And How Both Prenatal & Postpartum Pilates + Yoga Can Help

Obstetricians are amazing. They literally save lives every day. They deal with women & families at their most vulnerable & deal with their most precious creations – their children. They pay more in professional liability insurance than any other kind of doctor. There is just so much at stake. So it makes sense that their focus is on getting a woman & her baby through pregnancy & delivery without complications.

Unfortunately, there is a huge gap between pre & post-natal medical care & good information being given to women around post-natal recovery. Why aren’t obstetricians telling women about appropriate exercise & movement during pregnancy? Why don’t they give guidance around healing pelvic floor issues post-birth? And why does no one talk about continence problems & prolapse after having a baby?

The simple answer is – it isn’t their job. That’s not what they’re trained to do.

Some OBs will refer their patients to a women’s health physiotherapist during pregnancy. But only if there’s an obvious issue (such as pelvic or lower back pain). Some private hospitals in the western world will provide a session or course with a physiotherapist. But only after they’ve delivered their baby. Women’s health physios are an incredible resource during pregnancy. If you have the option to do so, I recommend everyone see one routinely from their second trimester onwards. And continue post-birth.

But what about all the women who don’t fall into these categories? Who doesn’t have access to good physiotherapy care? If you’re never guided about appropriate exercise while pregnant? Are those who are told by their doctor or midwife that it’s “normal” to have continence issues after birth or experience a prolapse? These things are so common, but they are not normal. And in many cases, they’re avoidable or treatable.  

In Australia, the US & the UK, it is common practice to have an average of 12 visits with a doctor while pregnant. Once the baby has arrived, how many visits does a woman routinely have? ONE. One visit. This appointment usually involves checking for healing of stitches & incisions that happened during the birth. But there is so much more that we need to be aware of before returning to normal life & our regular exercise routines.

Here are 5 issues that I see affecting post-natal clients & strategies to manage/avoid/heal them where possible.

1.      Exercise Pre & Post Birth

One of the best ways to take care of your body & avoid a difficult post-natal recovery is to exercise carefully & correctly during pregnancy & after delivery. Appropriate exercises will give you the core control that you need without the strain & pressure on the abdominals that we want to avoid.

What can you do to help?

As soon as you find out you’re pregnant, start making modifications. While prenatal yoga & Pilates are ideal, always avoid intense abdominal exercises such as sit-ups, crunches, seated twists, full planks & side planks. You want to allow your “6-pack” area (the rectus abdominus) to soften as it needs to expand & separate as your baby grows. A lot of trainers will advise you to stop doing abdominal exercises such as these from the second trimester onwards (usually when you start showing a small bump). But it makes more sense to allow these muscles to soften as soon as possible. Overly tightening this area will only make it more difficult for the muscles to soften & separate later on. Instead, focus on core exercises that keep your spine in a neutral (straight) position such as all fours kneeling, side-lying, standing & sitting.

2.      Diastasis Recti

This is the most common complaint I see from women, and in many cases, it isn’t a problem & will rectify on its own as long as you take some simple precautions. A diastasis of the rectus abdominus is where your anterior abdominal wall (your 6-pack muscle) separates from the connective tissue in the center (called the linea alba). In a full-term pregnancy, 100% of pregnant women will have this abdominal separation. It is completely normal. However, problems can arise if the separation remains weeks/months post-birth. Your doctor, a physiotherapist, or a good post-natal exercise instructor are the best people to check this for you, but you can also check it yourself (although keep in mind a lot of people find it difficult to know what they’re looking for). I have a short video tutorial on this which you can access here. Essentially, we are looking for a separation of less than 1cm, and some resistance of the connective tissue (rather than a very soft or weak midline). Any more separation than this is an indication your core muscles are not functionally supporting your spine & there is likely to be a weakness in other areas too (like your lower back & pelvic floor). Keep in mind genetics play a big part in diastasis recti, some women are just more prone to it than others. However, there are several things you can do to improve the outcome.

What can you do to help?

As discussed above, during & immediately after pregnancy, avoid planks & side planks, abdominal crunches, sit-ups & loaded twists. This includes getting out of bed – always roll onto your side & use your arms to press up to sitting to get out of bed. Post-birth avoids full planks & side planks until the separation has closed to less than 1cm. Instead, focus on engaging your core muscles while you’re in a neutral spine position, such as all-fours kneeling, laying on your back, side-lying & standing exercises. It’s crucial to maintain good posture as much as possible throughout your pregnancy. We also need to avoid lifting anything that is too heavy – if you can’t lift something easily, if you’re struggling to keep your bank straight as you lift it or you’re needing to strain, then it’s too heavy. Targeted postpartum yoga & Pilates classes should address all of this.

3.      Weakened pelvic floor & continence issues

It is normal for your pelvic floor to weaken during pregnancy. However, it is not normal to notice urine leaking (or in serious cases, stool leakage) when sneezing, coughing, or laughing post-partum. A lot of midwives & doctors will try to tell you that it’s common, but remember common does not mean normal & it’s something you need to address.

What can you do to help?

During & immediately after pregnancy, avoid sport or exercise that creates continuous heavy downward pressure on your pelvic floor, such as running, skipping, kick-boxing, jumping, CrossFit, or HIIT workouts. Make sure your pelvic floor has returned to a baseline of strength before you begin engaging in these higher-impact exercises. Again, pelvic floor connection is best checked by a physiotherapist, but allowing yourself around 5 months of recovery postpartum is a good guide. Correct pelvic floor & core exercises are important to practice regularly. Again this is something good postnatal Pilates & yoga classes should cater to.

4.      Pelvic Organ Prolapse

This is one of the more serious conditions that affect women post-pregnancy & later in life. A prolapse happens when one of the pelvic organs (bladder, bowel, uterus) is no longer adequately supported by the pelvic floor muscles & falls down or pushes against the walls of the vagina. It can often be seen protruding as far down as the vulva. It can feel like numbness, followed by heavy downward pressure & which makes simple tasks (like sitting to standing, walking, going to the toilet) very difficult. It’s much more common than we are led to believe, but can be embarrassing, upsetting & incredibly uncomfortable, therefore making it one of those things we don’t talk about. You’re at a higher risk if you’ve had multiple children, twin or triplet pregnancies, you’re a smoker (causing chronic coughing) or you have a job requiring constant heavy lifting.

What can you do to help?

Similar to precautions recommended for incontinence, avoid sport or exercise that creates continuous downward pressure on the pelvic floor during & after pregnancy. If you have given birth more than twice, be especially gentle with yourself during pregnancy & the recovery period. It’s important to be mindful of carrying older children, too. Try to limit how often you lift them up & help teach them that you’re no longer able to carry them for long periods. Constipation can be an added burden on a weakened pelvic floor, so ensure you’re drinking at least 2-3L of water every day & eating plenty of vegetables. Correct pelvic floor & core exercises are crucial for your recovery & your prenatal + postnatal Pilates/yoga classes should always go through this in detail. Some doctors may recommend a pessary treatment, which is where a silicon tool is placed inside the vagina to support its internal structure. In more serious cases, surgery is needed.

5.      Delivering your baby laying on your back

For centuries, women were encouraged to labor in whichever position felt most natural to them, usually, one that took advantage of gravity to facilitate the downward movement of the baby – squatting, sitting, kneeling, all fours, or even standing. During contractions, the baby is pressing down on the cervix & making its way further towards the birth canal, so using gravity to assist the process is incredibly helpful. These positions also allow for the pelvis to widen 1-2cm more than if you were laying on your back.

It wasn’t until the 20th century that the process of birth became heavily medicalized. And with medical interventions came epidurals – and an epidural anesthetic makes it very difficult to be in a position other than on your back. Epidurals make it harder to feel when to push & a woman will often rely on midwives telling them when this should happen. This can increase the duration of labor & also lead to a higher chance of needing forceps or suction for delivery. All of these interventions put additional strain on the pelvic floor muscles, leading to the issues post-birth that we have already spoken about.

What can you do to help?

There is no doubt that labour can be incredibly painful & an epidural is a safe & accessible way to manage this pain during delivery. However, you can talk to your doctor & support team prior to the birth to discuss a lower dose epidural rather than a classic epidural. These are the same medications, just used in a smaller quantity. Note these are often referred to as “walking epidurals” – they do not actually allow women to walk freely, but they do offer more movement & sensation than a complete epidural. There is also the option of gas & oxygen which some women find are enough to help them manage contractions. Also discuss your options for side-lying & semi-sitting with support (seated in a water bath is a fantastic option), as both of these positions allow the pelvis to move more freely than if you are flat on your back.

I also encourage all my prenatal clients to learn as much about birth as possible during their pregnancies. Learn about what happens during labour, how your body reacts & how the baby works with you through this process. Watch YouTube videos, listen to podcasts, and speak to friends about their experiences. Knowledge is power – the more you know, the more prepared you will be. And don’t be shy in telling your support team exactly what you’d like your birth to look like. Plans can & often change, but it’s helpful to know what your ideal is before the birth. If you have access to a hypnobirthing course during pregnancy, this is a wonderful way to learn about drug-free options during labour & ways to manage pain using movement, breath, sound, visualization & relaxation techniques.