Postnatal FAQs

Q. I was taught in my Pilates classes to pull the navel towards the spine on the exhale.  Why, at Birthlight, do we teach the mums to do it on the inhale?

Reply (Francoise)

Thank you for your question on the very important point of the postnatal core toning with yoga breathing that is taught in Birthlight.  No, it is not correct to say that we teach mums to pull their navel towards their spine on an inhalation. The main toning action is of course an exhalation and this is in conformity not just with the yoga tradition but also with anatomy as all the four layers of abdominal muscles are gently pulled up with the thoracic diaphragm, to which they are attached, on exhalation.  The action of ‘reverse breathing’, (named in contrast with the ‘birthing breathing’ we teach in yoga for pregnancy) is exactly this drawing in on an exhalation, that mums gradually learn to extend for the benefit not just of muscular tone but better functioning of the endocrine system, resulting in better hormone balance. When mums are familiar with this practice, let’s say after a week or two (it can be done right after birth for everyone including C section births) then the pelvic floor muscles are involved: the ‘reverse breathing 2’, (that we are now calling Postnatal Breathing 2 for clarity because many people don’t know what reverse means) is as follows: draw in pelvic floor muscles on inhalation, then draw more on exhalation -automatically continuing the action of pulling navel to spine as all the pelvic muscles are connected.  At the end of your extended exhalation, release. Most mums will need a normal breath (a breathing cycle with no action) in between practices at the beginning but after a short time mums become able to release muscles completely at the end of their exhalation and then draw in their pelvic floor again on a new in breath. It’s very important to release completely between practices as we promote elasticity over tone, in contrast with many repetitive toning practices that are out there for postnatal core toning. But while in pregnancy yoga the focus is on the release, in preparation for opening the birth passage, in postnatal yoga the focus is on the drawing in action with the outbreath.

Sorry a bit of a long winded answer but I hope it clarifies the misunderstanding that perhaps many Birthlight teachers have about the Birthlight postnatal breathing. There is no contradiction with Pilates.  We are closer to the essence of yoga by extending the exhalation. By pre-drawing the pelvic floor on inhalation we help new mums reverse the inevitable sagging of the pelvic floor hammock from late pregnancy – that affects mums irrespective of the type of birth they have had-  in order to get a more effective core toning action with the exhalation

One of my ladies has been informed by her doctor that she has torn her ligaments under the left side of her baby. I would love to hear from anyone who has encountered this and how they assisted the healing process. I’m aware some women experience stretching pains as their bump grows caused by tight abdominal muscles but haven’t come across anyone whose actually torn them. Any advice gratefully received.

The stretchy pains that women feel as the babies grow come not just from the abdominals but also from the ligaments that hold the uterus in place. There are the round ligaments at the front and the broad ligaments at the back. In Blandine Calais-Germain’s book ‘The Female Pelvis’ there is a great illustration on page 57 that shows how much these ligaments have to stretch and also how they change direction. The round ligaments differ from other ligaments in the body in that there are muscle fibres present often causing them to contract which the women feel as a sharp stitch like pain. This can happen while rolling over in bed or during sudden movements – I think it’s the body’s way of protecting itself.

All the breathing work we do helps the body to accomodate the baby with more ease. Lots of deep belly breathing helps open space. It also helps the women to slow down and adjust and adapt to their growing babies.

The woman may find that is was just a particularly stretchy phase for her body and the baby was in an uncomfortable position or she may well have torn some ligaments. If she has torn, then I would avoid big stretches and allow the body to heal. Breathing will help improve the circulation to the area and promote this process. She might also invest in a belly bra – to help take the strain off those ligaments. I’m not a big fan usually of these type of things as I tend to think that muscle tone is encouraged to atrophy further, but with sprains and strains they can help the body put more energy into repair.

Query re pregnant woman who had PGP in previous pregnancy.

Yes do treat her as though she already has SPD but be very careful that you empower her with ´dos´rather than ´donts´regarding what she can and cant do (see your manual about this- there is a page on it). working in dandasana and offering double lifts of pelvic floor 10 breaths in each of the 3 areas- lifting on inh, then lifting further on exhale to relseas at end of exhale works very well if she uses yoga belt-scarf around the feet and holds each end to lift the sternum. This will strengthen both the pelvic floor, recuts abdominus and deep back muscles. Really watch her transitions and ask ker how she lefts her toddler- show her how to do so whilst engaging PF. I find that cranial osteopathy tends to be more effective than physio but anything she can get for free is a plus. If she can afford to go to cranio too, then this is great. Self nurture will be really important and lots of encouragement so she can feel positively and build strength and hopefully have a much better experience of pregnancy this time round. If she treats it preventatively then there is no reason to encounter the same discomfort as last time. Hope this helps- abdominal breathing every day aslo super helpful and isometric movement against wall with hands to strengthen rectus- see if you can give her a 5-10 min programme to try at home every day.

Birthlight CPD notes – pelvic girdle pain
Pregnancy-Related Pelvic Girdle Pain (Chartered Physiotherapists Guide)  (website)

There does not seem to be a consensus among Gynae/obstetricians about when the placenta takes on a fixed position, but it’s worth continuing to seek an answer. What I have found over the years is that:

a) if the placenta is truly previa (covering the cervix) after 28 weeks there is no hope of moving it;

b) if the placenta is sowewhat low on the right hand side, supported inversions with slow breathing seem to be effective in avoiding placenta previa;

c) that women who have been told that they have a low lying placenta tend to be (rightly) anxious about it and therefore it is worth recommending a lot of breathing practice because at best this will work (together with the supported inversion) but at any rate this will contribute to a calmer outlook;

d) so it’s important that women do not get stuck with a label of placenta previa but that they find out from the scan exacly how low the placenta is and how it’s lying, perhaps just a low tip is causing worry rather than the bulk of the placenta and then from a yoga perspective there is much more scope for positive results. Perhaps we could have a helpline with someone like Ina May (Gaskin) as she must have dealt with lots of cases of low lying placentas on the Farm and find out what she says.

If someone has a true placenta previa, there is a risk of bleeding and I would be careful to avoid strong standing poses and squats. But these cases are very rare, in all my years of teaching I have only come across a few. My father was born with a true placenta previa, that came out first; French midwives say that such babies are born ‘with a hat on’ and will be very lucky. There was no bleeding. I think the main reason why placenta previa is feared is the risk of haemorrhage for both mother and baby.

Looking forward to finding out more on this topic

Francoise

As usual with posts about complicated postnatal issues, your post about repair of prolapse (you say vaginal but it seems more like a uterine prolapse felt in the vagina?) raises more questions before anything sensible can be said.

The first question is about the birth, how was it? Do you know whether this lady had a retroverted uterus? was the baby posterior? was the baby large? lenght of labour and any interventions? Sometimes the birth process causes extreme tension of some of the ligaments that attach the uterus to the pelvis, particularly to the sacrum. Did this lady experience sharp pains at any time during her pregnancy, particularly in mid pregnancy? How does her prolapse feel: as heaviness in the top part of her vagina? or as a collapse of one or both walls? when she walks? more when she gets up after sleeping? How are her bowel movements in general and at present? has she been experiencing any bladder problems before or since giving birth?

All these questions aim at understanding better where the weakness is. A hyteropexy consists of applying a mesh of artificial tissue to support the cervix, or a replacement ligament sling to hold the uterus in place without affecting the cervix (preferable if this lady wants to have more children). This sounds like a great replacement of natural body functions without damage to the organs. Yet after meeting several women who had this procedure I have been alerted to possible complications, both short term (bladder issues, painful sex) or long term (need for further surgery after a few years and particularly around the menopause when hormones affect tissues).

In the Oxford medical dictionary, the risk of complications is given as 1 in 3 or 4. It may be a coincidence that I met women who experienced complications but nevertheless the risk seems high enough to be taken into consideration. Also, 3 to 4 weeks of bed rest are recommended after the procedure as per the Oxford entry. Which new mother can comply with this unless she is lucky enough to have full time child care? what are your lady’s circumstances? She might not even be told that she needs this rest, as the women I met who had hyteropexy. So lots to be taken into account! Re yoga: our birthlight postnatal breathing and pelvic re-alignment practices are taught in a basic way that is appropriate for a majority of new mothers but in the case of any prolapse much more is required. This becomes yoga therapy rather than yoga and demands more knowledge and skills. In the module of the Postnatal Manual on addressing postnatal ailments with yoga, there is a short description and an image of Maha Mudra practiced with a belt or rebozo. I have used this classic yoga pose with bandhas successfully for reversing uterine prolapses, even after a long time, before laparoscopic surgery could be offered to women (it was hysterectomy or put up with it !). I would also recommend the ‘3 sphincters’ toning in a supported setu bandha pose 3 times a day (just a few minutes followed by rest in the supported inversion). Make greater use of the isotonic practices (pressing palms of hands on exhalation) in supported setu bandha to improve general muscle tone in the pelvis. The breathing needs to be really full, with awareness and dedication.

More than this I cannot comment without appraising this lady. I am sure you have taught her well, Sarah, prolapses are complex and require more than our standard yoga practices. My views on the ball exercises you mention are that they can be beneficial or harmful depending on cases, while yoga is more gentle and restores elasticity long term irrespective of the kind of prolapse. But then you can say I am biased! I am interested in improving our practices therapeutically to help ladies in situations like the one you describe and your post is an incentive to go deeper and offer more effective practices. Please let me know what this lady decides to do and if you send me a personal email I am happy to guide you in supporting her with yoga either as an alternative to surgery she can try or as a post-surgery recovery (that will be needed).

This is a condition for which Viparita Karani is most beneficial, with the pelvis raised on a couple of firm pillows and legs against a wall or resting on a chair if this is tiring, every evening for about 20 minutes if possible (a good time to practise some Pranayama and relax, perhaps listening to a tape). When sitting at work, women can use a box to raise their legs under their desk. It is better not to hold standing poses, but to use flow yoga. Avoid Vajrasana unless women can use one cushion under their feet and another to sit on. Avoid hot baths.

These are all very common sense practices but cumulatively they can be very effective. Pregnant women with varicose veins are often only offered support tights. These are effective but also constricting. Yoga supported inversions are something positive women can do when they are not wearing the support tights, particularly in the evenings when many women have heavy legs

Supported viparita karani with legs up wall/ on chairs and pelvis raised a little, assuming no contraindications, toe scrunching and stretching, pointing and flexing the feet, ankle rotations, windscreen wiper feet, rolling toes inwards and outwards – like nutation and counternutation positions to help blood flow, maha sacral mudra, shakti mudra, pran mudra all to help return blood flow and relieve the back flow, using ball or chair rather than standing if thats better but all fours may be preferable and all slow micro movements of pelvis, avoiding hot baths.

If she is comfortable on her back still as she is in 2nd trimester perhaps a whole sequence of upper body stretches could be done- slow turning of the head to each side, stretching one arm alone floor above head in line with shoulder – like in postnatal, x 3 times and big release each exhalation, stretching over the head to other side like palm tree, palms together at chest extending hands forwards and up in a loop in front exhaling back in front of heart, could be done with sound. Lots of padding with folded blankets so she is very comfortable.