In a culture shifting away from body-shaming and leaning towards encouraging empowerment of your journey throughout pregnancy and childbirth it's no wonder that the loud pressures of pregnancy "fitness" have been reduced. Embracing curves, stretch marks, and all shapes and sizes of pregnancy is becoming more and more emboldened. All throughout mom-groups and birth groups, you'll now hear women chanting along the lines of "We are powerful, hear our birth roar!"
We now know that yes, you can gain more than 15-20 lbs and still have a healthy pregnancy and birth. While being active in pregnancy is still good for you, your circulation, your endurance, and mental health, there is a whole other side to prenatal fitness that many people don't know.
To understand what we are about to get into, you need to know some basics about the pelvic anatomy.
First off, the pelvis is mobile. It is not one solid piece of bone. Not only is it mobile, but it is surrounded by many different muscle groups, such as the pelvic floor, the psoas, and glutes. Included in the pelvic structures are also significant amount of ligaments supporting the pelvis.
Throughout the end of pregnancy, the body is flooded with a hormone called Relaxin. Relaxin is responsible for helping cervical change, preparing the uterus to accept Oxytocin (the hormone to cause contractions), and it also creates a relaxing effect on our joints. This is to help relax the anatomy of the pelvis, allowing it to become even more mobile during labor and birth, and to allow a baby to pass through it.
Understanding this is important, because what people think prenatal fitness is about [physical health], is actually about helping this hormone Relaxin do its job. The goal of Relaxin is to open everything up, but in our daily lives we are constantly tight, malpositioned, sedentary and setting up our bodies to have difficult labors and births. It is believed that our current lifestyles, along with our current medical model of care for maternal health, have been apart of the US's high cesarean rates.
Want to avoid pregnancy aches & pains and even reduce your risk of a cesarean section?
Doing the activities listed below can help, not only stretch the right muscles and ligaments, help open up your pelvis, but also make sure your baby is in the proper position for birth (Pro tip: is isn't only about baby being head down!).
Dr. Rachel Miller, a Physical Therapist that specializes in prenatal and postpartum women's health in Metro Detroit, MI states that "The Pelvic Floor is a collective of muscles that have a very important job of delivering a baby earthside. Often times, overexercising the pelvic floor in a way that does not allow relaxation or lengthening of these muscles, may impact the flexibility of the pelvic floor". If you're pelvic floor is too toned, you may experience difficulties birthing your baby.
Remember those kegels everyone tells you to do? Dr Rachel Miller discussed how pelvic lengthening, aka a "reverse kegel", can be done to down train the pelvic floor to prepare it for birth. She states "These are equally as important as strength and cardiovascular activity". You can do this activity by lying on your back or side, and using your breath to tune into your pelvic floor. "When you inhale your pelvic floor will naturally lengthen, and when you exhale it will rise. You can use positions such as deep squats, happy baby, or child's pose to help tune into the pelvic floor which stretch and lengthening these muscles"
Doulas, midwives, and OBs often run into too-tight pelvic floors with people who do significant amounts of core work and tightening, such as professional dancers and runners. This may run the risk of a baby being unable to descend, becoming distressed during descent and potentially the need for an episiotomy if baby is too stressed, or cesarean if a baby cannot descend into the pelvis and past the pelvic floor.
Dr. Rachel Miller states that a person with a too-toned pelvic floor may experience "being unable to tune into the rising and falling of the pelvic floor while resting, a hard time letting go or has to bear down to poop or pee, or in some cases entry pain with sex." She recommends focusing on lengthening your pelvic floor starting at 34 weeks.
She also strongly encourages prenatal yoga. Prenatal yoga is a practice that works on balancing, lengthening, and flexibility within the pelvic muscles and ligaments. All things which promote a healthier, easier labor and birth.
Evidence has shown a reduction in pregnancy pain, labor pain, hypertension, intrauterine growth restrictions, depression and anxiety in those who practice prenatal yoga.
Another exercise she cautions against is sit ups during pregnancy. "You can look for signs of doming, or tenting in the midline of your belly, leakage, or pain as a sign of increased pressure. Although there is no research yet to show that this will reduce chances of Diastasis Recti, aka Mummy Tummy, being aware of the signs of increased pressure on the midline may be a helpful strategy". So during your workouts, pay attention to what you're feeling in your belly. Do you feel pulling or burning at the end of the day or after your workout? Even being mindful of how you get out of bed or sit up off the couch should be watched.
Look for a physical therapist in your area who works specifically in the women's health and obstetrical field to create a plan that is just right for you! Continuing care after birth is just as important to restore the strength of your pelvic floor after a baby has passed through. Even if you do have a cesarean birth, the weight of a pregnancy can do some damage to your core and floor. In France, all birthers receive pelvic floor therapy after having a baby and its time we catch up and take care of our birthers too! To learn more about Dr Rachel's services, or schedule a virtual consultation with her you can go right to http://drrachaelelizabeth.com/. She also offers a free eBook for the 4th trimester and has a blog to learn more.
Correcting Imbalances and Restrictions During Pregnancy
Along with these changes in your routine, you may also want to consider adding in Chiropractic care to your physical health routine. As mentioned before, pelvises are significantly more mobile in pregnancy, and our lifestyle keeps them [typically] malpositioned. From the way we sit, walk, and sleep to injuries, falls, or bumps you may have had prior to or during your pregnancy, all affect your pelvis. Think about the way you sit on a couch or chair, typically your sacrum is tucked in [Ever have sciatica? Get your sacrum off that nerve!]. If you think of a mobile pelvis, that needs to be wide open to birth a baby, closing off your sacrum reduces significant amount of space. This is why birthing on your back, may actually limit your pelvic space as there is less room for the sacrum to move out of the way as intended.
In many people, their pelvis can be tilted, and off balance. Chiropractic care, specifically the Webster Technique, can help ensure your pelvis is balanced and prepared to open for birth completely. Chiropractic care can even reduce your risk of having a breech baby!
Why does your pelvic physical health affect labor and birth? And what is the 4th important step to an easier birth
Remember that Pro Tip of "It isn't only about a baby being head down" we mentioned earlier? Here is what we mean. Which way your baby is facing, if their chin is tucked, or if their head is tilted can all affect labor patterns, where you feel your contractions, if a baby is less likely to fit through the pelvis, if your labor progresses or stalls, how long your labor is, and how long you will be pushing for. And all of those factors can be affected by your prenatal and pelvic fitness throughout your pregnancy. An imbalanced pelvis, pelvic floor, or tight ligaments can create restrictions that change the baby's head position in your pelvis.
Ever heard of back labor? They're typically really long labors, need intervention, and require a cesarean more often because that means a baby is posterior aka Sunnyside Up! Positional work during pregnancy, and in labor to release any restrictions holding the baby in that position, will help rotate the baby into a better position, easing back labor, and helping prevent a cesarean birth.
One trailblazing organization that is changing the way doulas, midwives, OB, and nurses practice positional work in labor is SpinningBabies. SpinningBabies was created out of the physiological aspects of birth in regards to Optimal Fetal Position (The best position for baby to be birthed), the pelvic structures, creating balance and space within the pelvis and uterus, and allowing baby to be in the best position for birth. The bodywork that SpinningBabies practices is based on releasing restrictions of the muscles, ligaments, and fascia within your pelvis. SpinningBabies has shown to reduce the need for a cesarean by up to 14%!
To learn more about SpinningBabies and what exercises you should be doing go to their shop and purchase the Parent's Class DVD along with their Daily Essentials. Warning, you'll be upside down with loads of information about your body and your baby!
If you're expecting, consider adding in a pelvic floor therapist, prenatal yoga, chiropractic care, and SpinningBabies to your routines for a shorter and easier birth experience. Your local doulas may be able to help find resources near you for someone who specializes in prenatal and postpartum care, and may help you utilize these tools in the birth room as well. Finding a doula that is trained in SpinningBabies is worth their weight in gold!
Margaret Rodeghier is a birth & postpartum doula, placenta encapsulation specialist, and Certified Lactation Counselor in Metro Detroit, MI. She has been providing professional services throughout Southeast Michigan since 2014, and attended her first birth in 2005. Margaret has 2 children that share her childhood love for Harry Potter and lego building. To learn more about her services you can find her at ProfessionalBirthSupport.com and m.me/TheGPdoula