I Thought Having a Fit Pregnancy Was a Good Thing

I have been really into fitness and running for many years. When I became pregnant with my first born, I was determined to have a healthy and fit pregnancy. I researched the safety of working out when pregnant. Everything I read pointed to continuing with the activity that you did previously with exceptions for certain core exercises and marathon training. Pressing play every morning for my home workouts and running every week gave me a sense of accomplishment. I felt like the more in shape that I was, the better my labor, delivery and postpartum would be. Boy, was I wrong. Exercise during pregnancy is not a bad thing, don’t get me wrong. I just happened to be doing the wrong types of exercise for my body.

It’s Game Time

When I finally went into labor 10 days past my due date, I thought that physically I could handle the intensity and strain. I was very strong from working out every day. What I didn’t take into consideration was the position of the baby and my own anatomy. My labor lasted for 21 hours, and I pushed for 2 of them. It turns out that the plyometrics, barre workouts and running were only tightening an already tight and asymmetric pelvic floor. When there is asymmetry and tightness, this can lead to a baby being stuck in the birth canal. Prolonged pushing in the lithotomy position with already tight muscles is the perfect recipe leading to nerve damage. This is what happened to me. I couldn’t lift my leg and had numbness after giving birth. I had pain in my pelvis for months. It was not the recovery that I expected having had such a “fit pregnancy”.

Bouncing Back Postpartum

As soon as I was given the green light for working out again postpartum, I hopped right in with barre workouts. The pounds melted away and I started to regain my muscle tone, but the pain was still there. Little did I know, I was only continuing to tighten an already hypertonic pelvic floor. I never went to pelvic floor therapy, because I was postpartum right at the start of the pandemic. Being a physical therapist myself, I never specialized in women’s health issues. I understood a lot about anatomy and the neuromuscular system, but that region was never talked about in my basic PT school curriculum. It wasn’t until I started incorporating more stretching and yoga into my daily routine that the pain finally started to go away. It also sparked my interest in learning more about prenatal care and the pelvis.

What’s Going on Down There?

I started to become more interested in my own anatomical alignment and what may have caused the nerve damage in my left leg. I always knew that I had more flexibility in the hamstrings on the left side and tightness in the hip flexors of the left side. On occasion, I would end up with a pelvic rotation, where the left side of my sacroiliac joint would rotate forward because of it. I spent most of my childhood and teen years doing gymnast. I was a leftie for that sport meaning I led all of the elements in my routines with the left leg. Could this have led to more of an obliquity in the pelvis and a tightness in the psoas on that side? I started to question everything I did for activities.

Let’s talk about this psoas. The iliopsoas is a muscle group that results in flexion of the hip joint and is made up of the psoas major, psoas minor, and iliacus. It attaches to the vertebrae at T12-L4 (most of the lower spine) and to the lesser trochanter of the femur (the thigh bone). Tightness in the psoas can cause the pelvis to rotate putting strain on the sacroiliac joint and the lower spinal levels. Exercises that further tighten the psoas include, gymnastics, ballet, plyometrics, and cycling. Looking at my prenatal and postnatal workout choices, I knew they were not ideal for this issue I seemed to have.

Another thing that I discovered was the glute weakness that I had on the left side compared to the right. The gluteals are made up of the gluteus maximus, gluteus medius and gluteus minimus. This large muscle group commonly referred to as the booty, help to extend the hip joint, stabilize the sacrum (tailbone), and counterbalances the pelvic floor. When the glutes are weak and the psoas is tight, it makes a terrible combination of a forward rotated pelvis. In my case, it was one sided and a rotated pelvis is not ideal for a baby trying to make its way through the birth canal.

Digging Deeper

The pelvic floor is made up of three muscle groups, which work together to provide a strong bouncy dom. They attach the tail bone in the back to the pubic bone in the front and the sit bones to one another side to side. This muscle group supports the pelvic organs, stabilize the pelvis, assists in bowel and urinary function, and aides in sexual performance. The pelvic floor works in conjunction with the diaphragm to circulate blood and lymph.

When taking a breath in, the diaphragm moves down and flattens, pushing the organs down below it. When we exhale, the transverse abdominals (the deepest layers of the abdominals), contract like a corset and increases pressure in the abdomen. Ideally, the pelvic floor works in conjunction with this. The dome-like structure of the pelvic floor should lift and contract as we exhale and lower and relax as we inhale.

Simplified, there are muscles of the pelvic floor that connect front to back (tailbone to pubic bone) and side to side (sit bones to sit bones). When the muscles are tight front to back, it will cause tilting of the tailbone. Tight muscles of the pelvic floor can cause constipation, hemorrhoids and pain during sex. When the muscles are not contracting effectively and are weak, it can cause urinary incontinence and pelvic organ prolapse.

Everyone always talks about kegals, but kegals aren’t for everyone and may even be damaging to certain pelvic floor issues. I have always had a strong pelvic floor with no urinary incontinence issues during my pregnancy or postpartum. I thought my pelvic floor was good because of this. What I didn’t realize was the pelvic pain, constipation and hemorrhoids that I suffered with postpartum was a result of a hypertonic pelvic floor. It was a different kind of pelvic floor dysfunction.

How Posture Plays a Role

When looking closer at my posture, I am aware that I have developed a habit over the years of tail tucking. I remember when we were doing postural assessments of each other in PT school, I had a swayback posture. Essentially my tail was tucked under, and my upper back was hunched forward. I’m not going to go into great detail on the biomechanics of this, but this posture shortens the pelvic floor muscles and usually indicates weakness in the glutes. It also creates a lesser outlet for baby to come out of the birth canal.

Another bad habit of mine is sitting more on my sacrum and less on my sit bones or ischial tuberosities. This more I sit in this slouched posture, the more that my pelvic floor muscles shorten and tighten. Remember how I said that my left side was rotated forward with the psoas being tight? My final postural bad habit is crossing my left leg over the right when sitting. This is my go-to sitting position. This imbalance furthers my forward rotation on that side and decreases blood flow to the pelvic floor.

I’m Pregnant Again. Now, What?

Pregnancy and childbirth are so unpredictable, and many factors play a role in the outcome. Since becoming pregnant for the seconds time, I decided to control what I can. A change in activities from running and plymetrics will help me find balance. I’ve been doing prenatal yoga three times a week and prenatal specific strengthening exercises the other four days. Running or plyometrics will be avoided to spare the increased pressure on the pelvic floor. I hope to find some balance with yoga poses specific for posture and hypertonicity of the pelvic floor.

Along with exercise modifications, I am going to incorporate full body breathing exercises. I have been meditating daily to help relaxation of the pelvic muscles. My postural awareness has improved, so I am trying to avoid lounging in a posterior tail tucking pelvic tilt. I am more mindful when I start to clench my glutes while standing or cross my legs when sitting. I’m not perfect, but I am more aware than last pregnancy.

As I start to think about a birth plan, I want to try to avoid an epidural. I’d like to avoid pushing on my back in the lithotomy position. The positioning and choices made during that last birthing experience contributed to issues I had during the pushing stage. I will have a doula there this time around to help advocate for me. She will provide me with the wealth of information and experience regarding my positioning for optimal fetal alignment. Will these changes help me achieve the birth and postpartum I desire? You just never know! I do know that “bouncing back postpartum” and a “fit pregnancy” won’t be my main buzz phrases this time around. Will I feel like I did everything I could to prepare my body for the physiological birth I want? That’s all I can ask from myself.