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The Staff of Femina Physical Therapy Blogs About Vaginismus, Pregnancy and Postpartum Best Practices, Treatments for Incontinence, and More

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postpartum pelvic health

Postpartum recovery should start Day 1.

Here are some tips to help you get your postpartum pelvic health (and general health) back on track:

This article focuses on 5 key techniques you can use to improve postpartum pelvic health.  It covers diaphragmatic breathing to activate core muscles and kickstart lymphatic drainage, pelvic floor muscle coordination, posture, and the benefits of a pelvic floor evaluation by a physical therapist to begin improving postpartum pelvic health on day 1.  It also provides detailed instructions and references scientific studies to provide further research. 

1. Breathing With Intention

One of the most important recovery tools for postpartum pelvic health is one that we do all day, but are you doing it with intention?  Diaphragmatic breathing can help you tap into your deep core muscles and assist in the healing process. When you focus your attention on breathing into the abdomen you activate the muscles of the core (diaphragm, intercostals, transverse abdominis, and the pelvic floor muscles). This breathing technique also helps to assist the pelvic floor muscles in another important job, lymphatic drainage. This can help eliminate excess waste and inflammation to help with healing. This is a great exercise to begin right after birth, when given the OK by your medical provider.

Additional benefits of diaphragmatic breathing were seen in the study by Fiskin et al., 2018, which concluded improved psychological state and increased mother-baby attachment. Not only are you reaping the benefits but so is the baby!

Read more: 5 Things you can do to...

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Levator Ani Avulsion - Injury during Childbirth

First: Understand your pelvic anatomy to better understand your injury

The pelvic floor is a group of muscles positioned like a hammock along our saddle region.

The group of muscles attach from our pubic bone on the inside and then to our lateral pelvic walls with a bundle of collagen fibers called the levator arch, and attach to the ischial spines (the inside of the sit bones) and tailbone on the back side.  During vaginal childbirth, the pubococcygeus muscle, a group of pelvic floor muscles, stretches 3.26 times more than its normal length to make room for the coming baby in the vaginal canal! As you can imagine, this may result in some perineal tearing and/or levator ani avulsion.
Levator ani avulsion occurs when muscle fibers of the puborectalis (the innermost muscle of the pubococcygeus group) are detached from its insertion on the pubic bone. This is somewhat frequently occurring, and about 20% of women experience an avulsion during their first vaginal childbirth. Risk factors include instrumental-assisted delivery (forceps presenting a higher risk than vacuum), older age at vaginal birth, second stage lasting longer than 2 hours, baby weighing over 8 pounds and 13 ounces, and those who had a grade 4 perineal tear. 
 

What does this mean for folks that have this injury?

As bad as it sounds to have an avulsion, research has shown that it does not necessarily increase perineal pain in postpartum or beyond. However, it does put women at risk for pelvic organ prolapse either early in postpartum or in their later years.

Read more: Pelvic Floor Injury During...

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Getting Back to Exercise Postpartum

A healthy lifestyle includes getting back to exercise postpartum

Exercise has shown to be beneficial in all stages of life, and the postpartum period is no exception.

Some of the benefits of postpartum exercise are:

  • Strengthen and tone abdominal muscles
  • Boosts energy
  • May help prevent postpartum depression
  • Promotes better sleep
  • Relieves stress
  • Can help you lose the extra weight that you may have gained during pregnancy
    (ACOG, July 2019).

Even with all these benefits, research shows that most mothers stop participating in exercise programs which leads to increased weight gain and obesity (Minig et al., and O’Toole et al., 2003). There are many adjustments that have to be made when becoming a new mother and the information on the internet regarding postpartum exercise can be misguided and overwhelming. Let's break down what the literature says about guidelines for returning to exercise postpartum.

Read more: Getting Back to Exercise...

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mommy tummy

Mommy tummy aka diastasis recti abdominis (DRA) is a prevalent issue.

One in three American moms have DRA that persists greater than a year.

So what is a diastasis recti? It is the stretching of the linea alba, a connective tissue that runs down the midline of the abdomen and connects the abdominal muscles. The stretching happens during pregnancy in almost 100% of mothers to make room for a growing baby. Many of these moms are told this is a normal part of pregnancy, even by their healthcare providers.

DRA is not just about appearance, it is also connected to pelvic floor dysfunctions as well as pelvic and low back pain. In a study by Kari Bo et al., they found that mothers in the US with DRA were also more likely to have the following:

Read more: Mommy Tummy - Not Something...

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Photo by Kelly Sikkema on Unsplash

Many women experience lower libido, vaginal dryness, sore muscles, and tender skin in the genital area after childbirth.

These issues can make sex uncomfortable, or even unappealing.  

Many women are not comfortable bringing up their sex lives to their doctors and midwives, thinking that it “will get better with time.” However, if you find your sexual health impacted for more than a few months after childbirth, you might start to wonder when you’ll be feeling back to normal.

Read more: Common Postpartum Issues...

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Photo by Sharon McCutcheon on Unsplash

Pelvic pain during the postpartum period is common, even for those who had a “perfect and easy” pregnancy, labor and delivery. Often times, healthcare providers will tell women that the pain “will get better with time,” however it's important to advocate for yourself and seek out care if you feel like you need it. Read my previous article about advocating for your postpartum care here.

Common types of postpartum pelvic pain and what you can do at home:

Vaginal Dryness

After delivery, your estrogen levels drop and progesterone levels stay high, especially if your are breastfeeding.

What you can do:

A simple solution can be drinking more water and using a water-based lubricant, read my previous blog on choosing the right lubricant for you.

Read more: Postpartum Pelvic Pain and...

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