Please read my later posts on some of the pelvic floor issues I encountered after birth. Further information and experience changed some of the opinions I expressed here. After my first pregnancy I got back into running slowly. I was engrossed in the experience of being a mom for the first time. My focus was on learning how to juggle the needs of my newborn with "regular life." Sophia was also a winter baby, born in the middle of a snowstorm, her birth marked the beginning of a LONG winter. Cabin fever was what got me outside after a few weeks of being hunkered down with my newborn. I started with walking and snowshoeing, but found on one of my "walks" I had the itch to run and so I started jogging. My running increased from there, but I never really did any strength training post-baby. This yielded some embarrassing results as I started to run more (you can read about it in this post and this one from two years ago). So this time around I'm focusing on strength FIRST, before I start running.

Along with my running I've been maintaining a weekly strength training regime during my pregnancy that focuses on core and upper body. It will be important to continue the upper body strength training post pregnancy but there are two areas that I think require a little more focus after giving birth: the core and the pelvic floor.

CORE STRENGTH:

Your ab muscles can take a beating during pregnancy, they get stretched and strained as your baby grows. It's important to keep them strong through pregnancy (I talk about that in this post) to minimize the strain on the muscles. But once you have given birth there's a lot of "bouncing back" that needs to happen to get those stretched muscles back to their original state. Here are a few of the exercises I'll be employing to get my abs back in shape post baby:

1. Plank Pose: This is the number one core exercise I do through pregnancy and I'll continue to do it afterwards. I usually do 3-4 reps of a one minute hold. Often times I incorporate these throughout an AMRAP (As Many Reps As Possible) workout between other exercises like squats or push-ups.

13/1/09 carla pic david poole exercise number 1

2. Knees to Elbows: This is a Crossfit move that (I think) is pretty tough. We have a squat rack in our basement (thanks to my husband:-)with a pull up bar, so I'll be doing these hanging from the pull up bar similar to the girl in the first image (but I can probably only get my knees up as high as the lady in the third image). The goal of the movement is to get you knees to your elbows, or as in the second image: level with your elbows. Great exercise for the lower abs.

3. Kettlebell Swings: The Kettlebell swing really engages the core to stabilize your body during the swinging motion. It's important not to arch the back or have excessive movement during a kettlebell swing. It should be a smooth motion and a solid core is what allows for that.

4. Burpees: Another great core exercise that also gets the heart rate up is the Burpee. Basically the burpee is a plank pose with a hop and a jump. Start standing, jump down to a pushup/plank position, hop the legs forward between the hands and then jump up. The plank pose and the motion of hoping the legs forward between the hands, both engage muscles in the core.

PELVIC FLOOR STRENGTH:

After my last pregnancy I focused on core strength but neglected to strengthen the muscles in the pelvic floor so my primary focus post-pregnancy is going to be strengthening the muscles in the pelvic floor. This is where we're going to get a little technical and for some the information my boarder on "too much," but if A) you're a woman and b) you've had children then you may want to pay attention, what I learned really shocked me.

Traditionally when you think pelvic floor you think Kegels. Yes. Those little exercises developed by Dr. Arnold Kegel way back in 1948 to help women with postpartum incontinence (ahem...sounds familiar). I knew about Kegels before giving birth the first time and at the instruction of my midwife did maybe a few of them in the days after giving birth to my daughter. When I asked her again about it this time, mentioning some of the issues I've had, she said: "Well, you can start doing them now and then focus on doing them more after the birth. If that's not working there is physical therapy."

WHAT?!? Physical therapy?!? For "down there?!?" I had to stop myself from falling out of the chair in the birthing center when she she continued: "I can give you his card if you like."

Um. No thanks. That was all I need to hear to take matters into my own hands. I'm a fit girl. I'm also a smart girl. If I can figure out how successfully train my body to run a marathon then I can for sure as heck figure out how to train my pelvic floor muscle to keep me from leaking. So I started to do a little research. Finding out first what the heck the pelvic floor muscles are and exactly where they are.

This diagram helped answer my question of where the pelvic floor muscles are, but I wanted to know a little more. I turns out that the pelvic floor muscles are comprised of several muscles (the pubcococcygeus, puborectalis, iliococcygeus and coccygeus) and connective tissue or fascia. These muscles connect the pelvic bone to the coccyx bone at the end of the spine and support everything contained in the pelvis. The goal is to have a taut (but as I learned not tight) pelvic floor. Simple enough right? So how do we make that sucker "taught?" This is what I wondered so I Google "pelvic floor exercises." Most every result described some sort of Kegel exercise, like this one from the Mayo Clinic:

"Find the right muscles. Insert a finger inside your vagina and try to squeeze the surrounding muscles. You should feel your vagina tighten and your pelvic floor move upward. Then relax your muscles and feel your pelvic floor return to the starting position. You can also try to stop the flow of urine when you urinate."

This is probably what you've heard from your doctor. It's what my midwife told me. But looking at the diagram of where the pelvic floor muscles are and then reading the description I couldn't help but think: there have to be other ways of strengthening the pelvic floor.I am not a medical expert and won't pretend to be, and maybe I do have a penchant for questioning the way "everybody else does it," but there was something in me that thought: how does squeezing the muscles in the vaginal wall help tone the muscles of the pelvic floor? They aren't even connected? There may be a perfectly reasonable explanation for this, which I didn't find, what I did find was this: a blog post titled Pelvic Floor Party: Kegels are NOT invited.If you get the chance, read the whole article, but if you don't have time here is the gist of it. In the post an amazing mother runner, Kara Thom interviews biomechanics scientist Katy Bowman about the pelvic floor. Her insights made sense to me.

Bowman talks about how kegel exercises, longterm can actually weaken the pelvic floor because they draw the pubic bone closer to the coccyx bone and the closer those bones get the more "slack" the pelvic floor becomes. See her diagram below:

One of the things Bowman mentions that combats the pulling of the coccyx towards the pelvic bone are the muscles of the glutes (your butt muscles). She remarks that, "zero lumbar curvature (missing the little curve at the small of the back) is the most telling sign that the PF is beginning to weaken." Bowman's suggestion: deep squats.

"The Kegel keeps making the PF [pelvic floor] tighter and tighter (and weaker and weaker). The short term benefits are masking the long term detriments. Ditch the kegels and add two to three squat sessions throughout the day (anywhere). The glutes strengthen and as a result, they pull the sacrum back, stretching the PF from a hammock to a trampoline. Voila! You can still practice opening and closing your PF in real-time situations, but you don't have to approach it like a weight-lifting session or anything. It doesn't need to be on the To Do list :)"

Bowman's responses in conjunction with the anatomy and physiology of the pelvic floor made perfect sense to me. Strong glutes=healthy pelvic floor. So after this pregnancy I'll be focusing on doing some deep squatting to help get my pelvic floor back from a slack "hammock" to a "taut" trampoline.

Some of you may be thinking: Why would you take the advice of a blog post by a biomechanics scientist over the advice of your own doctor? Probably because I'm always looking for "other ways" of doing things and questioning the status quo. I presented the article to my midwife and she was intrigued and said, "Go for it, tell me how it works." So I'm gonna give it a try and see if my experience is different this time around. In some ways, and this is just my personal opinion, I wonder why we are still using techniques that were developed back in the 1940's when women were sedated for childbirth and told to "rest" during pregnancy (running would be totally out of the question)? I'm not "anti-kegel" just wondering if maybe there's a better way?

What exercises helped you bounce back post pregnancy? What do you think of Bowman's argument? Do you have a positive experience with Kegels? Squats? Other exercises?

--Sarah

I am not a medical expert and am unqualified to make medical recommendations, the information expressed in this post are my thoughts and opinions. Please consult your physician with questions regarding your health.

The Post Baby Comeback Plan Part Two: Strengthening

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