The pelvic floor after birth

Julia Ronnenberg is a midwife and specializes in the topic of pelvic floor and regression. I am very happy that she wrote this guest article on the topic of pelvic floor after birth for me. You can find more information about Julia and her services on her website mammacita.de.

Have fun reading!

We are often only consciously aware of our pelvic muscles when their strength is waning. Then, when the pelvic floor muscles can no longer fulfill their tasks. As a midwife, I have cared for many women who only learned about their pelvic floor and its function through pregnancy and birth. Since this time in particular demands a lot from the female body, the topic is incredibly important in the postpartum period and the time after.

So let's talk about pelvic floor. What stresses and strains does the pelvic floor have to endure during the birth of your baby? How can you gently get it back into shape afterwards? And what should you pay attention to if you want to carry your baby in the postpartum period?

Summary

Basic information about the pelvic floor

Think of your pelvic floor as a kind of strong hammock that carries your insides with all their organs down. It is made up of three layers of muscles and ligaments that stretch like a fan between the tailbone and pubic bone, interrupted in the middle by the three important orifices of the body: the urethra, vagina and rectum.

The pelvic floor muscles hold our organs in place in the pelvis, close the three orifices completely or partially and thus have the task of ensuring the continence of the bladder and bowel. In the best case scenario, a strong pelvic floor will ensure throughout your life that nothing will leak out unintentionally, even under high pressure (e.g. through sneezing, coughing or laughing). In addition, it counteracts the pressure that is exerted on our bodies when carrying heavy loads.

The pelvic floor is probably the most versatile muscle in our body. It must be flexible and able to swing, but at the same time strong and stabilizing. In addition to the functions mentioned above, the pelvic floor muscles are actively involved in our sexual life and, together with the deep abdominal and back muscles, support the straightening of the spine.

The pelvic floor and your baby

During pregnancy, various forces act on the pelvic floor, causing it to become increasingly softer and weaker. Your body produces pregnancy hormones that loosen the tissue to prepare it for a natural birth. Your pelvic floor also carries more and more weight due to the growing baby in the uterus. This means up to 6 kg of additional load until birth.

To make matters worse, the position of the pelvis changes during pregnancy because the abdominal muscles also become weaker due to the growing baby bump. The result can be a hollow back, which makes the work of the pelvic floor muscles even more difficult. All this already has a weakening effect on the pelvic floor. It is therefore a misconception that a C-section makes targeted pelvic floor training after birth superfluous.

However, a natural birth puts the crown on the whole thing and demands maximum performance from your pelvic floor. The muscles have to stretch extremely and the tissue usually suffers minor injuries. A birth injury, such as an episiotomy or perineal tear, further weakens the pelvic floor and prolongs the healing process. You should therefore definitely use the weeks after birth, the postpartum period, to regenerate your body. First and foremost, this means relaxing and lying down a lot. In the second step, when all the wounds have healed, postpartum gymnastics helps to build up the weakened muscles.

How can I take care of my pelvic floor during the postpartum period?

After a period in which your pelvic floor muscles have been very stressed, they are particularly fragile and need to regenerate. Why should you give it this time in the postpartum period? To avoid late effects of pelvic floor weakness. A weak pelvic floor catches up with most women as they age, but even young women (especially in the first year after giving birth) can have symptoms of a weak pelvic floor. They may notice urine leaking from their bladder or wind from their bowels every time they sneeze, have a small cough or jump. The pelvic floor can no longer reliably perform its functions.

Symptoms of a weak pelvic floor are:

• Bladder weakness / incontinence
• Problems in the bowel area / at the sphincter
• Uterine prolapse / organ prolapse
• Permanent feeling of pressure in the vaginal area
• Pain during sexual intercourse, the lower back or the hips
• Incorrect posture of the pelvis

The motto is prevention. During the postpartum period, you should therefore refrain from too much physical exertion. Now you can postpone heavy housework, gardening or furniture purchases. But as a mother, you naturally want to take care of your baby. This also means holding it, carrying it and transporting it in the car seat. If you manage to consciously coordinate lifting and carrying the baby, you can take care of yourself. And as the baby's weight increases, you can actively strengthen your pelvic floor.

How much can you carry after birth?

Most people know that heavy lifting after birth and in the postpartum period is taboo. The rule of thumb is that you should carry a maximum of 5 kg of weight during this time. Of course, this is only a value for orientation. Your pelvic floor has no resistance to gravity in the first weeks after birth. It is severely overstretched and sags. That's why you should take the early postpartum period literally: Spend a lot of time lying down and stand as little as possible.

An old midwifery rule is "7 days in bed, 7 days on the bed, and 7 days around the bed."

Again, this rule is not mandatory to follow, but just to make it clear that you should take it easy and move between the sofa and the bed, especially in the first few weeks, instead of taking long walks. If you do carry your baby, keep it to short distances at first.

Let yourself be cared for and give your body time to process the strain. By the way, the pelvic floor is also stressed when you are sitting, as the organs rest on it when you are sitting. It will certainly be unavoidable for you to take care of your baby while sitting down. However, the best way to regenerate your pelvic floor is to breastfeed while lying down and to spend a lot of time in a horizontal position. A pillow under your pelvis also relieves the pelvic floor.

Fortunately, the baby's weight, which is usually between 3 and 4 kilograms, is not problematic at the beginning. However, there may be situations that are better left to dad or other helpers. For example, if the car seat and baby have to go in the car or the basket full of laundry has to go upstairs from the basement, you should delegate this task if possible. If you start with postnatal exercises after a few weeks, your pelvic floor will slowly regain strength.

General tips for carrying in a way that is gentle on the body (pelvic floor and back):

• When picking up from the floor, do not bend down, but kneel with your upper body upright
• Carry weight as close to the body as possible
• Distribute weight evenly (ideally in front of or behind the body)
• Avoid repeated one-sided carrying
• Tighten the pelvic floor specifically when lifting or carrying something

How to carry your baby gently for your back and pelvic floor

If you want to carry your baby, the need for closeness and your body's well-being will quickly come into conflict. Of course you want to comfort, care for and carry your baby whenever necessary. At the same time, you should not overload your body. I advocate a healthy balance here, where both needs are not neglected. If possible, don't wear it so long in the beginning and increase the wearing time with time and increasing physical fitness. Until then, perhaps your partner can take the lion's share to satisfy your baby's need to be carried. The following carrying methods are gentle on the body:

Carrying the baby in front of the body ...

... distributes the weight evenly. The baby should be as close as possible to your body and the center of your body. Very comfortable aids for this purpose are baby carriers and slings. Especially with small babies, you should make sure that the sling is tied correctly or that the carrier is adjusted appropriately. With a little practice and the correct carrying technique, they make your everyday life easier, provide free hands and great closeness.

Carrying the baby on your back ...

... with the right baby carrier or sling. Basically, our body is ergonomically designed to carry loads on our back. It automatically ensures a more upright posture. Switching between the two carrying options therefore makes a lot of sense. However, carrying on the back with carriers is not recommended until after 3 months, when babies can control their heads. With a tightly woven sling, it is possible to carry on the back from birth if the sling is tied well.

The older your baby gets, the more weight he or she puts on the scales. This is of course excellent, but it makes carrying more difficult. As long as a child cannot stand and walk, it is and remains a carrier. But you can reduce the load a little. For example, leave the car seat in the car and only carry the baby as soon as the weight becomes too much for you. If the child has fallen asleep in the car seat, use a frame to transport the car seat.

Carrying siblings

It becomes difficult for all multiple moms who have a sibling to care for in addition to an infant. Carrying and lifting only up to 5 kg in the postpartum period? What do I do with the one-and-a-half-year-old when he needs to be changed or comforted? It will not always be possible to do without lifting completely. After all, your older child has a need for mommy, too. However, you can reduce the physical effort for yourself.

Face your child at his or her eye level. For example, you can squat down to comfort or hug your child. Use a stool to make it easier for your child to climb up to the changing table or the bench, so that he or she can learn to do this under his or her own steam. If the sibling still sleeps in the crib, remove the slipping bars. Then it can get up on its own in the morning and does not have to be lifted out. In the end, you are not only relieving yourself, you are also giving the older child its first independence. And many are quite proud of that!

How long does it take to train the pelvic floor again?

After childbirth, regular postnatal exercises are necessary in any case to restore/maintain the functionality of the pelvic floor. For noticeable effects, you should train regularly for at least 12 weeks and keep on the ball even after that. After the postnatal gymnastics, I recommend that you do strengthening exercises before you start doing sports that stress the pelvic floor. In many cities there are special courses for mothers, where the needs of young mothers are taken into account.

After the postnatal period, some sports are particularly suitable for re-entry. These include, for example:

• Gymnastics/ Yoga/ Pilates
• Swimming
• Walking
• Cycling
• Dancing (without bouncing)

We midwives say, "It comes 9 months, it goes 9 months."

You can apply that to the pelvic floor as well. It can take months or even up to a year before it is sufficiently strengthened. It also depends somewhat on whether a woman is breastfeeding or not, because breastfeeding hormones loosen the tissues. Depending on the connective tissue and stamina, the pelvic floor can remain a lifelong issue for women. You can develop individual routines for this - for example, performing a certain pelvic floor exercise while brushing your teeth.

Everyday tips for a healthy pelvic floor with and without a baby

Pelvic floor training is also a topic for men and women without a baby. You can do a lot for your pelvic floor in everyday life by simply taking the strain off it and exercising regularly. With just a few routines, you can create good conditions for a healthy pelvic floor that is not exposed to too much pressure.

Let's walk through the pelvic floor-friendly day together:

Balanced standing up:

Little pressure on the pelvic floor is exerted by your abdominal muscles if you first roll to your side, push your legs out of bed and at the same time push your upper body up off the bed with your arms.

Standing and sitting:

Parallel positioned feet ensure good distribution of body weight and balanced blood flow.

Sneezing and coughing:

Turn specifically to your upwardly extended arm bend or shoulder. The lateral abdominal muscles will then cushion the pressure.

Straight back:

An upright posture basically relieves your pelvic floor. You should have neither a hunchback nor a hollow back.

Exercise abdominal muscles:

Start with exercises for the deep and oblique abdominal muscles. You should avoid sit-ups in the first few months.

Proper lifting and lowering near the floor:

Get in the habit of kneeling with your back straight instead of bending your upper body forward.

Eat a high-fiber diet and drink plenty of fluids:

Make sure you have soft stools, so you don't have to use much pressure when going to the toilet.

Are you interested in more midwife tips about the pelvic floor, pregnancy and birth? Feel free to check out my midwifery blog or follow me and mammacita on Instagram and Facebook page.