Importance of Specific Postpartum Exercise

Hello There! I’m back again to talk about postpartum exercise! I’m excited to soon begin postpartum exercise classes at Orange City Area Health System beginning this week! This will be offered to any woman who is beyond 6 weeks postpartum and has been cleared by their physician to resume exercise as tolerated. Today I’d love to share WHY I believe this exercise class is important, and WHO this class would benefit.

First of all, as a physical therapist, I’ve had the pleasure of working with at least a couple hundred women postpartum. At our hospital, each postpartum mother is offered the opportunity for an appointment with one of our women’s health physical therapists, usually at the same time as their first well-baby visit (about a week postpartum), to go through a quick assessment of any orthopedic issues they may be experiencing yet from their pregnancy or during labor and delivery. Clinically I would say about 75% of women have a positive test for a rectus diastasis (abdominal separation), so we always test for this, and then each patient is shown how to correct it. They also receive some basic core exercises that are safe to begin (modified for post-cesarean), postural exercises, and education on return to activity, among other things. I always enjoyed these visits and received so much positive feedback from women who thought the visit was very helpful in their postpartum recovery.

Speaking from a new mom’s perspective (as I’ve had four children), the postpartum period can be overwhelming. Not only do you have a new baby to care for, you may be learning how to breastfeed, possibly taking care of other children, potentially adjusting to a time of being home full-time, and surviving on very little sleep. On top of that, you have a body that is recovering from the changes that occurred during pregnancy, as well as any healing that needs to occur from a vaginal or cesarean delivery.

Many women that I talk to are concerned about their postpartum bodies and whether things will ever go “back to normal.” They are encouraged to walk but otherwise lay pretty low with more aggressive physical exercise and activity until their six-week follow-up. At this point, if they are cleared by their physician to exercise, a couple things can happen. I’ve seen women who are either obsessed with exercise or obsessed with losing weight as quickly as possible jump right back into whatever they were doing prior to pregnancy, whether it be marathon training or crossfit. I’ve also seen many women who don’t know what to do and feel overwhelmed by life’s new circumstances decide to avoid exercise altogether.

I encourage a more middle-of-the-road response, for a couple reasons. First of all, there ARE a lot of adjustments that new moms are going through, and when you are not getting enough sleep, exercise can feel like the last thing you want to do. So definitely working back into an exercise routine at a slow pace and offering yourself lots of grace is essential! But the main reason I suggest taking things slower is because your body, though healed, is not in a place to jump right into aggressive exercise. Just like a new runner would not start out running five miles, nor should a new mom jump back into an aggressive exercise routine. Here are a few reasons why:

  1. If an abdominal separation is not corrected, certain exercises could actually worsen this rather than helping it. Even core exercise could actually worsen it. This separation contributes to the lower abdominal sagging that many women experience postpartum.
  2. Most exercise classes and videos have quite aggressive abdominal exercises that even healthy, strong adults can’t do correctly! Often times they are substituting with other muscles to accomplish the exercise and have no idea that they are not even doing the exercise correctly. I see this over and over again clinically as well as in classes and on videos.
  3. Aggressive exercise often involves jumping, running, etc. that can cause some stress incontinence (leaking a little or a lot of urine) if pelvic floor muscles have not been strengthened properly. This can be a major annoyance to many women, but often times women just shrug it off as “the way it is.” I don’t think I can emphasize enough that, though common, stress incontinence is NOT something that you have to live with or put up with. Often times proper training can correct this very easily, but I believe the BEST time to deal with it is early postpartum!

Finally – WHO is this class for? It may seem that on first glance, this class is obviously for women who have recently had a baby and fall into that post six-week time period. But really, this class is for ANY woman who has EVER had a baby but has struggled to get back in shape, especially if there is some definite core weakness present. So really, this class can be for the new mom or for the 40-year-old woman who wants to get back in shape, but feels overwhelmed with where to start. In addition, if you are experiencing any pelvic floor muscle weakness or an abdominal separation that is not improving, this class could be perfect for you! I’ve seen 40-50 year old patients who come to the clinic with complaints of low back pain, find on testing that they have an abdominal separation from having babies 10-20 year’s ago, and we are still able to correct this issue at that point…and improve their back pain!

Want to know what the research says about postpartum exercise?

  1. Several studies show the incidence of low back pain up to six months postpartum was over 40%! Working on core strength can certainly help with this!
  2. Potential benefits of postpartum exercise – improved cardiovascular fitness, improved mood, decreased anxiety and depression, increased energy, decreased stress incontinence, improved sleep, and improved chronic disease risk factors
  3. Clinical Practice Guideline: Exercise in Pregnancy and Postpartum Period – Joint Section of Obstetricians and Gynecologists of Canada, and Canada Society of Exercise Physiology, 2003 stated:
    1. Initiation of pelvic floor exercises immediately postpartum may reduce risk of future urinary incontinence.
    2. Moderate exercise postpartum while breastfeeding does not affect the quantity or composition of breast milk or impact infant’s growth.

I hope this class fills a void that we have in our community – to help women transition back into exercise in a safe way – while avoiding injury, pain, or stress incontinence. If you are experiencing any of these symptoms and are questioning whether this class is appropriate for you, I encourage you to contact your physician, and you can also contact me with questions about what the class all entails. I’d be happy to answer any questions you have!

Tanya Rowenhorst





Importance of Specific Prenatal Exercise

Hey friends, it’s been awhile right? I haven’t touched the blog for quite some time, and it’s also been a couple months since I’ve posted or done anything with Refining Wellness. Why? It’s not a simple answer, but the closest is that I feel like I’m in a transition period in life where I am trying to figure out what God has for me – His purpose – how He wants me to use my time, my gifts, and my passions in this season with young children. I have a tendency to push forward with something I feel passionately about, sometimes not waiting on the Lord to hear a specific word from Him and not listening to my gut instincts. If something is good and my intention is to serve the Lord, I’m sure it will work out, right? So rather than continue to push forward, I’m going against my grain and stepping back…listening, being still…waiting.

However, another reason I have been quiet over here is that I have been working on a fun project that will launch in a couple weeks. I am excited to partner with Orange City Area Health System in offering two specific exercise and educational classes – one for women who are pregnant (antepartum), and one for women who are at least six weeks postpartum (after having their babies). This has been a dream of mine for a long time, but when I was actually practicing PT, there was no time to develop or implement such a program.

Today I’d love to educate and share why I believe specific prenatal exercise is so important for every pregnant woman, and will share more about the postpartum exercise class later this week. When I talk about prenatal exercise, I’m not talking about going for a walk or a jog or a swim, though these are great for maintaining cardiovascular endurance and strength. I’m talking about exercises that will help you function better, help you avoid back and pelvic pain (common ailments during pregnancy), and help you potentially enjoy a smoother labor and delivery.

If you’ve been pregnant before, you know the massive amount of change that your body goes through during 40ish weeks of gestation. As early as four weeks, the hormone Relaxin is released in the body, already causing laxity in tendons, ligaments, and connective tissue. I’ve seen many pregnant women just in their first trimester already experiencing back pain. This laxity, along with a more forward shift in posture due to the baby’s position, can lead to multiple issues in the spine, SI join pain, hip pain, sciatica (pain shooting down the leg), and pubic symphysis pain (groin pain).

ACOG (American College of Obstetricians and Gynecologists) has the following recommendations:

  1. In the absence of either medical or obstetric complications, 30 minutes or more of moderate exercise on most, if not all, days of the week is recommended for pregnant women.
  2. Women can continue to exercise from mild-moderate exercise routines.
  3. Weight bearing exercises may be continued considering prior level of fitness.
  4. Avoid – exercise in supine (laying on back) after 1st trimester due to decreased cardiac output and prolonged periods of motionless standing, as well as exercise involving high risk of falling.

So, we know that general exercise is beneficial and recommended. We also know that there are major changes going on in the body that may limit what we typically do for exercise and also predispose us to injury. I myself have had several bouts of pretty debilitating pain during pregnancy due to exercising beyond my limits, which made it hard to walk, bend over, and sleep well during the second half of my pregnancies. I can remember one specific pregnancy where I was in my third trimester and pregnant with my third child. My older two were not quite two and four at the time, and my almost two year old son was a particularly busy handful. My husband is a farmer and a seed salesman, and during the spring and fall, I do a lot of single-parenting. I was of course, by myself at home with my kids after a hard day (as in hard on my body) of work and was in a lot of a pain. I could barely stand or walk, and he was getting into absolutely everything. I ended up putting my kids in the car, putting on a movie, and just driving around for an hour (crying) until bedtime because I felt like I was unable to take care of him safely any other way. It was a horrible feeling and I felt like a failure as a parent.

But this doesn’t have to be a norm for pregnant women. We often just accept that back pain is normal during pregnancy, and we just deal with it. If you are having pain that is affecting your function (your ability to do your job, take care of your kids, sleep well, clean, even go for a walk) I highly encourage you to see a physical therapist! There are SO many things that can be done for you and it’s been such a pleasure of mine to assist many women in getting through their pregnancies with less pain and improved function.

But what if we could avoid debilitating pain all together? What if we could DO something  during pregnancy to prevent getting to the point where we aren’t functioning well? That is the point and purpose of this class. I’m going to teach you how to strengthen specific muscle groups that will help decrease your chance of back and pelvic pain, including your deep core muscles that provide stability to the spine and pelvis in absence of the typical stability that our body has through tendons, ligaments, and connective tissue.

Research shows that the transverse abdominis muscle, an important muscle for core stability, minimizing abdominal separation during pregnancy, and helping facility continence in conjunction with the pelvic floor, gets completely turned off during pregnancy. A 2005 study showed that strengthening the transverse abdominis during pregnancy was associated with a dramatic decrease in diastasis rectus abdominis (DRA), or abdominal muscle separation. I would say that clinically, at least 75% of postpartum women have a positive test for a DRA, which is a risk factor for postpartum back pain and injury.

Next, many women experience stress urinary incontinence (SUI) during pregnancy (leaking of urine with an increase in intra-abdominal pressure, like when you cough/sneeze/jump) and many more experience SUI afterwards. SO many women I talk to consider this a normal part of having babies. They laugh it off and accept that it is just something they’ll have to live with. But that is simply not true. Though common, it is NOT something you have to live with. Who actually WANTS to leak urine? This seemingly minor issue is only going to get worse as you age if you don’t do something about it right now when you are young! In addition, 50 percent of women do not even do a kegel correctly! Teaching women how to properly use their pelvic floor is important for this reason and several others. Not only does it work in conjunction with the transverse abdominis to provide stability to the pelvis, but having a strong pelvic floor can help with labor and delivery!

Other parts of this exercise class will include specific exercise and stretches that will help to prepare your body for this end result – giving birth to your child! The stats are significant – exercise during pregnancy can do the following:

  1. Decreased risk of preterm delivery
  2. Decreased risk of going past term
  3. Decreased incidence of macrosomia (birth weight greater than 8 lbs 13 oz)
  4. Mother tolerates stress of contractions better
  5. Higher apgar scores

The exercises that you will learn will help improve endurance during labor, cope with contractions, and overall help each mother feel more competent in dealing with labor, potentially reducing necessity of medical interventions. Your body was created to carry a baby and it was created to give birth. In fact, only about three percent of female pelvis’ are incompatible with vaginal birth, but c-section rates in our country are around 30 percent! There are many factors  that contribute to that rate, and that is a topic for another article, but in general, our society creates a spirit of fear around childbirth, when actually, childbirth can truly be a beautiful and empowering experience when women have adequate preparation.

Finally, here are a few more positive benefits of exercise during pregnancy that research has found:

Maternal Benefits –

  1. Maintain healthy body weight
  2. Reduced weight gain
  3. Improved sleep
  4. Decreased musculoskeletal complaints
  5. Improved posture and body mechanics
  6. Reduced depression
  7. Possibly eases labor with fewer complications of delivery and faster postpartum recovery.

Fetal Response –

  1. Heart rate responds favorably to sustained recreational exercise
  2. Increased nervous system maturity
  3. Enhanced cardiac autonomic function

I am not a fitness instructor – I am a Doctor of Physical Therapy who has almost 10 years of clinical experience and specialized training in women’s health and working with the pregnant and postpartum population. I’ve given specific exercise instruction to hundreds of women. This will not be your typical fitness class as I will be teaching and educating while we exercise so that you actually know WHY you are doing what you are doing, HOW to do each exercise properly, and HOW this is going to help you. My goal is for women to feel empowered to walk confidently through pregnancy knowing that they can maintain function without limitations during pregnancy, feel prepared for childbirth, and experience a quicker recovery period postpartum! Please feel free to contact me with any questions, and don’t forget to register ASAP!