Birth, pelvic health, Pregnancy, Prolapse

Pregnancy After Prolapse – Pelvic Floor Physiotherapy

If you’ve read anything else on this blog you’ll know I am a massive advocate for pelvic floor/pelvic health/women’s health physiotherapy (or physical therapy as it’s called in the US). I believe ANY woman who has given birth, or is going to give birth can benefit from it, even if it is just a one-time assessment.

So obviously, I am not the exception to this recommendation. I’ve talked about my previous experience with PFPT as a postpartum woman and when dealing with my prolapse, but this is the first time I have seen one as a pregnant woman. I wasn’t quite sure what to expect, or even sure if I needed to go! I had seen some posts on Instagram from women I follow about seeing PFPT in their pregnancies (Brianna Battles & Michelle Coels of One Tough Mama) and wondered what their trigger was to actually book an appointment to see them. Then I finally got my head out of my own ass, and realized I am legitimately having symptoms that I would be telling my clients to go to physio for. I was having some minor leaks and heaviness, which in and of itself is enough to warrant physio, so I just got down of high horse, and booked an appointment.

I was a bit nervous. Was she going to think I was wasting her time? Was she going to just tell me everything I am feeling is normal and look at me like I’m an idiot? I know, irrational, but those were my fears. Luckily, the physio I saw was one of the nicest women I have ever met, and let’s be honest, I’ve never met a physio I didn’t like! She heard and validated my concerns, assured me that what I was feeling was common, but definitely not normal, and then we jumped right into an assessment.

She was so thorough, it made my nerd heart happy! She had me stand and felt my abs and glutes, she had me squat, then single leg squat on each leg, and me do side bends each way, then had me lay down and contract my TA and then coordinate that with movement. She assessed my diastasis and we discussed how to monitor that moving forward. She examined my PF muscles, and had me do some contractions and assessed where I was feeling pain, how my prolapse was doing and gave me some exercises to work on.

We discussed strategies to deal with my symptoms. One of which was some leaking, or stress urinary incontinence, which I had never experienced before I got pregnant the this time around. Even when I was full term with Bruce, I never leaked, nor did I postpartum. She mentioned bladder irritants, which I had heard of and discussed with the physician at the Pelvic Floor Clinic when I was diagnosed with prolapse. I knew they could contribute to frequency, but what I didn’t know is that they can also contribute to incontinence! The way she put it is, if your bladder is already irritated by certain foods, then when you add a cough or sneeze on top of it, you’re more prone to leaking! This totally made sense to me, because otherwise I could not find any sort of pattern or correlation to my leaking. It was so infrequent, and didn’t seem to relate to my activity level or even the fullness of my bladder when I put any pressure on it, but I hadn’t taken my diet into consideration! And after chatting with a few friends, they all corroborated these thoughts anecdotally.

We also discussed the strength of my muscles. She rated my PF muscle strength a 3+ out of 5, whereas previously I’d been a 4 out of 5. So I mean, considering I am 23 weeks pregnant, those tissues are so swollen and loosened because of relaxin, I’m pretty happy with a 3+! I mean, obviously, I’d love to be 5/5, but I gotta take what I can get! She gave me a few things to work on, and we found while the front half of my muscles were weaker, the back half was actually quite tight.

The we discussed preparation for labor & birth. She had some suggestions on positioning, like don’t lay flat on your back, which I mean, is kind of common knowledge these days, I think? Isn’t it? Or maybe that’s just for birth & pelvic health junkies like me! She suggested I try to squat or be on all 4s as much as possible and also encouraged me to avoid pushing using a crunching motion, which a lot of women get sucked into. She suggested I focus on keeping my arms up, at least shoulder height if not overhead with something to hold on to. She said this stops the crunching motion and allows the TA to aide pushing better. We discussed things like perineal massage and EPI-NO, but not in depth. Overall we both agreed that I am in a much better place going into this labour because I actually know how to relax my PF muscles, and that was probably what made my pushing experience so drawn out the first time. I remember feeling SO vulnerable when I actually did relax those muscles, and not feeling encouraged or well coached by my midwife when I did.

This is the #1 reason I suggest all first time moms (or any pregnant woman who hasn’t delivered vaginally, but wants to) see a PFPT in pregnancy! They will help you learn how to connect with those muscles and how to know what it feels like when you both contract AND relax those muscles, because relaxing them is key when it comes time to allow baby to pass through them.

Pregnancy After Prolapse (4)

pelvic health, Pregnancy, Prolapse, Self Care

Pregnancy After Prolapse – The First Trimester

~Read where you left off here~

So the line was pink. I was officially pregnant. Again.

It happened so much faster than we had anticipated. It was no longer a debate of being ready, because ready or not, it was happening. One week after learning we were expecting our second little one, my husbands parents were scheduled to come for a visit. We debated whether or not to share the news, it was SO early after all, but we decided if this pregnancy ended prematurely, their support would be so needed, so we told them.

That just reinforced how great it was. They were ecstatic! Of course they were, what grandparents aren’t excited to learn they will be welcoming more grandchildren? I looked to my mother in law for support, my husband and his older brother are only 13 months apart after all. She reiterated what we already knew, it would be hard in the beginning, but so worth it. And we had planned it after all, it will all work out in the end!

Overall the first few weeks I felt pretty good. I still had energy, continued my workouts, and kept up with life. Things were great!

Then I was struck with vertigo.

I had cared for patients with vertigo, and knew it was awful, but I always thought they were over dramatic. But let me tell you, from first hand experience, it is all consuming. When you feel like the world around you is spinning, and closing your eyes just makes it worse, and you haven’t figured out what triggers it so it hits you randomly, it is hard. So hard. Even harder when you have a toddler to care for, and pregnancy nausea has hit. The vertigo was the worst in the morning, which, lucky for me, coincided with when I was feeling the most nauseated. The two just fed off each other and I felt awful. Caring for Nugget was even harder, because bending down or doing anything that required me moving my head out of vertical, set it off. Add that to nausea and it was a sure fire recipe for a trip to visit the porcelain throne. But I was lucky, after couple of weeks, it self-resolved. I didn’t really do much besides give into my salt cravings and drink as much water as I wanted.

But all the vomiting did a number on my core. The force required for that really puts some pressure on the pelvic floor, I now understand why some women leak when they throw up! I started having a lot of heaviness and discomfort. I freaked out. I was so worried that I was causing my prolapse to return and went to a pretty dark place. The combination of vertigo, with pelvic floor symptoms and exhaustion all added up to my headspace being all out of whack. I had a lot of very negative thoughts. There were many moments where I freaked out that I was damaging my body beyond repair. I even had really low moments where I hoped I would just miscarry so I could not worry about it anymore. I laid in bed crying, feeling like a terrible person and mother for wishing this very much planned, very much wanted, pregnancy away. The emotional turmoil you go through after being diagnosed with prolapse can really mess with you, and I didn’t realize how deeply, until then. It was like I was back to the day I was diagnosed, spiraling down a dark hole of ‘what ifs’, fearing I would never get out again.

I talked to some other moms they offered so much great support. They validated my feelings and helped me see what was really important – that I wanted this baby and I knew exactly what to do to get him or her here as safely as possible.

My symptoms waxed and waned over the next few weeks, and came to a peak around 11 weeks. I finally asked my prolapse support group, and they all suggested I talk to my pelvic floor physio. I mean, I knew I should, but I was in a bit of denial. I let my ego get the best of me, and thought I knew everything I possibly could, and there was nothing she could tell me that would help. But I emailed her anyway, and I am so glad I did. She replied quickly, and said it was totally normal to feel like that at the end of the first trimester. The uterus gets heavy, but has not come up above the pubic bone yet, so the entire weight of it is supported by the PF muscles. She reminded me to take it easy and it should pass, but to call her if I had any questions.

And she was right! Within a week, all my symptoms were gone! I even went on an 8 km hike up a mountain, and felt totally fine at the end and still the next day!

Then I was just tired.

So. So. Tired.

I never really noticed the exhaustion with Nugget, because I didn’t already have a kid and could sleep or nap whenever I wanted. Not the case when you have a 15 month old who gets up at 6 or 7 every morning. No sleeping in when you’re a parent, and even less so when your husband is working 6 or 7 days a week. This did not work out well with working nights. I work nights the majority of the time, and it was catching up with me. I started getting reflux to the point where I avoided eating because it felt like nothing ever left my stomach, I basically felt like my digestion came to a screeching halt. I started losing weight, which is the opposite of what you want to happen in pregnancy. Not to mention I was basically a zombie whenever I was not working. My poor toddler had the worst mom.

I talked to my midwife, and we agreed it would be best if I stopped working nights. I felt so guilty coming to that decision. I actually quite enjoy night shift! Plus, as a nurse, working nights is a bit of a badge of honor. I felt like I was being a baby by giving them up so early in my pregnancy, but I knew I had to do what was best for me and this baby.

It was like the clouds parted. I was finally sleeping at the same time every night, and sleeping through the night again. Before, with such a wonky sleep schedule, I was waking every couple hours because my body couldn’t figure out it’s rhythm. My reflux resolved, I had energy to exercise and play with Nugget again, and surprisingly my skin almost completely cleared up!

Moving into the second trimester, I finally started feeling like myself again.

Pregnancy After Prolapse (2)

Pregnancy, Prolapse

Pregnancy After Prolapse Series – Am I Ready?

This series of blog posts will follow my journey after healing my prolapse from my first birth, into my second pregnancy and beyond!

After I was diagnosed with my prolapse at 8 months postpartum with Nugget, I was devastated (you can read about that here). I thought my life was over and I wasn’t sure if I’d ever be prepared, physically, for another pregnancy and birth. I was terrified of picking up my baby out of the crib, never mind growing a second one!

Then I went to pelvic floor physiotherapy, and subsequently healed my prolapse. Then came rewiring my brain to actually accepting the thought that, maybe, I can have another baby. I mean, ever since I decided that kids were in the cards, I knew I wanted a lot of them! Like, 3 or even 4!

Before I was discharged from physio, I made sure to ask her thoughts on pregnancy, birth and postpartum. She had zero concerns with me getting pregnant again, gave me some great advice for labour and suggested I come back in for a check up at 6 weeks postpartum.

So, I had the go ahead from the professionals I trusted, but was I ready? Emotionally, I was SO ready. When I was pregnant with Nugget, my plan was to have him, then start trying for number 2 at 8 months postpartum, so they could be super close in age. Well, obviously, that didn’t happen. My husband wasn’t quite as antsy as I was to have babies right on top of each other, and I was still nervous about my body. I had felt betrayed and needed to learn to trust it again before taking on the challenge of pregnancy.

So I focused on getting strong. I started a new workout program, committed to working out every 2-3 days and for probably 2-3 months I stuck to it. I loved it. I was so happy with how my body felt, how my clothes fit, and how I felt in general. My body finally felt strong again. All of my muscles had blossomed, my core felt so supportive, and I was finally feeling like myself again.

I was ready. My body felt ready. My husband was ready.

It was time.

It took 9 months to conceive Nugget, so even though I was ready to start trying, I had absolutely no expectations for it to happen anytime soon. I was okay with that, prepared for a long road ahead.

Still, I did all the things. I peed on sticks. I took prenatal vitamins. I tracked my basal body temperature. I even tracked my mucous.

But even then, with perfect timing, most couples only have a chance of conception of 20% for any given cycle. Like I said, prepared for a long road.

We didn’t want to put our life on hold to have another baby, so we kept living it. We used the hot tub, we drank our fair share of wine, beer and coffee, we didn’t change our diet or exercise regimes. We just lived our lives.

I was so prepared for it take months to happen. After all, it had the first time, and nothing had changed in that department, as far as we knew, besides being a couple years older.

And then, two months in, it happened.

The line turned pink. The stick flashed ‘pregnant’.

Next thing we knew, we were preparing to be the parents of two under two.

{continued here}

Pregnancy After Prolapse

 

fitness, pelvic health, postpartum, Pregnancy

Pregnancy is Temporary, but Your Choices Last Forever

Being avidly interested in perinatal fitness & a new mom myself, I come across a lot of advertising and social media posts about exercise in pregnancy and postpartum. I often find myself scrolling through the comments to see what the general consensus is on the latest (usually controversial) video or message is.

One comment that almost always crops up is:

“I did crossfit/ran marathons/did crunches/did what I always did when I was pregnant and my baby turned out perfectly fine”

And all I can think is you just don’t get it!

While there are definitely recommendations for exercise in pregnancy circled around maintaining baby’s health, Mom’s health is just as important!

(I know, groundbreaking stuff, right?)

When I (and many other well-educated fitness professionals) say maybe it isn’t the best idea to do crunches, or run long distances, or lift super heavy, I’m not saying this because I think you are putting your baby’s health at risk. I am saying these things because you are putting yourself, your body and your future function at risk!

Yes, you can powerlift (or sprint, or do jumping jacks, or whatever) when pregnant, and baby will probably be fine, and it might feel okay for you at the time, but should you? Probably not.

Something one of my idols in the fitness industry, Brianna Battles says regularly about exercise in pregnancy is:

Just because you CAN, doesn’t mean you SHOULD.
~Brianna Battles, Everyday Battles

It all circles back around to training with intention. When pregnant, a lot of women fear losing themselves when the baby comes (I know I did. I so did!) so they try to keep doing what they’ve always done and enjoyed through their pregnancy, as if to prove to themselves that they are the same! But, as much as you are the same, you are so not the same during (and after) pregnancy. You are growing a human! That is a big-freakin-deal! You need to respect that. You need to surrender yourself to the fact that as important your personal goals are, the priority should be keeping your body healthy and strong in this (so very short) chapter of your life.

There are so many more factors at play in the perinatal period when it comes to exercise and fitness. Hormones influence your connective tissues. A growing uterus influences center of gravity, balance and movement patterns. Diastasis recti influences core function and strength. The weight of baby on the pelvic floor influences it’s ability to respond appropriately (hello, pee sneeze – not normal!). So we need to take all of these things (and more) into account when training in pregnancy.

Yes, we can program exercise along the same lines you are used to and enjoy, they just might look a little different. The how of exercise is often more important than the exercise itself. It’s about strategy rather than just do’s and don’ts. If you follow Brianna (mentioned above) Jennifer Cambpell of Mama Lion Strong & Healthy Habits Happy Moms, or Jessie Mundell, or Julie Wiebe or Katy Bowman, they all preach ‘ribs over hips’ and keeping your ribs, spine and pelvis neutral.

[Side note: I would be literally nowhere if it wasn’t for all I have learned from following these amazing women and for their trail blazing in this field]

So, can you complete a heavy overhead press while 30 weeks pregnant? Yes. Okay, but can you do it while maintaining your ribs over hips, without your diastasis bulging, and without holding your breath? No. Then that exercise isn’t the best choice for you in this chapter of your life. If you say you are just going to do it because it feels fine to you, my next question is why? What is the value of continuing to do an exercise that maybe isn’t the best for your body at this point? Is it because you think you should be able to do it? Is it because you’ve seen other pregnant women do it and you want to look ‘badass’ like they did? Is it because you’re afraid of looking like a weakling or a failure who didn’t have the guts to go for it? Take a look inside yourself, and analyze why you feel you need to do a specific exercise or program. Is it worth the risk? Spoiler alert: putting your glory ahead of your future function is not badass and doesn’t take guts. You know what takes guts? Putting yourself first. Saying no when someone challenges you. Looking within yourself and standing up for your own values. That’s badass. That takes guts. Going with the flow because everyone is doing it, that’s cowardly. Having the courage to stand out on your own is the pinnacle of strength.

Now I’m not saying you can never do your favourite not-so-ideal-in-pregnancy exercise again. That is definitely something you can return to. However, it’s something you need to work up to, and be mindful of how your body is functioning, and be ready to maybe take two steps forward and one (or two or three) steps back along the way. It’s about checking the ego, and respecting where your body is at during this very important period and allowing yourself to surrender to it. This chapter in your life is temporary. Eventually it will end, but the choices you make within it can have lasting consequences if you aren’t smart about it. In closing, I’d like to bring it back around to another quote from Brianna;

Pregnancy is temporary, Postpartum is forever.
~Brianna Battles, Everyday Battles

Try not to forget that, because your body won’t.

having-the-courage-to-stand-out-on-your-own-is-the-pinnacle-of-strength

Birth, Pregnancy, Prolapse

No, I Don’t Want to Hear Your Birth Horror Story

*Update*
*This post is in no way suggesting that women who suffered from traumatic births have no right to share their story, that is not my intention at all. Telling your story of a birth that didn’t turn out as planned can be incredibly healing. I’m merely suggesting that sharing stories with the motivation of inciting fear is not appropriate, and sharing traumatic birth stories may not be the best way to prepare a pregnant woman for birth*

What is it with women today?

We seem to glory in sharing horror stories about birth. As if you one-up each other in who had the worst experience.

Why do we describe birth as this horrifying experience you just have to ‘get through’ because the baby is ‘worth it’?

What if I told you, you could enjoy birth?

That you could look forward to it, and actually want to do it again?

I know I do! I cannot wait to get the opportunity to do it all again!

I was recently talking to a friend who is very pregnant with her first baby. She told me she is ‘terrified of labour’. It made me so sad. I just wanted to reach through my phone and hug her, and say ‘No, no, noooo! Please don’t be terrified!’.

I think a lot of the root of the fear with labour & birth stems from us being so disconnected from our bodies. Our health system has trained us to fear discomfort. Any time something feels off in pregnancy, we back off. We limit movement, we stop everything. Life comes to a screeching halt as we know it.

I just read an article titled The Scary Truth About Childbirth.  The title alone makes me stabby. To summarize, the article suggests that vaginal (and ‘natural’) birth is over-glorified and it’s injuring women in the form of pelvic floor (PF) injury, prolapse, tears and pelvis fractures. It uses words like ‘horrifying’ and suggests that the natural childbirth movement is to blame. It offers up un-helpful solutions such as get induced early, and have an epidural.

No.

No. No. NO.

NO!

While I believe the intention of the article was to educate women about the risks of vaginal childbirth, which are rarely discussed at length (true). It’s shock & awe, fear-mongering approach is everything that is wrong with medicalized birth today.

Inciting fear into pregnant women is not the way to help the situation. Suggesting MORE interventions is not the way to help the situation. Describing injuries that thousands (millions?) of women suffer from as ‘horrifying;, ‘humiliating’ and ’embarrassing’ is not the way to help the situation.

So what can we do?

Well, first, maybe let’s stop approaching birth as terrifying. Fear increases pelvic floor muscle tension, which in itself is a barrier to vaginal childbirth. The PF muscles have to relax and release, and stretch up to 2.5x their length in order for the baby to pass through. This is not possible if the woman is too scared to let them go. This can result in prolonged labour, prolonged pushing, and ‘failure to progress’. A label as failure to progress usually leads to more intervention, such as instrument assisted birth (forceps or vacuum), which greatly increases a woman’s risk for prolapse and/or tearing (or cutting, depending on the care provider).

Let’s think about this from a different perspective. The hormones needed for childbirth are the same hormones needed to acheive orgasm. Oxytocin is released naturally in the brain when having pleasurable intercourse, and is the same hormone that triggers the uterus to contract. Now, if you were having sex, and you were terrified of an orgasm, do you think you’d ever get there? Uh, nope. Highly unlikely. If you were terrified of having sex, would it feel good? Nope, it might even hurt. Same goes for childbirth.

All this fear mongering, is contributing to traumatic births, which contributes to more fear mongering, which just continues in a cycle.

Just STOP.

There is no benefit to making a pregnant woman fear labour and birth. Yes, there are risks. Yes, she should be aware of them and educated on her options. Yes, she should be made aware of potential outcomes of vaginal childbirth.

But we can do it without scaring the shit out of her! We can do better.

If you tell someone you’re planning on running a marathon, people don’t bombard you with stories of how their sisters mother in laws grandmother ran a marathon once and she had a heart attack in the middle and died. No, they congratulate you, and encourage you, and ask you how you’re training, and get excited! Why can’t we approach birth this way?

How about when you get on the topic of birth with a pregnant mama, you tell her she’s going to do great. You tell her that birth is amazing and it’s going to be one of the biggest accomplishments of her life. You tell her that it’s going to be like climbing a really tall, steep mountain, but the views along the way and at the top are the most breathtaking views you’ve ever seen.

Finally, let’s educate women how how best to prepare their body for birth. Like I mentioned, it’s like climbing a mountain, or running a marathon, except we don’t know how long it will be or how steep the climb, or what barriers we may face along the way. So let’s train for that. Let’s encourage women to move their bodies, nourish themselves (as best the can) and get their mind right for the journey ahead. Let’s teach them activities and movements they can do now that will help them later. Let’s get their bodies strong and capable, so when the time comes they are as well-prepared as they can be. Let’s teach them to have an open mind, and be educated about as many of the potential outcomes as possible so they’re prepared to go with the flow of whatever their body and baby presents. Let’s help them be okay with the unknown, not fear it. Let’s share positive birth stories, and help them trust that their bodies are capable of giving birth, and trust that their care providers will have mom & babies best interests at heart. Let’s encourage them to get in tune with their bodies, so they know how to listen to those primal urges that go along with the process.

Birth is amazing, let’s remember that.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

If you’re pregnant and wondering where to start with getting over your fear of birth, here are a few suggestions, things that helped put me at ease:

Watch Birth Story: Ina May Gaskin & The Farm Midwives

Read Ina May’s Guide To Childbirth

Watch How to Have a Harmonized Childbirth

Read I Came Along, I Wrote A Song For You {The Birth Story Of Sparrow}

Watch Welcoming Theodore

Watch Waterbirth of Scarlett

Watch Birth of Sloane

i-dont-want-to-hear

Birth, pelvic health, Pregnancy

Hold Your Breath, Count to 10, Push Your Baby out, and Your Uterus too

Have you ever heard the term ‘Purple Pushing’?

I hadn’t either, until after I was diagnosed with a grade 2 cystocele (bladder prolapse) and a grade 1 uterine prolapse.

You read that right ladies, all that preaching I’ve been doing about being safe to prevent prolapse, well it didn’t save me.

And I’m about 99% sure I know exactly why.

Two and a half plus hours of ‘purple pushing’. Now the details of the pushing phase are a little foggy in my memory, probably due to the extreme fatigue I was hitting by that point. But I do remember on more than one occasion, grunting through a push and my midwife telling me to stop ‘pushing into my throat’… READ: shut up and bear down. Well when you bear down like that, you’re not only pushing your baby out, you’re pushing everything out. It’s really a matter of what gives first.

And you’re thinking ‘So what? Isn’t that what we’re supposed to do? That’s how it is in the movies, and on TV and in every birthing video ever

Nope. The research says otherwise. Actually, current UK & Canadian recommendations advise against directed pushing. Directed pushing is when the midwife or OB tells the woman when and how to push, usually at the beginning, middle and end of a contraction (that’s right, 3 full body, everything you’ve got pushes per 1 minute contraction) while they count to ten and you turn purple in the face (hence purple pushing).

I remember my midwife telling me 2 pushes per contraction wasn’t good enough. I remember thinking there was absolutely no way I had it in me to put that much effort in, 3 times, every couple of minutes. No wonder I was passing out between contractions by the time we transferred to the hospital. It just didn’t feel right. It felt forced, and painful, and wrong. Birth shouldn’t feel like you’re working against your body. It should feel like your body is doing this amazing thing and you’re kind of just along for the ride and helping out a little, which is what it had felt like for me up until that point!

The fact is that pushing like this not only is exhausting, it is not effective, it is damaging your body and sometimes can increase the risk for your baby to go into distress before they are out.

Boy can I speak to how exhausting it can be to push like that. It is essentially flexing every muscle in your body, while holding your breath, for 10 or so seconds, 2-3 times in a row, every 2-5 minutes. For those of you who’ve been through it, you feel me. For those of you who haven’t, imagine doing a 1 rep max squat, 3 times in a row. Not fun. This has also been found in the research, the effectiveness of the maternal muscles in contracting effectively to push out the baby is related to how frequently they are asked to contract. So if you contract 3 times per minute, rather than once, the muscle contraction gets progressively less effective, decreasing the efficiency of the push.

If a woman is allowed to push spontaneously when birthing (i.e. when she feels she needs to), it has been found that she instinctively pushes with the peak of the contract, once per contraction, thereby maximizing the efficiency of the push and making the most of the effort she is putting in voluntarily (if you can call it that). If you triple that effort, without any marked increase in effectiveness, it is possible the woman may become physically exhausted, before the baby is born, increasing the likelihood of an instrumental delivery.

This is exactly what happened to me. I was SO tired, and we intended on going to the hospital to use a vacuum to assist. So we took a break from ‘coached’ pushing, I was basically left to push voluntarily for about 10-15 minutes during the transfer, and I believe that, coupled with the moving around required to get to the hospital, helped Nugget get to the point where we didn’t need a vacuum after all.

I also believe that pushing like this is what has caused my prolapse. You see any time you bear down (think actively pushing out a poop, sorry if that’s too vivid for some, but I think we’re way past that if you’ve read this far!) you are putting pressure on your pelvic floor. The act of bearing down creates tension in the diaphragm, core muscles and directs all of the pressure created in your abdomen downwards, onto, you guessed it, your pelvic floor and all of those lovely organs sitting on top of it. So if you think, 3 pushes per contraction instead of one, thats 3x the amount of pressure placed on all of those muscles and organs. No wonder 50% of women who have given birth vaginally are estimated to have some degree of prolapse!

This act of holding your breath and pushing also increases the risk of harm to the baby. Let’s think about this logically: when you hold your breath, you are not taking in oxygen. Now, sitting on the couch doing nothing and holding your breath for 10 seconds probably isn’t a big deal. But when you’re literally flexing every muscle in your body and also you are the only source of oxygen for another human currently contained within your body, you are consuming oxygen at a much higher rate. And if there is less oxygen circulating in the mother, there is less oxygen getting delivered to the baby. There is even evidence that bearing down for more than 5 seconds can cause late-decelerations in the baby’s heart beat, often a precursor to an emergency c-section.

So why are we still holding on to the era of ‘we must actively push the baby out’? There are a lot of reasons. The medicalization of childbirth, where it is made to be the most convenient for the doctor, woman on her back, with an epidural working against gravity. Another is our bodies are no longer the bodies of ‘natural’ humans. We no longer hunt & gather, walk miles and miles each day, squat to forage and toilet. Our musculature is different than that of our ancestors due to the vastly different environment we live in. More often than not, we hold a lot of tension in our pelvic floor muscles, and those interfere with childbirth, especially when we are tense and scared of the event at hand. But if we were to take care of all of those variables, the fact is we wouldn’t have to actively push at all to give birth. Do you see elephants and lions and any other mammal that has a uterus holding their breath and grunting on those nature shows? No. 99% of the time the baby animals literally just fall out of the mother, after the uterus does all the work!

This is why we have to take care of ourselves in pregnancy, be educated about our rights and options, and choose healthcare providers that align with our goals and intentions. We have to be our own advocates and stand up (both literally and figuratively in this case) for what we know is right! We have to listen to our bodies, and I mean really listen. We have to get to know them in great detail, know every sensation, what is normal and what isn’t. That way when big events like this come along, we are prepared to work with our bodies instead of against them.

And above all, Squat!

Just keep squatting everyone.

makes-1

Birth, fitness, Pregnancy, Uncategorized

What I Learned From my Labour & Birth

They say hindsight is 20/20.

39 weeks
Me in early labour at 39 weeks pregnant!

I thoroughly believe that is true. Looking back at my labour and birth of nugget nearly 6 months out, there are a few things I would have done differently, if I had the chance. This doesn’t mean I regret anything. I did the best I could with the knowledge I had at the time, but I also believe that it’s smart to take every experience you have and try to learn something from it.

  1. I wouldn’t have pushed so early
    As soon as I felt the urge, I pushed. It felt good, so I kept doing it. Looking back now, I think I was just over excited and should have let my body and my uterus do more of the work before I started actively participating. Even when a woman is not actively pushing, your uterus is still working to bring baby down with each and every contraction. I would have focused more on ‘breathing baby down’ or breathing through contractions and allowing them to do their work and conserving my energy for the work of actively pushing later on.
  2. I would have squatted more during labor
    I honestly have absolutely no idea why I didn’t do this. Squatting during labour helps open the pelvis and relax the pelvic floor, allowing baby to come down more easily. I prepared by squatting throughout my pregnancy, I knew that squatting in labour was beneficial, but for some absurd reason it did not pop into my head once to squat during labour. I think maybe I had it in my head that squatting should be reserved for pushing, but even then I didn’t think of it.
  3. I would have paid better attention to my posture
    All day in early labour I was so keen. I stayed in alignment, made sure I was giving my baby the best passage through, until I got into the birth tub. For some reason as soon as I got in there, I sat back on my sacrum (re: slouched) and I believe that influenced nugget bumping into my pubic bone on his way out. I also started out pushing in this position, which when I think back was actually a terrible idea!
  4. I would have slept!!
    Man, I wish I had slept more in early labour. I woke up at 4:30 in the morning and stayed awake until 9 the next morning after he was born, with the exception of a few very short naps. I had it in my head that labour was going to be quick and didn’t let myself relax. I was also worried if I got too relaxed, labour wouldn’t start and I would have to be induced. Being induced terrified me, so that was always in the back of my mind.
  5. I would have paid closer attention to my body
    Going into labour I thought I was very body-aware. Now, thinking back, I don’t remember feeling the baby move down. I was shocked when my midwife told me how low he was because I didn’t feel it. I don’t remember feeling my contractions move him down until he was crowning. I don’t remember feeling my pelvic floor, whether it was relaxed or not. I would have put more mental effort into concentrating on how everything felt and how it was changing as I progressed.
  6. I would have seen a women’s health physiotherapist prenatal
    Now this isn’t essential, however I believe it would have dramatically helped me connect with my transverse abs and pelvic floor while I was pregnant to better prepare them for labour and postpartum. It probably would have also made me realize that I had a tight pelvic floor and allowed me to work on releasing that tension before I went into labour.
  7. I would have moved more in the later stages
    If I had known how much of a difference getting up and walking out to my car and contracting in those awkward positions would have made, I would have done it so much earlier! If I had known possibly hiking up and down the stairs even one time would have helped nugget sneak past my pubic bone and stop that excruciating pain I would have done it in a second. My midwife said later she thought about suggesting it, but didn’t think I would have been very receptive to the suggestion, which may or may not have been true.
  8. I wouldn’t have put so much pressure on myself
    As soon as my water broke, it was game on. I was raring to go. I’ve never been much of an endurance athlete and that was totally reflected that day. I wanted things to happen and I wanted them to happen NOW. I happened to be wearing my FitBit and I recorded nearly 60 stories of stairs walked that day! Looking back, instead of basically climbing a mountain worth of stairs, I should have rested, relaxed, and let my body do it’s thing.


I hope you can learn a bit from the things I would do differently if I had the chance. I’m hoping I will remember this when it comes time for nugget #2 and I can have the homebirth I dreamed of the first time around. I can only hope that my words and experience will help even one other woman takes steps towards having the birth that she hopes for, whatever that looks like.

 

what I learned

Birth, fitness, pelvic health, postpartum, Pregnancy, Self Care

Why the 6-week Clearance Isn’t Enough

So you’ve had your 6-week postpartum check-up with your doctor, OB or midwife. They say ‘All is good, you can resume exercise’. You think ‘Awesome! I’m going to go out for a run tomorrow!’. Then tomorrow comes, you start running, and you feel like a bowling ball is bouncing inside your vagina, you leak, or worse you lose control of your bladder or bowels.

No one wants this. Why didn’t they warn you?

You’re not alone. The fact is, it takes a lot longer than 6 weeks for your pelvic floor, abs and uterine ligaments to return to normal. I am 5 months postpartum and still only feel maybe 90% normal. I can’t tell you why doctors and midwives don’t talk about this, but I’m hoping by reading this you’ll have a little bit more insight into postpartum exercise.

I talked about relaxin and pregnancy before, but did you know relaxin influences you for up to 3 months postpartum? And other hormonal changes will influence the laxity and strength of muscles, tendons and ligaments as long as you are breastfeeding?

True Story, Bro.

Let’s look at this logically though. Even if we take the scientific mumbo jumbo out. Your uterus was just huge (relatively speaking), then within the span of 6 weeks (or less) it shrank back down to the size of a pear. All of those ligaments, tendons and muscles that were holding that giant uterus up for 9 or so months have been stretched and loosened to accommodate it. They are going to take time to get back to where they were before. Here’s some perspective, if you had your leg in a cast for 9 months, then got the cast cut off, do you think you could go out and run a marathon 6 weeks later? Doubtful. Why do we treat all those very stressed ligaments inside our abdomen and pelvis any different? They’ve gone through massive changes and we need to respect that. We need to slowly and gently start adding exercises back in to allow those structures time to re-adapt back to their former glory.

Think of your pelvic floor like a trampoline. Now imagine a 400lb sumo wrestler sitting on that trampoline. That’s what your pelvic floor is like at the end of your pregnancy. Trying desperately just to keep everything up. Now imagine that sumo wrestler sitting there for a few months. How stretched would that trampoline be?

Ya, let that visual sink in for a moment.

We want that PF to bounce like trampoline, and be taught enough to resist the pressure of the organs it’s holding up (uterus, bladder, bowels) but flex with breath and impact. If you were trying to fix that stretched out trampoline, and someone kept jumping on it while you were working, it wouldn’t be very effective, would it? This is how it works with your PF and impact postpartum.

So what do I mean by ‘impact’?

I mean jumping, skipping, running, jogging, box jumps, jumping jacks, basically anything where there’s a period of time where both of your feet are off the floor, no matter how short the period of time is. Yes, even if it is a split second. Yes, even if you land gently.

Now, this isn’t to say you can never do these things again. This is definitely something you can work your way back to eventually. But you have to take your time, be careful and do it right. If you want your body to be functional well into old age, it’s important to take care of it now. If you want to have more children and want your body to support those pregnancies well, it’s important to respect this postpartum period and recover appropriately.

So the next question is how?

Well first, go see a Pelvic Health Physio (do I sound like a broken record yet?). Then work with a personal trainer who specializes in postpartum (like me, soon!) or purchase a program that is designed for postpartum women, like Birth2FitMum.

The most important thing, though, is to be mindful of your body. If things don’t feel right, don’t do them! Let go of your ego, and just be proud of where you are at currently. Just because you aren’t in the same place you were months ago, doesn’t mean you are broken, it’s all part of the journey! You grew a human! Go You!

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While I am in the process of obtaining my PT certification with prenatal/postpartum specialization, I’m not quite there yet. Even then, I won’t be able to help everyone, but I don’t want that to hold you back from reaching your goals. My lovely friend Lorraine Scapens over at Pregnancy Exercise has most generously offered to give my readers a 10% discount on her programs that I used when pregnant and still use postpartum; Fit2BirthMum & Birth2FitMum as well as her other programs Super Fit Mum & No More Mummy Tummy Challenge. Simply enter the discount code ‘HMHB‘ at checkout to get your 10% off!

Birth, fitness, pelvic health, Pregnancy, Self Care

Pregnancy Fitness – How I did it

In previous posts I mentioned that I maintained working out throughout my pregnancy. Now let me preface this by saying I am not a doctor, midwife, physiotherapist or personal trainer (working on this one!) and I am simply explaining what I did, what worked for me and how I felt doing it. Before I got pregnancy  I was working out regularly, lifting (relatively) heavy weights and doing some high intensity workouts.

Most women experience a dip in stamina in the first trimester, and I was no exception. Even though I only had minor morning sickness I definitely had the fatigue, all I wanted to do was sleep. And I did. Because why not? I was smart enough to realize that come 8 or so months from then I wouldn’t be able to sleep all day, so I did! In addition to magnificent, glorious, magical sleep (can you tell I am writing this post-baby, with a 2 month old who still enjoys multiple night wakings?) I continued on my merry way working out the way I normally do. I lifted weights 1-3x per week, depending on my work schedule, and walked 25-60 minutes with the Big Brown Dog 4-6 days a week. I did not do traditional “cardio”, mostly because I fucking hate running. Hate. Despise. Loathe. I tried it once last year in preparation for the Tough Mudder. I managed to scrounge out a few 8km runs and deluded myself into believing I found the ‘runners high’ but nothing stuck.

I digress.

The moral of the story is until about 14 weeks, nothing changed. I worked out normally, lifting ‘heavy’, walking. Living life. Somewhere around the beginning of the 2nd trimester I decided to purchase the Fit2Birth Mum program from pregnancyexcercise.co.nz. I cannot say enough good things about this program. It felt exactly as hard as it should, I ended my work outs sweaty, but I never felt overworked or out of breath. The best part of her program is the owner, Lorraine Scapens, also hosts a Facebook group for each program and answers questions from users about their specific needs in a timely and friendly fashion.

In addition to the Fit2Birth program I continued my weight lifting, progressively lowering my weights as the weeks went by. For some perspective I started deadlifting and squatting approximately 150lbs, and my final weight lifting session was somewhere around 34 weeks and I was lifting about 65lbs, read: less than half my normal, but probably way too heavy for some other women. I also focussed on maximizing the strength and flexibility of my pelvic floor. I did many stationary squats (think peeing in the forest) as this has many benefits for pregnant ladies, which I will get into in it’s very own post later on down the road.

Now for the benefits, at least from my perspective.

As mentioned previously, around 9 weeks or so, I made a lengthy journey across the country to share the good news with my family in person. This included many hours sitting awkwardly in an airplane. I think it’s no coincidence that this is also when I started experiencing sacral-iliac joint pain. I thought this was the end of the world as I knew it. Working out keeps me sane. I knew a lot of women start having SI joint pain, and they are hooped. No more workout. No more walking. No more functioning. Done. So I snuck down to my nice little basement gym and did the easiest workout I could muster, and prayed and went to bed. The next morning before I got up, I was so paranoid that the soreness from my workout would be the death of my in addition to my newfound SI pain. I got up. I was sore. But no SI pain? Magic!

Well if you think about it, SI joint pain is usually born from a poor interaction of the sacrum and the ilium, two bones on the back half of your pelvis. Relaxin allows the ligaments holding the two bones together to loosen, allowing the bones rub painfully. One would think, strengthening the muscles around these bones would help hold them in place properly, decreasing the amount of pain. This was certainly true for me. This carried on throughout my pregnancy, every time I got lazy and didn’t work out for a while, my hips would get sore, I would work out, the pain would go away.

I also believe working out helped Nugget be in the perfect position for birth from early on. At my 20 week ultrasound his head was so low in my pelvis the tech had to all by smash my bladder in order to see it well enough to take measurements. This was true again for my follow up ultrasounds at 24 and 34 weeks. As soon as I knew that he was head down, I squatted until I could squat no more! Squatting is a functional movement. Back in the day (re:100+ years ago) humans used to squat regularly. Think hunting/gathering/child rearing/harvesting fields etc. Our bodies were designed to squat! It makes so much more sense physiologically than bending at the hips. We are so much stronger in a squat! Also, squatting helps open up the pelvic bones and lengthen the pelvic floor to allow the baby’s head to descent into the pelvis and make it less likely to flip. I’ll explore and share my love for the squat in it own post later on, as I could go on forever!

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While I am in the process of obtaining my PT certification with prenatal/postpartum specialization, I’m not quite there yet. Even then, I won’t be able to help everyone, but I don’t want that to hold you back from reaching your goals. My lovely friend Lorraine Scapens over at Pregnancy Exercise has most generously offered to give my readers a 10% discount on her programs that I used when pregnant and still use postpartum; Fit2BirthMum & Birth2FitMum as well as her other programs Super Fit Mum & No More Mummy Tummy Challenge. Simply enter the discount code ‘HMHB‘ at checkout to get your 10% off!