3 Strategies to Get Back to Exercising After Baby

“Training gives us an outlet for suppressed energies created by stress and thus tones the spirit just as exercise conditions the body.” – Arnold Schwarzenegger

Starting an exercise program after childbirth can be hard. Adjusting to a new baby is hard enough work! Our sleep patterns change, our diets adapt, we are nourishing and caring for a baby that is dependent on us for survival. Never mind the normal barriers to exercise - changing our routine or schedule and finding time! Here are my 3 strategies to getting back to exercise after baby (or maybe starting for the first time):

1. Do what YOU love
   Do you love to run? Go on walks? Power lift? CrossFit? Yoga? Pilates? Horseback riding? My number one recommendation is to choose whatever movement YOU love. If you love going to the gym and working out, do it. If you love going outside and running, do it! Just because Mama Susie Q down the street is doing a specific exercise routine, doesn't mean you "should" too.  If you pick an exercise that you don't enjoy doing, it is going to be hard to stay motivated to do that exercise. Move for fun!
    

2. Slow is Fast
   So maybe you were an avid runner and could run 5 miles everyday or front squat 175lbs or maybe you just went on long walks. Whatever movement you loved to do, I hope you continue doing it, but it's important to build back up to where you were. Take your time, don't rush it and let the body heal from the inside out. It's not only OK, but it is great to swap out intense exercises for something slower and more focused on healing the body (like diaphragmatic breathing and functional progressions) while you replenish yourself. Having a baby doesn't make you fragile, but you can train smart!
    

3. Embrace the Chaos
   Coming from a self-proclaimed perfectionist, this one can be difficult. Pre-kiddo I could set aside a full hour and go work out. After-kiddo I'm just happy to go to the bathroom alone. That carries over to exercise routines. As nice as it is to get out of the house and exercise, sometimes that isn't feasible with work schedules and childcare. What do I do instead? I don't expect perfection and instead embrace the chaos. I let the toddler join me. Sure it might mean a 20 minute workout paired with kettlebell swinging the toddler or trying to do a dead bug with her hanging on my side or jumping on my belly. But you know what? That's an awesome workout! Some people even pay big money for that kind of resistance training...and my kid gives it to me for free! If you're hesitant to workout because of your kiddo, I encourage you to include them in the workout and go with the flow. An added bonus is that your kiddo sees you exercise. hopefully for fun and they learn that moving is part of life, not a chore!

Squats and Pregnancy (Part 3): Why Should I Squat during Pregnancy and Labor?

Now that we know how to squat during pregnancy and the health considerations we should look at prior to squatting, why would I even want to squat during pregnancy? How will squatting even possibly help labor? What are the possible benefits (and risks) of squatting while in labor?

Squat during Labor for Optimal Fetal Position

Supported squatting allows for greater mobility of pelvic joints than any other position and eliminates external pressure allowing for optimal fetal position (4)

• May enable you to rotate and descend in a difficult birth
• Squatting lengthens the trunk and allows more room for baby to maneuver into position

Squatting for Pain Management during Labor

Squatting may decrease pain severity during the second stage of labor compared to lying on one’s back:

• During the latent phase, pain severity in lying down and squatting positions was significantly less than the mean pain severity in sitting. (7)
• During the active phase, pain severity was significantly less in squatting position compared to lying down or sitting. (7)

Squatting for Decreased Labor Time

Squatting may decrease time of labor:

• The first stage of labour was approximately one hour and 22 minutes shorter for women upright as opposed to lying down (9)
• The upright position was associated with a reduction in duration of second stage for women without epidural anesthesia (8)

Benefits of Squatting during First Stage of Labor

• Reduces the need for epidural (9)

• Babies of mothers who were upright were less likely to be admitted to the neonatal intensive care unit (9)
• Women who were upright were less likely to have caesarean section. (9)

Benefits of Squatting during Second Stage of Labor

• Reduction in assisted deliveries (8)

• Reduction in episiotomies (8)
• Fewer abnormal fetal heart rate patterns (8)
• Reduction in shoulder dystocia rate (5,10)

Risks of Squatting during Labor

• Possible increase in second degree perineal tears (8)

• Increased estimated blood loss greater than 500 mL (5, 8) Note: This may be due to the ease of measuring blood loss when upright. (5)

Squatting vs Lying Down on Back Position, other Considerations during Labor

• Research shows that there is no clear difference in the number of third or fourth degree perineal tears (8)

• No clear difference in the rates of caesarean section when squatting during second stage of labor (8)
• There was mo clear difference in the number of babies admitted to neonatal intensive care when squatting during the second stage of labor (8)

Squatting in Labor: the Decision is UP TO YOU

I whole-heartedly believe that women should give birth in the position they feel most comfortable. This can include squatting, lying on their backs, sitting, on all fours, lunging, etc. There are risks and benefits in everything we do so it’s important to listen to your body and do what you feel is right. There is not one way or a right way to give birth. It’s important to take the research and do what is best for you given your circumstances and preferences!

References:

1. Russell, J.G.B., “The rationale of primitive delivery positions”, British Journal of Obstetrics and Gynaecology, Sept. 1982, Vol. 89, pp. 712-715.
2. Di Paolo, Julia, Montpetit-Huynh, Samantha, Vopni, Kimberly, “Pregnancy Fitness”
3. Russell, J.G.B., “Moulding of the Pelvic Outlet”, J. Obstet. Gynaec. Brit. Cwlth, Sept. 1969, Vol. 76, pp. 817-820.
4. Penny Simkin, Janet Whalley, Ann Keppler, Janelle Durham, April Bolding, Preconception: Improve Your Health and Enhance Fertility
5. Vicky Chapman, Cathy Charles, The Midwife's Labour and Birth Handbook
6. Reid, Harris., Alternative Birth Positions. CAN. FAM. PHYSICIAN Vol. 34: SEPTEMBER 1988
7. Valiani M1, Rezaie M1, Shahshahan Z2. Comparative study on the influence of three delivery positions on pain intensity during the second stage of labor. Iran J Nurs Midwifery Res. 2016 Jul-Aug;21(4):372-8. doi: 10.4103/1735-9066.185578.
8. Gupta JK1, Sood A2, Hofmeyr GJ3, Vogel JP4., Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev. 2017 May 25;5:CD002006. doi: 10.1002/14651858.CD002006.pub4.
9. Lawrence A1, Lewis L, Hofmeyr GJ, Styles C., Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev. 2013 Aug 20;(8):CD003934. doi: 10.1002/14651858.CD003934.pub3.
10. Nasir A1, Korejo R, Noorani KJ. Child birth in squatting position. J Pak Med Assoc. 2007 Jan;57(1):19-22.

Squats and Pregnancy (Part 2): Squats to take you from "Pregnancy Butt" to Peaches

The Many Faces of Squats during Pregnancy and Postpartum

Did you know there’s a million and one different ways to squat? And guess what, there is not a “best” squat for everyone, find the best squat variation for YOU that works with your goals! Squats are one way to help turn "pregnancy butt" into peaches.

Body Weight Squats during Pregnancy

The first set of squats are great because as parents we frequently get up and down from the ground, chair or couch and it’s great to replicate these movements. Being able to do these squats can help so we don’t get stranded on the ground or trapped under a sleeping baby unable to move. 

1. Body weight transition from Bear to Squat and Tripod to Squat —> for when you sit on the ground and need to stand
2. Body Weight Air Squats—>squatting is one of the most basic functional movements we have and it is great to train for everything from sitting on a chair to picking things up off the ground
3. Box Squats, both Conventional Stance Box Squats and Sumo Stance Box Squats—> If you ever go from sitting in a chair to standing then you already do box squats, so let’s focus on doing them correctly and utilizing the glutes to our advantage.

Weighted Squats during Pregnancy

Weighted squats are a great addition to a workout routine. As parents, we must be able to move with weight for everyday function. This includes picking kids up, carrying carseats, putting kids into beds/cribs and even bending down to pick something up from the bottom shelf of the grocery store. It’s important to add weight as it is nearly impossible to go through life without it…as much as we train for birth it is equally important to train for life.

1. Goblet Squat—> If you are new to lifting weights or need a confidence boost, goblet squats are a great exercise as it moves the load closer to your center of gravity, helping you get into a better position. Better yet, if you can’t squat low, this is a great exercise because the weight helps act as a counterbalance making it a little bit easier so you can train for progress
2. Front Squat—> This is a great squat variation for those looking to improve flexibility while strengthening the upper back and quads
3. Back Squats—> A back squat can help improve overall glute, low back and hip strength
4. Bulgarian Split Squat—> This squat help you get both deep and low into your squat, allowing for the pelvic outlet to fully open. Added bonus in the fact it helps prevent muscle imbalances, challenges mobility, all while recruiting the glutes and improving core strength and stability

Improving Squat Mobility while Pregnant

Needing a little TLC to get into the squat position? Try some squat therapy to help mobilize the hips and upper back to get you to a better squat today! Also, did you know that not being able to do a squat could be caused by anything from foot mobility to a tight upper back? If you are looking to improve your squat, give us a call at (331) 307-7110 to schedule an appointment today and start building those peaches. 

Squats and Pregnancy (Part 1): Should they be avoided?

More and more I have been asked the same line of questions, “Can I squat during pregnancy? Is it safe to squat? Why should or shouldn’t I squat?” Here are a few considerations for squatting while pregnant. As always, it’s important to work with the body you have today and do what is best for you!

Considerations for Squatting while Pregnant

1. Squatting with abducted thighs expands the pelvic outlet, the area the baby must descend from in order to be birthed but closes the pelvic inlet (3)

   1. Squatting increases the pelvic outlet by one centimeter in the transverse diameter (side to side) and two centimeters in the antero-posterior diameter (front to back). The overall result is an increase of 28% in the pelvic outlet while squatting compared to lying on the back. (1)
   2. Due to the opening of the pelvic outlet and thus closing of the pelvic inlet, deep squatting may not be recommended for babies with a breech presentation. If the baby is in a less than ideal position, it may close off the top of the pelvis and give baby less room to move around and get into the ideal position. For this reason it is generally not recommended to perform deep squats after 32 weeks unless you know the baby is head down
2. Health Considerations
   1. Pelvic organ prolapse: If you have a diagnosis of a cystocele or rectocele, then a deep squat may not be ideal until the prolapse has been corrected
   2. Hemorrhoids: Deep squatting may increase the risk of hemorrhoids due to poorly managed intra-abdominal pressure 
   3. Other health concerns as discussed with your healthcare provider
3. If you have pain during squats, please reach out! Squats should never be painful and there may be changes we can help you with to make squats pain-free.

Training for Birth: Why Should I do Squats While Pregnant?

“Squat 300 times a day and you will give birth faster” - Ina May Gaskin

We love to train for birth - doing movements that are going to help prepare you for childbirth or help with the postpartum healing processes. Squatting is one of the movements we love! The thing about squatting is that in our Western culture, we have moved away from training our bodies to squat. This is highlighted by Alternative Birth Positions which stated, “Most North American women are not used to squatting, and cannot maintain the position for long.”(6)

While the squatting position can be a great asset during labor (see Part 3- Squatting During Labor: The Research), “squatting, even unsupported can be tiring and may need to be practiced during pregnancy.” (5) The book, Pregnancy Fitness, stated that “If you haven’t been accustomed to squatting and then try to do it in labor, you may not find the success you were hoping for.” The second stage of delivery, when your cervix is fully dilated and you are pushing, can last anywhere from 20 minutes to 2 hours. You wouldn't run a marathon without training, so why not train squats in preparation for birth? 

Squats help strengthen the pelvic floor muscles in a way that is functional and natural. The muscles utilized during a squat are the same muscles needed to stabilize the core, low back and pelvic floor. Squats are a great asset to any workout regime because they help strengthen and stabilize the body in a ways that we move everyday!

Added bonus? Just because you are pregnant does not mean you do not have to have pregnancy butt (aka mom butt, pancake butt, flat butt). We believe all butts can be peaches and squats may just help build those peaches. 

References:

1. Russell, J.G.B., “The rationale of primitive delivery positions”, British Journal of Obstetrics and Gynaecology, Sept. 1982, Vol. 89, pp. 712-715.
2. Di Paolo, Julia, Montpetit-Huynh, Samantha, Vopni, Kimberly, “Pregnancy Fitness”
3. Russell, J.G.B., “Moulding of the Pelvic Outlet”, J. Obstet. Gynaec. Brit. Cwlth, Sept. 1969, Vol. 76, pp. 817-820.
4. Penny Simkin, Janet Whalley, Ann Keppler, Janelle Durham, April Bolding, Preconception: Improve Your Health and Enhance Fertility
5. Vicky Chapman, Cathy Charles, The Midwife's Labour and Birth Handbook
6. Reid, Harris., Alternative Birth Positions. CAN. FAM. PHYSICIAN Vol. 34: SEPTEMBER 1988
7. Valiani M1, Rezaie M1, Shahshahan Z2. Comparative study on the influence of three delivery positions on pain intensity during the second stage of labor. Iran J Nurs Midwifery Res. 2016 Jul-Aug;21(4):372-8. doi: 10.4103/1735-9066.185578.
8. Gupta JK1, Sood A2, Hofmeyr GJ3, Vogel JP4., Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev. 2017 May 25;5:CD002006. doi: 10.1002/14651858.CD002006.pub4.
9. Lawrence A1, Lewis L, Hofmeyr GJ, Styles C., Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev. 2013 Aug 20;(8):CD003934. doi: 10.1002/14651858.CD003934.pub3.
10. Nasir A1, Korejo R, Noorani KJ. Child birth in squatting position. J Pak Med Assoc. 2007 Jan;57(1):19-22.

Urinary Incontinence & Your Period

Lately I have heard more and more women ask about incontinence that only occurs at certain times of their cycle. For some it is the week before their period starts and for others it is only during their period that they notice increased incontinence. Unfortunately, the research on incontinence and a woman’s monthly cycle is seriously lacking. Luckily, we do have one study that gives a little insight into cyclical incontinence. The study showed 41% of women notice their incontinence is cyclical and of those women 42% notice symptoms just before their period and 36% of women notice increased symptoms during their period.3

Leaking Before & During your Period

While we need more research on cyclical incontinence, it can be helpful to look at the research we do have—specifically increased incontinence during menopause.  Menopause, like the premenstrual time frame, is when the natural production of estrogen declines. In fact, estrogen levels are lowest right before, during and immediately after the period. These low estrogen levels can decrease ligament laxity and increase ligament stiffness.4 What this means is that approximately a week before menses occurs there is a drop in estrogen which is believed to decrease the strength of the urethra, the tube that connects that bladder to the urinary meatus (how we get urine from the bladder to the outside).

The human body is an amazing thing - it changes and adapts to the hormones that our body naturally releases and the pelvic floor is no different. In fact, the pelvic organs as well as the surrounding connective tissues are all estrogen-responsive, meaning the tissues respond and adapt to fluctuations in estrogen.2 We commonly see this effect in women with stress incontinence who are pre-menopausal due to lower levels of estradiol being produced.1  With the decrease in estrogen, the  pelvic floor and surrounding ligaments are unable to appropriately adapt to changes in intra-abdominal pressure, causing increased incontinence due to the decreased strength, increased stiffness and decreased ligament laxity.

These natural fluctuations in estrogen may also affect the orientation of the cervix. The change in orientation can affect the sphincter of the urethra, or the ability to start/stop the flow of urine efficiently and effectively. This helps us better understand that increased incontinence before and during our periods may be due to the decrease in estrogen which changes the pressure around the urethra causing it to lose elasticity and not being able to fully close and stop the flow of urine.

Leaking When Using a Tampon or Menstrual Cup

By inserting a tampon or a menstrual cup we are naturally altering intra-abdominal pressure (IAP). Altering our ability to appropriately create and maintain IAP, we alter our body’s ability to properly adapt to the environment. This is done through either hypertonic (tight) muscles that are unable to properly relax and therefore unable to create a strong contraction because it is always contracting or hypotonic (reduced tone) and are not able to create a strong contraction.

Leaking only when using a tampon or menstrual cup may also be a sign of a cystocele (bladder prolapse) masking stress urinary incontinence. A cystocele can cause the urethra to kink and actually block the flow of urine. By using a tampon, it acts as a pessary to reduce the cystocele and unkink the urethra allowing for the proper flow of urine. Unfortunately, in some cases, this proper flow of urine reveals incontinence that was previously hidden by the cystocele.

What can we do about it?

As there are structural changes taking place, it may be a good idea to re-frame your workout based on your cycle. If you are one of those that notices increased incontinence prior to your period or during, it may be a good idea to transition to lower impact exercises or focus more on the rest and recovery phase of health. Now that is not to say that you can’t exercise, it may just be a good idea to swap out double unders or box jumps for step ups + push ups or unilateral farmers carry or even Russian kettlebell swings.

As with any leaking or incontinence issue, it is important to be evaluated by someone with extra training in pelvic floor health. That way a care plan can be created based on your specific needs. To find one in your area reach out to a pelvic health provider by searching Herman & Wallace Certified Pelvic Rehabilitation Practitioners or the list of APTA’s Women's Health PT.

Resources

1.    Lu Y1, Lang JH, Zhu L. Estrogen receptors in pelvic floor for female stress urinary incontinence. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2007 Jun;29(3):402-6.

2.    Tzur T1, Yohai D1, Weintraub AY1. The role of local estrogen therapy in the management of pelvic floor disorders. Climacteric. 2016 Apr;19(2):162-71. doi: 10.3109/13697137.2015.1132199. Epub 2016 Feb 2.

3.     Bidmead J, Cardozo L, Hooper R. The impact of the menstrual cycle on urinary symptoms and the results of urodynamic investigation.BJOG. 2001 Nov;108(11):1193-6.

4.     Reese M, Casey E. Hormonal Influence on the Neuromusculoskeletal System in Pregnancy. Musculoskeletal Health in Pregnancy and Postpartum: An Evidence-Based Guide for Clinicians. January 2015. (pp.19-39).