What to Expect When You’re No Longer Expecting?
Imagine being pregnant for 9 or 10 months (yes, 10) and then the next day – you’re not. It’s tough to wrap your head around the shift that takes place in your client’s lives, AND their bodies. The human body is a master of adaption. It can grow life and then revert back to it’s pre-growing form. The postpartum or postnatal period is the the time after delivery. It’s a time of major change just as pregnancy is. Post pregnancy workouts are important for their well-being but there is a lot of consider.
As the trainer, you are a major factor in postpartum care of these ladies. Your goals for training prenatal clients, as detailed in my previous article for thePTDC, Prenatal Training Advice for Personal Trainers, will shift in postpartum training but are just as important. Your main goals should be to:
- Make them feel like a functioning, normal woman and enhance their general well-being for daily life. Baby brain, anyone?
- Make them move, perform, and feel better in their new and improved body.
The following are guidelines to follow when training women in the postnatal period. This is a big opportunity for trainers.
Getting Back Into the Gym
The general guidelines for post pregnancy workouts advise waiting 4 weeks with a vaginal birth and 6 weeks with a Cesarean section (C-section) before returning to exercise.
That being said, a lot of things can affect the return date. A natural delivery, episiotomy, tearing, C-section, infections, recovery, and postpartum depression. You may find yourself training women who are 2 or 3 weeks postpartum or women who cannot return until a few months postpartum. As soon as they are up to it, you can encourage light activity. This will help with recovery and well-being. Allow the client the time they need to establish some sense of “normal” before they come back to avoid additional stress.
Depending on your client’s history of exercise and current condition postpartum, you will need to determine how much exercise actually happens in your initial sessions. I stole the following answer from Alwyn Cosgrove on how to train cancer patients. Not that your postpartum clients are ‘sick’, but they’re going through major physiological events of their own…and are going to be freakin’ exhausted. So, how do you re-start training a previously pregnant client? The answer: with low, low, low, low, low volume. And, don’t forget low volume. Remember goal #1 – always make them feel better when they walk out, then when they walked in.
Job Title: Nanny/Trainer
Semi-private sessions will take on a whole new meaning. Child care is not easy or cheap and you’ll likely have mom’s bring their babies to their sessions. If possible, you/your gym should encourage it. It will make it much more likely for new moms to continue their post pregnancy workouts with you postpartum.
You don’t have to love babies or even be that comfortable around them to train postpartum women, you just might have a few wee ones sitting in on your sessions now. Moms can have baby hang out in their car seats, or on a mat on the floor with some toys when they get a bit older. Don’t worry if mom asks you to hold baby, they won’t judge your awkward football cradling. While it might feel uncomfortable, at least you didn’t do this:
How to Fix the Mummy Tummy
Ah, the dreaded mummy tummy. Not so yummy feeling for lots of ladies and getting rid of it is often the stated goal of post pregnancy workouts. That bulging lower belly area that many women would give up their pinky finger to lose. You can thank those post-pregnancy pounds for this left over baby belly, but more importantly your Diastasis Recti (DR) plays a starring role.
DR was covered in the prenatal article, but to recap it is the separation of the rectus abdominis muscle that often occurs in pregnancy. A diastasis is a two finger or more width separation of the rectus muscle sideways. The muscle gets overstretched and the abdominal contents exert pressure anteriorly, so the muscle begins to separate and the connective tissue becomes weakened. This is one reason why your postpartum clients may still look 4 months pregnant when their baby is a year old. No one likes to be asked when they’re due when they’re not even pregnant anymore, right?
Step 1: Retraining the Breath
It might seems simple, but you will have to teach them how to breathe again. You will likely encounter women with flared ribcages and paradoxical breathing (read Mike Robertson’s breathing work here to understand proper diaphragmatic breathing). They are in a state of constant inhalation, which is wreaking havoc on their posture and their ability to contract the abdominals. The anterior abdominals therefore have no chance to return to their pre-pregnancy length, and overactive hip flexors trying to stabilize the pelvis in lieu of this are keeping them in an anterior pelvic tilt. All one big, rib-flaring, unstable, inefficient breathing cycle.
Get them breathing properly and watch the ribcage become pulled down and hip flexors begin to relax. Only then you will actually get proper abdominal contraction and compression to close the DR. Molly Galbraith wrote a great article on a case study with this exact issue, and will show you how to fix it.
Step 2: Retraining the Abdominals
There are going to be some jiggly bits and bellies going on, and that’s perfectly normal. Ladies recently postpartum will likely have a tough time getting a solid abdominal contraction, especially in the lower rectus region. They might feel like there are no abdominal muscles left, like they have a serious case of abdominal amnesia. Those muscles have been overstretched, not functioning at capacity for months, and don’t know how to turn on anymore. Practice makes perfect here.
What abdominal exercises should you do? Elevators and contractions should be in every workout and every day life. These will begin strengthening the transverse abdominis in order to compress the abdominal contents to help close the DR. Low level dead bug activation exercises will be their new best friend in order for the anterior abdominals to pull the pelvis into a more neutral position. Refer to Robertson’s article “Core Training for Smart Folks” for the progressions to follow.
What abdominal exercises should you avoid? In the case of DR, you need to steer clear of exercises on all fours, front loaded planks, and any supine crunching or flexion movements.They are only going to put more pressure on that weakened connective tissue and exacerbate the separation.
Be cautious of rotation exercises and any loaded exercise where they core has to stabilize heavily. When your client is going from supine to seated or standing, get them into the habit of rolling to their side before coming up instead of jackknifing up and bulging the belly. And, be sure your clients know that front loading baby carriers need to go until that DR is closed as to avoid increased pressure on the abdomen.
Step 3: Retraining the Pelvic Floor
“I laughed so hard, tears ran down my leg”. Nothing should ever be that funny.
To avoid seriously embarrassing leakage accidents, get to know the pelvic floor. Imagine the pelvic floor like a hammock. It is a group of muscles and soft tissue supporting the region from pubic bone to base of the spine and hold the organs in place. The pressure of the fetus, along with labour and delivery can weaken the tone of these muscles. ‘Pelvic floor dysfunction’ can be from weak muscles not closing the badder normally, to a sagging (prolapsed) uterus.
Kegels, pelvic floor contractions, should be done daily (for as long as they can remember to do them) and incorporated into your sessions. In your movement prep get in the habit of doing 1 or 2 sets of 10 repetitions, working up to a 10 second hold each rep. You can progress these into your strength work, for example on the concentric motion of a squat they pull the pelvic floor up. Please, no jumping jacks. No running, no squat jumps, no box jumps, until that pelvic floor is rock solid (many months).
“I Just Want My Pre-Pregnancy Body Back”
Believe me, if I had a dollar for every mom that said this to me, I definitely wouldn’t be spending my winters in Edmonton, Alberta still. It is not a quick fix and there’s no magic to it. Reinforce that it took their body almost a year to transition in growing a baby, so it’s probably not going to take anything less to return to that previous version of their body. Try to explain that this is about reinventing the body in the long term, not getting back to what they were.
Just like prenatal training, correcting posture and developing posterior chain strength are going to be the main ingredients of your workouts. Get the pelvis out of anterior tilt, the upper body less kyphotic, and build strong glutes. In your first few phases, you likely won’t need to program in metabolic activity to get a training effect. Not only unnecessary, but uncomfortable due to breasts that are doubled in size and unsafe with relaxin still providing loose ligaments and tendons.
Wrap it Up
“She may look relatively normal, but don’t let that fool you”. – PTDC coach Dr. Cassandra Forsyth-Pribanic
A woman’s body is going through significant change after pregnancy, just as it did during. Your job is to design a program to rebuild their strength and fitness level with proper progression. If she’s used to intense workouts or training for competition, re-framing the idea of what a workout should feel and look like is imperative.
Remind them that the most important thing they can do for themselves and their child, is to take care of themselves and not put themselves last. Tough one for mama’s! Proper nutrition, hydration, and ample activity will really save them in their sleep deprived fog. Be a sounding board, an escape, and a place of non-judgement.