This month I had the absolute honor to speak with Jamie Justice of Empower Women’s Health and Wellness for our monthly webinar. Jamie is both an incredible person and all around expert in women’s health, and I highly recommend her to all friends and clients of Empowered Mama Fitness!

Jamie founded her company in hopes of helping women get help with pelvic floor issues sooner. She recognized that many of the problems women need physical therapy for years after having a baby could have been prevented had they gotten the appropriate care shortly after birth. She’s passionate about changing the language women use about things like postpartum incontinence  from “normal” to “common.” Meaning that even though pelvic floor issues are very common in women who’ve had a baby, they are not normal. Healing is possible!

Postpartum

Jamie says that even years out from having a baby can still be considered postpartum. Your body changes so much with pregnancy and having a baby, that it’s imperative to put some work into restoring optimal function in your postpartum time. This does not mean “bouncing back” or fitting into your pre-pregnancy jeans. It means restoring optimal function to a body that’s probably developed some weakness and imbalance through the process of growing, delivering, and caring for a tiny little human. Unless these imbalances are addressed and corrected, there’s a good chance you’ll end up suffering far longer than necessary, and needing more intensive help down the road.

Prolapse

Within the first 3-4 weeks, even if the birth went perfectly, there is still a need for your body to rest and recover. Your tissues and ligaments have gone through a lot! If you feel some pressure and heaviness in your pelvic floor, it could be because your pelvic organs are sitting lower, which Jamie emphasizes is normal immediately after having a baby.

However, true pelvic organ prolapse is when the bladder, uterus, and/or rectum fall down a bit as a result of stretched ligaments and other body imbalances. This is a feeling of heaviness that lasts longer than the immediate postpartum time, and is accompanied by a sensation similar to that of a tampon falling out. If this is the case for you, Jamie recommends seeking the care of a pelvic floor PT.

Bleeding

Bleeding is normal after giving birth (whether vaginally or by c-section), and you should pay attention to your bleeding as your body’s way of telling you if you’re resting enough. If your bleeding increases after a bout of activity, take it as a sign to slow down and rest. By 4-6 weeks, your bleeding should be over.

Leaking

Leaking is not out of the scope of normal within the first few weeks. Your body is recovering and everything that has been stretched out is working hard to return to normal. But again, if you have leaking that persists after the first 3-4 weeks, it’s time to see a specialist.

After Immediate Postpartum

Once you’ve passed the 3-4 week mark, all of these mildly uncomfortable symptoms should be over for the most part as you go about your daily life. By this time, you shouldn’t be experiencing any prolapse symptoms, leaking, or pain. You also shouldn’t be experiencing urgency before urinating (like wondering if you’re going to make it in time!), and have the ability to empty your bladder fully without pushing. You shouldn’t be experiencing any kind of pain, in your back or otherwise.

At your 6 week check-up, you will typically get the green light for intercourse, which may not be especially comfortable at first. Especially if you’re nursing, your estrogen levels will be low which can cause dryness. Even still, you shouldn’t experience any pain with intercourse. If you had to have stitches after delivery, you may have some scarring, which can cause tight, tense muscles. If any of this is causing you pain, you want to get yourself into a pelvic floor PT (like Jamie!).

Layers of the Pelvic Floor

The pelvic floor has two layers. The deeper level is responsible for support, holding up the organs, and providing stability to your entire body. This is the piece of our core that we aren’t usually aware of in daily life. It is a deep layer of muscles that goes back to the tailbone, attaches to the sacrum, the spine, and hip muscles. It literally links everything together, and is a huge part of your ability to become strong, stable, and to move without pain. If this part of your core isn’t working well, something has to make up for that, which is why you might experience back or hip pain. This leads to imbalances in your body, which, if not addressed, can cause chronic pain later in life.

The more superficial layer of your core is what should kick in when you run, jump, sneeze or cough, and it’s also responsible for sexual arousal.

If you have a c-section, it doesn’t mean that your pelvic floor will be unaffected. Especially if you went through labor and even spent some time pushing, your pelvic floor will definitely experience some stretching. Even if you go in for a planned cesarean, you have to remember that just being pregnant puts a lot of extra pressure on your pelvic floor, and will need to take some time to recover. And a c-section scar can even affect your pelvic floor muscles. Everything is connected!

With a vaginal delivery, most people tear towards the back and off to the side. As it heals, there will be scar tissue, which is very normal. And because there are many muscles attached to your perineum, they will undoubtedly be affected by the scarring depending on where and how severe your tear or cut is.

The Importance of Breath

When you’re postpartum, it’s incredibly important to be aware of your core and intra abdominal pressure. Ultimately, many postpartum issues are not necessarily caused by tearing and stretching, but by the way you manage your breathing! Obviously, when you’re pregnant, everything inside of you gets a little squished to make room for the baby, including your lungs. During this time, it’s common to adopt suboptimal patterns of breathing that stay with you after you have your baby, unless you do the work to correct it.

The abdominopelvic cavity is pressurized in everyone. If you imagine a balloon, you can understand that there is pressure inside. If you push on the side of the balloon, it’s going to increase pressure elsewhere.

It’s similar when you’re pregnant. Your center of gravity moves forward, and your back muscles may become shortened. If you imagine your torso as a balloon, you can picture that there is more pressure toward your belly button.

Your respiratory diaphragm can also get very tight by the end of your pregnancy, and if that’s not moving optimally, it can create extra unnecessary pressure.

Another thing that adds extra pressure is tight obliques. Women tend to overuse their obliques in pregnancy, because their front muscles are so stretched out. This is another area that needs to be addressed as we heal.

Extra pressure in the postpartum body is something we definitely want to avoid. It can contribute to diastasis and prolapse, prevent these things from healing fully, and keep your body from getting stronger.

So what’s the magic key to getting things back on track? Breathing exercises! While breathing exercises may not be that fun or exciting, and may even feel a bit pointless, they are an essential bridge to getting you back to more traditional exercise - or just living your daily life in a balanced and healthy body.

Think about it as retraining your brain body connection. Many women take the 6 weeks to rest and heal, and after getting the green light from their doctor, go right back to the exercises they were doing before. This is a recipe for pain and injury. But if you take the time to retrain your core with your breath, you’ll be setting yourself up for success once you start to feel ready to get back to it.

If you’re interested in belly binding postpartum, Jaime says that it can be a helpful tool to aid your body in coming back together. You just want to make sure you don’t cinch it so tight that you can’t take a deep breath. This could be too restrictive and add extra pressure that you don’t need. You want to aim for light compression.

Jamie encourages you to take it easy, be gentle with yourself, and not rush back into heavy exercise. The first 6-8 weeks are truly just for rest, reconnecting with your breath, your core and pelvic floor, and working on your posture. After you’re recovered in full, you should gently ease back into exercise. Your body is wise, and will tell you what it wants if you’re tuned in.

Recommended Exercises

Let’s talk a bit more practically about breathing. Put one hand on your chest and one hand on your belly, and take a few breaths. Gauge which hand moves more - your chest/ribs or belly. Typically, postpartum women will breathe more up in their chest because of that sticky diaphragm. But take a feel in your own body and see where you’re at!

Eventually, you want to aim for what’s called 360 breathing. This is where you’re not overly breathing into your chest OR your belly, but rather into your ribs. Place your hands on your ribs (right around your bra strap), with your four fingers at the front and your thumb at your back. Take a deep breath, and see if you can get your fingers to expand in all directions - front, side and back. When you exhale, pretend that you’re blowing through a tiny stir straw. This will encourage you to engage your middle stomach muscles rather than your obliques (which are probably on overdrive from your pregnancy!) Try this exercise a few times each day to check in with how you’re breathing!

When you’re ready to get back to kegels, Jamie recommends starting by lying down on your side or in child’s pose (so gravity isn’t adding extra challenge). Eventually you can work up to an upright position like kneeling, sitting, standing, hands and knees, or even standing on one leg. Variety is key here! With each kegel, imagine gently lifting up a “marble” with your pelvic floor - up and in - with your exhale. This isn’t going to be a super strong move. And you shouldn’t hold the kegel, just coordinate it with your breath, contracting with each exhale. Jamie recommends starting this as soon as you can after delivery. Not necessarily within the first days, but within the first week or two is a good idea!

Conclusion

Every postpartum woman deserves to see a pelvic floor therapist! If you’re anywhere within the postpartum spectrum and have a specific concern, Jamie says that you should see someone as soon as possible. If you just want a general tune-up to make sure your body is balanced and back on track, it’s fine to wait until after your 6 week checkup with your doctor or midwife. It’s a great idea to get checked over before you get back to your regular life.

In postpartum, it’s so important that you take care of yourself. Your body has just gone through an incredible amount of change, and you’re deserving of extra care and attention. Jamie understands that you have a lot on your plate right after having a baby, which is why she offers in-home physical therapy to postpartum mamas. She’s passionate about making pelvic floor therapy as accessible as possible, and her kind and gentle demeanor make her a wonderful choice if you are seeking PT. (Jamie’s office is in St. Charles and she lives in DeKalb. She’s willing to drive within a reasonable radius to see you!)

You can find Jamie on her website, or contact her at jamie@empowerwhw.com. And make sure you follow her on Instagram @empowerwomenswellness for some inspiring and practical content!

Click here to watch the full conversation with Jamie.