Healthy Beginnings

I had the pleasure this week of being a guest speaker at a couple of Healthy Beginnings meetings, which are drop-in groups for young children, babies and their caregivers sponsored by the local health unit.  I spoke to one group in Duncan earlier in September, and two groups on Thursday in Shawnigan Lake.  I did a little demo of core work with the women (all moms except for one nanny), and checked a few for diastasis recti (everyone was good to go!).  But aside from encouraging more people to strengthen their pelvic floors, I really wanted to get two points across:  a) let them know that I’m here as a resource for them in the community; and b) emphasize the notion that fitness is holistic, and that postpartum fitness, especially, has little to do with fitting into pre-pregnancy jeans.

Let’s talk about the second point first.  I’ve written about this before here so I won’t repeat those points now.  But I was struck at the drop-ins by how much women focus on changing their size after pregnancy.  Of course I already knew this was the case, but every time I see signs of it, the red light starts to flash in my head: teachable moment!  teachable moment!  There are practical reasons to want to get back to pre-pregnancy size–the most significant of which is probably financial, as buying an entirely new postpartum wardrobe right after buying a new maternity wardrobe is an onerous expense.  But there is nothing wrong with taking time to get there, and moreover, a healthy lifestyle + time is the best formula for healthy and lasting post-pregnancy weight loss.  Anything extreme–extreme exercising, or even not-so-extreme dieting–is dangerous, plain and simple (and most likely ineffective).  

The thing is, we all know this, and beating people over the head with such information doesn’t work.  So instead, I tried to focus on the positive:  rather than telling people what not to do, I suggested what they can do to improve their health and wellbeing after baby, and to strengthen their bodies so that they can move with freedom, and with the knowledge that they are protecting their bodies from injury. Even more importantly, I tried to emphasize that they can do that without having to be away from their babies.  (Although there is nothing wrong with working out solo either–the point is, women have lots of options and they can pick and choose what is right for them at any given time.)  And I’ll tell you–it felt very good to look around the room at women’s faces and feel like they were soaking these messages in.  I know the relief I often feel when someone in a position of some authority/expertise gives me permission to be kind to myself and to follow my instincts about what is right or wrong for me as a parent, and I hope I was able to do that for some of the women there.

On the second topic: although part of my reason for going to the drop-ins was to let women know about Fit 4 Two, I had a bigger purpose in mind, and that was to let them know that there is a place they can go if they have questions about things to do with health and fitness during pregnancy, birth, and postpartum recovery.  I got involved with Fit 4 Two because I wanted to reach out to women as someone who is not a clinician of any sort, but has other kinds of information to share, and is happy to be a source of support.  Sometimes people hesitate to call on professionals when they have questions they feel are minor, or they have questions that professionals may not be equipped to answer (even the best birthy clinicians may know little about exercise physiology, for instance).  I wanted to introduce myself to the women as a fitness professional, but more importantly as their peer:  I know a lot about pre and postnatal fitness, but I’m also someone who has struggled through the pre and postnatal phases  and can lend an empathetic ear if they too are facing challenges.  So I was so glad to have the chance to go into these groups and let the women there know that they can email or call me any time with questions; if they are within my scope of practice, I’ll answer, and if they are outside it, I can help connect them with appropriate resources.  The point is that they aren’t alone, and they don’t have to pay a penny to be supported at this time in their lives, when so many women end up feeling isolated, inadequate, and often (sadly) at war with their own bodies.  Of course I’d love for them to take my classes, but it’s not about that; it’s about creating genuine relationships, and meeting women where they are, whether they are ready for and interested in a group workout or just need some basic information about how to work with their pregnant or postpartum bodies.

Oh, and I got to cuddle a newborn.  That was probably the highlight of the whole thing for me, personally.  There is nothing better than holding someone else’s newborn baby…  😉

An epidural is not the only way to protect your pelvic floor

There has been a lot of discussion this week about press coverage given to a new study suggesting that epidurals may prevent trauma to the pelvic floor during delivery. Basically, the idea is that an epidural relaxes the muscles such that they don’t tear. I don’t know whether or not that is true. I haven’t read the study itself, only representations of the story in various places. I know that Amy Romano at Science and Sensibility is sceptical, and I think she is a pretty trustworthy source of information. It has been interesting to follow the discussion between her and the study’s authors in the comments section of her blog. (And ire-provoking to see the known ideologue Dr. Amy Tuteur’s $.02 popped in there, too—but I digress…) Whether or not the study’s conclusions have merit, the coverage of the study, particularly in the Globe and Mail, has been quite atrocious.

I’ve said it before and I’ll say it again: I don’t think there’s anything inherently wrong with epidurals. They have an appropriate time and place, and the only person who can really say for certain whether or not an epidural is indicated is the woman with the baby descending through her pelvis. I’ll trust her to be the judge of how she wants to manage those sensations. So, this is not an anti-epidural rant. Hell, I was practically desperate for one with my first baby—got to the hospital in transition and begged for one. I was too far gone, at 8 cm, to qualify—and in retrospect I’m glad that was the case, as it was a very cool experience to give birth without drugs—but at the time, if someone had tried to suggest that I was wrong to ask, I’m sure I would have wrung his or her neck with my own bare hands. That said, there are definitely risks involved with an epidural, just as there are risks with any invasive medical procedure. Risks v. benefits. That’s the name of the game.

So, there may be benefits to epidurals that we didn’t know about before. That’s awesome. It’s always good to learn new ways of preventing women from lasting harm to their bodies. Women want good options when it comes to health care. But a) this study isn’t saying epidurals prevent tears—it’s saying epidurals may play a role in preventing some kinds of pelvic floor damage; and b) the uncritical coverage of this study has not explained that there are also many other steps women can take to safeguard the health of their pelvic floors. The point is: there is nowhere near enough data to say that epidurals are necessarily the best approach, and they certainly aren’t the only one, either.

What else can women do? There are the often-cited birthing strategies that include not giving birth on one’s back, but instead choosing a position that is more in synch with physiological processes occurring and can benefit from gravity; avoiding fundal pressure; and pushing spontaneously, rather than following directions for pushing. But there are other things women can do as well, before they get to the moment when they are actually in labour—a moment when they may or may not want/be able to think about those strategies.

Women who perform simple pelvic floor exercises during pregnancy and after delivery can greatly reduce their chance of pelvic floor trauma and the speed of postpartum healing. The stronger the pelvic floor, the more flexible; the more flexible, the more likely those muscles will get up and out of the way and not tear while a baby passes through. A strong pelvic floor can also prevent/reduce the significance of other common pregnancy- and birth-related concerns, such as hemorrhoids, prolapse, and urinary incontinence. And as a bonus, contracting the pelvic floor automatically gets the transverse abdominus to co-contract, helping to tone the abdominal muscles. These are seriously awesome exercises that can be done anywhere, at any time of day, with no special equipment.

 So, what do you do? Basically, you want to do a modified Kegel, which can then be performed in various series, at various speeds, and in various patterns. If you’ve never done a Kegel before, the idea is to draw the muscles of the pelvic floor (PF) up and into the body, as if you’re stopping yourself from going pee. Draw them in, breathe, hold for a few counts, breathe, relax. Once you get the hang of that, you can move on to combine PF work with other core strengthening exercises such as curls (unless you have diastasis recti), superwoman, and cat-cow. You can do them sitting on a chair or an exercise ball, standing, lying on your side, on your hands and knees, in child’s pose—there are many positions that work, all of which have a slightly different benefit.

The bottom line (pardon the pun) is: strengthen your pelvic floor. Pregnant or not, this is a good thing to do. But if you’re pregnant or contemplating giving birth at some point, strengthening your pelvic floor is a noninvasive, key step in minimizing the risk of tearing and other significant trauma to the perineal region.

%d bloggers like this: