Health & Fitness over 4 years ago by Liz Adams

Wellness Expert Q&A: Advice from a Pre- and Postnatal Physical Therapist

I have a feeling a lot of you are going to be very excited to read today’s Wellness Expert interview with Dr. Laura Gleason, a Physical Therapist and fitness instructor specializing in pre- and postnatal women’s health. Laura is passionate about working with pregnant and postpartum women and founded Beyond the Bump Wellness in 2018 with the goal of bridging the gap in the current standard of care for postpartum women. Laura offers workshops and virtual consults that focus on optimizing physical, as well as mental and emotional, wellness after having a baby, and she loves helping expecting and new moms exercise in a way that will support long term health and wellness. You all submitted so many great questions for Laura, so let’s get to it!

Q: How can I mentally prepare for all of the physical and lifestyle changes that come along with having a baby? I really want kids but I’m terrified of childbirth!

A: I believe knowledge is power so the more you can educate yourself now, the more prepared and ready you may feel. While certainly, some things are out of our control, there are many things you can do to be proactive about preparing for childbirth and postpartum recovery. Assemble your “team” that will help support you if you need it. This may include a Physical Therapist, doula, lactation consultant, mental health professional, etc. 

Q: Is there anything women should be doing, health-wise, if they plan to start “trying” in 1-2 years? 

A: One thing I would suggest is to get your baseline. How well can you contract and relax your pelvic floor? How does the space between your abs feel (from your sternum down to your pubic bone). This will give you something to compare to postpartum when you are regaining abdominal and pelvic floor function. If you know you had a 2 finger width gap between your abs before pregnancy, then a 3 finger gap postpartum isn’t as significant, for example. 

Q: Please share your tips for preparing for birth! Do things like perineal massage really help? 

A: One of the most important ways to prepare for birth is to learn how to relax your pelvic floor and practice this while you breathe. An easy way to practice is when you are having a bowel movement! Try to keep your throat open vs closing it off and bearing down. Learning to push with an open glottis (keeping your throat open) can be protective of your pelvic floor during delivery. Perineal massage (where you massage and stretch the back part of the vagina and the tissue between the vagina and anus) may be helpful starting at 34-35 weeks, and the latest recommendations are 2 times per week for 10 minutes, but check with your OB or midwife first. 

Q: I’ve read a few articles lately stating that it’s easy to do Kegels the wrong way. What is the right way to perform Kegel exercises? 

A: First of all, it’s not just all about kegels! It is important to learn how to do the opposite and relax your pelvic floor as well. For some women, it may be very challenging to do a kegel before they learn to relax first. Some women actually bulge downward instead of lifting upward, and it should be a squeeze and lift. One of my favorite cues is to think of the claw game at arcades- you know, the one that is impossible to actually get the stuffed animal. Your pelvic floor is like the claw: it lowers and opens as it relaxes and then closes and lifts as it contracts (kegel). Sounds silly, but try it 🙂  Incorporating breathing can also be helpful: inhale as you relax and exhale as you contract/kegel. Finally, it is important to incorporate all of this into functional movements and be able to have good pelvic floor control when you are standing, walking, lifting the car seat, etc so practice kegels in different positions. 

Q: What kind of exercise do you recommend in the 3rd trimester? 

A: Exercise during all stages of pregnancy has so many benefits, but this is not the time to go for personal bests. Similar to postpartum exercise, pay close attention to how your body is feeling and modify further for any symptoms you experience. Respect the fact that your balance may be off, it may be harder to breathe, etc. Strength training is my favorite mode of exercise during pregnancy. After delivery, the core is very weak, but if you have strong arms and legs, that will help you function better in those early days/weeks especially. 

Q: How do you know you’re ready to start working out after having a baby?

A: Every person is going to be different in their recovery, but here are a few key guidelines. 

  • Keep in mind that even if you exercised a lot during pregnancy, you’ll be deconditioned after delivery/recovery, and your body is completely different! It’s important to rehab and retrain your body before you jump back into your old workout routine the second you are “cleared” by your OB/midwife at 6 weeks. 
  • You can start working on breathing, gentle core engagement, contracting AND relaxing your pelvic floor, stretching, walking, etc within the first few weeks after delivery.
  • Actual working out needs to start very easily and progress slowly. Women are often given the advice “just listen to your body” but so often they don’t know what to actually listen for! Things like incontinence (leaking urine, stool, or gas), changes in urgency or constipation, pressure or heaviness in your pelvic floor, coning/doming along the midline of your abs, or pain anywhere are all signs from your body that you aren’t quite ready for that movement or level of exercise. Modify and take a step back, but if it doesn’t improve, that is a great time to seek guidance from a PT. 

Q: What are some easy at-home workouts for postpartum moms?

A: I encourage women to do whatever they love to do: things like yoga, pilates, cardio, strength training all have their place and can be done at home with little to no equipment. It is not so much what you do but how you do it. So pay attention to form, breathing, and frequently checking with how you are feeling. Exercise at this stage should be restorative and leave you feeling energized, not depleted. 

Q: I’ve been experiencing a fair amount of pelvic pain while getting back to running postpartum. Any ideas for what may be going on? 

A: It may be that you need to build up more baseline strength first. Running (with correct technique) is not easy! It takes a lot of strength and control. I would suggest really focusing on strengthening especially in your glutes and core. If you are breastfeeding, this is even more important as you may have more overall laxity around your pelvis (and your whole body) due to hormones. A video running analysis can also be very helpful to be able to watch your running gait in slow motion and identify anything that may be contributing to pain. Finally, I would encourage you to take it slow. Recent guidelines suggest waiting until 12 weeks postpartum before returning to running (but doing a lot of strengthening and pre-running exercises before that time), and then it should be a gradual process starting with a run/walk program. 

Q: Is it normal to still feel very sore “down there” at 8 weeks post-partum after a day of light activity? 

If you have done more activity than you are used to, some soreness is to be expected. You are still recovering! If soreness does not go away, consult your healthcare provider. 

Q: Would love to hear your tips for recovering from C-Section! 

A: One of the most important things to consider after c-section is scar massage. I see a lot of women months or years after their cesarean birth who have a lot of sensitivity, discomfort, and adhesions (the skin doesn’t move well) around their scar. This may contribute to other issues including back and pelvic pain, inability to use your abs effectively, and even pain with sex.  Always follow your OB/midwife’s advice, but you can typically start gently touching around your incision soon after delivery. After the incision is healed, usually around 6 weeks, you can start massaging directly over your scar for a few minutes a day. Move it in all different directions, focusing more on areas that seem less mobile. 

Q: Are the belly bands worth the hype? 

A: There are a couple of types of “belly bands”, so I’ll briefly address each of them. First of all, belly supports during pregnancy can definitely be helpful for decreasing discomfort on the belly, back, and pelvis. After birth, there is absolutely no evidence that belly bands/binding/wraps help your abs come back together or shrink the circumference of your belly. And, especially if you have it very tight around your midsection, it can actually cause increased pressure downward on your pelvic floor and contribute to symptoms of prolapse, like heaviness and bulging. If you are given a belly band/support after a c-section, that can be beneficial but try to wean out of it as soon as you comfortably can and don’t have it too tight. 

Q: If I experienced mild pelvic floor prolapse after having my first baby, will a second baby/birth make it worse? 

A: Not necessarily! I would recommend working with a Pelvic Floor Physical Therapist to make sure your pelvic floor is in as good of shape as possible prior to a second pregnancy and to learn strategies to continue to manage prolapse symptoms during pregnancy and with pushing. During delivery, pushing with an open glottis (keeping the back of the throat open) vs holding your breath and bearing down can be protective of your pelvic floor. 

Q: Do you have any exercises to help repair diastasis recti or help with that lower belly pooch? 

A: I get this question sooo much and I wish I could give everyone 1-2 magic exercises that would help their diastasis recti. The fact is that every body is different, and there are many factors that may influence diastasis recti. A few things that almost everyone can benefit from are learning to breathe well, addressing postural issues, and regaining lower abdominal and pelvic floor muscle strength. 

First, it is all about breathing…When we are pregnant, we often fall into shallow breathing patterns out of necessity since there is a baby in the way of taking a good deep breath. After we have the baby, working on taking diaphragmatic breaths, where you expand 360 degrees around your ribcage is important for your abdominal and pelvic floor function. It also helps stimulate the parasympathetic nervous system which helps us relax and what mom doesn’t need that?!

Second, postural issues…There are postural changes during pregnancy that can persist long after childbirth if not addressed. Things like flared out ribs and excessive pelvic tilting can contribute to diastasis recti.

Finally, strengthening the lower abdominals and pelvic floor…Typically during pregnancy, the lower abdominals get most stretched while the upper abs stay tighter and stronger. This imbalance can contribute to diastasis recti. Learning to activate your lower abdominals (and pelvic floor) effectively can help improve tension along your midline and improve overall core function. 

It is also really important to try to incorporate these things throughout your day. For example, if you catch yourself holding your breath, having poor posture with ribs thrusted way out, and overly gripping with your upper abs every time you lift the car seat (or a laundry basket or a toddler), that is likely not going to be helpful for your diastasis. Instead, try exhaling, stacking your ribs over your pelvis, and engaging your pelvic floor and lower ab muscles while you lift! 

Q: Would love to hear your tips for building pelvic floor strength back up again. I hate peeing in my pants!

A: See my response about kegels! Other tips depend on when you are experiencing the incontinence. If it is when you cough or sneeze, try thinking about quickly contracting your pelvic floor right before. Leaning slightly forward on the balls of your feet can help activate the front part of your pelvic floor (where the pee comes out!) and decrease leaks. If you are peeing your pants when you run or do high impact exercise, you’ll want to also work on the technique of the activity and coordinating pelvic floor function with all the other muscles you are using during that activity. If you are leaking because you can’t make it to the bathroom in time, try taking some deep breaths and distracting yourself by counting backwards, for example, to decrease the urgency. 

Q: Any suggestions for lower back/hip pain from carrying a baby all the time? 

A: This is so common because after pregnancy and birth, your core is very weak and then you have all of these really high demands on your body: carrying a baby all the time, lifting that awful, awkward car seat, sitting for a long time in less than ideal positions while feeding, etc. Building strength back up will definitely help those aches and pains but in the meantime, aim to have variety in your movements and positions. Try carrying your baby on the other side of your body for part of the time or use a carrier/wrap. 

Q: How do you recommend staying active postpartum when we are so tired all the time? It’s hard to get motivated when I’m running on empty! 

A: Such a great question! I think it can be helpful to reframe what staying active and exercise mean to you. For example, instead of trying to get out the door to the gym, focus on moving your body throughout your day to day activities. Do a few exercises on the ground when your baby is doing tummy time or playing on the floor, go for a stroller walk, do some squats every time you change a diaper, etc. Ideally, doing even little bits of exercise and movement throughout your day should energize you a bit. Find a group of moms to exercise with (possibly virtually these days!) so you can get some socialization as well (with or without your babies).  And give yourself grace! Sometimes you have to prioritize sleep over exercise and that is OK!!

Thank you for including me in Wellness Month! These were some awesome questions that were asked. This is definitely a very crazy time in the world right now, and prioritizing our wellness is more important than ever. If you want more information and support, and maybe seeing a Physical Therapist in-person isn’t an option for you right now, some PTs including myself are offering virtual online consultations. I would love to continue to help you navigate your pregnancy and postpartum period. ❤️

Thank you, Laura, for sharing your expertise! Anyone interested in learning more is welcome to connect with Laura on her website, Beyond the Bump Wellness, or on Instagram and Facebook.