the connection between muscles and the brain seems to have been, well, interrupted, to say the least. 

There are plenty of tips available online for the latest and greatest move to “get your belly back.” While abdominal strength is crucially important, these muscles have just gone through a major shift in stretch pressure and landmarks. In this early postpartum period, the abdominal wall and pelvic floor are still healing, and are not ready to be challenged by exercises like crunches or planks. In addition, you cannot simply strengthen a muscle group that is not really even coming on at the right time, in the right way. 

So what’s a new mom to do? In addition to focusing on being vigilant about her own rest and nutrition, physical activity is important at this stage. The right level of physical activity will likely be gentle, such as taking short walks, preferably outdoors. The consistent practice of walking for 10-20 minutes daily will be much more helpful for overall strength, endurance, mood, sleep, and bowel health, than working out too intensively too soon, and ending up being set back by problems that ensue, such as bladder control problems, pelvic or back pain, or abdominal muscle separation (diastatsis recti).

The safest and most effective way to “kick start” the pelvic floor and abdominal wall, is to practice the all-important coordination of how these muscles work in concert with the breath. The respiratory diaphragm – your main breathing muscle –and the pelvic floor (also known as the pelvic diaphragm!) move up and down in parallel with each other as you breathe, rising on the exhale, and descending on the inhale.

To feel this motion and facilitate it, try the following “Bellows Exercise”:

  • Lie on your back with your knees bent up (called “hooklying” positon) and a small soft ball or cushion between your knees.
  • Hold the ball gently with your knees, just enough so as to not drop it.
  • Relax your abdomen and breathe naturally, but more slowly than you normally would. Become familiar with the gentle motion of your belly with your breath – rising on the inhale and falling on the exhale.
  • Next, as you exhale, gently squeeze the ball between your knees until you exhale as fully as possble, and as you inhale, release the squeeze on the ball, again holding it just enough to not drop it.
  • Continue with this pattern as you breathe slowly and naturally, and pay attention to what you feel in your pelvic floor and lower abdomen. You can even feel your very lower abdomen on both sides with two fingers just inside of the corners of your pelvis.
  • Notice that as you exhale all the way, you may feel your lower abdomen gently pull in, and your pelvic floor gently rise up inside you. You don’t need to make this happen, just imagine it as you follow it with your breath and the coordinated squeeze and release of the ball.
  • Practice this for 3 minutes, 2-3 times per day

This exercise will prepare your abdomen and pelvic floor to be ready for more challenging activities once they are healed from childbirth. By learning good coordination with the breath, you will have a much better chance of recovering full strength and meeting your fitness goals once you are ready to start challenging your core in other ways.

If you do experience any back or pelvic pain, or bladder control problems that persist past 6-8 weeks after giving birth, these are not normal and should be addressed right away before proceeding with exercise. Contact your pelvic health physical therapy specialist for help.

The information contained in this article is provided for informational purposes only, and should not be used as a substitute for the advice of your physician or licensed health care provider. You should consult your physician or licensed health care provider before engaging in any exercise activity described in this article to determine if it is right for your needs.