Introducing Laura Malnati Chambers, our esteemed guest poster, who will be sharing her invaluable insights on gaining confidence in our bodies after childbirth—a topic close to many hearts. Laura, a renowned expert in postpartum wellness, brings her compassionate guidance and personal experiences to empower us in embracing our post-baby bodies with self-love and acceptance. Laura is not only a mom but also a doctor of physical therapy, a certified personal trainer, and a Pregnancy and Postpartum Corrective Exercise Specialist. After a 13-year career working in the clinic, she made a transition to building a virtual business. This new venture allows her to serve even more moms while creating a more flexible schedule for herself and her family.
Enjoy. L&L -J
Gaining confidence in our bodies after childbirth
Something about childbirth tends to throw our modern medical system for a loop. No wonder so many women are left feeling unsure about their postpartum bodies.
I mean, can you imagine having an ACL repair, a rotator cuff repair, or an ankle reconstructive surgery and then just being sent home with no other guidance than to rest for 6 weeks before gradually working back into normal life? Because we know that maximal tissue healing requires stressing those injured tissues in very specific and progressive ways, this scenario wouldn’t happen. In most cases you’ll be scheduled for physical therapy the very next day and over the course of 8-12 weeks will be guided through a progressive rehab program to help your body recover and rebuild optimally.
As a physical therapist for over 13 years, I’d argue that there is equal value in the physical treatments that happen in PT as there is in the educational and emotional support that happens there. Because you’re seeing a professional multiple times per week throughout your early recovery, you get to learn so much about your body, how it heals, and why you’re doing the exercises you’re doing. Plus, any questions, concerns, or frustrations that arise can be addressed.
Then why is it that after all the adaptations that come from 9 months of growing a human inside your uterus and then delivering that human either naturally or with medical assistance that we send women home with the generic advice to take it easy for 6 weeks? Yes, childbirth may be more of a natural event than an ACL surgery, but what about all those women with persistent pain during intercourse, urine leaks with activity, or pelvic organ prolapse after having babies? Because they’re given the impression that they should be good to go after 6 weeks, they can be left feeling like they’re permanently broken now that they’ve had a baby.
For too many women, this is the start of a downhill spiral with their bodies. They’re struggling with managing their “baby weight.” Then their postpartum symptoms are worse when they try to exercise, so they feel broken. Maybe they try the kegels everyone recommends but that doesn’t help. They don’t understand what else they can do to help their symptoms and fear making things worse, so now they exercise and move less which leaves them feeling even worse about their bodies.
The first thing I want you to know, Mama, is that you are not broken. You don’t have to accept these new symptoms as your new normal. There are a lot more things you can do to help your body recover than just kegels. I wish you could have 8-12 weeks of PT to learn all the things, but then again, what mama has time for all those appointments? If you do have the availability to see a pelvic health (also known as women’s health) physical therapist, I highly recommend you do. You’ll learn so much. But if you don’t, you can still heal.
Like after other injuries or surgeries that cut, tear, stretch, overwork, or immobilize parts of the body, your body just needs to be progressively challenged to regain the strength, mobility, and control it’s lost.
A quick side note: There are injuries that can occur during childbirth that can need medical attention, and it can be helpful to have a medical exam to screen for those if you feel your symptoms are severe or they’re not responding to a holistic exercise routine.
Body changes with pregnancy
First, let’s talk about some of the adaptations the body makes as it progresses through pregnancy. In “normal” non-pregnant anatomy the rib cage is stacked roughly over the pelvis in relaxed stance with a natural curving in of the lower back (lumbar spine) and curving out of the middle back (thoracic spine). To accommodate the growing baby, the rib cage flares out and tips forward, the pelvis spreads more open in the front, and the inward curve from the lumbar spine tends to move higher in the spine.
Due to these postural changes, the diaphragm cannot move very well as our primary breathing muscle and other muscles tend to kick in. The glutes cannot work well as our primary hip stabilizers and other smaller muscles tend to take over. Our paraspinal muscles (that run along our spines) tend to work overtime to support the increasing weight of the baby in the front while the stretching of the abdomen reduces the amount of abdominal muscle activity.
All these adaptations don’t necessarily revert right back to “normal” just because the baby has been delivered. Often postpartum women are left with stiff thoracic spines, altered alignment of their spinal curves, rib cage, and pelvis. And the formerly dominant muscle groups like the diaphragm, glutes, and abdominals may continue to let the smaller compensator muscles do their work.
What can all this mean for the poor pelvic floor, the muscle group blamed for most postpartum symptoms? It’s getting way overworked! When big muscle groups aren’t doing their jobs effectively or when alignment of the core is altered the result can be increased pressure bearing down into the pelvic floor. This can manifest as signs of pelvic floor weakness like urinary incontinence (peeing on yourself) or pelvic organ prolapse, or it can create issues with overactivity of the pelvic floor like painful intercourse or feeling like you constantly have a UTI.
Body Changes from delivery
Obviously, there are also body changes that happen from the delivery itself. Which tissues are stressed or injured will depend on a number of individual factors specific to each woman as well as whether she had a natural vaginal delivery, an assisted vaginal delivery, or a C-section. There may be muscle and fascial stretching, tissues that were cut, and tissues that were torn. Whether a woman experienced no tearing, significant tearing, or was cut for an episiotomy or c-section, there will still be tissue healing that needs to happen after delivery. Like other body parts that suffer injuries, these tissues will heal maximally when they’re given an initial period of rest then gradually loaded with specific exercises as they continue to rebuild.
A small but related tangent– depending on what type of delivery you had hoped for compared to how the actual delivery went, there can be very real challenges with reconnecting to those body parts. For example, a woman who has dreamed of a natural vaginal delivery her whole life is rushed in for an emergency C-section. Or after hours of pushing has to have an episiotomy and the baby pulled from her with forceps. The point is that there may be healing that needs to happen beyond the physical healing of those tissues before a woman is ready to feel whole in her body again. That’s ok. Take that time, do that work, reach out for help if you need it.
Hopefully you can now start to see a more holistic picture of why symptoms like midback pain, pelvic floor dysfunction, or deep hip pain may persist after childbirth. The bigger question now becomes, what can I do about it?!
Start Gently, but start
The recovery will look different for every woman depending on so many factors like prior activity level, type of delivery, age, time since delivery, etc. My first advice is to start gently but make sure to start something. What I mean is don’t just assume your body will do all this healing on its own without you putting in a bit of work. This isn’t a no pain, no gain type of situation, however. Learn to tune back into your body, to trust it and to work with it to learn when you can push a little more or when you need to back off. I like to start with a few key areas:
1. Tune into your pelvic floor
2. Retrain your diaphragm
3. Improve thoracic spine (rib cage) mobility
4. Reconnect with your deepest layer of abdominal muscles
Tune into your pelvic floor
Before you can train your pelvic floor, you need to know how it’s currently working. Sometimes it truly is weak and needs some isolated strengthening, but other times it may actually be too overworked and need some rest. Muscles that are too weak often have signs like: urine leaks, tampons falling out, heavy or pressure feeling, or sex just not feeling like it used to before kids. Overactive pelvic floor muscles may feel like: having a UTI though tests come back negative, painful penetration, constipation, urine leaks, heavy feeling, or difficulty starting the urine stream. While these aren’t exhaustive lists, you can start to get a little idea of where you may fall, but you’ll also notice that there is some overlap.
To further understand how your pelvic floor is working, try a kegel test.
Step 1: From sitting or lying on your back, contract your pelvic floor by doing a kegel (if you’re not familiar with this, one way to try it is by squeezing the muscles you would squeeze to stop the flow of urine). Hold that contraction for about 2 seconds, then relax.
If you could complete that easily, isolating only your pelvic floor without squeezing your butt, abs, or thighs, and you could feel the relaxation after you contracted, then move to step 2 of the test. If you couldn’t isolate your pelvic floor contraction from your other muscles, you may need to start by just working on your control and getting your brain to connect with those pelvic floor muscles. If you couldn’t feel the relaxation part of the exercise, you may have pelvic floor tightness, and your exercise would be to do a very small contraction and then focus more on learning to let go of the tension within your pelvic floor.
Step 2: If you easily did step 1, try holding that contraction now at a moderate effort for 10 seconds. Make sure you can still feel your muscles relax after that 10 second contraction. Technically, most advice says you should work up to being able to do 10 of those 10 second contractions in a row, but if you can do at least 5 with good control, you probably have pretty good pelvic floor strength and can progress to more advanced exercises.
Retrain your diaphragm
The diaphragm is such an intriguing muscle! It is shaped somewhat like a dome that arches up into our rib cage, right at the base of the lungs. Its edges attach along the inner borders of the lowest ribs all the way around our rib cage- front, sides, and back. When it contracts down, it stretches the lungs open and pulls in air for breathing.
It also does another very important function: as the top of our core muscular system it helps regulate the pressure that builds in core of the body. Why do we care about that pressure? Because at the bottom of the core is our pelvic floo. If the diaphragm isn’t working well, it’s not able to help with pressure regulation. This means more pressure is likely to be forced down into our pelvic floor which can result in prolapse, incontinence, or pelvic floor muscle overactivity.
How can you make sure your diaphragm is working well?
During relaxed breathing, the diaphragm should be the only muscle that’s working to stretch open the lungs and pull in air. Because of its attachments to the ribs, when it contracts the lower rib cage widens out. At the same time, the neck, shoulders, and spine muscles should stay relaxed.
Here’s how to test yourself. Sit up comfortably in a chair and place your hands along the sides of your lower rib cage. Take a comfortably big breath in and notice what happens to your hands. If the diaphragm is working well, you should feel your rib cage widen out into your hands while feeling no tension within the neck or spine. If you didn’t feel those things happen, your diaphragm probably needs some training. You can repeat this breathing exercise for 5-10 breaths multiple times per day to help retrain your body to use the diaphragm as the primary breathing muscle.
Improve thoracic spine (rib cage) mobility
Ideally, the most flexible part of the spine is the thoracic (middle back) because then it can be our primary site of movement while the lumbar spine (lower back) stays more stable. Often, this pattern gets reversed and the lower back can become painful from overuse. I find thoracic mobility to be a favorite amongst postpartum women because we often are stiff from pregnancy adaptations not to mention all the bending we do to care for and nurse that baby.
My favorite exercise for gaining more midback motion is side lying thoracic rotations. Start lying on one side, knees pulled up toward your chest like the fetal position, and your head supported on a pillow. Place your top hand behind your head then let your elbow fall back behind you and pull the rib cage with it. You should be rotating through the whole rib cage and thoracic spine and opening your chest up toward the ceiling at this point. From there, breathe into your ribs using a big diaphragmatic breath (breathing wide into your ribs as described above). This helps create more motion in your ribs so that when you breathe out, you may be able to rotate open just a slight bit farther. Complete 5 breaths on each side, trying to rotate just slightly farther after each breath out if you can.
Reconnect with your deepest layer of abdominal muscles
The abdominal muscles that cover the front and sides of our abdomen are actually made of 4 separate muscles. While the rectus abdominus tends to get all the attention because it’s the sexy “6 pack” muscle, it’s not usually the first place to start when training your abs postpartum. The deepest layer of abdominals (transversus abdominis- aka “TA”) has upper, middle, and lower segments. Not always, but very commonly when there’s pelvic floor dysfunction, the lowest portion of this TA muscle is less strong and active than it should be. It’s usually a good place to start abdominal training because it helps support the other abs and the pelvic floor.
There are lots of ways to exercise this muscle, but I like to start with having women learn to feel what a lower TA contraction feels like. After that, it gets easier to incorporate this important muscle group into lots of other exercises. Some women pick this up very quickly, while others may need a few days or even weeks of tuning in and practicing before they can really feel it.
How to “find” your lower TAs
Start lying on your back with your feet on the floor and knees bent up. Place your fingertips on the bony point of the front of your pelvis on each side (this is called your ASIS). From there move your fingers about 1 inch toward your belly button so that you’re feeling over the fleshy part of your lower abdomen. When you’re just relaxed, your fingers should be able to press into that tissue easily. This is important because when your lower TAs contract, you’ll feel the tissue under your fingers firm up. This is a nice way to tell when you’ve contracted the correct muscle.
There are 2 main ways to work on a TA contraction. The first is by using a kegel exercise because when you do a strong kegel your TAs will kick in to help. So, you can try that from this position. Try tightening your pelvic floor strongly and see if you feel those muscles firm up under your fingertips. If you do, this may be a great exercise. Perform 10 or so of them trying to hold about 5 seconds and really tuning in with your awareness to feel what it’s like to use those lower abs. Just make sure you’re able to completely relax your pelvic floor between contractions.
If the kegel exercise doesn’t work for you, you can also try an isolated approach. For this you’ll start in the same body position and with your fingers in the same place. Imagine there’s a string connecting your two pelvis bones (those ASIS points we talked about above). Try to contract the muscles that would pull along the string and bring those ASIS points closer together. As I mentioned above, sometimes finding this lower TA comes easily, but other times it takes lots of repetitions of bringing your awareness to that region before the coordination for how to contract it kicks in. Stick with it in small bouts so you don’t get too frustrated!
Bringing it all together
I hope you find these exercises both simple but also effective for helping you reconnect to some key areas of your body postpartum. I find that when women start to see small things improve– like less mid back pain or improved ease of pelvic floor activation or finally finding your TAs—they start to find more hope and confidence that they will recover and feel strong again. Remember, you are not permanently broken, but your body has been through a lot and deserves some attention. Initially, those first 6 to even 12 weeks, resting and settling into life with that new baby may be all it can handle, so give it time to just rest. But then don’t forget to re-engage with it. Use it. Trust it. You got this, Mama!
If you’d like to learn more about postpartum recovery, how your whole core works together to support the pelvic floor, and progressive exercises to build more strength and confidence after having kids, Laura has a free hour-long workshop designed to do just that! You can learn more about Laura and her workshop here.
