The 40-day postpartum quarentine is 40 days too long

Many women are still told not to exercise for 40 days (or 6 weeks) after birth. This well intended advice from medical professionals is unfortunately causing lots of problems for postpartum women such as incontinence, sexual dysfunction, back problems, “jelly bellies”, and poor body image.

The general consensus from gynaecologists and midwives is for women to adhere to a 40 day waiting period after giving birth before starting to exercise. These 40 days are meant to wait for lochia (postpartum bleeding) to stop, stitches to heal, and the uterus to shrink down to its normal size.

While the intention is good, this “rule” causes problems. How can all women, younger, older, first time moms, 10th time moms, with C-sections, with episiotomies, with water births, women who were fit before birth, women who have never exercised, professional athletes, fit into the same 40-day quarantine category?

Also, when told not to exercise, women are left to define exercise themselves. Does this include walking? What about Kegels? And once the 40 days are over, are women allowed to now start running and going to aerobics? Does the body magically recover in 40 days while avoiding exercise?

Women post partum are vulnerable physically and emotionally. It is a time when life is upside down and thinking of her own body becomes a last priority while learning to be a mom and taking care of the little one(s) 24-7. For some, the 40-day rule provides a nice “excuse” to not have to start doing something about the alien postpartum body she has been left with for 6 weeks. While it is great for a new mom to focus on being a mom, this long wait makes recovery MUCH longer and MUCH harder. The longer the wait, the harder it is to get the pelvic floor musculature to respond again. And in many cases, physical therapy machinery is needed to get the process started well. Being a great mom is a lot easier with a properly functioning body.

The other problem with this general guideline is that some women wait the required 40 days and then jump into their normal pre-pregnancy exercises (aerobics, weight training, tennis, etc.) without ever doing the necessary work to reactivate and strengthen the core. This can cause a slew of problems including incontinence, a protruding abdominal wall, and muscular compensations that can lead to back pain, knee pain, etc.

The solution is to give more specific advice. So, instead of this general advice, here are some more specific guidelines for exercise after birth:

1.) Start doing Kegels as soon as able. Ideally this means moments after birth and definitely before leaving the hospital. This actually speeds up perineal healing.

2.) As soon as you can, start walking around and doing some basic mobility exercises. For a normal non-medicated birth this could be within hours. For a medicated birth you may need a little more time to get moving due to the anaesthesia.

3.) Even with lochia, gentle exercises for core recovery can be started within those early days.

4.) Diaphragmatic suction exercises should wait until the uterus has shrunk. This varies from woman to woman. You can try them a month after birth and should definitely be able to do them after the 40 days.

5.) From here the progress should be constant towards brisk walks and core stability.

6.) The 40-day rule is probably a decent guide to follow before starting heavy lifting or other exercises with impact. And even then, a better gauge is for women to have first recovered the core before adding external loading or impact.

7.) The most often skipped step in this recovery series is RESISTANCE TRAINING. The best way to recover a pre-pregnancy slim body, is resistance training accompanied by a clean diet with adequate calories to support breastfeeding. As soon as the pelvic floor can hold its own again and the core is stronger, adding a few days of full body circuits can really speed up the recovery process and best of all, prevent achy backs and necks from all the forward bending that comes with taking care of a baby.

The old-fashioned 40-day guideline is too vague, very conservative, and in most cases harmful. Yes, women should ease back into exercise and should progress through pelvic floor recovery, abdominal reconditioning, and then general conditioning but they definitely should not spend the first 40 days after birth waiting to start exercising. Since after the birth of a mom, life can be quite complicated, it is good to remember that exercising and bonding with the baby are not mutually exclusive. Most postnatal recovery exercises can be done with baby!

5 Ways to Jazzercise Your Privates!

The pelvic floor (pf) musculature is really complex and intricate. Fortunately, it is very simple to work because all these muscles have two basic functions that we can consciously control: closing/opening sphincters or lifting up the floor of the pelvic girdle. This is good news because working this delicate area is very simple but can also get boring with only a few options for our daily exercises.

So, here are 5 ways to do Kegels to spice it up for you:

1.) Hold steady

This is the basic Kegel you probably already know. Just squeeze, lift, and hold! Release and repeat. Simple yet effective. These you can get good at doing while multitasking such as driving, working on the computer, talking on the phone, brushing your teeth, etc. Change up the hold time for variety from 3 seconds all the way up to 30 seconds or more.

Warning! Don’t do while driving unless you are good at multitasking. My mother-in-law tried this while driving and almost had an accident. Multitask with other more benign activities until you reach mastery.

2.) Quick fire

To get the most out of our pfs, we need to work them at different speeds. This drill entails contracting and releasing as fast as you can for 10 seconds, resting, and repeating.

3.) Rhythm Squeeze

Pump your perineum with Michael, Britney, Usher, or Elvis! This one is my favourites and gives us endless options by inviting different artists to join us. Just as it says: squeeze and lift with the beat of the music. When you get more advanced, you can trade off between the slow beat and the double beat of the music.

4.) Elevator

These last two require a bit more concentration and fine motor control. In the elevator exercise we can imagine the pf as an apartment building with 3 or 4 floors and activate the musculature in phases. For example, totally relaxed is the basement, 20% contraction is the first floor, 50% is the second floor, 70% is the third floor, and the fourth floor is maximum contraction. Remember that elevator rides can be just up, just down, or you can be a kid on the elevator and joy ride up and down and between floors.

5.) Back to front, front to back

This last exercise is quite tricky and takes some time to master. Here you need to distinguish between the anal, vaginal, and clitoral/urethral parts of the pf muscles. In general, the difficulty increases back to front. The exercise consists of starting the contraction at the anal sphincter and moving to the vagina and then the urethra/clitoris and as usual, releasing and repeating. The harder version is the same but starting at the front and moving to the back.

There you have it. 5 different ways to Jazzercize our private parts!

Chinese vaginal balls

Today's blog comes to you thanks to my lovely postpartum ladies. If it wasn't for them, I wouldn't be the proud owner of some "CVBs".

First, let me give you a fair warning. My blog is about perinatal fitness and wellness. This includes sexual health and the pelvic floor. Pelvic floor includes the anus and the vagina (among other items). So, if any of these topics are not your cup of tea, stop reading now. Please don't continue reading and then write me a comment/email that you were grossed out or insulted in some way. Ok?

So the story goes like this.

Ladies in my postpartum groups were talking about how sex wasn't all that appealing now, how it was a bit painful, how they didn't have much libido, and how all this was effecting their lives and their relationships. Thankfully at my studio we talk about these issues openly with no embarrassment and the women are comfortable sharing intimate details about their health and well being. So, at the end of the conversation we had decided to have a "tuppersex party". This is like a Tupperware party but the items on sale are sex toys, lubes, massage oils, etc. This way the ladies wouldn't have to fight their way to a sex shop with baby, the stroller, the diaper bag in tow just to get some items that can bring sexy back to their romantic lives. It's all about making it easy for the new moms.

Here in Catalunya/Spain one of the common recommendations from gynecologists and physical therapists for strengthening the pelvic floor are these Chinese vaginal balls (CVB). In Catalan they are just called "Bolas chinas" or "Chinese balls". Basically they are 2 silicone balls a bit smaller than a golf ball attached by a silicone string. The balls have little weights inside and at the end of the string there is a silicone loop. The task is to insert these balls in the vagina and keep them there. That's it. When the pelvic floor is weakened (like after pregnancy and birth), it is difficult to keep the balls in the vagina and they may even fall out.

Second warning: Now comes the personal bit. If you are uncomfortable reading about me and my experience with these balls, stop reading now.

So, I bought some of these balls from the tuppersex lady. I always try everything that I suggest to my clients whether diets, workout plans, masseuse, osteopaths, acupuncturists, etc. I am my own guinea pig always first. So, if I am to suggest these Chinese balls to my clients as an aid to rehab the pelvic floor, I better try them myself.

They sent me pink balls! I ordered purple balls! :( (they didn't have blue ones. I really wanted some blue balls. hehehe)

One of the reasons I wanted to buy these balls now was to see more objectively the changes in my pelvic floor through pregnancy, birth, and recovery. We all know you don't know how far you've come (nice pun there...) if you don't know where you started. So, now I have a good baseline reading. For me, these balls stayed put through walking around my apartment, running in place, and doing some deep body weight squats. I get an A for pelvic floor strength!

These particular CVBs were like balls within balls. There was a weighted little ball inside the bigger ball. So what happens as you move is the inner ball bounces off the outer ball which creates a stimulus to the vaginal walls and they contract in response. Well, that is all well and good but this process makes noise! So, there you are, shopping at the local supermarket working on your pelvic floor strength and someone will ask, "What's that noise coming from your crotch?".

So, for now I can only say that the CVBs can help you work your pelvic floor; however, I'm not sure they are any better than doing regular old Kegels that don't require any equipment and don't make any noise. I can see a benefit to using CVBs after birth to re-establish the neuromuscular connection to perineum as they provide an external stimuli to help you reconnect your brain to your vagina.

Anyone else had an experience with a post partum pelvic floor recovery product or method? Did it work? Do you recommend it?

Diaphragmatic suction exercise to decrease intra-abdominal pressure

This method is all the rage in Spain for postpartum core reconditioning. It is a method used by physical therapists dealing with urinary incontinence and uterine prolapse and comes from France.

It involves exhaling all air, closing the glottis, and contracting the diaphragm to create a vacuum within the abdominal cavity. This exercise is done in apnea (without breathing).

The vacuum in turn creates an involuntary contraction of the pelvic floor and the transvers abdominus. The stronger the suction, the more muscle fibers and motor units are recruited of these two muscle groups. Different postures are used to change the emphasis to different areas of the pelvic floor and the difficulty of the exercise.

These exercises are contraindicated for pregnant women, people with untreated hypertension or problems with ocular pressure. For healthy people who want to (re)train their pelvic floor and deep core stabilizers, these exercises are fabulous. They are a little tricky to learn and teach, but once mastered the results are incredible.

This is one of the main methods I use in the postpartum recovery courses I teach to get the ladies back into awesome shape.

I filmed a video of this exercise today and as soon as I can figure out how to insert a video onto this blog, I will post it for your viewing pleasure. :)