The Race to the Bottom?

Is anyone else tired of the controversy, the judging and the alleged “mommy wars” that are dominating media coverage of all things birth and baby related lately? Me too! Today I wanted to write about a subject that, while not without differing perspectives, is hopefully a topic that won’t make anyone feel judged or stressed out or guilty and that might help women to make healthy choices that fit their goals, their lifestyles and their parenting styles (whatever those may be). 

I’m talking about Losing The Baby Weight. In general, it tends to be pretty much assumed that every woman wants to lose the weight she gained during pregnancy as quickly as possible after she gives birth. Most of us express envy at the Gisele Bundchens and Heidi Klums of the world who seem to be able to get back into supermodel shape within days of giving birth. Controversy may emerge around coverage of this kind of lightning quick weight-loss, in terms of the depiction (or lack thereof) of realistic images of women in media, both pre- and post-pregnancy, and how this defeats attempts to promote healthy body image. While I think it is essential that we talk about these issues and work as a community to alleviate the pressure to look model-thin, whether pre-conception or post-natally, there are other issues that pertain to Losing The Baby Weight that rarely seem to be touched upon and they are deserving of some attention.

My concern here is with the kinds of exercise that women are engaging in in the postpartum stage so that they can achieve the seemingly universal goal of reaching their pre-pregnancy weight. I don’t want to suggest that we shouldn’t be questioning this goal as a preoccupation in and of itself – it is vital that women be encouraged to love their bodies, no matter what shape they take on after having children. Putting that aside for the moment, if you do want to lose your baby weight, whether for aesthetic reasons or for health reasons or both, it bears keeping in mind that your body has been through a major change and numbers on the scale/waist measurements/BMIs/etc. may not be the greatest indicators of postpartum health and fitness. Not only that, but there are many types of exercise that may have been great for your pre-conception body – and that may someday be great for your body again – that can actually do more harm than good to a postpartum body.

I recently had the opportunity to attend a Toronto doula meeting where Kim Vopni, Postpartum Doula, Pre/Post-Natal Fitness Consultant and Certified Personal Trainer, aka Fitness Doula, was speaking. Kim was there to talk to us about pelvic floor health pre- and post-natally and she had some incredible information to share.

The pelvic floor is a highly vascular and innervated group of muscles and ligaments. It extends from the pubic bone to the tailbone and attaches to the sits bones (so think abs to lower back and all the way across the pelvic region). In addition to supporting the pelvis and the spine, it also maintains continence (i.e. it helps to prevent you from peeing your pants) and supports our internal organs. As many women who have had children (and some who haven’t) can attest, a healthy pelvic floor is a significant component of good quality of life. I don’t think that anyone out there would challenge the notion that incontinence, pelvic pain or organ prolapse (where internal organs, such as the bladder or the uterus may drop and even begin to protrude from the vagina) are significant barriers to positive living. Sadly, these and other symptoms of pelvic floor dysfunction are all too common in older women because they didn’t know how to prevent them in the first place and our healthcare system isn’t very good at prevention or with things that have more to do with quality of life than length of life. Often, by the time women seek help, they are at a point where surgery is the only answer. Not only that, but frequently the steps we take in the postpartum stage to lose weight and “get healthy” actually contribute to pelvic floor dysfunction.

First off, prevention is the key. Whether you are pregnant or not, you are probably doing kegels (or feeling guilty for not doing kegels). While kegels may strengthen the pelvic floor muscles (depending on the person, what state their pelvic floor is in when they start and what else they’re doing for their p.f.), they aren’t enough to create overall pelvic floor health and in some cases, they may be doing more harm than good. Katy Bowman, a biomechanist who focuses on the everyday functioning of the human body, has spoken up about the importance of squats in lieu of kegels for improving pelvic floor health. Basically, kegels are the vaginal equivalent of holding a heavy object with a bent arm for a prolonged period of time. Sure, your bicep is working and maybe getting stronger, but think of how this would affect the way that your bicep works as one part of your entire arm. Mostly what you are doing is making the muscle tighter, not necessarily stronger, and you may lose tone in other muscles, lose flexion ability, etc. as a result. In the long-run, you would be doing more harm than good to your arm.

As a more effective and universally helpful alternative to kegels, Bowman recommends squatting properly and frequently to improve the health of our pelvic floors. She notes that issues related to pelvic floor dysfunction tend to be much more common in places where women do not squat to go to the bathroom. By not squatting regularly, the tonality of our pelvic floors is reduced. If our pelvic floors are already weak, kegels may actually be weakening them further, although the muscles may seem to be getting tighter (remember, tight ≠ strong). Visit Mama Sweat for the interview with Bowman that started people talking and that explains the biomechanics behind this assertion.

Ok, so, good squats, several times a day (making sure to retain the curve in the small of your back as you descend – once you get to the point where you can’t, stop). Easy enough, right? Right, but according to Kim Vopni and others, this isn’t enough, especially if you’re at risk for pelvic floor dysfunction. If you’re pregnant, if you’re having symptoms of PFD (back pain, heaviness, mild incontinence) or if you’ve recently had a baby you should consider yourself ‘at risk’. First off, Vopni recommends seeing a physiotherapist who specializes in the pelvic floor (find one in Canada here). They will be able to assess your pelvic floor health and detect early pelvic floor dysfunction or early prolapse (which often does not have any symptoms) through a visual, as well as an internal exam. They will check for strength, balance and coordination of the p.f. muscles, as well as assessing how well you can both contract and release them. Once they’ve assessed you, they’ll be able to recommend exercises and techniques based on your individual needs.

The second suggestion Vopni made is an excellent tool that is generally marketed to pregnant women, but that can actually be beneficial pre-conception or postpartum – the Epi-No. The Epi-No was inspired by the practice in some African cultures of placing gourds of gradually increasing size into opening of the vagina in the weeks before birth, to help the tissues of the perineum stretch. For pregnant women, the Epi-No is presented as an effective tool for preventing tearing and/or episiotomies during childbirth. An additional benefit though, is that it allows women (pregnant or otherwise) to actually measure their progress as they learn to both effectively contract and release the pelvic floor. Using what Vopni refers to as “up/down training” one can rely on the Epi-No’s gauge to actually see when the muscle is being squeezed and, more importantly, released (because we want to be able to control our pelvic floor muscles – we don’t want them to be in a permanent state of hypertonicity, or chronic contraction). This squeeze training can be done at any point during pregnancy or pre-conception. Once you reach 35 weeks gestation, you can then begin using the Epi-No to gradually stretch the tissues of the perineum in order to prepare them to stretch when your baby is born. This is done by inserting the balloon into the vagina and inflating it until the point of discomfort – but not pain – and then sending your breath to where you feel the resistance. After a few minutes of breathing into that sensation (think of the way you breathe into a stretch during a yoga class), you release your pelvic floor muscles to allow the balloon to come out still inflated. If you haven’t been doing the up/down training prior to this point, you may find that last bit pretty difficult.

All right, all right…enough about all this pre-conception, pre-natal pelvic floor health stuff, you’re here to read about Losing The Baby Weight and so far I haven’t given you any tips or strategies for how to do that! Well, I’ll tell you something, I’m not going to. What I am going to tell you is what not to do in the quest to reach your pre-pregnancy weight so that you can enjoy long-term health. You may not lose all the weight in six weeks or two months or six months, but if you avoid the pitfalls I am going to outline below, you will have a much better chance of being able to maintain an active lifestyle for years and years to come. You may take a little longer to lose the weight initially, but you’ll have a better shot at keeping it off for good if you don’t hurt yourself trying to get it off too fast.

First off, if you were going to a trainer or boot camp before you became pregnant, don’t assume that that person or program is going to be your best resource for weight loss after you give birth. Your body will be changed by pregnancy and birth and you need to rely on professionals who understand exactly how it’s changed and how it needs to be treated in order to reach optimal health. A trainer who has “worked with postpartum women” or a boot camp that advertises itself as a “great way to burn off the baby weight” are not necessarily what you should be looking for. You want to make sure that whoever is instructing you has proper training for working with postpartum women (not just experience working with pp women who may not have known any better). Talk to that pelvic floor physiotherapist you found for recommendations or look for programs that emphasise pelvic floor fitness (if you’re in Vancouver, you might want to contact Vopni directly). Vopni teaches what she calls PFilates (pronounced phil-ates) – Pilates for the Pelvic Floor. PFilates programs include the kinds of exercise that you should be doing to focus on overall core strength (not just abs!) and glute strength. If any postpartum trainer suggests an intense cardio program with a lot of running and jumping, or a core training program that involves a lot of crunches, v-sits or back bends, find someone else! Those intense cardio routines are going to put a lot of pressure on your pelvic floor during a time when it needs to be protected and the extreme abs approach will encourage your rectus muscles to separate. The linea negra – the dark line down a pregnant belly – is an indicator of that kind of normal (and relatively minor) separation during pregnancy. If the separation isn’t given time to reverse after birth it can lead to diastasis recti, where your internal organs are actually pushing forward between those muscles.

You may not lose all of the weight as quickly as you would with a boot camp or running program, but core breathing techniques, walking, glute strengthening and other pelvic floor-friendly approaches to fitness will ensure that when you do eventually go back to boot camp or return to running half-marathons, you won’t have to worry about peeing your pants or having your internal organs gradually fall out of your vagina (which, let’s face it, is not going to be good for your long-term fitness goals). Take your time, rest, bond with your baby and focus on feeling good about yourself where you are (not where you want to be in six months) while you gradually and carefully get back into shape with the help of a qualified postpartum trainer. If you make those things your priority, your long-term health will be better for it, which will mean many more years of running and boot camps with a healthy pelvic floor that can support that kind of lifestyle. As Vopni told us at the meeting, trying to do too much too soon in an attempt to Lose The Baby Weight as fast as possible is really and truly a race to the bottom.

Related: The Mommy Tummy AKA Diastasis

 

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One thought on “The Race to the Bottom?

  1. Pingback: Exercise in Pregnancy Part One: It Does Your (and Your Baby’s) Body Good! | Empowered Birth

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