Hopefully by now those consuming this content as part of The Village, have read and digested my thoughts on both the physical and emotional significance of pelvic floor health, and some simple principles to keep in mind for rehabilitation and strength work.
Here, in our final week on the pelvic floor, I have set out some exercises to take you from day zero/the day of birth, through the rest of your life.
As well as the specifics and the technique of what you do however, regularity and consistency are important when it comes to the pelvic floor. In general daily life, finding the time to spend 5-10 minutes on this each day is ideal; for those of us more acutely in those early months of postpartum, I would recommend also making these exercises the focus of any daily movement or breathing practice that you do each day.
Everyone will have different points in their routine when it more naturally feels possible to do this – I find the easiest time for me to remember – outside of focussing on it when I am practising yoga – is when I am lying in bed about to fall asleep. Spending a few minutes working on the first two exercises here, is a nice bridge from wakefulness to sleep, and can be a useful wind-down tool at the end of the day. I also find it feels less like wasted time and more like a constructive part of me unpacking the day and getting ready to rest.
Exercise 1 – Healing Breath
Wherever you are lying, in your hospital bed, at home surrounded by breastfeeding snacks and muslin cloths, on the sofa with a warm baby lying sprawled across your chest, take a deep soft and full breath in and see if you can become aware of the centre of your body opening up – vocal diaphragm lifting in the upper palette/back of the throat, ribcage opening in all directions, pelvic floor releasing and descending as it fills with breath. Imagine you are pouring your breath down into the pelvic bowl, filling it up.
As you exhale, again keeping everything soft, become aware of your body drawing back in towards centre, your vocal diaphragm closing and descending in the back of your throat, and your pelvic floor gently drawing up. At this point you are not actively manipulating or ‘efforting’ any part of the breath, and on day zero you may feel almost nothing in your pelvic floor. We are training awareness and sensation, not trying to ‘do’ anything. All we are looking for, gradually over those first few weeks, is an awareness of the pelvic floor naturally hugging up on the exhale.
The Healing Breath is also a chance for a new mum to connect and root through a simple cycle – the cycle of inhale and exhale. In the early days, you are living without the usual borders or delineation of life, without the cycle of day and night, without the rhythm of Monday to Friday, without a menstrual cycle, without any of the usual fixed points of our existence. The Healing Breath can become an anchor in the absence of all of this.
Exercise 2 – Activation and Integration
You can do this lying in the same place as Exercise 1, or you can take a more conscious and constructed resting pose such as savasana. Take the same inhale as in Exercise 1, and on the exhale, consciously engage and hug up your pelvic floor, keeping it tugging up as you also knit together your abdomen as though pulling a pair of curtains together, towards the midline of your body that runs along your navel. You can clasp your hands lightly on your stomach as you do this, and feel your fingers pull apart with every inhale and find each other again across your belly with each exhale.
This is a more conscious, deliberate, and effortful version of Exercise 1, though legs, arms and face stay soft. Having cultivated awareness, we are now seeking to remind our brain and body of the order of integration (pelvic floor then abdomen) and to gently regain strength through engagement.
Exercise 2 however, also becomes every single pelvic floor exercise you do for the rest of your lives. As you become stronger and more able to maintain the muscular engagement of the exhale, you can perform Exercise 2 sitting up on a bolster, cushion or simply on the floor. In the first few months, even years after birth (or in fact any time you attempt this if you haven’t before) you may find that hugging your pelvic floor up and knitting your abdomen together whilst sitting up takes energy and focus. You are now working against gravity, both in terms of the weight above your pelvic floor, but also your internal organs against softer and perhaps separated abdominal muscles. After my son Frankie’s birth, I had a 4-centimetre separation behind my navel, and working on Exercise 2 while sitting up was very hard work!
You can then build this Exercise 2 approach and awareness into any movement you do. In yoga, for example, as I am still newly postpartum, I will practise certain classes as pelvic floor focuses, working solely on maintaining the integration and engagement of Exercise 2 as I move through postures. I would not, then, keep my knees off the mat in plank pose. At the moment my core is weak enough that keeping my knees off the mat would simply turn the pose into an upper body workout, and my abdomen would give up and disengage/hang towards the ground. Instead, I put my knees on the ground and this allows me to rediscover the same level of engagement that I had sitting upright, and turns the pose back into what I need it to be at the moment – a chance to rewire and rediscover pelvic floor and abdomen.
Working like this requires you to be patient, brutally honest with yourself, and if in a public class, uncompetitive and entirely lacking in ego. This is hard when you are desperate ‘to get back’ to what you were doing before pregnancy. There is no faster route to functional strength, there is only a faster route to dysfunction. It is worth sticking it out, knowing that recovery takes time, and remembering that if you put the steady dogged minutes in now, you have the chance of emerging from the postpartum haze stronger and more in tune with your body than you ever were before.
Exercise 3 – The 30% Integration
Exercise 3 is an opportunity to work with stronger engagement, but also to integrate fully the ‘bottom up’ approach from the soles of your feet all the way up to the upper palette. I have to credit this brilliant exercise to my pilates teacher Eleah who is a genius at pelvic floor rehabilitation.
Lie in a semi-supine position, on your back on the floor or a yoga mat, with your knees bent and your feet flat on the ground. Find a neutral pelvic position by lifting your hips up gently, allowing your pelvis to sway and descend naturally to the ground, weight descending through your sacrum, but not tucking your tailbone or flattening the natural lumbar curve of your lower back (this curve will be more pronounced following pregnancy and gradually reduce through the first postnatal year).
Place a pilates ball, yoga brick, or thick book between your thighs. Inhale and allow your body to fill softly with breath as in Exercises 1 and 2. On the exhale, press the soles of your feet into the mat, finding inner arch, transfer the engagement all the way up your legs as you hug the ball/brick/book between upper thighs, hug your pelvic floor up towards your navel and knit your abdomen together, drawing everything in towards the midline. Spend some time holding your body in this state of exhale, focussing on engaging the following parts of the body to around 30% simultaneously: soles of feet, calf muscles, inner thighs, back of thighs, glutes, pelvic floor, abdomen.
In Exercises 1 and 2 we practise a more isolated engagement of pelvic floor/abdomen, keeping other parts of the body soft. In Exercise 3 we start to bring everything together, working from the ground up.
Exercise 4 – Three-part Release
I have already touched on why it is important to spend time working on the inhale, and the letting go. This three-part release breath can feel challenging and even a little frightening in the early days. You can either come back to it later if that is the case, or examine what happens when you trust that your body will still be a strong container for you even at that point of release.
Sitting down, ideally in a kneeling position with a block or pilates ball under your pelvis, exhale all the air out of your body with a ‘Ssshhh’ sound coming from your lips, as you hug pelvic floor firmly up and engage your abdomen. Inhale in three parts – part 1 is a slight inhalation and relaxation of the core. Hold this for 1-3 seconds. Inhale and release another third. Hold for 1-3 seconds, before filling your lungs completely and fully releasing your pelvic floor. Hold for a further 1-3 seconds at the point of complete release. At first you may feel most comfortable breathing normally for a few breaths between each of these three-part release breaths, before eventually doing 10-20 of these in a row.
Exercise 5 – Heel Lifts
I include Exercise 5 because it is a great one to do when you are trapped by an unexpectedly long sling nap, and want to breathe some connection back into your achey stiff body without waking up the baba. For those of us with koala babies, frustrated that we cannot exercise as much as we’d like, it is also a great one for building some pelvic floor work into your baby-wearing day.
Stand with your feet parallel and directly beneath your hips, and your spine neutral, relaxed and straight. On an exhale breath, engage the soles of your feet, the full length of your legs and hug your pelvic floor up towards your navel as you slowly lift your heels up off the ground. Work on keeping your heels directly in line with your feet, rather than spinning in or out, and bring an awareness to the back line of your legs from your heels to the centre of your buttocks. Inhale, lower the heels slowly and relax your lower body. Repeat!
I know we are a group full of yogis, birth workers, body workers, and pilates experts, as well as of course being a group of mothers, so I would love to hear from anybody who would like to share the exercises that have worked for them.
It may sound an odd request, but I would also love villagers this weekend to share a moment in their first postnatal year when they overdid it. I can’t count the number of times a mother has ‘confessed’ to me that she started running too early/walking too far/put her back out/worsened her diastasis in the early days, and these confessions are always delivered with embarrassment and guilt. I would like us all to cut ourselves some slack! We are navigating an entirely new body, and one that is changing incredibly quickly, and I have definitely ‘got it wrong’ after both my children’s births on more than one occasion.