Teaser alert: It’s NOT just more Kegels!
I’m sorry, you caught me hot under the collar because in the process of researching for this post I got lost in a rabbit hole of well-intentioned blogs steering women in the completely opposite way.
Lucky for me, I have a bread crumb trail to find my way back that includes a Master of Science degree in physical therapy, 15+ years of treating pregnant women, and countless exercise specialist certifications. Oh, and I own a vagina that has birthed three kids so there’s that. But I lament for those newly pregnant women trying to do “all the right things” that now think they can just Kegel their pelvic floor into the delivery room and call it a day. In the words of Dwight Shrute, “False.”
If you’re not sure what a Kegel is or how to do it, please do yourself a favor and refer to my blog Why Kegels Alone Aren’t Enough.
To better understand what your pelvic floor needs in pregnancy and birth, it’s important to remind yourself of the functions of the pelvic floor muscles. Remember these by remembering the 5 S’s:
Spincteric: The muscles of the pelvic floor inter-digitate with the urethral and rectal sphincter so contracting the pelvic floor can help close the sphincters and relaxing the pelvic floor will allow things to pass more easily through them
Supportive: Your pelvic organs such as your bladder, uterus, and rectum are suspended by ligaments almost like rubber bands and can occasionally become more stretched out and lax. We want the muscles that lie beneath these important organs to be up to the task of supporting them!
Sexual: The more these muscles are able to fully contract and fully relax, the longer and stronger your orgasms can be. Need I say more?!
Stabilizing: The muscles of your pelvic floor are the bottom component of your “core”. You need them to be strong and well-balanced to help stabilize the lumbo-pelvic region.
Slides the Baby Out! While we want these muscles to be strong enough to support the extra weight of your baby during pregnancy, we also need them to know how to relax and lengthen and blossom open to help your baby slide out when the time comes.
Learning to contract and relax your pelvic floor is an important part of every stage of your pregnancy, but let’s break it down by trimesters to really knock it out of the park.
First things first. If you’re feeling really lousy and just getting out of bed and making it through the day is using all your faculties, let’s just give you permission to listen to your body and rest. You have plenty of time left to incorporate a pelvic floor-themed movement strategy so just lower your expectations of yourself right now, young lady!!!
For those of you not plagued by morning sickness (which as we all know can really be all day sickness) or those other pesky “first trimester symptoms” (which as we all know can really take until 16 or 17 weeks to lessen), this is a great time to familiarize yourself with your pelvic floor muscles. Once again, this is a great place to start (link to blog again). Practice contracting AND relaxing these muscles twice a day, and stack it into an existing habit like brushing or teeth or making a commute.
In your first trimester, your body is experiencing its greatest surge of pregnancy hormones, progesterone, and relaxin, which serve to soften the connective tissue all over the body which means, yes the pelvis too. This might be a good time to modify exercises to eliminate a lot of high-impact moves especially with large separation of the legs which could create unnecessary pressure on the pelvic floor muscles. For example, consider replacing regular jumping jacks with half jacks and trade half scissoring for full scissoring moves of the legs.
By 16-17 weeks many women are starting to get their energy back. While you can continue to incorporate Kegels twice a day, it’s extremely important to move your pelvic floor movement strategy beyond Kegels and start incorporating these muscles into regular exercise and movements. Here are 3 examples of great exercises where you can incorporate pelvic floor activation that goes beyond Kegels.
Bridge: Start on your back lying over some pillows to create an incline. Knees are bent and feet are flat. Start by exhaling and contracting your pelvic floor, next deepen your baby towards your spine, rock your pelvis back and roll up into the bridge. Remember to keep your neck long and your shoulders loose with equal weight through both feet. At the top of the motion inhale and enjoy a gentle stretch to the front of your pregnant body. Now exhale (if you’ve lost your pelvic floor contraction, find it again), fold from your bra line, and articulate your spine down one bone at a time. Once your tailbone arrives back on the mat, inhale and allow your pelvic floor to blossom open like the petals of a rose.
Bird dog: Get into a hands and knees position, hands directly under your shoulders and knees directly under your hips. Don’t let the weight of the baby just hang into your midsection but rather hug your baby towards your spine. Think about reaching the crown of your head-long towards the wall in front of you while you stretch through your tailbone to the wall behind you, creating length and space in your spine. Imagine a glass of icy cold water resting on your lower back, filled all the way to the brim. Slide your left leg long behind you and your right arm long in front of you, keeping the baby hugged up and your pelvis level so the water won’t spill. Here’s the cherry on top. While out there, contract and engage your pelvic floor muscles and hold for a count of 5. Inhale to relax back to the starting position and repeat on the other side.
Wall squat: Stand with your back against a wall and your feet about 12 inches in front of the wall. Inhale to prepare and allow your back to slide down the wall until you’re in a squat position. Everyone will have a different depth they feel comfortable squatting to, but be sure to keep your knees behind your ankles and tracking over your 2nd and 3rd toe. Before sliding back up into the standing position, exhale to engage your pelvic floor and use those muscles to help your body return upright.
These are just a few examples of how you can incorporate your pelvic floor into an exercise routine, but you can also engage these muscles throughout the day with your activities of daily living. For example, engage your pelvic floor when going from sit to stand, engage these muscles prior to lifting anything, and find your pelvic floor before you cough or sneeze!!! Also remember that you are starting to grow in this trimester and one of the best ways for your pelvic floor to get used to the increased weight it needs to support, is to avoid sitting too much.
You can continue the Kegels from your first trimester (remember to contract AND relax the muscles), and the exercise/movement based pelvic floor contractions from your second trimester, but in this trimester we’re nearing GO time, and it’s time to add in some intentional stretching and visualizations to help this region prepare to slide your baby out.
Adductor stretch: The muscles of the inner groin are important ones to keep flexible. While you can do a regular straddle stretch, I prefer the wall stretch as it is often more sport-specific if you will (and yes, birth is the sport we’re referring to here). Sitting on a large exercise ball or ottoman close to a wall, scoot the ball or ottoman to the small of your back while putting your (clean) feet up on the wall with your toes turned out (external rotation). Allow your bottom to sink towards the floor getting a delicious stretch in the inner groin as you encourage the pelvic floor muscles to melt and relax.
“J” Breath: Typically the path the baby takes when making their entrance to the world is in a “J” shape as their head dips down under your pubic bone before curving around towards the vaginal opening. I think this is a useful visualization to use in the final weeks leading up to birth and should be practiced in a variety of positions: back lying over an incline, side-lying, all 4’s, even squatting. Take a deep breath in through your nose, draw the breath to the back of your throat as you exhale your air down, behind the baby, and around in a “J” shape towards your pubic bone, allowing all the muscles/tissues/tendons in the path of this “J” surrender and relax, giving your pelvic floor muscles permission to let go and blossom open like the petals of a rose.
Yes, those first forty days after you give birth deserve a trimester all to themselves. And sadly, this tender time of healing is often neglected in the standard American culture. But it’s not just a baby that’s been born; a new mother who needs to get used to her new body has also been born.
I don’t believe in any strenuous exercise in the first 6 weeks and have written a blog about why the words “mommy” and “boot camp” do not belong in the same sentence together.
As for your pelvic floor, if you’ve had a vaginal delivery it’s likely been through some degree of trauma. And if you’ve had a C-section, it still needs your attention.
In the first few days after birth, you can start by gently contracting and relaxing these muscles to create a muscle pump of sorts to help with swelling in this area and to tap into the muscle memory you’ve hopefully created in your pregnancy. Take it easy and try not to add more pressure and strain to this area by contracting these muscles before you do things like laughing, coughing, sneezing, lifting, etc.
Also, do your best to keep bowel movements regular and avoid sitting on the toilet for more than 5 minutes at a time. If you’re looking for more, try doing the Core Breath exercise that engages each of the four parts of your deep inner core. It doesn’t take too long, can be done in any position, and will really get your recovery off on the right foot.
In conclusion, Kegels are great but they’re not enough. I disagree with the article I was reading that simply said, “Practicing every so often-day or evening-will make your pelvic floor toned and healthy.” Hardly. So gather these tips like breadcrumbs in your topic to keep you safe when wandering through the confusing forest of online advice. And think of me as your trusty survival guide, here to light the way for you!