5 Birthing Tips for Pregnant Women

It has been a big year filled with many firsts – the biggest of all was the birth of my daughter Gabrielle this past April 2018. She is now 8 and a half months old!
As a Prenatal and Postnatal Pilates teacher, it was truly amazing to finally be able to practice what I have been preaching for close to a decade. Pregnancy and birth is such an important topic – especially as it relates to pelvic health. Pelvic health is my passion and something I wish more women discussed.
We have all heard the jokes about sneeze leaks after child birth and the importance of “doing your kegels” for pregnant and postpartum women.  But newsflash, there is SO much more to exercising your pelvic floor than just “doing your kegels.” (Hint, some women shouldn’t be doing kegels at all!)
Child birth is one of the most incredible feats a woman’s body can accomplish. The more a woman is physically and mentally prepared, the stronger and more empowered she will feel during this life changing event.
Here are our top 5 tips for a smooth birth. We teach these in our Bump Method Prenatal Pilates classes. That being said, not everyone is able to have a safe vaginal birth. Circumstances are sometimes beyond our control and we are so grateful to have medical interventions when needed. C-sections save lives everyday. And some people may simply choose to elect a caesarian birth for personal reasons.

There’s absolutely NO birth agenda here, simply tips that I (and many students before me) found helpful in preparing for a vaginal birth.

  1. Open Glottis. Always try to push with an open mouth (called open glottis). This also helps you dilate more quickly when in contractions. Try exhaling and letting your lips flutter – much like a horse. It sounds crazy, but it’s proven to reduce pelvic floor damage. This links to the next point.
  2.  Sphincter Law. Read up on “Sphincter Law”, a term coined by Ina May Gaskin. She has some great books also and a great TED Talk. Ina is a famous midwife with A LOT to say about birth, and her work is very empowering. I read her books during pregnancy and found her stories helped quell any anxiety.
  3. Spontaneous pushing is best for your pelvic floor. This means that pushing is non directed – you push when you feel the urge and not before.
  4.  Find your core and release your pelvic floor. Try to push at the end of your inhale when your pelvic floor is most open. The more open you can make your pelvic floor and the more connected you can stay to your deep core muscles – specifically your transverse abdominis – the stronger you will feel when it comes time to push. I had a pretty hard time figuring out how to push until my doula finally said “use your abs Nikki!”. Baby G arrived 3 pushes later. Stay connected to your deep core muscles during pregnancy by performing “hug the baby” core breaths. We have tons of video examples on instagram under #thebumpmethod and in our online prenatal video programs.
  5. Push side lying. If you have the epidural or are with an OB who won’t deliver you on hands and knees, try lying on your side with your top leg on a squat bar during pushing instead of on your back. This way your pelvic floor is 30% more open and studies show it is actually easier to get baby out with less tearing.
I sincerely hope these tips are helpful to any pregnant women who may be reading this. Here’s to you and your magical bodies! My favourite quote from midwife Ina May Gaskin is: “Your body is not a lemon.” You got this mamas. Your strength will surprise you.
With so much love.xo

How Prenatal Pilates Empowers Women

When I took my doula certification course several years ago, we learned about the pain-fear-tension cycle during child birth. This is hugely powerful concept that illustrates the spiral that can happen when women experience fear surrounding birth.  For most of our lives, we have been bombarded with negative stories of other women’s birth experiences and seen dramatic depictions in movies and on television. We have been conditioned to believe that excruciating pain is associated with labour; and because of this, most women I know fear giving birth. This fear can create a cycle of increased tension and pain. fear-tension-pain-cycle

Here’s how it works: Fear creates muscle tension, and tension increases perceived levels of pain, which of course leads to more fear.  This creates a cycle that inhibits the body from performing a normal physiological function.  The result is exactly what’s feared most – long, painful birthing or unnecessary intervention.

Fear comes from both misinformation and the unknown – from cultural myths and questions never asked.  Knowledge is power, and feeling powerful will reduce feelings of fear. Prenatal Pilates is an opportunity for women to receive the knowledge they need. They’ll learn how to trust in themselves and their bodies so they are prepared no matter what happens during their birth. Here’s a little bit of what we cover in The Bump Method Prenatal Pilates classes, both in person and on video. 

Posture: learning how to position your body during pregnancy to reduce back and hip pain. Tip: ensure your pelvis is stacked under your rib cage instead of thrusted forward (very common as your growing belly can pull you out of good posture).

Breathing: learning how to connect your exhale to the contraction of your pelvic floor and your inhale to the release of your pelvic floor. The inhale is key for the pushing stage of labour. Tip: picture your pelvic floor gently dropping and opening as you inhale into your diaphragm, then initiate the push at the very end of your inhale.

Birth Positions: learning the best body movements and poses for encouraging the baby to descend during labour and delivery. Tip: being on hands and knees and gently rocking OR using 2 pool noodles ( yes, pool noodles) vertically under each of your pelvic bones while seated can be a good for helping baby get “unstuck” and descend into the birth canal.

Diastasis Recti: learning how to avoid separated or “over-stretched” abs from pregnancy. Tip: avoid positions in your pregnancy and postpartum that will increase pressure in your abdomen. So no planks, crunches, or even curling up as you get out of bed. Roll onto your side first. If you see a ridge or dome pop up in your tummy during certain movements, that’s a sign your abs are stretching apart and you should get out of that position asap. Instead, learn to prevent diastasis recti through targeted “belly pumps” that work your pelvic floor and core at the same time, minimizing the pressure on your abdominal wall.

Bump Method Prenatal Pilates

Pregnancy and birth is the ultimate act of surrender. Surrendering to the unknown can be a pretty scary thing for most of us, but arming yourself with knowledge, support and a caring community of women is a sure fire way of making the journey more comfortable. You are never, ever alone!

xoxo

 

What everyone should know about Cesarean Birth

I first met my Obstetrician when I was 15 weeks pregnant. Since I was pregnant with twins it was suggested that my perinatal care be provided by the “high risk” OB in town. In this first (very brief) meeting, I was reassured that so far things looked good, but given I had not yet had children it would be in my babies’ best interest, particularly that of baby B, to be delivered via Caesarean section.

At this time in my life, I was over half way through my PhD, so my inquisitive mind needed to know, “what is the evidence to substantiate a C- section is in the BEST interest of baby B”?

In response, I was given a somewhat detailed answer pertaining to a recent five-year research trial that determined consistently poor outcomes for baby B when delivered vaginally. I accepted this, agreed to the recommendation and as I left my appointment, I was given a card with my scheduled Caesarean section date indicated.  In a way, it was a bit of a relief. My trust in our health care system at the time translated to me not giving much thought to the type of birth I would have.

c-section

However, I am most grateful (especially now!) that my naturopathic doctor did. In addition to helping me conceive, she ensured that “despite my impending Caesarean section”, I would be armed with the best possible health strategies for my future children.

What did she mean? She was talking about the microbiome. Delivery through the vaginal canal is the time when a baby ingests some of the first bacteria that will colonise its guts. But babies born by C-section miss out on this process, and end up with a different set of bugs – including some from the hospital environment.

Tons of studies have found evidence that this C-section microbiome could make the child more vulnerable to problems later in life, such as asthma, food allergies and even obesity. We are finally coming to understand how important the collection of bacteria in our guts is for our health.

microbiomeIt is only now that I understand how important certain aspects of her plan were – probiotics!! My children are now five years old and it’s only in the last two years that I’ve given more thought to how they were brought into the world, and how I was duped by the very care system in which I work. In retrospect, I was not given accurate information on what was in my babies’ best interest. Rather, I was offered a recommendation based on a biased perspective, one that medicalizes birth, disrupting our precious evolutionary fabric in the process.

My increasing knowledge and understanding of the microbiome has stemmed from one of the many hats I wear – a professor of pathophysiology at McMaster University. Simply put, the scientific evidence is now very clear: a well-functioning microbiome is the key to health – it represents the foundation and the evolutionary matrix that allows us to exist. This important new research SHOULD be transforming our health care approach, especially as it relates to perinatal care.  Almost one third of babies born in North America are now delivered by C-section. These babies can still receive the microbes they’re missing — and hopefully some of the health benefits — by being swabbed with their mother’s vaginal fluid shortly after birth.

The microbiome (gut microbiota of humans – formerly known as gut flora) represents a diverse set of bacterial species (approximately 1000-1150). These micro-organisms control our immune system as well as metabolism – they are everything! Here’s a video explaining how the microbiome is the future of medicine. Colonization of the intestine with important bacteria begins at birth, mainly due to transfer of bacteria from the mother, but also from the environment – to which the influences are many. Mode of birth, place of birth, breastfeeding and antibiotic use have been clearly demonstrated to influence the composition of the microbiota.

So, what exactly are the implications regarding Cesarean section? We still don’t have all the answers. What we do know, is that when your baby’s gut is colonized by the micro-organisms in the hospital operating room rather than from you, it doesn’t bode well for the long term health of your child. More disturbing is the fact that this is now understood to have a multi-generational effect.

So, what can we do with all of this information? As I said, our conventional practices that medicalize birth require a major upheaval. It is not to say we never need medicalization – of course there are times when medical intervention saves lives. This is where our current systems approach shines. However, the pattern of routine unnecessary intervention is a big issue and frankly the health of our population is suffering as a result.

Regardless of where you fit in the perinatal care process, you need to be informed. Beyond being informed, you need to be supported and empowered to make the best decisions. Thankfully our bodies are designed to adapt towards a state of wellness. We do however need the correct guidance on how to get there in a world of conventional practices that are hazardous to our health. I am so grateful to now be working with an incredible team in a one of a kind centre called The World of my Baby (the WOMB), who can provide this much needed help.

Exercise Tips From a Pregnant Pelvic Floor Physiotherapist

I was recently a guest health expert on the YouTube talk show Social Common. And oh, did I ever have a blast with the fabulous hosts Cat and Nat. They didn’t hold back on the questions about kegels, coming out of child birth “unscathed” and “vagina rehab” (aka Pelvic Health Physiotherapy). Sexologist Dr. Jess O’Reilly joined in afterwards for some extra tips. It was quite the uncensored show and will hopefully make you laugh while perhaps teaching you some new things 🙂 Check it out here

As many of you know, we work closely with incredible practitioners called Pelvic Health Physiotherapists to help our clients get the best possible results from their fitness training. These practitioners are specially licensed health professionals who offer both external and internal physiotherapy to help women prepare for and recover from childbirth, treat pelvic pain, incontinence, “mummy tummy”, and a host of other conditions that too many often suffer from silently. Well, not any more! Times are changing, and I’m so passionate about spreading the word that there is help.  It’s never too late to restore your core, so if you’re reading this and your kids are in their teens or beyond, keep reading. The following is an article written by Anita Vandenberg, an incredibly compassionate Pelvic Health Physiotherapist here in Toronto, and soon to be mama herself!Anita Vandenberg If you are pregnant, you may have googled – “safe exercises during pregnancy” – and what you likely found is overwhelming AND conflicting. So what are you to do? It’s important to seek out experts in the area of prenatal fitness, BUT also ask questions about their training, credentials and up to date research and education. We are frequently learning new information regarding exercise during pregnancy, so what may have been deemed a good idea a decade or even a few years ago has changed today.

As a pelvic physiotherapist I am constantly looking into the newest opinions, research and clinical recommendations for women to use during pregnancy and beyond. I work with pregnant and postpartum women on a daily basis who are working to prevent or resolve pelvic floor and core issues –  including incontinence and diastasis rectus abdominis (abdominal separation/mummy tummy).

And now I am thrilled to be on this pregnancy journey personally as my husband and I are expecting our first child in 2016. I always assure my clients that I follow the same pregnancy advice I give to them as I have seen so many positive outcomes!

Have you had surgery or known someone who has? If you have, you have likely heard of prehab – a proactive approach to avoiding injuries, pain or muscle imbalances. Prehab for surgery involves physiotherapy ahead of time to increase strength and stability around the surgical area. Prehab also improves the speed and effectiveness of your recovery, and decreases muscle compensations that can happen over time. Prehab is a good idea!

Why isn’t prehab for pregnancy and childbirth recommended to every pregnant woman? A cesarean section is considered surgery, and while a vaginal birth isn’t considered surgery – it still takes a toll on our body.  Health professionals are readily aware of the changes that occur in a woman’s body during pregnancy: a shift in centre of gravity, increased size of uterus and breasts, increased demands on core muscles to provide pelvic/low back support, elevated levels of the hormone relaxin which loosens ligaments and causes joint laxity… and that’s just naming a few.  Why not prepare your body for this life changing event? Prehab style exercise will help your body stay strong through these prenatal changes and support an easier postpartum recovery after your bundle of joy is born.

Tips for successful prehab pregnancy exercise include:

Trimester 3

1) See a pelvic health physiotherapist

Find out if your pelvic floor is working properly. SO MANY women don’t do kegels correctly, and their pelvic floor muscles are weak – either a) too tight/tense (hypertonic) or b) too loose (hypotonic). Find out the status of your muscle function by having a pelvic floor physiotherapy assessment (contrary to popular opinion, having a tight or tense pelvic floor isn’t a good thing!) So many women assume these muscles become loose, stretched out and weak just because you are pregnant.  On the contrary, many women can have tight pelvic floors, just like tension in any other muscle of the body. A tight pelvic floor can cause leaking and contribute to vaginal tearing during childbirth.

Finding out if you’re hyper or hypotonic early in pregnancy will help you choose the best options for exercise during your pregnancy. FYI- just because you aren’t “leaking” when you sneeze, doesn’t mean your pelvic floor is all good. If you have a tight hypertonic pelvic floor, breathing techniques, internal manual release and stretches will be recommended until the muscles have relaxed, and after that pelvic floor strengthening (core breath – aka the ‘new kegel’) will be introduced. If your pelvic floor is loose and hypotonic, the core breath will be introduced right away with other exercises layered on as you become stronger. I also check for diastasis (abdominal separation) on pregnant women. By improving their pelvic floor function, they improve their core activation which can minimize diastasis and make the postpartum recovery process much easier.

2) Learn to do core breath then layer on other exercises

Your core breath is what you may think of as a kegel along with a deep breath. Your diaphragm muscles and pelvic floor muscles work together along with your other two core muscles (transversus abdominis and multifidus). Start by lying or sitting with a small curve in your low back called neutral spine (pretend a grape is in the curve of low back that you don’t want to squish). Inhale wide into the sides of your ribs and belly, exhale and visualize picking up a blueberry with your vaginal and rectal openings. Inhale wide again to release the blueberries back down….yes you may not look at blueberries the same way again, but this is a very efficient way of activating your pelvic floor and the rest of your core muscles! ALTHOUGH to truly know if you are activating your pelvic floor properly, and if strengthening is appropriate for you – see tip #1 (see a pelvic floor physiotherapist). The added bonus of using core breath during pregnancy is that this is exactly the exercise you should begin doing within 24 hours of giving birth (regardless of whether you had a vaginal or cesarean section birth). Gently restoring your core from the inside out along with a lightly compressive abdominal wrap is what will help your abdominals to repair postpartum.

3) Avoid sit ups or crunches

Sit up/crunch type movements increase pressure in your abdomen which puts pressure on your organs, pelvic floor and low back. This pressure can lead to a diastasis, incontinence, pelvic organ prolapse, low back and pelvic pain. Using your core breath with numerous other exercises is a more efficient way of engaging your core. Take note if you do this type of curl up movement in/out of bed (many of us do). Instead – fully turn to your side, then push up with your arms as your legs swing off the bed (aka. Log roll). Also do the reverse when getting into bed.

4) Avoid planks/ front loaded exercises

Planks and hands & knees type exercises can be appropriate IF you’re not pregnant, don’t have a diastasis, and know how to engage your deep core properly. If you are pregnant and/or have a diastasis, these positions can increase pressure in your abdomen which can aggravate your diastasis, making your abs stretch apart too much. We have become engrained that we need to do planks, crunches etc in order to ‘work our core’. Using your core breath with every rep of weights, each squat, every wall push up, while stair climbing are other efficient ways of engaging your core during pregnancy.

5) Avoid high impact exercise

Activities such as running or jumping cause your core to work overtime during pregnancy, with all the force going through your pelvic floor during each heel strike or landing from a jump. When you add the fact that your ligaments and joints are looser and more unstable as a result of the pregnancy hormone relaxin, high impact exercise is generally best avoided.

FYI- just because you don’t notice leaking or heaviness symptoms doesn’t mean that unwanted changes are not happening in your body. It is possible to have a diastasis and prolapse without pain or pressure sensations. Options for high intensity exercises that are not high impact include: spin class, stair climbing, pool running, swimming laps, weight circuits and elliptical training. Before engaging in high intensity exercises, be sure to speak with your primary health care provider to be sure they are appropriate for you during pregnancy.

As a pelvic floor physiotherapist, I communicate often with fitness professionals since working together benefits you during your pregnancy and postpartum journey. Nikki Bergen of The Belle Method has created a physiotherapist approved pelvic floor friendly prenatal and postpartum exercise program called The Bump Method.  If you can’t make it to a class in person (currently classes run in Toronto and Milton, Ontario) you can stream The Bump Method video exercise programs here. There’s a full workout for each of the 3 prenatal trimesters, along with the 4th trimester postpartum period. The exercises incorporate core breath with other movements, including upper body exercises, lunges and squats along with weights and stability balls.

When doing any exercise- keep the above tips in mind to help prevent unwanted pelvic floor and core issues during pregnancy and beyond. Knowledge is power!

By: Anita Vandenberg MSc(PT), BKin(Hons) Registered Physiotherapist- Pelvic Floor and Orthopaedic, Certified Pilates Instructor, Certified in Acupuncture/Dry Needling

4 Birth Tips from a Labour Nurse

Originally published by The Belle Method in The Purple Fig

I recently had the privilege of being my best friend’s doula.  I flew out to LA where she lives with her husband and two other daughters and spent the week hoping baby # 3 would arrive during that 7–day window.

She did!

It was a gift: an absolutely life changing experience, especially for someone who has yet to have children herself.  From walking through quickening labor contractions in Santa Monica shoe stores (and terrifying many retail clerks in the process), to watching the veteran anesthesiologist narrate the epidural insertion like Morgan Freeman, to videoing the moment baby # 3 took her first breath – it’s safe to say that my copy of “what to expect when you’re expecting” and those doula birthing videos didn’t do it poetic justice.

Birth in North America has become a more private, medicalized affair than ever before.  Gone are the days that most women – mothers, daughters, sisters, aunts and friends – gathered at home to actively support each other’s births.  We’ve obviously made incredible medical progress, however it’s rare that first time moms today have ever witnessed a birth in-person.  We’ve lost the implicit confidence that comes from seeing how our bodies were designed to successfully create.  We spent countless hours and dollars on prenatal classes – from Lamaze to Hypo-birthing – all in the name of preparing for, and reducing anxiety over childbirth.  How much more confident would we be if birth was a normal event we’d been exposed to for years? Anxiety stems mostly from what is unknown. womangivingbirth-750x480

Fear is so powerful. Here’s how it works in labor: anxiety/fear creates tension à tension leads to increased pain à increased pain leads to more FEAR.  The cycle continues.  Speaking personally, I am the sort of person who likes all the information up front. Give it to me straight. The more I know, the less I fear.  That’s why I decided to interview our Labor and Delivery Nurse for her top advice for first time moms. She hesitated at first while thinking about it – then enthusiastically blurted out these tips. I promised her I’d share!

1)   Stay at home for as long as possible. You’ll be more comfortable there. Shower and eat and drink something before coming to the hospital. You don’t get any food or water if/when you opt for the pain meds.

2)   Be “pushy”. Ask questions about what’s happening, what drugs you’re getting, what your concerns are, why things are being done in a particular way. The squeaky wheel gets the grease. And ladies, you want the grease. (For example, I mentioned my friend was afraid of tearing from this big baby, so they brought us warm compresses and mineral oil and coached her when to push more slowly.)

3)   Have Realistic Expectations of your Partner.  Your partner may be the best birthing coach in the world, or not.  Talk to them about your expectations before hand, find out their fears and decide whether you want an additional person in the room for support who may be less emotionally invested (read: calm and objective!)

4)   Stop judging yourself. You may come in with an all-natural drug-free birth plan, but then things get hard. Like, you’re-not-coping-anymore-hard. If you get an epidural, you are not weak. You are not copping out. Women used to die from this all the time. Pain levels are different for each woman depending on the baby’s position, the length and type of labor and individual unique neural pain receptors.  Do what YOU need to do.

Above all, be kind to yourself.  You’re taking a giant leap of faith into the unknown. Do your best and know that your best is good enough. Your body is not a lemon. You can do this! And if you get the chance to support another woman’s birth, recognize the gift.