Rachel Berg offers a comprehensive run down on staying in shape during and after pregnancy

With images of pregnant celebrities and their recoveries in almost every glossy magazine, no wonder women feel the pressure to bounce back into their skinny jeans as soon as possible. This often leads to drastic action like slinging on the old trainers, going for a run around the block, or even returning to main stream fitness activities like Zumba, kettle bells or power yoga sessions too early.

It is best for new mums to abstain from running and jumping until at least six months postnatal (longer if breast feeding). This is because the hormones keep the ligaments soft, which in turn means no support for your joints, spine and especially your pelvis.

You also need to make sure that pressure in the abdominals doesn’t build up. We all know that feeling you get when you are constipated. That grit-your-teeth-and-hold-your-breath situation. Or when you cough so much you feel your undercarriage is pulling downwards. These feelings are caused by intra abdominal pressure and should be avoided by never holding your breath either during daily activities or when performing any exercises. Activities that are not pelvic friendly will put excessive pressure on your pelvic floor area and could cause a rectal or vaginal prolapse.

Our pelvic floor is the last taboo and not openly discussed. New mums seem happy to recollect the intricate details of their deliveries to other mums at coffee sessions, but often keep the fact that they are having regular ‘accidents’ a secret. The shocking statistic is that 50% of postnatal women experience some type of pelvic organ prolapse (POP) but this may not be evident until their baby is over a year old!

New mums may feel that leakage or weakness is part and parcel of motherhood and inevitable after having a baby, but this is not the case and should not be accepted. These muscles, like any others in an exercise workout, should be trained and conditioned to enhance the quality of your life so you can eventually do the things you want to do without wetness or worry. By exercising your pelvic floor muscles on a daily basis you should be able to strengthen them which will prevent any ‘accidents’ in the future.

Why am I leaking in pregnancy when I haven’t given birth yet?
As soon as you become pregnant the hormone relaxin is produced.
Its purpose is to help the pelvis to loosen up in preparation for delivery. Levels of relaxin are noticeably higher around weeks 10-14, dropping a little, then stabilising at about 24 weeks before peaking during labour. So leakage may occur in the early stages of pregnancy due to the hormones. Then, in the last few months, it’s the combination of the hormones, increased weight of the baby and uterus that puts extra pressure on the “slow twitch” fibres and so your exhausted and softened pelvic floor muscles may not be able to stop minor accidents.

Research suggests that it is pregnancy, rather than childbirth itself, which has the greatest effect on the pelvic floor muscles (PFM), with 64% of women developing incontinence symptoms during this time (Charelli & Cambell 1997).

Prevention is better than cure but unfortunately many women do not make pelvic floor exercises a priority until a problem occurs.

“I think my ‘accident’ at 7 months pregnant encouraged me to do my pelvic floor exercises” says Jacqueline, a first time mum. “I still do them every time I change her nappy!” she adds, and reports no problems with her pelvic floor since.

Raphaelle says, “I started to do my pelvic floor exercises at 5 months pregnant as I got worried that it would not support my delivery. Then I heard and read very different information about pelvic floor exercising that the muscles needed to be strong yet muscles need to be supple? Too much exercise will impair the delivery process!” “Six weeks after delivery I had to go to an emergency gynaecologist as I could not walk and felt I was “open wide”. He said it was just normal!” ”I now do my pelvic floor exercises weekly and have no pelvic floor issues but I can not hold a pee as long as before.”

Having asked a few midwives about this age old myth of muscles being too tight for delivery their reply is unanimous. Women who have good body awareness and control of their pelvic floor muscles are able to cope better with the stresses of labour and their recovery will be quicker. During the second stage of labour, all layers of the pelvic floor musculature must stretch and if a woman is familiar with her downstairs department then she has more chance of controlling and easing the baby into the world without causing extra trauma. Women who have not located their PFM before delivery may find their recovery much more difficult. If the exercises are not undertaken as soon after the delivery as possible then the muscles will remain stretched and become further weakened with daily activities. Often a misconception is that if you have a C- section your pelvic floor is left unscathed. This is not the case as having carried your weight of your baby on your bladder for nine months has tired out the muscles down under.
Lisa, practise nurse and mother to three says “I get many mums up to a year or more after delivery coming to my well-women clinics with problems and they don’t seem to have any awareness or education on how to exercise their pelvic floor. There needs to be more emphasis on the importance of these muscles during pregnancy and the consequences that could occur if you don’t do them. I see mums from NHS and the private sector and even though the midwives and GPs do offer information many women slip through the net or don’t think it applies to them.”

WHEN TO START?
While reading this article! Ideally if you can condition your pelvic floor in pregnancy it will make your recovery and location of the muscles quicker. All postnatal mums including those who have never performed a pelvic floor exercise must get squeezing as soon post delivery as possible even if the muscles are stretched and weak and you may not be able to feel anything. Through daily training of these muscles they will be activated and will become stronger. “Don’t stress about it, just do them whenever you think about it, I do mine when I’m brushing my teeth,” says new mum Virginia.

WHERE?
Location, location, location! Often pregnant mums say they have been doing their pelvic floor exercises but have been tightening the buttocks, or inner thighs instead. A common confusion is to think that a ‘pelvic tilt’ exercise (where you tuck your bottom under) is a pelvic floor exercise. To locate the muscles think of the three exits in your downstairs department. The superficial pelvic floor muscles wrap around these exits like a figure of eight. Front two exits in the top circle and the back exit in the bottom circle. You need to squeeze and then lift up inside to activate the deeper pelvic muscles which support our pelvic organs, prevents involuntary leakage, assists pelvic and spine stabilisation, helps the baby to turn in the second stage of labour and in to the bargain can increase your sexual satisfaction.

HOW?
SLOW TWITCH
The slow twitch fibres provide support to the pelvic organs and when pregnant support the baby inside you.

When sat at traffic lights draw the two sides of the pelvic floor in towards the centre and lift up inside when you see the RED light try to hold it for 4 counts and then release with control.
NB If the contraction fails after a few seconds and there is nothing left to release, duration of the hold should be shortened.
Progression:
On an individual basis gradually increase the length of hold aiming for the YELLOW light, then the GREEN! Ensuring you always have something to release and are able to lower with control.
Don’t crash the car please!

QUICK TWITCH
The fast twitch fibres maintain continence.

When your mobile phone rings tighten and lift the pelvic floor up in one quick contraction. Snatch the snatch! Pause before releasing slowly and with control. Relax fully at the end.
NB The aim of this exercise is to perform each repetition with the same speed and strength as the first. Initially this will be very difficult to do as the fast-twitch fibres will fatigue quickly

WHY?
Think of a handbag girls. Our PFM keeps the contents and lining of the handbag inside where they should be. Now think trampoline, our PFM acts as a shock absorber for when we jump, sneeze, cough and lift heavy things or let’s say push in the second stage of labour. When we sneeze or cough these muscles get it together so you don’t end up doing aqua aerobics in the supermarket!

So don’t delay squeeze from today as being lazy now may become a problem when we hit the menopause. Later in life when we hit the CHANGE we have less support from our PFM and could experience the handbags contents on the outside, God forbid.

Remember the sneeze season is fast approaching. These exercises can be done any time, any place anywhere and no body should be able to tell if you are doing them except maybe for that twinkle in your eye. Next time you think give it a wink!

If you are having any worries or concerns about your downstairs department do go to your GP and get referred to a Women’s Health Physio. Prevention is much better than cure.

Rachel Berg is the Founder & Director of Pushy Mothers Fitness the specialists in women’s outdoor exercise. (pushymothers.com)

Recommended reading: “Hold it Sister” by Mary O’Dwyer.