Laughing, sneezing, coughing, and other Pregnancy & Mom Goals we should have!

Part 5 – Bonus! 

Check out part 4, here


Some Core Strengthening!

Because our Pelvic Floor has an intimate relationship with our abdominals, having a healthy “Core and Floor” during pregnancy can help you find your waistline after baby is born!

These exercises are fabulous for keeping your Core strong during pregnancy, or starting back into abdominal work postpartum and are helpful in avoiding and rehabilitating Diastasis Recti (separation of abdominals)

No
Crunchies necessary!

(but that’s another blog series!)

Working the ‘Inner Core’ muscles should not burn like abdominal curls do. These are your endurance muscles. To challenge these muscles, we can ‘trick’ them into working with an unstable surface like a stability ball or disc under your hips or by moving our arms and legs and trying to keep our torso stable.

Watch that your belly doesn’t bulge outward or bump or tent down the centre.

                     

*Click the links below to view these exercises in video: 

Stability Ball Abdominals
(suitable for first trimester of pregnancy or approximately 8-12 weeks postpartum)

Knee Stirs
(elevate your torso on a soft bolster or wedge if pregnant)


During pregnancy, once that beautiful belly is starting to show, consider working your core by moving your whole body, arms or legs while using your
core breath throughout. This not only gives you a core work out but upper or lower body workout too! It doesn’t need to be strenuous to be work. We call this functional core work.

Here are a few video examples of functional core work:
*click the links below to be taken to the video:

How to roll over in bed while pregnant (yes, that’s a workout!!)

Standing Leg Presses

Seated Arm Pulls

For more videos follow me on Instagram @ruthruttandoula or come to a class to keep crushing your Pregnancy and Mom Goals!

Laughing, sneezing, coughing, and other Pregnancy and Mom Goals we should have

Part Four: Making it work!
Check out part 3, here!


Can we just be really real and intimate with each other for a moment?


1 in 4 women experience bladder problems (Leaking!)
1 in 3 experience bladder problems and/ or pelvic pain during sex

P.S. a healthy pelvic floor will keep embarrassment out of the bedroom and make sex more enjoyable.

I am not an exception to any of the above statistics! In fact I once went to the hospital due to inexplicable pain and the doctors were totally stumped. It was only after learning more about my Pelvic Floor that I realized the culprit was likely Pelvic Floor Dysfunction. While incontinence and pain are very common, it’s not normal and it can be prevented and helped.

Let’s recap what we already know from this blog series. We know where the Pelvic Floor is located. We know the Pelvic Floor has a special relationship to our Inner Core and that it must be strong and flexible.

Well, if all of this wasn’t enough, it also needs to know how to move at different speeds! This final step is what is going to get us to those goals!

We need the muscles of our Pelvic Floor to maintain a constant engagement throughout our days to hold up the contents of our abdomen and we need those muscles to be able to react quickly against sudden abdominal pressure: LAUGHING, SNEEZING, COUGHING, running, jumping and all our other pregnancy and mom goals! For simplicity, lets say that we need to know how to work our Pelvic Floor in a powerful, plyometric style (exerting maximum force in short intervals), “fast twitch” and for endurance (the ability to withstand wear and tear, lengthy physical stamina), “slow twitch“ engagement.

 

Here are some exercises to help you find both types of engagement.

A complement to our Wide Leg Stretch last post, this Wide Leg Squat in Parallel (or Plie in 2nd) can help to build proper strength.

Separate the legs just wider than the width of your shoulders, preferably with the knees and toes facing forward (alternatively, this can be done with legs turned out, but this should be avoided if there is a known issue with any sort of prolapse) Put a little more weight into our heels than toes and squat – bending and stretching your knees. Try to keep your torso upright (this time, don’t lean forward)

Using your “Core Breath” with the squat- Inhale to bend your knees and Exhale to straighten your knees. Do these squats slowly, matching the length of your breaths to the length of the movements. Keep your Pelvic Floor engaged and lifted throughout. This works the endurance or slow twitch fibers of the Pelvic Floor.

Parallel squat
  

Turned out squat
                       

.
Let’s add on…

Pause when you’re almost at the deepest part of your squat. Push into your heels to help activate your glutes (bum cheeks) and your hip muscles, and start to come up but stop yourself from coming all the way up with a short, fast Exhale to engage your core muscles, including your Pelvic Floor, as quickly and strongly as you can. Inhale to release as quickly as you can, and drop down into the squat again. Think of this as a pulse with and accent upward. Aim to be powerful with the Pelvic Floor like a striking action on the contraction. Recruiting the extra muscles of the hip, bum and legs will assist your Pelvic Floor and give you some lower body work. Start with 3 pulses and rest, several times. As you become able to contract and release quickly, you can work your way up to 5 pulses and eventually 10 pulses.

Take it up a notch

Once you’ve mastered the wide leg squat, here’s a variation that will make you work a little harder and take much more concentration on the core and floor. Switch your breath for this one – Exhale as you step out to the wide leg position and squat contracting the core and floor. Inhale to pull the legs back together (use a little inner thigh) and straighten your legs. This works for endurance and the stepping out action is plyometric for fast twitch integration. For an example: https://www.instagram.com/p/BRLVW6ZhdUi/?taken-by=ruthruttandoula

Hovering on Knees Or Bridging

Start sitting on your heels with feet together and knees apart at about a 45* angle. Using the “Core Breath” Exhale and lift your bottom off your heels (about half way between sitting and being right up on your shins) thinking of pulling the knees toward centre (but don’t actually move them) you should feel the muscles of your upper inner thigh, your glutes (bum cheeks) and maybe a little of the outside of your hips engage. Inhale and release.

For Bridging lie on the floor or a Mat, knees bent and about hip width apart. Using the “Core Breath” Exhale and lift your bottom off the Mat trying to keep your torso long not bowing, and using the glutes more than your hamstrings. Inhale and release. Maintain the contraction of the Pelvic Floor and core throughout both of these exercises.

Hovering


Bridging
  

Let’s add on…

This time hold the hover or the bridge and keep the inner core engaged. With a short, fast Exhale, engage your Pelvic Floor (in and up), as quickly as you can. Inhale to release as quickly as you can. Repeat 3 times and then release the squeeze. Work up to 5 repetitions, and then 10, as your ability and strength increases.

**Inner thigh work can be uncomfortable for some pregnant persons and could contribute to Symphysis Pubis Dysfunction. If you feel any pain in the pubic bone area with these or any exercises, stop! Likewise, not all pregnant persons will feel uncomfortable lying on their back for bridging and we do not recommend spending much time lying in this position exercising. Stop if you feel uncomfortable, breathless or lightheaded. In general, keep pregnant person’s heart above baby’s heart when reclining**


Let’s counter some of this inner thigh focus with the outer hip and thigh muscles, which work together with the Pelvic Floor and protect the pelvis and low back.

Maintain the integrity of your Inner Core and Pelvic Floor throughout and complete 5-10 repetitions of each of the Clam leg variations that you see in this:
https://www.instagram.com/p/BTBxN0rhInt/?taken-by=ruthruttandoula

Some movements should feel like you really have to think to keep yourself from wobbling and some will create a little burn on the outside of the thigh, hip and glute. Don’t forget to repeat on the second side!

Follow me on Instagram @ruthruttandoula or come to a class to keep crushing your Pregnancy and Mom Goals!

 

Laughing, sneezing, coughing, and other Pregnancy and Mom Goals we should have.

Part Three: All work and no rest make for a very stressed Pelvic Floor!

Check out part two, here!


Did you know that many of the symptoms of a weak Pelvic Floor are the same for a tight Pelvic Floor?

I think we commonly associate weakness with slack or lengthened and stretched out muscles but tight muscles can be weak and lack integrity too. A tight or hypertonic Pelvic Floor does not mean it is strong, it means it doesn’t know how to release and function well. (to truly know if you’re weak or tight, one needs to see a Pelvic Floor Physiotherapist)

Along with some ill affects on our daily life pre or postnatally, at tight Pelvic Floor can make the pushing stage of labour much more work. Some women inadvertently “hold” the baby in during the pushing stage.


In the last posts we’ve spent time getting some awareness and engagement of our Pelvic Floor, now let’s look at giving it some down time.  

These stretches should be appropriate for just about every one.

Lean forward with arms on a stable surface. This opens the distance between the pubic bone and the tailbone. Separate the legs, nice and wide and turn them to parallel. This opens the distance between your sit bones. This position in itself is a Pelvic Floor stretch. Use your core breath exercises and images from the last post to help you bring awareness to the Pelvic Floor.

Lunge gently from side to side. You should feel a stretch or lengthening feeling down your inner thigh and possibly through your Pelvic Floor. If you don’t feel any stretch, try separating your legs wider and be sure your tailbone is slightly lifted. Then try bending and stretching the knees together with the torso centered.

Breath easily and with a focus on stretching and opening the Pelvic floor. Keep your jaw and shoulders as relaxed as possible. This is a great example:

https://www.instagram.com/p/BQEEn-Fl-iK/?taken-by=ruthruttandoula

This should feel lovely and relaxing and is often a place women naturally want to labour. If you’re are pregnant, this is a great place to spend some time imaging the birth of your baby. Much like an athlete visualizes the positive outcome of their sport, you too can put some positives vibes out there!

 


Another option is to rest on a slightly elevated surface (a wedge or a soft bolster) with the legs butter-flied or up the wall. Alternatively, this can be done lying on your side with one leg up the wall and then turning over to do the same on the other side.

 

                                       


Since the Hip and Glute muscles often work together with the Pelvic Floor in 
most of our daily activities (we call them “co-recruiters”) it’s great to give them a stretch too. The “Figure Four” stretch standing, sitting or on your back is a great one.

 


To further release this area, the Franklin Method Pelvic Floor & Glute release with a semi firm ball is just the trick! 
Squeeze your glutes and press firmly onto the ball, then release. Do this several times. Then use the ball to massage the glutes, hip and hamstrings. When you remove the ball you should feel dropped and open on that side. Repeat on the second side.

**Be aware if you have piriformis syndrome or sciatica as this can put a lot of compression on the muscle and nerve. Stop if symptoms get worse**


See an example in this video
https://www.instagram.com/p/BQnybb2h48n/?taken-by=ruthruttandoula

 

Laughing, sneezing, coughing, and other Pregnancy & Mom Goals we should have!

Part Two: Fresh Breath

Check out part one, here!

How do I find this mystical body part the Pelvic Floor?

In a recent study 49% of the women verbally instructed to use their Pelvic Floor did so incorrectly! Gulp! As a Pilates Instructor this is a sobering statistic!

In our last post we told you where your Pelvic Floor is located. Let’s see if we can help you feel your pelvic floor and become aware of its movement.

Sitting upright on a firm surface (like a chair or a step), see if you can feel the two sit-bones right underneath you. Aim to keep a small curve in the small of your back so that your tailbone doesn’t tuck under, but be careful not to over arch your back.

Take a few slow breaths and see what your body does naturally.


Here is what should be happening: 


On the Inhale:

The diaphragm (main breathing muscle) contracts and pulls down.


The volume of the lungs increases and draws air in

(think of your torso and belly like a balloon inflating).

Abdominal pressure increases and Pelvic Floor responds (think of the boney landmarks at the base of your pelvis expanding or opening, you may even feel a little pressure downward).


On the Exhale:

The diaphragm (main breathing muscle) relaxes and moves up.


The volume of the lungs decreases and air flows out (think of deflating your torso and belly like a balloon).

The abdominal pressure decreases and the Transversus abdominis (lowest layer of abdominal muscle) contracts. This should feel like you’re gently shrink-wrapping your torso or tightening a corseted garment around your centre.

The Pelvic floor contracts (think of the boney landmarks at the base of your pelvis closing and gently pulling upward)

This breath is often referred to as “Core Breath”, “Diaphragmatic or Pelvic Breathing”.

Alternatively, you can do this on all fours. In either position, don’t change the position of your spine while doing the exercise. Just understanding this proper breath pattern is a huge step toward better Pelvic Floor health.

From some examples of “Core Breath” click here and here.

Adding on…


Front & Back

Exhale and imagine drawing your pubic bone and your tailbone closer together without using any leg, hip or cheek (glute) muscles. This should feel subtle and may feel more mentally challenging than physically! Inhale and let that go. 

Repeat a few times until it feels more intuitive.


Side to Side

Now trying using your exhale to imagine drawing your sit bones together. Inhale to release. This one is much trickier and the Glute muscles (your bum cheeks!) will want to join the party. You can imagine curtains closing if that’s helpful.


Let’s put this all together!

Inhale and allow your belly to fill with air. Think of yourself like a balloon gently stretching all the way down to the bottom of your pelvis. Imagine the four boney landmarks opening away from each other like the balloon expanding or a flower opening. When you exhale, notice that the torso deflates like a balloon and the belly should come back in toward your centre. Simultaneously, draw the four points of the Pelvic Floor closer together and think of gently pulling them up inside you. Remember not to recruit extra muscles.
.
You’ll know you’re doing this correctly if you feel an equal engagement around the anus and the vagina openings and a small sensation like you’re trying to levitate off your seat. Some other images to consider are picking up a blueberry with your vagina or the idea of holding a tampon in. Remember to do the work with a sense of ease, there’s no clenching allowed. 


Images to help you picture the actions of your pelvic floor

Egg in a nest – gently pick up the egg, place it back down. Remember to do the work with a sense of ease, there’s no clenching allowed.

 

picking up and place down an egg .

the movement of a jellyfish or the idea of holding a tampon in

.

a flower opening (and closing)

.

using the boney landmarks- pelvic bones (opening wider, coming closer together)

.

a balloon inflating and deflating

.

It may take some time to feel the awareness or to get the coordination. There’s no rush! The use of images can be really helpful. Your muscles have three times more sensory neurons than motor neurons which means that if you use a variety of images while practicing, your brain will mirror back to your body what you want it to do and you’ll have an easier time finding some sensation.

Once you’ve mastered this breathing in coordination with Pelvic Floor awareness we’ve got some other ideas for you to play with too!

 **the following ideas/ exercises are meant to create awareness and are not exercises that should be done everyday as part of a practice**

The next time you urinate see if you recognize when your Pelvic Floor is open and when it closes. (HINT: it opens to let things out and closes to hold thing in!) Are you able to keep it open for a few seconds after the stream of urine has ended? Are you then able to close it slowly as you did in the previous exercises?

When having a bowel movement, also take time to become aware of the pelvic floor. Notice your body’s own willingness and urge to push without any excess, intentional help from you. Can you support the urge to push with your Core Breath exercise (above) but this time keep your pelvic floor open both while inhaling and exhaling? This is a very calm gentle version of what it’s like to push during birth!

 

________

References:

Egg Photo: Artist – MaryJo Hoffman
Jelly Fish: http://www.worldatlas.com
L
otus Flower: Artist – Florence W Deems
Pubic Arch: https://en.wikipedia.org/wiki/Pubic_arch
Balloon Lung: https://basicmedicalkey.com
Bowel posture: https://suecroftphysiotherapistblog.wordpress.com

Laughing, sneezing, coughing, and other Pregnancy & Mom Goals we should have!

Part One: Getting to the Core of the matter.

What needs to be as flexible as your tongue, as strong as your abdominals and is incredibly important to the pregnant and postnatal body?! 

Your mind?!

Well, yes, but I was referring to your Pelvic Floor! Along with the transversus abdominis, multifidi and diaphragm, the Pelvic Floor is considered part of the “Inner Core” or “True Core”.

What does the Pelvic Floor do?

                          
Photo: Almay.com

These muscle systems work together to stabilize the pelvis, lumbar spine and rib cage when stress is placed on them… ummm, like during pregnancy or when carrying a newborn baby around.

The Pelvic Floor muscles help to hold the pelvis together and connect the pelvis to the femur (thigh bone). Daily, they work against gravity to hold up the contents of the abdomen and control what comes out, and when!

During pregnancy, the weight of a growing uterus and baby put a great deal of extra load on these muscles. Two of the most obvious and uncomfortable issues with a weakened Pelvic Floor are incontinence and hemorrhoids. A strong Pelvic Floor is needed for a more comfortable pregnancy.

 

Looking into the pelvis at the muscles of the Pelvic Floor.

Above    Below 

Why do we need a healthy Pelvic Floor?

A healthy Pelvic Floor is also essential for childbirth. Equally as important to a strong Pelvic Floor is a flexible Pelvic Floor. During birth it must know how to release, relax and expel! This flexibility can make pushing more effective, and therefore, possibly shortening this stage of labour and making it less exhausting.

After the birth of a baby, including a Caesarean birth, the Pelvic Floor is compromised and needs special attention to heal and function well. We highly recommend all postnatal bodies to see a Pelvic Floor Physiotherapist within the first six weeks of recovery.

A physiotherapist will be able to let you know specifically what to address within your body. If unattended, a dysfunctional Pelvic Floor can lead to a host of uncomfortable and undesirable affects including:

 

.

  • Urinary Stress & Urge Incontinence
    .
  • Hemorrhoids
    .
  • Pelvic organ prolapse
    .
  • Chronic pelvic pain
    .
  • Dyspareunia (painful intercourse)
    .
  • And can even contribute to back pain and cause mummy tummy.
    .


Don’t panic! Appropriate and safe exercising will help with blood circulation and delivery of oxygen to these important muscles as well as exercising the muscles themselves.

Let us show you how to show your Floor some Love!

 

 .

Make sure you stay tuned, all week, for the rest of this great 4 part series all about your Pelvic Floor!

5 Things Your Midwife Needs You to Know

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Pregnancy is a wild, exciting, and mysterious ride. You have questions, worries, and more questions and worries. As a midwifery grad and prenatal educator, there are a few of these I hear all the time, over and over again from every kind of client.  Here is my list of the top 5 things that your midwife wants you to know.

You shouldn’t be so excited about that ultrasound

“When is the ultrasound that I can find out the sex of my baby?”

This is the question that makes me twitch. I know what you mean, of course.  I know that you are asking about the second trimester anatomic ultrasound and I know when it will happen.  The thing is – the point of this ultrasound is not to find out the sex of your baby.  People often think of this as a ‘fun’ ultrasound, as a exciting and joyous occasion to count down to.  And every time, I have to be Boohoo Betty.

The truth is this ultrasound is a form of genetic screening, just like the ones you may have done earlier in your pregnancy with bloodwork and urine sample. The purpose of these tests is to find anomalies or abnormalities with your baby. Of course the hope is that all is well – all the organs are where they should be, there are the right number of fingers and toes, that the brain is the right size. Chances are this is exactly what will happen. And, yes, they will also check out your baby’s bits. The danger of approaching this ultrasound from the ‘what sex is my baby’ angle is that it becomes easy to forget the real reason it’s happening.

What if you are bouncing up and down from the excitement of finding out what genitals your baby has and are then told that he or she has a cleft palate, or something more serious?  You will be utterly unprepared.  The effect of this can be shock, heartache, confusion, even devastation. I am not telling you to expect the worst.  I am saying it is so important that you go into this ultrasound understanding it’s purpose.

You are stronger than you know

Sometimes in life, we want to be weak and we want to be coddled and that’s ok. (See: Abundance Shaming). Labour is not one of those times. Don’t get me wrong – it is so important to be supported and loved when you are in labour.  But, it is NOT a time where you can indulge yourself in being fragile.  Sweet lady, you are strong and your strength goes deep.  You need to know that.  You need to own that. If you find yourself thinking (or saying) that you can’t do this, you need to shut that shit down because your body hears everything you say and everything you think. If you have a moment or ten when you feel like weeping and you feel like you can’t go on, dig down. Dig down deep, my friend.  You are a fierce, powerful woman. Billions of women before you have done this and you have the support and love of all of them behind you, above you, and around you.  Even if you are soft and dependent and weak in other aspects of your life this, THIS, is your time to be strong and deep. You are woman.

We don’t give a shit if you poop

Everyone is so worried that they might poop when they’re pushing, that it will be embarrassing to poop in front of their partner and their care providers. I have to tell you something – everyone in that room poops too. Yes, they likely do it in private but no one else in that room is trying to push a human being out of their vagina at that moment. You are the warrior in that room. When you are pushing out a baby, shit happens (ohhh… I’m sorry about that but, really, you must have seen it coming).  When you poop, it’s not much different to us  midwives than you sneezing.  We nonchalantly wipe it away and carry on.  

And here’s the kicker – us midwives kind of like it when you poop. It means that you are pushing in the right spot and that all of that work you are putting in is worth it. When you are pushing in labour, you are using the same muscles that you use when you’re going to the bathroom. Sometimes, when a woman has an epidural, it can be difficult for her to feel if she’s pushing correctly.  A bit of poop can be visual confirmation that she is.  So, yay for poop!

Tearing Schmearing

In every prenatal class I’ve taught, every client I’ve cared for, this: “I’m so scared of tearing.”

You will be birthing a baby out of your vagina.  Your body will be doing many things it doesn’t normally do. (did you know your tail bone will actually move of the way?) And, yes, you might tear and it is not as big a deal as you think.  If you tear, you won’t feel it and you won’t know it. When you are birthing your baby, there are many other sensations and feelings happening, hormones coursing through you, adrenaline pumping. The only way you will know if you tear is after everything is said and done when you ask your midwife or your doctor.  That’s right – you’ll have no idea if you tore did or not.  

As an aside, I really want to come up with a better word than ‘tear’, one that isn’t quite so… violent sounding.  Maybe a variation of the word schism – that sounds more fun, right?

Home birth is safe

For normal, low-risk pregnancies, home birth with a trained care provider (ie: a midwife) is at least as safe as hospital birth. A recent study published by the Canadian Medical Association Journal (CMAJ) debunks (again) the myth that home birth is riskier than birthing in a hospital.  In fact, the rate of interventions is far lower for planned home births than planned hospital births including labour augmentation (that’s the IV pump of oxytocin), assisted vaginal deliveries (forceps, vacuum), and c-sections.

CBC News: Low-risk births just as safe at home as in hospital: McMaster study

Canadian Medical Association Journal: Outcomes associated with planned place of birth among with low-risk pregnancies (abstract and full study)


And lastly, a few good things to know about midwives:

  • Midwives are your primary care provider.  You cannot have both an OB and a midwife and you don’t need both.  Both are qualified to care for you during your pregnancy, labour, and birth.  Both can order the same tests and bloodwork.
  • Midwives have a Bachelor of Health Sciences degree, which means we have studied pregnancy, labour, and birth (and newborns and breastfeeding) for four years, including attending births and providing primary care. International midwives have a graduated from a 2-year Canadian university program to be able to here.
  • Midwives attend births both at home and in hospital (or a birth centre).
  • Midwives provide care for both you and your baby for 6 weeks postpartum, including home visits in the first week, which means neither of you need to see a doctor during this time.
  • Midwives and doulas are different professions, but together they make a beautiful birth team!