At the risk of making the understatement of the year… giving birth is no walk in the park! But once our beautiful bundle of joy has arrived, we often assume that our bodies will snap back into shape with no problem. For some lucky ladies, they may pop back into their pre-pregnancy clothes relatively quickly, however, we all go through such huge physiological changes during pregnancy, that there is no escape from the affect it has on our postpartum body, whether we can see it or not.
OUR AMAZING BODY
If we take a moment to understand just a few of the changes that occur during pregnancy, it’s no wonder we can’t go through pregnancy unscathed. Our bodies are truly amazing – adapting and growing one, if not more, small humans at once.
Changes to our bodies during pregnancy stem from the growth of the uterus along with physical and hormonal changes that directly affect posture, ligaments and joints. Hormones such as relaxin cause laxity in the joints, particularly the pelvis, which can lead to pelvic and lower back pain during and post pregnancy. As the bump size increases, the position of the pelvis alters and tilts to allow the baby space. This change in alignment puts more pressure through the lower back. General core strength will be compromised as the muscles stretch to allow space for the baby and the continued laxity means pelvic stability is challenged. Glutes tend to weaken, hip flexors tighten, pelvic floor strength is diminished – all of which leads to bad posture and alignment.
It’s not surprising that almost 80 percent of women suffer with back pain throughout and after pregnancy. Much of that pain comes from this postural malalignment. After going through the physical challenge of childbirth, our bodies then have to deal with a variety of, often-unspoken, post-birth realities:
- Your uterus is still swollen, your organs are still disarranged, and your skin is still stretched with possible stretch marks
- You bleed. This can continue for 2-8 weeks
- Your breasts will more than likely get larger and more painful
- All of the increased weight won’t just disappear overnight!
- Your feet may have grown. Due to the increase weight during pregnancy (about 25-35lbs) the arch of the foot is flattened
- Bladder weakness and incontinence is common. This can affect everyone whether you have had a C-section or vaginal birth.
With all of the above and more happening, of course our bodies are going to have changed.
And on top of the effects of pregnancy and birth, postpartum our bodies go on to cope with hunching over to breastfeed, carrying ever-heavier babies/toddlers on shoulders/hips, as well as weakened abdominal and pelvic floor muscles and an out of line pelvis. It’s no wonder most women soon develop slumped shoulders, tucked under tailbones, saggy bottoms and an overly forward head & neck – all known as a postpartum posture.
We all may recognise the image on the left below. Whist having perfect posture may not be sustainable all of the time, the postpartum body tends to suffer from malalignment more than others.
Vanity aside, this type of posture can leave us with excruciating neck pain, pelvic instability and pain, headaches and a general sapping of energy. When it comes to postpartum posture, the most important areas to focus on are lengthening out the short, tight muscles in the front of the body, working the posterior chain (back of the body) to strengthen the glutes and back muscles, retraining the pelvic floor and core and addressing any abdominal separation (diastasis). All of which will help realign your body.
EXERCISES TO SUPPORT THE POSTPARTUM BODY
Initially, exercises that help the body move more freely whilst strengthening are key. Mobilisation can help open tight chests, hip flexors and backs, making you feel more reinvigorated. Try these simple stretches:
- Kneeling hip flexor stretch
- Kneel on a mat and bring one foot forward placing your foot on the floor whilst kneeling on the back leg (in a lunge position).
- Keep a soft tuck of the pelvis to lengthen the lower back as you shift your weight forward until you feel a lengthening in the front of the hip. Hold for 30-40 seconds, then repeat on your other side.
- Place the hands on the floor for extra support if necessary
- Avoid extending in the lower back
- Doorway chest opener stretch
- Standing in a doorway, place one or both hands on either side of the doorway in a Y position. Take one step forward and allow the chest to stretch. Hold for 30-40 seconds.
While we’re all understandably keen to get our ‘pre-baby’ body back, it is important to take it steady. Through pregnancy, great strength in our abs is lost. Jumping back into old workouts can actually make these problems worse and more serious. Instead, abdominal workouts should focus on ‘knitting’ these muscles back together.
THINGS TO WATCH OUT FOR
Often the postpartum body has a few big alignment or muscular issues (such as diastasis recti) that need particular attention. If you are feeling increasingly uncomfortable, make sure you listen to your body and do get seen by a practitioner so you can get the correct treatment.
Pelvic girdle pain can often be the result of Symphysis Pubis Dysfunction (SPD). Simply put, this is where the front of the pelvis can slip or move causing sharp pains in the pubic area or groin. This is an unpleasant side effect of pregnancy and childbirth that can continue into postpartum life until pelvic stability improves, hormonal changes stabilise and the correct treatment is given.
A pelvic belt can be used to help support the pelvis, but appropriate rehabilitative exercises are essential. Almost all women with SPD will find parting their legs causes pain. So, exercises should be small, controlled and symmetrical, focusing on pelvic awareness, connection and strengthening. Functional exercises (that help with sitting, lying down and walking) will help you learn how to manoeuvre comfortably in everyday situations until you recover.
Sacro-iliac (SI) Pain is another pelvic girdle issue which can present itself during and most certainly after pregnancy. The pelvis is made up of more than one large circular bone:it consists of paired hipbones, connected in front at the pubic symphysis and behind by the bottom of the spine (sacrum) each made up of three bones. During pregnancy, the soft tissues supporting the SI joint loosen due to increased levels of the hormones which put abnormal wear and excessive stress on the SI joints. This change can cause lower back pain, sciatic symptoms and can be felt whilst driving, walking and lifting.
Again, the good news is that it is treatable. Side lying, asymmetrical rotation and exercises that mean parting the legs should all be avoided. Instead working the core and pelvic floor will help to support and stabilise the pelvis.
The following two exercises will help build strength in areas that pregnancy tends to affect. Building posterior chain strength (the back of your body – saggy bottoms, hamstrings, and weakened back muscles) is essential to regaining correct posture, along with your deep core stabilising muscles and pelvic floor. After 6 weeks postpartum these are great to practice every other day to aid your body’s recovery.
Stand with your legs slightly wider than hip width. Inhale to prepare and on your exhale zip up your pelvic floor from front to back and lower your bottom towards the floor hinging at the hips and keeping as upright as possible. Allow the arms to come in front of you. Aim to lower your bottom level with the bent knees, to challenge your core and mobilise your hip joints. On your next exhale drive back up through the heels, pelvic floor, core, glutes and legs. Aim for 2-3 sets of 10 reps.
Starting in a four-point kneeling position lengthen your spine and pelvis into a neutral position. Inhale to prepare and on the exhale connect the pelvic floor and abdominals and initiate the exercise with a tilt of your pelvis sending your coccyx towards your heels. Flex the entire spine moving one vertebra at a time. Allow only a slight flexion in the mid and upper spine and finish the move with a gentle nod of the head. Maintain this position for a breath. On the next breath, lengthen the spine from the top and bottom at the same time back to the start position. Aim for 2-3 sets of 5-6 reps.
Remember to be kind to yourself. Your body has been through a huge amount of change and trauma. Take your time to focus on your posture and not rush back into over doing it with traditional or high impact exercise until your body has had a chance to heal and recover.