postpartum exercise

[barbeqrn]

I am now 5 weeks postpartum and will be able to exercise next week per my MD. I am still very sore due to a third degree tear and episiotomy...wondering from anyone when this feels better and what I should start with in terms of exercise...I walked during pregnancy and before that I was a die-hard Cathe fanatic!

 

[Cathe Friedrich]

Hi!

I had a second degree tear(although I heard that the difference between second and third is tremendous) and an episiotomy. I found the soreness to get better at four weeks and much better at 5 weeks. Now its about 12 weeks and although it doesn't hurt at all to workout, I still feel a slight tightness down there at certain times. Almost as if its not sewn up right(but I checked and it is).

I would suggest doing only what is comfortable. By next week your doctor will be able to tell you if he/she thinks exercising is okay. At that point ask them what they recommend and at what intensity(yet still work within whats comfortable for you). Love and happiness to mommy and baby

!

 

[Sheila]

Postpartum exercise progression

<center><font size="1" color="#ff0000">LAST EDITED ON Mar-22-00 AT 09:11PM (EST)</font></center>

LAST EDITED ON Mar-22-00 AT 09:09 PM (EST)

Congratulations on your new addition!

Sorry about your tear. I have had students with the same symptoms at six weeks from such a tear. Healing time varies from individual to individual. Are you still doing your kegel exercises? This exercise will increase circulation to the area and help it heal faster. Also, warm soaks in the tub (I know this is hard with a newborn!) will help as well.

As for your postpartum progression back to exercise... I would suggest that you first start walking outside with your baby in the stroller. Spring is just around the corner but if it is still cold where you are you can dress the baby in layers with a hat. We went through the winter with our Strollercize classes here in North Carolina. Some of our babies were dressed in 4 layers of clothing for the class!

I know that if your were a "Cathe Maniac" before your pregnancy you are ready to get back to her videos. I would start with a goal of just doing 20 minutes of cardio (plus the warmup). I would still eliminate all the impact at first to give your "traumatized" pelvic floor time to heal. Try to do all your exercising with your kegels slightly contracted. When your tear is healed and you are pain-free from it, you can start to add impact to your workout as long as you can do so while maintaining a slight contraction of your pelvic floor. This is the ABSOLUTE KEY to the safe addition of impact for postpartum moms. If you add impact and you cannot hold a kegel contraction you will be further compromising your pelvic floor and therefore might leak urine when you laugh, cough, do a jumping jack, etc. I cannot stress enough the importance of being able to hold a kegel contraction while doing a particular exercise. We tell the moms in our program that "If you cannot hold a kegel contraction while doing a particular exercise, then you should refrain from doing that exercise until your pelvic floor is stronger." Listen to your body with regard to how hard to push yourself. Remember you want to get energized,not exhausted from your exercise regimen. Being a new mom is exhausting enough!

When you add step back into your exercise program, you might want to lower your step height from what you were accustomed to pre-pregnancy. Some women experience knee discomfort when returning to their step regimen due to the hormone relaxin still in their system. Remember, this is the hormone that loosened up your joints during pregnancy. In my experience, if you are nursing, it seems to take relaxin longer to clear your system postpartum.

I would also suggest that you start back easy with your strength training with moderate weights. Since you said you were a "Cathe fanatic" pre-pregnancy I thought you might be interested in a post of hers regarding some of her tape formats. The following is a direct quote from a post by Cathe regarding her return to weight training that she posted on the forum on 1/20/00:

"For weight training, I will come back easy. I will either do Body Pump classes here at the gym or do MIS, both with moderate weight. As I get stronger, I intend to lift heavier and begin the PS Series(or a similar type workout)and then I would also like to work myself back to one body part per day per week. As for my abs, I hope to return to working them 3 to 4 times per week with routines similar to that of my tapes."

Also, if you have a separated abdominal wall(i.e.diastasis recti) you must avoid any rotational work utilizing the obliques until this separation has pretty much come back together.

Good luck and keep us informed of your progress.

Sheila

 

[barbeqrn]

Thanks

Great information from both of you! Thank you so much. I am releived to know I am not alone when it comes to pelvic discomfort 6 weeks out! I di an ab workout for the first time today...I feel so weak!!!! Can't wait to get "back to normal"!

 

[Hazel]

Can you all clear something up for me?

This is my first baby, so excuse my ignorance. But it's possible to have BOTH an episiotomy AND a tear?

 

[barbeqrn]

Both

This was my first baby too...unfortuately I found out the hard way you can end up with both an episiotomy and tear! They are killers in the pain dept. but ease up as time goes by. There are different degrees of tears with a 4th degree being the worst I think. Hopefully you will escape without either!!!

 

[Hazel]

Yikes!

Thanks, Barb. I learn something new about pregnancy and birth just about daily, it seems. I had just figured the reason for the episiotomy was to avoid tearing.

Sorry to hear you went through that. Hope you're on the mend.

 

[Cathe Friedrich]

Hi Hazel!

Excuse my ignorance too

! I cracked up when I read your question because I, too, wondered the same thing. You know I have been so distracted since little Eric has been born that I never did research that answer. I think the way you end up with both is that if they see that you have started to rip(during delivery)they quickly cut you so that you don't rip further.

But I remember my thoughts being that if they saw that the skin was not going to stretch enough then why didn't they cut it before it tore. I guess there is just too much going on at that time. Oh well, little Eric was worth every rip and snip, hee hee!

 

[momincharge]

In addition...

it is also possible to have no episiotimy AND No tear! Let's look on the bright side of things here girls! No pun intended! I have done all 3. Believe me if your Dr allows you, your comfort returns much more quickly without stitches in that well um sensitive area!

 

[kellyeli]

I agree!

Having had an episiotomy with my first (and a small tear that didn't need to be stitched) and nothing with my second, I can honestly say that there is a world of difference. After my first, I realized that those muscle you use to do Kegels are used for a whole lot more that you don't realize. And after my second, well, let's just say that the thought of my doing laps around the hospital parking lot considering how good I felt was very tempting! Don't get me wrong, you'll still be sore, but WOW, it's sooo much better if your doc will work with you and guide you through the pushing to avoid tears and/or an episiotomy. I'm not certain if this really has a whole lot of bearing with first babies, I had a different doc for each delivery, so I can't say if it was the doc, or if it was because it was my second child. Second doc WAS a woman, though. Ah, just some food for thought!

Good luck to you all!

Elizabeth Kelly

 

[Hazel]

I continue to learn something new!

Silly me, I was just assuming you always had to have an episiotomy. I obviously still have much to learn (although I feel like I'm running out of time to learn it). I have my 6-month check-up tomorrow and will definitely be asking my doctor (a woman, with kids) about this. Thanks for helping me learn.

 

[BLinda]

If you can manage-

try to skip both the episiotomy and the tear! I had an episiotomy the first time- no tear, they just wanted to deliver him faster, and I know exactly what Cathe means about "Not being sewn up right." I remember thinking that I would never want to sit on a bicycle again. Well, after my second, no episiotomy, no tear, I was ready to ride an obscenely short time later (lets just say less than 6 weeks). It really makes all the difference in the world. I know there is nothing you can really do about it, except look for a Dr that won't cut you unless there is a reason. Anyway, good luck!

 

[momincharge]

More

I also had an epsiotimy on the 1st go 'round. My Dr gave you no choice--all a wam bam thank you maam kind of thing. Being young and foolish I asked no questions and followed orders. The Dr who has delivered all 4 (soon to be 5) of the rest allows you to be a part of the decision process. He lays out all of your choices and allows you to make an informed, intelligent decision. My attitude has been to try w/ as little help as possible then do what needs doing. My 3rd child was a big 8 12 w/ a pumpkin head-- when the dr saw that I was starting to tear we did an epsiotimy, 4th child was a facial delivery no epsiotimy, small tear w/ no stitches,2 & 5th child no episiotimy, no tear. If you are able to go w/o that epsiotimy it certainly recovers much more quickly! Could sit down comfortably almost immediately! So, I guess I could be a case study in how every delivery is different. All were wonderful experiences and never as terrible as all the stories people are telling you when preg. Wow! Talk about an endorphin high when you hold that beautiful child in your arms! Oops! I am rattling. Hope this helps you find out your options.

 

[Sue Tomasso]

Just heard about this topic on a local news program!

The gist of it was that doctors are performing the episiotomy procedure in cases where it can probably be avoided. Some doctors feel it may be better to allow a tear where it would naturally occur anyway and avoid the episiotomy alltogether.

I had an episiotomy with my first, I didn't ask any questions, and to be honest, I don't even know if there was any tearing involved. What I remember most (besides the pain of trying to sit down!) was that feeling of "not being sewn up right". I had a C-Section w/ my daughter because she decided to come into the world in the breech position. The doctor says I can attempt a vaginal delivery this time around (which I prefer anyway) but I will definitely want to have some input regarding the episiotomy this time around.

 

[ErinF]

Episiotomy AND tear free is the greatest!

With my first delivery I didn't have an episiotomy for the simple reason that the doctor told me to push and then walked away. He figured since it was my first I'd be at it a while. NOPE! My daughter came barreling out on the 3rd push, 2nd contraction. I tore really badly. It took forever to stich everything back up.

With my next 3 deliveries I didn't have either a tear or an episiotomy. WHAT a huge difference in recovery! Taking vitamin E really helps the skin down there be at it's healthiest and stretchiest. It also helps a lot to have a doctor or a midwife who is commited to avoiding an episiotomy and knows how help that happen by controlling the delivery.

Erin

 

[Sheila]

Technique to possibly avoid episiotomies and / or tears

With all the talk about episiotomies and tears I felt like you all would benefit greatly from the handout that we give to our class members in Healthy Moms. It is entitled "Perineal Massage." The following text is directly from our handout.

PERINEAL MASSAGE


Perineal massage is a technique used to increase the possibility of delivering a baby without an episiotomy. It stretches the perineal tissues, resulting in less resistance to the birth of the baby, and less need to cut into the tissue to make room for the delivery. If the muscles of the pelvic floor are relaxed, there will also be less resistance. Doing the massage helps a woman identify those muscles and learn to relax them in response to pressure. Massaging the oil into the perineum may soften the tissue, again reducing resistance and the need for an episiotomy.

The massage should be done daily for at least five minutes, beginning about six to ten weeks before your due date.

Either you or your partner can do the massage.

Some people recommend wheat germ oil, available at health food stores, but other vegetable oils could be substituted.

Make yourself comfortable, lying in a semi-seated position against some pillows.

The first few times you do this, take a mirror and look at your perineum (area between the vagina and the anus) so that you know what you are doing.

Dip your fingers into the oil and rub it into the perineum and lower vaginal wall.

If you are doing the massage yourself, it is probably easiest to use your thumbs. Your partner can use their index fingers. Put your fingers three inches into the vagina and press downward (toward the rectum). Maintaining steady pressure, slide your fingers upward along the sides of the vagina, moving them in a rhythmic “U” or “sling type” movement. This movement will stretch the vaginal tissue (mucosa), the muscles surrounding the vagina, and the skin of the perineum. You will feel tight in the beginning, but with time and practice, the tissue will relax and stretch.

Concentrate on relaxing your muscles as you apply pressure.

As you become comfortable massaging, use enough pressure until the perineum just begins to sting from the tension that you apply. You will later recognize this stinging sensation as the baby’s head is being born and your perineum stretches around it.

Good luck!