And Now, What about Mommy?

November 2, 2009

Pilates pregnant woman with exercise ballMarin Mommies is pleased to present another great guest post, this time by Zeina Grifoni MPT, Certified Pilates Instructor and owner—with her husband Tiziano—of Synergy+ Physical Therapy and Pilates Studio.

Pregnancy, birth, and now the aftermath—a beautiful baby, but what about mommy?

Pregnancy and new motherhood are amazing, life-changing experiences. Throughout pregnancy, an OBGYN or midwife makes sure that both mommy and baby are healthy and happy. Once the baby is born and the initial stages of healing are complete, all the attention shifts toward baby. While it is wonderful to focus on baby, many women are left wondering what is happening to mommy!

During pregnancy and soon after childbirth, many women find that they were not prepared for how their bodies are changing physically. They are surprised to discover the extent of pelvic floor muscle weakness, the amount of time it takes to return the abdominals to normal length and strength, and the postural changes that occur as a result of pregnancy, nursing, and caring for the new baby. These changes can be difficult both emotionally and physically. Whether the pregnancy and birth were smooth or complicated, many women are unsure of how to physically prepare for pregnancy or recover post-partum.

What can be done for the mommies out there?

How can Pilates help?

Pilates is a great way to prepare for and recover from pregnancy and birth. It is essential, however, that Pilates is taught by someone with training specific to pregnancy and post-partum care, as there are many physical changes that a pregnant woman’s body goes through that differ from those of the general population.

Named after its creator, Joseph Pilates, Pilates is a series of exercises that focus on stretching and toning muscles. Most people know Pilates for its emphasis upon flow of movement, centering, stability, and control of breathing. These principle foci have the combined objective of restoring the body to a place of balance by allowing the individual to gain healthy postural alignment, relieve overworked muscles, and attain spinal mobility.

When Pilates is individualized to a pregnant or postpartum woman, the effects can be dramatic. Some of these include maintaining strength during pregnancy, increased ability to push during labor, and return of strength to the abdominal area post partum.

What about Physical Therapy?

Physical therapy is very effective in treating dysfunctions that occur with muscles and joints. During pregnancy and childbirth, a woman’s body undergoes enormous changes that put stress on the very areas of the body that physical therapy targets. A physical therapist trained in pre and postpartum care can provide coaching on the use of pelvic floor muscles (including the vaginal walls, urinary and anal sphincters), suggestions for ways to relieve and minimize low back pain should it occur in the pre or post-natal phases, and minimize the impact the pregnancy has on joints. A physical therapist can also help reduce diastisis rectus (a splitting of the rectus abdominus muscle of the trunk) should it occur during pregnancy, as well as strengthen the abdominals throughout all the different phases of pregnancy and recovery. Additionally, a physical therapist can arrange for an appropriate pre and post-natal exercise program.

Pregnancy

During pregnancy, the body changes at an enormously fast rate. Pregnant women quickly notice an increase in the flexibility of their joints, muscles, and ligaments as soon as the pregnancy begins. The greater flexibility is a result of increases in the release of a hormone called Relaxin. The purpose of Relaxin is to relax the pelvic ligaments and soften and enlarge the opening to the cervix; however, Relaxin also affects all the joints and ligaments in the body. Relaxin is found in its highest amounts early in pregnancy, as it helps develop the interface between the placenta and the uterus. Some women who have had tight muscles and joints in the past actually feel better as a result of the release of this hormone, but the majority of women are more likely to notice differences in ways that do not feel so great. These changes can include movement of the pelvis, which, in turn, can cause back pain, occasional nerve pain, and increased risk of repetitive strain injuries in the neck, shoulders wrists and hands, to name a few.

Ever wonder why it is so hard for a pregnant woman to sit straight up?

The abdominal muscles in a pregnant woman stretch by more than 50% of their original length. These muscles include the rectus abdominis (the “sitting up” muscle), the obliques, which are just below the rectus and help hold the ribs against the trunk, and the transversus abdominis muscle, which is the deepest layer of the abdominal musculature. The changes that these muscles undergo cause them to function less efficiently and decrease the amount of support they usually provide to the spine and pelvis. The rectus abdominis, in particular, stretches and begins to separate away from the midline, creating what is called a diastasis rectus This is a normal change in pregnancy; however, in some women, the rectus abdominis does not return to normal post-pregnancy and requires special attention. The extreme stretching of all the affected muscles is what makes sitting straight up prohibitive while pregnant and directly after. Not until the muscles re-gain their integrity and force can women sit up straight again. (It’s Okay, though, as baby cannot sit straight up for at least 2 years!).

Birth

During birth, the body goes through an enormous physical ordeal. Some women have an easier time of birthing than others. Although each experience is unique, all women experience many of the same physical changes that have to take place in order for the mother to get the baby out (vaginial birth). The uterus contracts very forcibly to assist in opening the birth canal and ultimately birthing the baby. The pelvis widens to allow the baby to fit through the vaginal opening. This puts an enormous strain on the sacro-illiac joints (the joints in the posterior pelvis), and can often also impact the coccyx (tailbone). The abdominals contract in order to push the baby out. The amount of pushing necessary varies by individual due to the effectiveness of the uterine contractions and the size of the pelvis versus size of the baby. Tearing of ligaments, vaginal soft tissue, and separations of the pubic bones and sacroiliac joints are complications that can result from childbirth.

If a woman has a cesarean section, whether planned or emergency, the abdominal wall is cut through (all three layers of muscle!) and then stitched back together. A mother who goes through this procedure needs to have the doctor’s approval before starting any exercise program, especially one that involves the abdominal muscles. As soon as she is clear for exercise, it is imperative that she restore strength to the abdominal wall in order to prevent any incidence of back pain, since the abdominals can no longer do the work of supporting the trunk.

Post partum

In the Post-partum phase, many women’s bodies heal without event. Some, however, experience unresolved difficulties that can improve with proper training through Physical Therapy and Pilates. In most cases, the entire body, including oft tissues and belly, return to their pre-pregnancy state over time. For some women, this happens immediately post birth; for the majority, however, the process takes a full year from the time that the mother stops nursing her baby. For the skin to return to its normal state, it can sometimes take up to 3 years. Some common complications that some women experience during the post-partum healing period include urinary incontinence, which can occur in conjunction with a prolapsed bladder, diastases rectus that does not close, umbilical hernia--the umbilicus is a weak place in the abdominal wall where hernia is common,. Inability to urinate/defecate can also be a result of a tightened, overstressed pelvic floor that can no longer relax enough to release the urinary and anal sphincters.

During breastfeeding, the hormone Relaxin stays in place. Additionally, the uterus contracts as a woman breastfeeds in order to return to its original size. Other changes include increased use of calories to make milk, and increased beast size. While some women may appreciate their enhanced size, larger breasts can actually put increased stress on the upper back muscles and change posture.

After all of these changes, can a woman’s body return to her pre-pregnancy state?

Yes! Women can return to their pre-pregnancy weight and fitness level. But as with any dramatic change to the body, whether caused by an orthopedic injury or pregnancy, it takes time for the body to heal, the muscles to return to their normal position, and the joints to regain their prior integrity.

An OBGYN in conjunction with a Physical Therapist can often help restore normal function of the pelvic floor, decrease diastases recti, and help resolve incontinence and/or over tightened pelvic floor issues. Pilates with an instructor trained in pre and post-natal care can help women regain and maintain a strong, healthy body.

It often takes some work and an investment in one’s self for a woman to return to her prepregnancy state, but with a bit of determination and the right help from medical and fitness
professionals, that goal can be reached!

Zeina Grifoni MPT, Certified Pilates Instructor

Zeina is available for individual assessments and group classes through Synergy+ Physical Therapy and Pilates Studio.

Zeina Grifoni studied Physical Therapy at Samuel Merritt College in Oakland and graduated in 2002. She then moved into the study of Pilates to strengthen her rehab potential for both athletes and the physically challenged population. After having two babies and going through the process of restoring her own body to physical health, she dove into a deeper focus on woman’s health.

She and her husband Tiziano Grifoni, own Synergy+ Physical Therapy and Pilates Studio in San Anselmo, CA. The focus of Synergy+ is overall health and wellness for the physical self. Zeina and Tiziano hold pre-natal, post-natal, and Mommy and Me Pilates classes as well as Physical Therapy and individual Pilates sessions. For more information, log on their web site at www.synergyptpialtes.com.