postpartum

Tips For Understanding And Running With Your Post-Pregnancy Body

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Read my latest post for Women's Running here or below:

Pregnancy can be a lot like training for an endurance event–it’s just spread out for nearly 10 months. But once the “race” is over, the accolades of your accomplishment don’t fade away: you’re still in charge of keeping a tiny human alive, all while trying to recover physically and keep your headspace balanced. When you do come out of the fog of those early weeks of parenthood and want to resume some sort of exercise routine, what should you expect? Here are some tips about how to approach the journey of postpartum exercise.

First Postpartum Checkup: Ask Questions

Usually this occurs about six to eight weeks after delivery. In most cases, your doctor will “clear” you for exercise. Make sure to probe about what this actually means and discuss what your goals might be. A lot of this depends on your previous activity history, as well as your labor and delivery. Even if you were active throughout your pregnancy and had a fast labor, it still takes weeks or even months for your body to heal. Have your doctor examine your pelvic floor strength and check to see if you have any abdominal separation (which is quite common). Ask for a referral for a pelvic floor therapist if there are concerns, or get a second opinion if something doesn’t feel right.

Be Body Positive

Both pregnancy and exercise allow you to get to know your body in different ways. If you were active while pregnant, it probably gave you a deeper understanding of how your body responds to stress, as well as to changes in weight gain and distribution, blood volume, oxygen capacity and digestion. It also likely helped you understand your approach to body image and self-appreciation. During labor, your body is literally pushed to its extremes in every way–physically, mentally and emotionally. When the baby does arrive, our bodies can feel like a wreck of what they once were: we’re engorged, bloated and squishy in areas that we don’t want to be. In those early postpartum weeks and months, the physical and emotional extremes linger, making it easy to slip into negativity. While you may feel like there are never enough hours in the day for yourself, try to practice mindful body positivity. Replacing negative thoughts with positive ones during exercise will leave you with a stronger core and better sense of self-worth.

Prepare To Work Out With A Stroller

Once the baby arrives, you may need to do the majority of your workouts with a stroller. You will probably run at a slower pace: after all, you’ll be pushing the stroller, the car seat (if your child is younger than 6 months old) and your baby! Chances are, that’s at least 25 extra pounds that you are pushing forward. This can be quite physically challenging, so starting with a run/walk method is quite effective. If you don’t have a jogging stroller, long walks and even stationary strength training with the stroller are great ways to get your heart rate up. It’s always an added bonus when your baby falls asleep: being able to have your baby nap AND get a workout in can leave you with a sense of accomplishment. Embrace that “super mom” feeling!

Get Good Breast Support

If you plan to do any sort of impact activity, you’ll know immediately if you need a more supportive sports bra the second you take your first step out the door. Wearing two bras isn’t ideal, so invest in a supportive bra; or, better yet, get a sports bra specifically designed for nursing, if you are actively breastfeeding. Since you may need to stop mid-run to breastfeed (or know you’ll need to once you return home), having a nursing sports bra can make your life a little easier.

Be Flexible With Your Time

Regardless of whether you’re breastfeeding or bottle-feeding, you’ll need to be flexible with the time you allot for your workout and plan your route ahead of time. There have been countless times when I had to stop and feed my son on a park bench mid-run, which added at least 30 minutes to the time I’d planned to be out–all because my little man decided he was ravenously hungry or had an epic diaper blowout (or both).

Adjust Your Pace

When you resume running after pregnancy, your perceived effort and sense of pace will likely be different. In a sense, you may feel like you are starting running all over again. Even if you aren’t training for anything, you should approach running as if you are and gradual increase your distance, intensity and speed.

Strengthen Your Core

Your core is weak(er) postpartum, and you may even have some form of diastasis recti (the natural separation of the two abdominal walls). A weak core may cause a muscular imbalance (or can lead to future injury) in the hip flexors, glutes, lower back and legs. It’s a good idea to complement running with strengthening exercises that focus specifically on the postpartum body, including preventative and corrective diastasis recti exercises. You can start with some basic diaphragmatic breathing–which, done regularly, can help to gradually knit the abdominal wall back together.

Expect Soreness And Fatigue

Even if you ran all nine months of your pregnancy or exercised in other ways, chances are that your stride length will have decreased, your pace will have slowed and your form will have shifted during that time. When you start running again, be very cautious with your pace and increase your distance gradually. Relaxin, the hormone that allows your ligaments to stretch and expand over the course of your pregnancy, is still at an all time high for as long as six weeks postpartum. Once you’re cleared for exercise before or after this period, you will still be at risk for over-extending your muscles and ligaments. Starting at a slower pace is key to preventing injury.

Pay Attention To Your Pelvic Floor

No matter how many months postpartum you are, make sure to pay attention to your pelvic floor (the hammock-like structure of muscles and ligaments that support the organs of the pelvis, which include the bladder, uterus, bowels and vagina). High-impact activities like running can further weaken your pelvic floor, which can cause a variety of minor or major issues ranging from occasional urine leakage to organ prolapse. You’ll want to make pelvic exercises part of your regular routine, even if you don’t notice any problems. Sometimes it’s only when you exercise at a higher intensity, cough or sneeze mid-run or are more tired than usual that you notice a problem, so don’t assume you are exempt from practicing pelvic floor exercises. These muscles also weaken with age and inactivity, so making them part of your routine is critical.

It’s Worth It

Are all of these things really worth the trouble just so Mom can have a few active minutes to herself? Your body has endured a tremendous number of changes from pregnancy to postpartum, so of course it’s going to feel hard in the beginning. Acknowledging this and easing back into exercise with a better awareness of our new bodies takes time. Embrace the process and your new body. Focus on the positives, the milestones and the way you’re feeling. Getting back in touch with your body and finding a rhythm and routine takes a lot of practice, so be kind to yourself as you adjust to your new routine.

The Elephant in the Room: Running & the Pelvic Floor

A few months ago, a new app, B-wom, which acts as a personal trainer for your pelvic floor, contacted me about being an Ambassador to their platform.  Definitely check it out--having more control and awareness of your pelvic floor is SO IMPORTANT in women's health.  I was invited to share my own experiences with them about fitness and my postpartum journey on their blog; you can read it here or below:

When I was discharged from the hospital after having my first child, I was given a “welcome home” packet with information about how to care for my newborn, breastfeeding advice, warning signs to look out for in the immediate days postpartum, and general advice about my new postpartum body.  In the fog of new motherhood and extreme sleep deprivation, I barely touched the pages of literature that were there to “aid” me. I spent the initial postpartum days hobbling around our NYC apartment trying to figure out how to swaddle my baby, change his diapers, and breastfeed, all while trying to wean myself off pain medication I was given to help me cope with my badly bruised tailbone, tearing, and my episiotomy.  

Unlike many other countries, in the US, a couple xerox copies of literature are generally all the help new mothers are given immediately after having a baby, if any.  A lot of times there isn’t even a couple printouts of information hastily thrown at the mother as she’s leaving the hospital to help guide her in the unchartered world of motherhood. Aside from 6-week postpartum checkup, you’re on your own.  Unless you’re willing to pay hundreds if not thousands of dollars for a doula who may (or may not) provide a postpartum follow up or have a lactation consultant visit your home, the proverbial village of raising a child and helping the mother recover doesn’t really exist. 

When I finally got around to reviewing the literature during a neverending pre-dawn cluster feed, there was one paragraph that mentioned women should start doing pelvic floor exercises “immediately postpartum.”  I honestly didn’t really know what that meant at the time, let alone the importance of this.  Frankly, thinking about “exercising” my pelvic floor made me nauseous, as EVERYTHING hurt so much in that region.  Anything that involved sitting, squatting, or going to the bathroom was excruciating.  Walking was incredibly difficult, as was going up and down stairs. Little did I know that a relatively “normal” vaginal birth would be just as difficult to recover from than a C-section.  As a person who was very used to an active lifestyle pre pregnancy and throughout the nearly 10 months of it, not being able to do the most basic movements without debilitating pain was a huge blow mentally, emotionally, and physically.

 

Elephant in the Room by Mark Bryan

Friends, family, and even strangers that I came to know through online blogs told me this was completely normal to feel this way. Everyone said to take it day by day, and they were right.  One week postpartum, I was able to walk multiple city blocks and navigate subway stairs, though very slowly and gingerly.  Two weeks, I was up to over a mile.  By 4 weeks, while I still was bleeding occasionally, I was able to walk 4 miles.  It was still painful from time to time, especially when I overly exerted myself.  I had to be very careful.  And yet by the 6-week mark, I was able to go on my first 3 mile run, which (fortunately) was nearly pain-free.  Yet things felt “different” in my pelvic region in the weeks (and months) that followed.  It felt “heavy” and often sore, and I sometimes leaked urine if I wasn’t careful.  When my doctor “cleared me” for exercise at 6 weeks, I mentioned this to her.  It seemed embarrassing to talk about it at first.  It was only during that checkup that she told me my pelvic floor was weak and that I should be doing pelvic floor exercises every day, and equally as important, she told me the reasons why. She even showed me how properly release and contract my muscles.  Little did I realize that while all OBGYN’s should be encouraging their patients to do this, it’s actually not very common practice.  How many other women out there don’t even realize this is so important to not only know about, let alone do?

Pelvic floor muscles are really a hammock of support for your bladder, uterus, vagina, and rectum.  So if your pelvic floor muscles are weak, these areas won’t function as well as they should.  The pelvic floor is also part of your general core. When you think “abs” and “core”–this also includes your pelvic floor muscles.  They support your lower back (lumbar spine area) and your hips.  So, when one has weak pelvic floor muscles, there can be cascading negative effects on all these areas.  Postpartum women are more apt to suffer from these effects, as especially if there is vaginal delivery, there can be some form of “trauma” to this region. Even if there is no tearing or episiotomy involved, the very act of pushing a baby out of the birth canal stretches the pelvic floor beyond its limits and therefore strains and weakens these muscles.  And yet, it’s not just this group of the population that may have issues–it can affect everyone (men and women, of all ages), not just post partum or post menopause women.  

In my own experience, because I talked about my issues with my doctor early on, did more research on my own in the months that followed, and began to integrate pelvic floor exercises in my routine, I was able to resume my active lifestyle pretty quickly after giving birth.  Since I didn’t have any severe issues like organ prolapse and I closely monitored my progress, I even was able to run a marathon less than five months postpartum with little pelvic floor issues during training.  I was lucky.  While I am a more informed individual about the pelvic floor and more attune to its interconnectedness with my own body, I still have flair-ups from time to time, even two years after giving birth.  I still dread coughing or sneezing especially when I am running as I know I may pee just a bit.  I still get embarrassed when I talk about these “incidents” sometimes.  Even writing about my experiences gives me pause.  But being open about this is extremely important to discuss with others.  I’ve now learned so many of my friends and family suffer from a weak pelvic floor, and yet didn’t know what to do, and most just sort of accept it as “that’s life.”  I find women tend to be more apt to think we can handle this on our own, it will go away with time, or “that’s the way things are,” and not to seek help if there is an issue, no matter how minor.  We joke about peeing when we sneeze, but we may not do something about it.

However, there are some solutions.  First and foremost, it’s educating women to be more open about discussing their issues–no matter how minor–with their doctors, and their community.  And taking action to prevent things from getting worse is also key, as inaction can actually make it worse.  Having a weak pelvic floor may even prevent some women from doing things they love to do, or used to do.  Regaining strength and control to these muscles will help, and yet it takes time and regular practice as often as one brushes their teeth.  Talking the right steps to mitigate this can also be at your fingertips -whether it’s finding a physical therapist who specializes in the pelvic floor or even easier- the B-wom app, which acts as your own personal pelvic floor fitness coach.  Seeking help now will give you more confidence in yourself and allow you to move forward and take control of your life.  

The Best Hidden Exercise You Should Do Every Day

This post was originally published in Red Tricycle, where I am also a contributor.  You can also read the whole article here:

Recently, a friend of mine mentioned that she didn’t like running that much.  It wasn’t because she wasn’t in shape, or she wasn’t fast, or she didn’t have the time…it was because she felt like she had to pee every time she took a step and that was holding her back from doing what she once loved to do years ago.

Ladies, if you had to pick ONE exercise to do every single day, it should be training and toning your pelvic floor. 

I used to think that the pelvic floor, or “doing your Kegels” had more to do with enhancing your sexual pleasure than really anything else.  We’ve all seen Sex and the City and heard the talk (mainly from Samantha) about the importance of doing Kegels and why.  It’s true that having a strong pelvic floor can definitely help in this department but that’s only one reason.  The other (in my view, even more important) reasons why having a strong pelvic floor is so important isn’t really discussed as much, or at least as openly, as it should.  Yet it affects everyone (men and women, of all ages), not just post partum or post menopause women.  Especially if you are active, here are some reasons why strengthening your pelvic floor NOW is so helpful:

●The pelvic floor is part of your general core. When you think “abs” and “core”–this also includes your pelvic floor muscles.  In fact, your Deep Core Stability Muscles include the pelvic floor.  Having strong pelvic floor muscles help support your overall core stability and strength.  When you have a strong core, it helps with your overall stability, posture, and form, all of which make you a better runner and athlete.  If you want to be a faster and stronger runner, you should be doing your pelvic floor exercises.

●The pelvic floor supports your lower back (lumbar spine area) and your hips.  If your pelvic floor is weak, it further increases your risk of injury to this area (or other areas that are supported by the pelvis, lower back, and general core…like glutes, hamstrings, groin).  Doing pelvic floor strengthening can also help with any pain management you may have in your have lower back pain or pain in your hips.

●A strong pelvic floor will help with incontinence issues.  Just because you feel like you may need to urgently pee when you are exercising at a higher intensity doesn’t mean you’re exempt from training your pelvic floor.  Or that one time you sneezed and you felt like you needed to pee (or maybe you even leaked a bit of urine)…or even worse–you sneezed during exercise, that’s probably when you really noticed an issue.  Developing a stronger pelvic floor can help with any incontinence issues, no matter how minor they may seem. 

●A weak pelvic floor can make constipation worse.  The pelvic floor muscles are really a hammock of support for your bladder, uterus, vagina, and rectum.  So if your pelvic floor muscles are weak, these areas won’t function as well as they should.  When you train your pelvic floor, you are more able to have a healthy elimination.

●A strong pelvic floor helps with childbirth and postpartum recovery.  If you are thinking about having a child, whether you are a first time mom or not, having better control of your pelvic floor will help with delivery (it helps move the baby down the birth canal, and during the “pushing” phase of birth).  And doing pelvic floor exercises immediately after giving birth can be a great way to help regain strength in this area (again, it’s part of your core), and also promotes healing from any tearing sustained during childbirth.  Your pelvic floor muscles get stretched out in just a matter of hours during childbirth vs. the 40 weeks that it takes your abdominal muscles to stretch out, so it’s extremely important to begin a regular strengthening routine for your pelvic floor.  Once you are “cleared” for other exercise, having a well-established deep core routine and stronger pelvic floor muscles will be so beneficial to a mother’s mental and physical wellbeing.  While there is a lot of discussion in our culture about “getting our bodies back” and “getting rid of our mommy’s pooch,” working towards a strong pelvic floor should be the primary go-to exercise in the postpartum exercise routine.

●Your pelvic floor muscles will get weaker with age and non-activity.  Just like any other muscle, if you don’t focus on strengthening or using it properly on a regular basis, it becomes weaker over time.  And hormones won’t help, which is why postmenopausal women suffer more from pelvic floor dysfunction. 

So, how do you begin?  There are lots of variations, but the most basic one is that of a Kegel.  You can do this sitting or standing, anywhere and everywhere.  Begin by tightening your pelvic floor muscles, starting from the back to the front (anal sphincter to vaginal sphincter), and hold for a few seconds.  Then release, allowing your muscles to soften and then gradually relax for a few seconds.  Remember to breath throughout this process (have your breath start with your diaphragm, then chest), as you would when you are doing any other strength training exercise. You can repeat this sequence 10 times, and do 3 reps. You can gradually work up to tightening your hold for more seconds at a time, increasing the intensity of your effort, and the frequency of these exercise.  Like any strengthening routine, it takes time to see results.  But doing them on a regular basis, especially combined with diaphragmatic breathing, will eventually give you a stronger inner core.

For those that think they have more of a severe issue, the good news is there is additional help out there.  You can talk to your OB GYN (who should be checking your pelvic floor strength as often as they see you, but many of them do not), or you can also go to a Physical Therapist who specializes in the pelvic floor.  If you also practice yoga or Pilates, you can also talk to your instructor about additional exercises to do to help with pelvic floor awareness and strengthening.

In my own practice, I have found that incorporating them into my daily activities like putting my makeup on, eating breakfast, riding the subway, or washing dishes help me to be as regular about doing them as I am about brushing my teeth.  Aside from the stated benefits above, training my pelvic floor has helped me become more aware of my entire body, especially my core, and not just the “outer unit” muscles. As an athlete, it’s extremely important to be attune to not only the muscles that you think you may use in a specific exercise, but to be aware that your body is a system of interconnectivity.  If one area is (or becomes) weak, it’s going to eventually affect another area that is more dominant. The pelvic floor is unfortunately a very common weak area for most everyone, and yet if affects us in so many ways when we’re exercising or going about our daily lives.  The benefits of doing these exercises on a regular basis last a lifetime, so start today. 

Motherhood and Running: the BQ and Pregnancy Conundrum

(This post originally appeared on CityCoach's website, as a guest blog post.)  

 I’m a mother, runner, and a Boston qualifier.  But I will likely not be able to run the race that I qualified for (and got in), because I am pregnant again.  Here is my story.

I was never a super-star runner, so when I first started to run marathons, I never thought that qualifying for the Boston Marathon was even a possibility for me.  Just getting across the finish line feeling strong and happy was the goal.  But over the years, race after race, I gradually chipped away at my times, and each time, the goal was to go faster than before.  The more I ran, the more my goals shifted.

When I became a mother, my goals and priorities continued to change.  For me, and I’m sure for other active mothers AND fathers, finding time to run (and train) became even more a balancing act.  There were times when I questioned if some of my running goals were realistic or “worth” my time and effort. And in the early weeks postpartum, just getting outside felt like a huge victory from a time management standpoint and also my mental and physical wellbeing. It was incredibly important not only for my overall health that I continued to be active, but it became more a part of who I was as a person: it gave me a bigger sense of purpose.  Having longer term goals--whether it be time specific, or more general ones--was incredibly important as a new mother, as it is so easy to “lose” one’s self in the crazy world of parenthood.

A few months before giving birth to my son, I decided to sign up for a marathon, held less than 5 months after his due date, as I thought (a bit naively) it would be a great way to "bounce back."  Of course, after I gave birth, I took much longer to recover than I ever anticipated, so that left basically 11 weeks to train for the race.  I took training run by run, week by week, but I managed to do the minimum.  When I ran the race, I ran conservatively and didn’t have specific time goal in mind--just to feel good the whole way.  When I crossed the finish line at 3:45, it was a total shock, as not only was it a PR, I realized that if I could finish in that time with minimal training, then qualifying for the Boston Marathon was a feasible goal.

The next marathon I signed up for was held another 5 months later, with the primary goal of qualifying for Boston.  This time, I trained a lot harder: hill repeats, interval training, speed work, tempo runs, etc, and also bumped up my weekly mileage significantly more than ever before.  This was much harder to do as a full time working mom, who also was still actively breastfeeding, but I knew that I needed to do this for myself.  I knew I would regret it if I didn’t at least try.  Just like when I trained for the first postpartum marathon, I took it week by week.  It helped to really “pace” myself during my training, as sometimes I was just too tired to push myself 100%.  And that is normal.  When you have a big goal in mind, it’s easy to get too obsessive and then caught up in the self-doubt periods: thinking about the bigger goal too much is counter-intuitive and can be daunting.  It’s the constant balancing act--reminding yourself every so often of your larger goal so you have something to focus on, but also being “present”--and always trying to remain positive and yet realistic.

When I ran the race, it was harder than I expected (it was a marathon, after all), but I pushed through and achieved my goal.  The last few miles I was way off pace but I kept chanting “Boston, Boston” in my head, and then would alternate it with my son’s name, over and over again to block out the negative thoughts.  My BQ time was near 4 and half minutes under the qualifying standard, so I knew that that was sufficient buffer time to get in.  So, when I got the official email nearly a year later from the Boston Athletic Association (BAA), it was icing on the cake. But, literally 2 days later, I found out I was pregnant.

The BAA current policy states “refunds or deferments of bib numbers for the Boston Marathon will not be granted for any reason, including injury, pregnancy, military exercise or deployment, and family emergencies.”  So, women who happen to get pregnant (like me), who want to run the race have basically two choices: still run the race (in my case, I would be almost 8 months pregnant), or cancel their entry and have to retrain, run and qualify for another marathon.  

When I read these rules after I found out I was pregnant,  I initially felt like I had never qualified and got accepted into the race.  Like it was “my mistake” for “allowing” myself to get pregnant slightly earlier than planned, or that as a “maternal age woman,” I really couldn’t have it all: run Boston and have young children at the same time.  If you’re due in June 2017 like I am, even if you were an elite runner, if you were to try to run another race to re-qualify, it wouldn’t even be feasible to do so for the mid September cutoff for qualifying times.  So, my hopes of running Boston won’t be until 2019.  

Certainly if the BAA does change the rules to allow for deferments or refunds for reasons of pregnancy, this could potentially be Pandora’s box (Would one need to have proof of medical record? How far in advance would one need to notify them? What if there was a termination or loss of pregnancy after deferring, could you retract the deferment?).  While I’m not advocating strongly for the BAA to change the rules for reasons of pregnancy alone (especially not over some of the other valid reasons they state), it does make me think how much harder it is for women athletes--especially those that want to be and are mothers--to achieve their goals.  Either one meticulously plans when they want to have children around their training and goal races (which anyone trying to get pregnant will tell you this is pretty hard to actually do!), or one has to delay their goals (whether it be having children, or their race goals).  

For me, who isn’t a “naturally” fast runner, it’s hard enough to train for the Boston Marathon and get in, but adding being a mother on top of this further complicates it.  Even if one is super active during pregnancy, your physical capabilities start to drop the bigger you get (you’ll inevitably get slower, and most women will eventually stop running completely before their eighth or ninth month, if not before), and then post-partum, you have to build in recovery time immediately after the birth, and then slowly build your way back up.  It’s months essentially away from running completely or certainly being in peak physical shape before and immediately after a baby.  And months more to get back to what you used to be.  

Perhaps becoming a mother is a choice, as is choosing to run.  But as a mother and athlete, for me, I find that both are key to having more of a balanced healthy life.  Can we really have it all?  We can try. Being an athlete makes me a more focused and centered mother.  Frankly, it’s become part of who I am and one of the things I most love.  Being a mother makes me have more perseverance, better time management, and gives me sense of larger fulfillment--which also carries through in my running.   While I may not be running the Boston Marathon anytime soon, this experience has given me an even deeper appreciation for my fellow mother athletes--novice and elite--it’s a new sisterhood that I am now part of.  And yet it’s a struggle.  We’re faced with a lot of obstacles that we have to overcome especially as we return to the sport:  the physical ones (the general postpartum recovery, a bladder that will never be the same, never sleeping enough or the same way again), and also ones that we can’t control, like not being able to run a race that we qualified for because life got in the way.  But just like any training cycle, hardships makes us stronger: we set new goals, we overcome the negatives, and we move forward.  Hopefully just faster, stronger, and more focused than ever before.