Today I would like to write about preparing your body for birth. More specifically, a vaginal birth after cesarean or VBAC (pronounced "v-back"). If you would like more info on VBAC, cesarean, etc please check out ICAN (International cesarean awareness network). My local Chapter (Twin Cities, MN) is fantastic, and you might have a chapter near you with local meetings as well! I am grateful that we have c-sections, and also grateful that VBAC is a safe and wonderful option for so many! This post is not going to go any further into any of that for time's sake. But know that this post has nothing to do with helping you decide what the best option for your birth is- that is something you can explore yourself with your provider, partner, and with wonderful resources such as ICAN.
First, WHY should we prepare our body for VBAC?
You may have heard it said that "we were made to birth." And I do agree with that statement. Our bodies are incredible and were made for birth! But, we live in an artificial environment. Our bodies do not move the way that they were intended to move. We have outsourced the work of our muscles and we aren't moving in the variety or frequency that we really were designed to. Because of this, it's really essential both for minimizing pain and also for an easier birthing, to change our movement habits to stack the cards in our favor. Does this mean that everyone who "prepares their body" will have a successful VBAC? No. Does this mean if someone has a cesarean that it was their fault? Absolutely not! Does this mean that everyone who has a vaginal birth doesn't need this *exact same stuff*?! No, no no! I am simply giving you a tool that will both help baby to find optimal positioning for birth, and also help your pelvis to be at the optimal function for the birthing process. These same principles can apply to all pregnant moms!
1. Walk daily. Walking is an essential movement, not just an exercise. Think of it as an essential movement vitamin that your body NEEDS to function properly. Walking not only aids the birthing process, but also whole body health and longevity. Our ancestors likely walked 5-7 miles a day! Aim to slowly increase your miles. Take at least one mile walk every day (in flat shoes) and a longer walk on the weekends. Increase your miles further by spreading them throughout the whole day! Making mindful choices like parking in the back of the parking lot and walking somewhere instead of driving all count in your miles for the day.
2. Sit less and use variety with your resting positions. Research is showing us that sitting for prolonged periods of time has an impact on long-term health and longevity. Additionally, it weakens the birth muscles and decreases birth space. If you are chair sitting, make sure you sit with a neutral pelvis (see above) and take breaks to stand, walk, and stretch every 15-20 minutes. Consider a dynamic work station that alternates between standing, sitting (in a variety of positions, if possible!), walking and stretching throughout the day. Try sitting on the floor more often than in a chair, if possible.
3. Get out of positive heeled footwear and flip flops. Wearing shoes with even a slight heel will alter skeletal alignment and cause muscular imbalances that can contribute to pelvic floor, back and SI joint discomfort and issues. Choose flat shoes and take note that even most standard athletic shoes do have some degree of a heel. You’ll also want to make sure your sandals have a back, as flip flops cause similar imbalances in the body. If your body has grown accustomed to positive heels (they're even in most athletic shoes!), do correctives and slowly transition to minimal footwear. Check out Katy Bowman's book "Whole Body Barefoot" for tips on transitioning.
4. Squat to eliminate. Our bodies are designed to squat to go to the bathroom and in fact many cultures still do today! It will help with the mobility of the pelvis for optimal birth mechanics and will also help with easier elimination of the bowels. You can get stools to elevate your feet, or consider a product like the Squatty Potty that brings the feet up into a squat position. They even sell that at Target now!
1. Use a neutral pelvis. Sitting on your tailbone will weaken the pelvic floor, hurt the back, and decrease birth space. Roll forward onto your “sit bones” (ischial tuberosities) so that your pelvis is neutral. The top of your pelvis (ASIS-Anterior Superior Iliac Spine) should be in a vertical line on top of your Pubic Symphysis. You will see your natural lumbar curve. Relax your upper body and avoid trying to arch your back. It is often helpful to sit with something under your sit bones (a rolled up towel, yoga block, etc) to allow your pelvis to roll forward into a more neutral position. Video of me explaining neutral pelvis HERE.
In "lifestyle modifications" above I mentioned that you should sit in a variety of positions throughout the day. GET OUT OF THE CHAIR! As much as you can. A chair shaped pelvis is not a happy pelvis. Try more floor sitting! But when you do- bolster yourself up so that you can easily find neutral pelvis. Check it out for yourself. Try sitting on the floor. It's not too easy to get into neutral pelvis without REALLY FORCING IT. Next, try sitting up on a block, bolster, or cushion and then just RELAX into neutral pelvis. No forcing it and causing additional tension, please. That's not what we're going for. We are allowing ourselves into neutral.
2. Weight Back in your heels. Now that you have neutral pelvis, it's time to get your weight back where it should go. Pregnancy and baby carrying tends to shift our weight forward. Not because it SHOULD, but because we let it. We outsource the work our posterior (back of the) leg muscles. This not only puts a lot of strain on our core (diastasis recti anyone?), but it also turns off the muscles that should be holding us up all day. These are also muscles that support the pelvis.
3. Feet hip distance. This helps to use the lateral (outside) hip muscles that support the pelvis. Women often stand with their feet much closer together than hip distance. Additionally, when we walk we tend to allow our feet to swing in quite a bit! Check out your foot prints if you walk through snow (rain? sand?) and see if your foot prints are actually hip distance apart. Chances are, when your foot hits the ground it is closer than hip distance. If we can think about bringing our feet back to hip distance and keeping our feet "in their own train tracks" while walking we can increase the strength of the lateral hips (I have done several blog posts on lateral hip strength. Check out THIS ONE as to why lateral hip strength is important for pregnancy pain)
4. Relax the belly. We spend a lot of our lives sucking our belly in. Whether for vanity sake, stress, or because we think it's proper core engagement. Note: It's not proper core engagement and even if it was, we should not be engaging our core all day. I added stress to the list because I personally notice that when I'm stressed out that my core sucks in more! It's amazing how these habits sneak in! So take a deep breath and then RELAX your belly away from your spine. Notice if you are sucking it in and then be like Elsa and LET IT GO! This will help with the 2nd stage (pushing) of birth because it's releasing all the intra-abdominal pressure that has been built up from all the sucking in that we then have to push against whether to go to the bathroom, or to push out something much cuter, but less frequent- a baby! Check out this video of me explaining it (I was pregnant in the video, too!)
These exercises are designed to help the body transition back to more optimal alignment and aid in teaching the body how to function properly through all that we do throughout the day. For example, are you getting up off the toilet for the one millionth time that day (baby on the bladder)?! You can do this in a way that uses the posterior (back of the leg) muscles and uses the "squatting" muscles. Or it can be done in a way that keeps the pelvis tucked and doesn't use those muscles at all. Think of how many SQUATS you could get in a day if you just used the appropriate muscles every time you got up?! THAT is the goal. To optimize what we are doing ALL DAY. Because our body adapts to how we hold it and move it throughout the entire day and is not as concerned with the one hour a day (HAHAHA- I have 4 kids so I laugh at this) that we exercise. So don't think of these exercises as the end all be all. They are simply a tool to help us move better. Know that this is in no means an exhaustive list. I encourage you to seek out the assistance of a Restorative Exercise™ Specialist to get your own personalized assessment and correctives. Okay... after that way too long disclaimer, here they are....
1. Calf Stretch. We want to lengthen the posterior (back of the leg) muscles. This will help with pelvic mobility and pelvic floor health (I could write a whole blog post as to exactly why). Think of your calf stretch as your Vitamin C. YOU NEED IT. I try to do at least 3 calf stretches a day. You can calf stretch while brushing your teeth, talking on the phone, combing your hair.... the possibilities are endless! I keep a half dome in my bathroom, living room, kitchen. They're all over! You can also roll up a yoga mat and it works almost as well. Keep the weight back in your heels and your pelvis neutral (your correct alignment as discussed above!). Only walk your non-stretching foot forward if your hip doesn't come along with it. Hold for 60 seconds on each side. VIDEO of me demonstrating calf stretch HERE.
2. Double Calf Stretch
Does your pelvis even move? It should! When you bend over to pick something up (toys, dishes, laundry.... story of my life) do you do it by flexing your lumbar spine, or do you do it by allowing your pelvis to move? This one is going to help with pelvic mobility and also with all the muscles down the backside of the legs- hamstrings and calves. Only go as far as you can go until your pelvis stops moving and your lumbar spine (low back curve) starts flattening. This and the single legged calf stretch are HUGELY important and are prep work for squatting..
3. Psoas Release This exercise feels like you're doing nothing. Because you are. Except, you're not. You're allowing the resting tension of your psoas muscle to relax. This muscle deserves many of it's own blog posts. Here is one I did a while ago.
First, find a bolster or supportive cushion (or sleeping bag rolled up in a sack- get creative if you have to!). Next, sit up tall with your feet in front of you and feel your hamstrings touching the floor. When you lay back into a bolstered position, you only want to go as far as you can go without your hamstrings popping up off the floor. If, after you're down in this position, you can drive a matchbox car under your hamstrings, then you need to bolster yourself higher. It's not unusual for me to need to double bolster people! Position the bolster so that the back of your ribs is NOT on the bolster so that it is just under your shoulders. Put a rolled up blanket or half dome under your head so you don't feel like your head is uncomfortably flopping back. As you rest here, allow the back of your rib cage to relax down towards the ground. When you start, you may notice your ribs thrusting way up towards the sky. But as you continue to relax here (great place to watch a movie! I just introduced Star Wars to my kids in this position last week!) notice the tension in your psoas releasing by the back of the rib cage coming down towards the floor.
4. Hamstring Strap Stretch I am a big fan of doing this stretch in the psoas release position. It protects the core because it is allowing the ribs to relax down and it helps us to not go past our boundaries because if we do, the opposite hamstring will lift off the floor. After getting in your psoas release position, bring a strap just underneath your toes. Slowly lift the leg up, but stop if the opposite hamstring lifts off the ground, because this is showing that your pelvis is beginning to tuck to compensate for being at the end of your hamstrings range of motion. Relax the toes towards your body. No barbie feet! Try to avoid the mindset of "the more I feel this stretch the better it is." You may feel more of a stretch if you were to pull you hamstring way up towards your face, but it's not going to help you any more than just being *where you actually are.*
After about 60 seconds of stretching straight back, send the foot across the midline towards the other leg. Keep the hips on the ground and avoid rolling.
5. Inner Thigh Stretch
And there you go- this is an EXCELLENT start to your alignment, movement, and corrective exercise journey! This is by no means an exhaustive list. But I wanted to give you a few things to get started with! If you'd like to learn more- I do in person and Skype sessions!
Working on movement and alignment not only helps to prepare for birth, it also helps ease pregnancy pain and helps with a smoother and easier postpartum recovery. And don't get me started on pelvic floor and really... whole body health! The great thing about this work (or maybe not so great thing depending on how you look at it) is that everything affects everything. So a byproduct of working on alignment for you birth is that you're going to start helping that wonky knee. That annoying foot pain. That digestive stuff. It's all connected! Our body is not a bunch of parts working in isolation, so we can't fix or help anything in isolation. We must look at everything in relation to everything else.
PS- taking photos with a bunch of our kids is kinda chaotic. I might have to do a PART 2 with more.. They were totally at their limit. You probably are after this super long post too. Don't blame ya!
MANY thanks to my beautiful friend Jessica Anderson of Peaceful Beginnings for letting me take photos of her. She is an ICAN leader, cesarean and VBAC mom, doula, childbirth educator and mother of almost 3! She is teaching a VBAC class along with another amazing VBAC mom, Katie Champ of Empowered Birth at the studio in a few weeks. Sign up!
I wrote a while back about why the squat is not the new kegel. Check out Part 1 HERE
I want to write on this again because I still get people asking me and each other "what should I do- Kegels or Squats?" Of course, I direct them to my previous post, but I figure I would expound on what I said there for further clarification.
Here's what I just posted on facebook last night, while thinking this over:
"Looking to strengthen/fix/optimize the function of your pelvic floor? The question should not be "should I squat or should I kegel?" Because there is not one exercise that will strengthen/fix/optimize the pelvic floor. It's a whole body problem and requires a whole body solution."
Squat vs. Kegel is NOT the question we should be asking. We must think of our body as a whole. There is not one exercise that will fix/heal/strength/optimize your pelvic floor because your pelvic floor responds and adapts (whether positively or negatively) to how you move all of your body all of the time. So a squat, or a kegel for that matter, is not going to really do what you hope for it to do if you're not walking and if you're sitting in a desk chair on your sacrum all day, for example.
Let me give you an analogy that may help make this clearer. The kegel vs. squats debate is like debating a high grains/low fat diet vs. a Paleo diet. Only, instead of learning all that goes into the Paleo diet you say that being Paleo means eating red meat all the time and pretty much only red meat. After all, you just read a couple of blog posts on the benefits of red meat, so that MUST be what being Paleo is all about, yeah? Not realizing that red meat is part of the Paleo diet, yes, but it's just one small piece of many different vital nutrients needed and even the red meat that is consumed is not just any old red meat, but a specific type of red meat (grassfed, for example). Eating a bunch of red meat does not make one a Paleo anymore than doing a bunch of squats makes someone have an awesome pelvic floor. Yet, of course squats are a fantastic part of a whole body movement program that optimizes the function of the pelvic floor and the stability of mobility of the pelvis.
Or maybe this one resonates with you more. You know kale is healthy. So you just eat kale, and only kale. All day, every day. And nothing else. Would you really be healthy? Or maybe you eat Snickers bars for the rest of the day and then gorge yourself on kale at night. WOULD YOU REALLY BE HEALTHY? No. You need the nutrients in kale, of course, but you also need a whole spectrum of nutrients throughout the day too.
So let's stop debating squatting vs. kegels and let's start:
Check out some "alignment snacks" HERE for just $5 for a nice way to learn some of these stretches that will in turn help strengthen your pelvic floor (and.... the rest of your body too! The great thing about it being an all body problem is that the all body solution fixes a whole bunch of other crap too!). A few that I suggest:
~Walk this way, stand this way
~All Around the Thighs We Go
~All fo' the pelvic floor
~Leg goes forward, leg goes back
~Stretch the standing muscles
Lower back pain during pregnancy. We're told it's "normal." But does normal=natural? Does normal=required? I propose that what is normal in our society is what is typical or common, but not necessarily the way our body is intended to be. Rather, it is a result of our current movement (or lack thereof) and alignment habits. SO! If lower back pain is not a requirement of pregnancy, how do we fix it? Or better yet, prevent it?
It's about where your pelvis is, in relation to the rest of your body. Check it out:
Most people are *already* forward leaners. And then they get pregnant. It's not the pregnancy that is causing the back pain, but the habits we already have coupled with an extra 10, 20, 30 pounds out front. This habit of forward leaning and pelvic thrusting not only compresses the low back (lumbar spine), but also causes us to thrust the contents of our abdomen forward into the core (diastasis recti anyone?). It causes less mobility of the sacrum because we're using the muscles in the front of the legs instead of the muscles we should be using that are behind us. Not to mention, the implications all of these issues cause for pelvic floor health and optimal birth mechanics. Can't you see how related it all is? Why ALL THESE ISSUES ARE SO PREVALENT?! Why often times someone with core issues, for example, also has pelvic floor issues. Or people who have back pain also have diastasis recti (splitting of the '6 pack muscle'). Not all movement is created equal. We have to move more, yes! But we all have to move mo' bettah as well.
NOW- TEST YOURSELF!! Grab your cell phone charger and flip it over so that the heavy plug in part is on the ground. Make your own plum line like the one I drew on the picture above and stand how you normally stand and SEE where your pelvis is in relation to the rest of your body. It can be very revealing!! It may be helpful to have someone else test you because often times we need to shift a lot more back than we think we have to. You will probably need to lean your upper body forward to counteract just how far back you have to lean. Otherwise, you'll fall over.
I was talking to someone the other day about what a tough sell what I do is. It really is a paradigm shifting thing for most people. People want "3 simple exercises to do 3 times a day." But I can't offer that. Plus, if i did it wouldn't REALLY solve your problems. Especially if you're thrusting and forward leaning the rest of the day. What we NEED to do is get your alignment back where it should be... and what we need to do to get you there is to help your muscles to re-adapt to being at the proper length to hold you there. Got it?
Here's a few steps:
1. Get out of positive footwear.
You can't not lean forward and alter your alignment in any degree of positive footwear. I'm not just talking high high heels. Even most athletic shoes are positive in the heel. Any shoe with the heel higher than the toe box is positive.
2. Be mindful about your alignment.
Now that you KNOW it, you need to adjust it. It's a brain thing called proprioception. Your brian is used to you leaning forward all the time, maybe. So, it probably feels weird NOT to do that. This weird feeling doesn't mean that it's not more optimal. It just means that your habit needs to change. It might feel weird for someone not to smoke all the time, but that doesn't mean they shouldn't quit smoking. Ya feel me?
3. Walk. As much as you can. In your heel-less shoes, with your weight back in your heels and your feet staying hip distance apart. Some day I'll blog about gait mechanics more, I promise. But just WALK AS MUCH AS YOU CAN. My teacher, Katy, says in one of her books that walking is not exercise, it's a biological necessity. In the same way that we know we need certain vitamins (example: we'd get scurvy if we didn't get vitamin C) there is going to be a consequence if we are not walking. I'm not trying to freak you out.... and I'm not trying to say that every little bit doesn't count. But definitely want to stress that walking is really super important.
4. Lengthen and strengthen the muscles of your backside.
Here are a few to try right away:
Calf stretch (PS- old video and MY GOODNESS that girl has grown up since then!!)
Double Calf stretch (which is more about lengthening all the muscles along the back-side, not just the calf like the name implies
Hamstring Strap Stretch- keep the pelvis untucked and the opposite leg on the ground (opposite hamstring should NOT come off the ground at all). PS- I just happened to have this photo but now I'm thinking- I should take photos of my kids demonstrating all the exercises!! Photo booth gives me 3 SECONDS ONLY to get into a position to take a photo... hence all the vids.
Is our pelvis shape predetermined by our genetics or do we have a say in the matter?
Guess what? Yay, we have a say! (and I'm a poet and I didn't even know it)
You may or may not know that there are several types of pelvis shapes. I learned from the amazing and incredible Gail Tully of Spinning Babies that pelvis shape can play a big part in the ease of childbirth. Particularly if baby is in certain positions such as posterior (Looking up- babies spine against mom's spine. Also called "sunny side up"). While I don't think it's a good idea to stress about your pelvic shape, I do think that it can be empowering to know that YOUR PELVIS SHAPE IS NOT FIXED. You can change the shape of the pelvis from front to back based upon how you move your body around! It's not a case of "Whelp- I was born this way, so there is nothing I can do about it, I'm destined to have harder births." This is absolutely NOT the case. First of all, there are many cases of individuals with pelvis shapes that tend to cause more issues having no issues whatsoever, and additionally, you can make changes in how your pelvis is shaped based on (important so I'm saying it again) HOW YOU CARRY YOUR BODY AROUND.
So you say- well my mom had a *insert pelvis shape* pelvis, and I do so how is that not genetic. What is interesting is that we DO tend to move and sit the way that our parents do. If your mom is a pelvis tucker or sits on her tailbone, then there is a high probability that you do to. As children we are great observers and we learn a lot about how to stand, sit, and move with our bodies by how we see others doing it. So you MIGHT have the same shape pelvis as other women in your family, but likely it's because you move like them.
Let me say this again because I find it amazing! YOUR PELVIS SHAPE IS NOT FIXED. Is this completely amazing and mind blowing to anyone else as it was for me to first time I heard it? Have you ever heard a woman told "you just can't give birth vaginally- there isn't enough room"? Imagine the implications of this little piece of knowledge. And PS- it's not always that there truly isn't enough room- sometimes it's just good old fashioned B.S.
Our sacrum is designed to be MOBILE. Ever heard of someone complaining of SI pain? They're referring to pain at this joint. The SI is the Sacroiliac JOINT. And why do we have joints? For movement, of course. Unfortunately, in our culture most of us don't have moveable sacrums anymore because we don't often put ourselves in positions that require the mobility of the SI. And the body works in a "use it or loose it" kinda way. The sacrum is designed to move in and away from the pelvic bowl. If you're a nerd like me, the technical term for the motion of the sacrum is "nutation and counter nutation." See picture below to see the joint that in an optimally functioning body allows the sacrum to move.
Next, let's consider the distance from the Sacrum to the Pubic Symphysis
For childbirth and also optimal pelvic floor health for ALL, it's optimal for the distance from the sacrum to the PS (pubic symphysis) to be greater. This will, in turn, lengthen the pelvic floor and bring it to a more optimal length (yay for pelvic floor health!) and create more space for a baby in the pelvic cavity.
There are 4 defined pelvis shapes, shown in the picture to the side. These are defined by measuring the pelvic inlet. This blog post isn't going to define the different types, but there is much information out there on the different types including this article from Spinning Babies. You can see that the Gynecoid pelvis is much rounder vs on the other side the platypelloid pelvis is much more oval. Let's use the platypelloid pelvic shape, for an example. You can see clearly from the picture of the pelvis shapes that platypelloid pelvi are more narrow from pubic symphysis to sacrum. This can create a more strenuous birthing process for all parties involved and more potential damage to the pelvic floor, to boot! But- once a platypelloid not necessarily ALWAYS a platypelloid.
PS- my computer likes to autocorrect that to "platypus" so be on the lookout for typos!
IF we change the way we move our body (skeleton!) around- we can increase the anteior/posterior distance in the pelvis (the distance from sacrum to pubic symphysis). Cool huh? I wouldn't worry so much about figuring out what shape of pelvis you have. If you already know- cool. If you don't know- this information is going to help ALL of us.
Here's a few starter tips for how to increase the anteior/posterior pelvic space and also helping to free of the sacrum so that it is more moveable:
1. Squat to elimiate. Seriously, get a squatty potty! I say this all the time, but our body is designed to SQUAT to eliminate. The squatting causes the illium to widen, which decompressed the SI joint... allowing it to move into the optimal position. (note: I'm an affiliate to squatty potty- by clicking on my banner you support a hard working mama)
2. Change the way you sit and stand.
I've discussed both of these before so I'll just post links to those posts:
~Where you pelvis is in relation to the rest of you
~Below is a short little video relating to pelvic alignment when sitting. Think about it this way. Either you are sitting ON your tailbone, or you are sitting on your SITTING BONES (ischial tuberosities). We want to avoid sitting on our tailbones because it draws the sacrum IN to the body- creating the opposite of what we want for easier birth (and pelvic floor function).
3. Hip opening and Squat Prep!
Just because squatting is awesome, doesn't mean that it's awesome FOR YOU AT THIS EXACT MOMENT IN TIME. Here's a post I did a while ago on the Squat
Truthfully, we must spend a lot of time doing squat PREP. Preparing our bodies to be able to squat more effectively so that we can get benefit from our more aligned squatting. We also need to lengthen our calves and hamstrings to give us the length we need to get deeper into the squat without compensating in some way. Since it's already been done- click on the squat post linked to above and within that blog post I linked to a post that will specifically take you through some of the squat prep exercises.
Mama Aligned is Lindsay McCoy.