Body After Birth: Treating Post-Pregnancy Problems

I was featured on UTSWMedicine.org in an article about Body after birth: Treating post-pregnancy problems. Read it below or click here to read on utswmedicine.org

BODY AFTER BIRTH: TREATING POST-PREGNANCY PROBLEMS

By: Ashley Rawlins, P.T. and Sara Reardon, P.T.

Published: 30 August 2016

Giving birth is hard work. And it’s hard on your body. So it’s to be expected that you will need time to recover. And that’s the key — you should recover.

But too many women spend months and even years after childbirth dealing with pain or embarrassment about incontinence. They think it’s normal. That it’s just what happens to the body after childbirth.

It’s not. Physical therapy can ease pain and discomfort during pregnancy, labor, and delivery. And there are ways to treat postpartum problems so you can fully enjoy life with your new baby.

Postpartum problems can affect quality of life

Postpartum problems can be traumatic for women – physically and psychologically. We once treated a patient who had a severe laceration of the vagina and significant scar tissue that became infected. She was treated, but it remained painful. The thought of another pregnancy scared her – not just because sex was painful, but because she was worried about reinjuring it during childbirth.

We taught her some gentle yoga poses and how to use intravaginal massage to soften the tissue and ease her pain. When she became pregnant again, we worked with her throughout the pregnancy to keep the tissue soft to decrease the likelihood of tearing. She did wonderfully during and after labor and delivery.

While you may have a six-week postpartum visit with your doctor, you likely won’t see a physical therapist – in the United States anyway. Physical therapy is included in postpartum care in some countries.

We look forward to a day when this is common practice here as well. In fact, a July 2016 article in Cosmopolitan discussed how we are (slowly) waking up to the fact that women don’t have to live with these problems.

Let’s take a look at a few issues you may face after giving birth and what you can do to get back to your life again.

Confusion about exercise

For many years, women were advised not to exercise until after their six-week postpartum appointment. Recent recommendations you can start when you feel ready. But start slowly. Your body is healing. Take your baby for a walk in the stroller. Try some gentle yoga, or go swimming. Avoid cycling or high-impact sports such as running or CrossFit.

If you had a cesarean section, you will need more time to recover. Remember, you had major surgery. Talk with your doctor about what you should and shouldn’t do.

If you’re breastfeeding, try to nurse or pump before you exercise so your breasts aren’t full. Make sure you have a supportive bra with nursing pads. But don’t leave the bra on after exercise because prolonged compression can lead to a clogged duct.

And finally, stay well hydrated, especially if you’re nursing.

Back pain

Your abdominal muscles have stretched. If you had a C-section, they’ve been cut. You may have diastasis recti, in which a gap between your abdominal wall muscles can cause a protruding belly. This all compromises ab function and puts additional stress on your back and pelvic floor muscles.

You need to strengthen those muscles and retrain them how to contract and properly brace yourself during daily activities.

Start with a basic position such a sitting, concentrating on posture. Then move to standing and squatting. You can even do mini squats holding your baby!

Planking is a great core exercise. This helps strengthen your abdominals and lower back in addition to your upper body and arms, which need to be strong to lift and carry your baby!

UT Southwestern Angela Zoe squat
A patient practices squats while holding her baby.

When you feel ready, start slowly with a modified version. Place your hands on the floor directly over your shoulders like you’re about to do a push-up. Rest your knees on the ground, keeping your back flat and abs tight. Your head should be in line with your back. As you progress, you can extend your legs and raise yourself up on your toes for a full plank.

Hold the plank for 10 to 20 seconds, increasing up to a minute as you get stronger.

In physical therapy, we may ask you to bring your baby to practice picking them up or putting them in a car seat. You do these things over and over, but if you do them incorrectly or you don’t have the proper strength, you could be setting yourself up for injury.

UT Southwestern PT plank Zoe
Sara Reardon, P.T., helps a patient perform a plank.

Urinary incontinence

Your pelvic floor muscles may be too weak or stretched out after childbirth to support the bladder and keep the urethra (the tube urine comes through) closed.

We recommend starting gentle Kegel exercises right away. Your pelvic muscles may be a bit stunned after birth, and gentle contractions can be helpful to improve blood flow and promote healing.

Try a Kegel exercise with a lower abdominal contraction. Lie down with your knees bent and feet on the floor. Slowly inhale, then exhale. Pull your navel toward your spine and tighten the pelvic floor muscles. Repeat this 10 times two to three times a day. If doing this increases your pain, stop and consult with your physical therapist.

You may experience postpartum incontinence when you cough, sneeze, or laugh. You can retrain your timing coordination so that it once again becomes an automatic reflex with the “knack” technique, a well-timed contraction of the pelvic floor muscles.

Sit or stand tall with your chest lifted. Squeeze your pelvic floor muscles and contract your urethra, vaginal muscles and anal sphincter. Maintain this contraction as you cough. After you cough, relax the pelvic floor muscles.

A physical therapist trained in pelvic health also can advise you on lifestyle modification and hydration habits that may help.

Laceration recovery

If you had tearing, an episiotomy, or a C-section, you can begin scar massage six weeks after giving birth. Scar tissue massage stretches the tissue surrounding and on the scar so it doesn’t adhere to the underlying tissue and allows you to move freely without pain.

Start by lightly touching or stroking the scar and general area of the incision – first with your palms and then your fingertips. Talk with your physical therapist for more specific guidelines on scar tissue massage during the stages of your healing.

A physical therapist also can train you to use a vaginal dilator to relax the muscles and prepare the tissue for sexual intercourse. These devices look like tampons and come in various sizes. We’ll also teach you some relaxation strategies.

Child’s pose and deep squats also can help lengthen and relax pelvic floor muscles that may be causing you pain.

UT Southwestern PT scar massage
Sara Reardon, P.T., performs scar massage on a patient who had a C-section.

If you experience physical problems that prevent you from fully enjoying life, talk to your doctor or physical therapist. Don’t accept it as normal. Reclaim your body after childbirth!

To talk with a physical therapist about care before, during, or after pregnancy, request an appointment online or call 214-645-8300.

Read the original article here.

I Made it to the Dallas Morning News!

Thanks to the lovely Leslie Barker, I was interviewed, along with other experts, for an article on finding peace around the holidays for the Dallas Morning News. Check it out!

KEYS TO HEAVENLY PEACE: HOW TO EASE HOLIDAY STRESS

By Columnist: Leslie Barker of the Dallas Morning News

Posted: December 7, 2014

Maybe it was seeing Halloween costumes displayed next to Christmas ornaments. Or forgetting to thaw the Thanksgiving turkey. Or hearing “Little Drummer Boy” on the radio for the 71st time.

Whatever first set your holiday heart pounding, your hands sweating and your fingers trembling, your stress level is, in all likelihood, up. It may not level off for a while.

That’s the bad news. The good? There are simple ways to bring it down. When you’re finished, you’ll still have chores and obligations, but also a renewed spirit to deal with them.

Start by putting down your to-do list and your smartphone, neither of which is going anywhere.

“Checking your phone or email is sending us into a high anxiety state,” says Angela Wagner, owner of YogaSport studio on Lemmon Avenue.

Ditto for well-meaning people who aren’t on your gift list — but they drop in bearing a cellophane-wrapped something for you. We can’t do anything about them, but we can offer one-word, one-minute-or-more ways to establish peace on Earth — your Earth. Here goes:

Breathe

Inhale through your nose to a count of four or five. Exhale slowly through your nose to the same count.

“When we resist and fight and judge reality, that’s what causes the stress, not the circumstances,” says Brother ChiSing (a.k.a. Norman Eng), director of Dallas Meditation Center in Richardson. “Breathing mindfully increases your ability to be aware, to accept and then to make better creative choices in the moment.”

Doing so “opens your heart,” adds assistant center director Bobbie Perkins. When that happens, it’s “a little easier to deal with people, even family members you don’t like to be around all that much.”

Wagner advises doing this — not phoning a friend, not texting another one — when standing in line, for instance, with armloads of wrapping paper or rib roast. “It relaxes your whole nervous system. You’re getting that extra oxygen, getting rid of your distractions.”

Chew

As tasty as gum can be, flavor isn’t what helps relieve anxiety, says Kevin P. Gosselin. He’s assistant dean for research and evidence-based practice at the College of Nursing, Texas A&M University in Bryan.

“It’s a somatic process, the process of chewing gum to reduce the physiological anxiety we experience,” says Gosselin, who has a doctor of philosophy degree in educational psychology. “Chewing gum is a way we can reduce that anxiety. It provides a tangible outlet — biting down.”

A couple of caveats: Choosing sugar-free will also relieve the stress of anticipating cavities as well as make your dentist happy. And chew doesn’t mean chomp sloppily.

Listen

Music has been used as therapy since Plato’s time, but is a lot more accessible nowadays. As for its calming nature, Gosselin says there are two schools of thought.

The first is selecting your own music. The second is choosing music that meets certain criteria: 60 to 80 beats per minute; no voices, only instruments; and no horns, percussion or anything with “a more abrasive tambour,” Gosselin says. In other words, choose piano or string instruments.

“From my research, classical music is typically better at reducing anxiety than self-directed,” says Gosselin, whose studies involved nursing students. “I tend to stick to classics like Bach, Mozart, Haydn.”

Franz Gruber wrote “Silent Night,” so that might be a good choice. Whether to include “Little Drummer Boy” — that’s up to you.

Touch

Specifically, your pets.

“There’s actually work that’s been done that shows primarily if you pet your own dog or cat your blood pressure will lower,” says Bonnie Beaver, a professor of animal behavior in the College of Veterinary Medicine at Texas A&M University in College Station. “It’s more significant if it’s your own. Otherwise, there’s a tension: ‘Is this one going to bite me?’”

Research suggests that when you’re stroking an animal, there’s a release of oxytocin, a calming hormone, “which then physiologically helps relieve stress,” she says. In addition, the animals tend to have a corresponding lowering of blood pressure while they’re being petted.

Studies have mostly been done on dogs, including one showing that dog owners who had survived a heart attack were less likely than non-owners to have a second heart attack. The calming influence, though, has been verified with other species as well, says Beaver.

“For me, I have great stress release with a horse and a dog and a cat.”

For an added benefit, after petting your pooch by the crackling fireside, take him for a walk. Fresh air is calming; plus, people are more likely to talk to you, so you’re getting that social component. Do so only if your dog is good on a leash. “If they’re pulling you down the sidewalk,” Beaver says, “that’s not good.”

Dallas Morning News Angela photo
Angela Wagner demonstrates a restorative pose that allows you to passively reverse blood flow. (Ron Heflin/Special Contributor)

Extend

We tend to live our lives a bit on the hunched side, says Wagner. “We’re hunched over our computer, driving cars, holding the baby, reading your phone.”

Thus, she recommends a couple of yoga poses. Though one takes a little more bottom-scootching than the other, both can be done between trips to the mall or when the in-laws are shouting along with A Christmas Story while it’s on TV in the other room.

For the simpler “cat-cow,” get on your hands and knees. Inhale, dropping your belly, arching your back as you raise your head. Exhale, curve your spine, tuck your belly, let your head drop.

“When you’re rounding it to cat, you’re exaggerating the negative movement” of the hunch,” she says. “The general backbend of cow will reverse some of the negative of rounding forward. You’re releasing some of those tight muscles in your chest, your pectoral muscles and shoulder muscles.

“Your body is meant to be in strong alignment. The way we hold ourselves is a huge part of the way we feel.”

For “legs on the wall” pose, lie on your back facing the wall. Scoot your bottom as close to it as possible, then lift your legs so they’re flush against the wall. Pull your shoulders down and, if you like, grasp your elbows above your head and rest your arms on the floor.

“This relaxes the central nervous system,” Wagner says. “You’re reversing your blood flow. You’re doing it passively. The wall is doing the work for you.”

Stay there for a few breaths, a few minutes, a few stanzas of “Twelve Days of Christmas.”

“I haven’t found it to take the place of a nap,” she says, “but it’s always written up as one of the most restorative poses.”

Soak

Bubbles are fine, but to make the most of your tub experience, be sure you’re generous — as in a cup or two — with the Epsom salt.

Epsom salt, or magnesium sulfate, has been touted as a stress reliever because when the body is stressed, it loses magnesium, which Epsom salt can replenish through the skin. It’s also been touted on various websites (including empathsolutions.com and Dr. Oz’s Pinterest page) as increasing energy levels.

Of course, you may need to do this before the kids are on holiday break. Or just hand the older set a threaded needle and some popcorn. By the time they tire of stringing the stuff, you’ll be out of the tub and refreshed.

Read the story on Dallas Morning News.

From Gym Rat to Yoga Mat

Sarah Ingredients of a Fit Chick logo

Sarah from Ingredients of a Fit Chick featured me in her blog today. Read about 6 of my favorite, and very practical, reasons to practice yoga. Welcome to 2015 everyone, it’s going to be a great year!. Visit my post here. (Oh and there might just be a discount code for my DVD’s at the bottom of the article, keep on reading!!)

20 Min Home Workout (Baby Optional!)

Now that I have sweet Luke, the days of going to the gym whenever I want are over. So, I’ve decided to embrace home workouts and practices. I recently started with this simple 20 minute workout posted at my local 24 Hour Fitness by one of the trainers, Xavier.  I adapted it to incorporate little Luke and he had a ball.  I even recruited my husband John to join us. We were actually sore the next day!

20 minute workout board
Here is the workout. It’s basic but it keeps you movin’ and groovin.’ Get your timer out and set it to one minute. If you are using your phone, put it on airplane mode. You can escape for 20 minutes and you definitely don’t want any push notifications, texts or calls distracting you from your goal.
Angela Luke pre workout
Here is Luke and I pre-workout. We are pretty energized and ready for action!
Angela push up Luke rocker
Luke loves his rocker. After having a C-section delivery, push ups aren’t as easy for me as they used to be. Using the rocker and my knees as a base is a fun way to incorporate Luke while keeping my incision site chilled out.

Angela push up Luke
Another fun way to do a pushup is old-school style on the floor or a mat. Placing the baby below you will help you lower to the perfect place. Do not let your shoulders go lower than your elbows.
Angela jumping jack Luke
Everyone knows how to do a jumping jack. I just did it in front of Luke and he thought it was the funniest thing in the world.

This video isn’t the best but you know how to do a basic squat, right? To supercharge the squat (and make it more fun for your little one), hold the baby in front of you and keep your chest lifted as you squat.

In this exercise, Roxy, Bella and Luke joined in on the fun. To do a forearm plank, draw your shoulder blades in and down, draw your belly in and engage your legs. You can also drop your knees to modify.

Luke born to play golf
Once you are done, Luke suggests laying out your play mat and taking a nap. 🙂

We hope you enjoy the family workout as much as we did. If so, share it with your friends!

Angela’s Faves – March 2014

Welcome to the first installment of Angela’s faves. Check out a few people, places and things that are inspiring me right now.

Angela's faves

 

FIRST, INDULGE YOURSELF:

Have a gluten or dairy intolerance? Vegan or wannabe? Check out my favorite Dallas (And NYC!) bakery Tu-Lu’s. All of their items are gluten free and many yummies are dairy free as well. Indulge without the tummy ache AND support a local business owner. I mean, why not, right? (and if your loved one is not intolerant, they will gladly indulge as well. John agrees, the coffee cake is especially yummy.

TIME TO GET INSPIRED:

The weather is finally changing and it’s time for spring cleaning!  I love this article on tips on how to spring clean your closet. The ladies at All in a Row know what’s up when it comes to organizing. 

FINALLY, LET’S GET GOING!

Need some convincing that this meditation thing IS in fact really doing something good? For those of you (us) who like proof and science to back things up, click for a short video about your brain on meditation.  It’s pretty rad to SEE the results. Now go grab your meditation pillow and let’s get to it!