Can Exercise During Pregnancy Make Labor Harder?

Can Exercise during Pregnancy Make Labor Harder?

Adriana Lozada: Hello again, Mighty Parent or Parent-To-Be, and welcome to Birthful. I’m Adriana Lozada and as we continue with our Movement and Body Wellness series, I’m delighted to share with you the talk I had with prenatal yoga teacher, pelvic floor yoga instructor, and all-around birth and anatomy geek, Deb Flashenberg. 

And one of the things that I love so much about this series as a whole is how the state of your body’s soft tissues and muscles and your postural habits directly impact the flow of your birth. And if you’re asking, “Why do you love that, Adriana?” …well, I love it because that’s something you do have control over. For all the uncertainties that come with labor, the state of your physical body is one thing that you can get curious about right now, during pregnancy, and then when you learn where your body is at— so what is your starting point?— then you can take whatever steps are needed to support your body so that you have a more flowing birth and also a better postpartum experience and recovery. 

And then, when you connect your exercise history with the physiology, balance, and alignment of your pelvic floor and core, you get these amazing insights on how YOU need to move (or not move) for a really supportive and holistic approach toward pregnancy movement. 

This episode connects really well— See what I did there? Pun intended— it connects really well with Molly Deutschbein’s episode (that’s also a part of this series), which focuses so much on your structural alignment and posture, and I find that it also brings insights into some of the things that happened during Lauren Horton’s birth story if we connect it with her history as an athlete. So, for example, one thing that stands out in my mind is when Lauren mentioned that she got hemorrhoids after her long pushing stage, and after listening to this episode with Deb, you might have your own “A-ha!” moment. 

This is also a great time to remind you that the point of all this information that we bring is not so that you view it from a place of shame or judgment, but rather as an opportunity to gain insights and gather tools that you can use moving forward. 

Alright, so today’s topic is one that has been on my mind for a while, ever since I was at a birth where the baby was crowning for a long time and the caregiver made a frustrated comment about “these yoga people with their tight perineums.” At the time, I was appalled, well, because the way she said it was not supportive for the birthing person that was trying so hard to get her baby out… but the comment stuck with me, and of course, I then needed to know if her comment held any truth. And, if so, what could be done during pregnancy to make things easier during labor?

So, in this episode, Deb is going to give you some pointers on how to know if your pelvic floor is too tight, and some ways to balance it. We’ll talk about why you don’t really want to be doing Kegels just because, how to squat in a way that doesn’t close your pelvic outlet, the different types of incontinence, and Deb’s own close call with an episiotomy. 

Also, you’ll hear how pelvic PT can be an important piece of the puzzle, and I will definitely be circling back to that topic during our Birth Prep series, where we talk about pushing physiology and how you can approach the pushing stage so that you protect your pelvic floor. 

You’re listening to Birthful. Here to inform your intuition.

Adriana: Welcome, Deb. I am so glad you’re here!

Deb Flashenberg: Thank you. I am a long time listener of yours, so it’s quite an honor to be on the show!

Adriana: It’s so exciting— and I love when there’s fellow podcasters that come on the show because we have so much passion (y’know, passion for birth and passion for sharing and broadcasting messages). And yeah, I love telling my listeners about other shows. So what’s the name of your show?

Deb: Yoga | Birth | Babies.

Adriana: So fabulous! So, tell us a little bit more about yourself. What do you do aside from podcasting?

Deb: I do a lot!

Adriana: Right?!

Deb: Which hat do I put on first? Well, I started the Prenatal Yoga Center in New York City And then just from that journey, flourished into becoming a labor support doula. And then I also became a Lamaze teacher. I did the midwifery assistant program down at The Farm. And then years after accumulating all that birth knowledge, I had my kids.

So I have the hat of being the, y’know, the director of this studio, a yoga teacher. I teach teacher trainings all around the country, y’know? And I write for different blogs, as well as my own. So it’s all birth advocating— so it all kind of revolves around the same thing, just different roles.

Adriana: Mhm. No, and it’s lovely! And it’s not only that, like, once you get into what… However, whatever was the gateway that brought you to birthwork or birth-related information, you just want to help more and more. And I find myself in the same situation, right? I was… I started just with birth doula and then progressed to doing sleep consultations and postpartum education classes and then the podcast… And it’s just so enriching to the soul.

Deb: It is, and it’s all… but it’s all based on the one idea of like, “How can we help?” And I feel you’re in the same boat of this “How can we help women have a really exciting…”— or, not exciting ’cause some people don’t find it exciting— but just autonomy and empowered birth, that they can own and have it feel like a positive experience throughout their life. And I think all these different venues that you and I do are just trying to support that. 

Adriana: Yeah! And maybe this was your experience as well, but it wasn’t until I became a mom that I realized how insanely difficult and, like, earth (earthquake!) shattering becoming a mom is— like, to your identity, to your life, to all the things, like how much it asks of you. And now I find we’re just starting to hear more about it. My daughter just turned 13! When she was itty-bitty, this was not the talk. And I think a lot of people out there still don’t know, right?

Deb: Yeah, sometimes I actually have to catch myself with my prenatal students that don’t have kids, pulling back, so I don’t wanna scare them. But yeah, I feel like we don’t talk about it. It’s hard to have it all and something has to give, y’know, at certain points. And it’s an ebb and flow of what’s getting more attention.

But yeah, I don’t think I fully understood the weight and responsibility of motherhood, even though I had been working in that field for almost ten years, y’know, before having my own kids. But then all of a sudden that responsibility of motherhood and so much giving and then family and supporting that and running a business… It’s a lot. It’s a lot. Love it.

Adriana: It’s too much. Too much! That idea that you’re gonna have it all, y’know?! I love how… What we’re gonna talk about today, which is: “Can exercise during pregnancy make labor harder?” How that sort of parallels what needs to happen in your physical body, and what makes more of a difference for your physical body, is kind of parallel to what needs to happen to your mind.

Deb: Yeah, there needs to be a surrender to both, and acceptance, and social acceptance— y’know, I know we’re gonna talk about, like, exercise and kinda the body image. And I think there’s this image that many of us take on, like, “Oh, I’m pregnant, but I’m only gonna change in my belly and boobs, not let anything else change,” y’know, ’cause that’s, like, this Hollywood image. And then we also have this Hollywood image of what moms can do— which is supposedly everything. So I think we kinda have to surrender and take the mask off of it.

Adriana: So let’s talk about that physical part. “What are the benefits of exercising during pregnancy?” first, and then get into, like, “What should that exercising look like?”

Deb: Sure. So I think exercising is fantastic! I’ve been a prenatal yoga teacher, an avid exerciser, and prior dancer, so clearly I support exercise! It’s amazing for keeping the aches and pains at bay during pregnancy. It’s a great release of endorphins.

Especially for prenatal, I think coping skills and learning breathing are all gonna benefit some sort of labor, whether it’s a vaginal or cesarean, still having the coping skills and the breathing. So I think it’s incredibly important. But what I think sometimes happens is we often hear this common saying of, “Oh, if you did it before, you can absolutely keep doing what you were doing during pregnancy,” and I think that’s where we start to get a little bit misaligned with “How can exercise help create a more of a functional birth?” So, keep exercising— but do it mindfully. Does that make sense?

Adriana: Absolutely! And I think when we used to have this sort of mantra of “If you were doing it before, you can continue doing it while pregnant,” there was always the caveat of “But, like, don’t horseback ride or do things that are jerky and jump,”— y’know, no trampoline jumping! Like, there were a little bit of things that people…

Deb: Yeah, but it goes further. I think it needs to be explored further.

Adriana: Yeah. No, but I mean, like the… When this was being said, there wasn’t that widespread idea of boot camps and, and fitness, y’know, doing weights and lifting— like, all of that was not what everybody was doing then.

Deb: Right. It wasn’t quite the trend, and this trend of, like, the boot camps and the barre class and even the spinning— it’s relatively new in terms of what we think of, y’know, exercise. If you think back, even like in the ’80s where this kind of Jane Fonda— and I think in the ’80s and ’90s there was, like, step class and then spin, really. I mean, I might not be totally on par with this, but I think it’s maybe, like, 2000/a little later that spin, barre classes maybe like 15-10 years ago. So these things are relatively new and very tightening for the body, which is not helpful.

Adriana: Right! And that’s why I thought it was so important that you reached out and we were talking about this today, because not that we’re knocking weight training and, y’know, cross training and all that. It has its place! It’s just that we’re seeing people (that are really doing that before and during pregnancy) having a harder time with labor and postpartum because of it.

Deb: Absolutely, and I’m… I’ll out myself. I was the person on my spin bike five days a week, pregnant. In fact, I had my clothes to go on… I had my gym clothes to head to the gym for, I think it was like a 9:00 a.m. spin class, when I started labor! And I thought, y’know, “If my contractions go away, I’ll make the 10 o’clock,” y’know, ’cause of my obsession (I’ll call it that). A little obsession with “Can I keep this body physique that I had?” I was doing before, it really made my labor so much more difficult, and my postpartum. 

And it was that kinda turning point for me, of having been through it myself and seeing the detriment of continuing to that extent that I really started to change the way I approach how I teach yoga and just the methodology, to help women have a better birth— ’cause one thing that was really hard is, if it’s a really long birth process and the healing process is harder and all of a sudden you’re a new mom, you don’t want your body and your pelvic floor and your abs to be the main focus. You wanna be able to focus on, y’know, creating this relationship with your child and breastfeeding and enjoying it.

And because I was so hardcore before, it really became a stressor that I was seeing a PT twice a week and I was doing all these pelvic floor exercises to try help kinda rebuild myself. And the labor was really arduous and it created a lot of fear about heading into my second labor, and I want women not to have to have that.

And what was really interesting was I was working with a homebirth midwife, I was working with a very well-established doula, and an OB. I had a huge team, and no one ever said, “Hey, Deb, let’s look at what you’re doing exercise-wise. Maybe we need to look and refine it.” And so that’s why I’m so passionate about, y’know, “Exercise is great— but are we exercising in a way that’s going to help or hinder the birth experience?”

Adriana: Mhm, absolutely. And that’s, y’know, why we’re talking here today about this topic. But one question I have for you, Deb— ’cause sometimes I hesitate— like, you were doing all these classes, you were doing your spinning, if somebody would have told you, “Wait, hold on— you’re doing too much,” would you have listened, though?

Deb: That’s a great question, and I don’t know. But what I do think, if someone said, “Hey, Deb, if you do this it may actually make your birth harder,” I think then I would’ve listened. If someone said, “Oh, y’know, don’t worry about gaining some weight,” I probably wouldn’t have. But if they wanted that… If they put that magic piece of “Do you want your birth to be harder?”— and, again, what woman’s like, “Yeah, gimme the hard birth!”— I think that would’ve made the difference. And that’s why I say this to people, like, You don’t want your birth harder. You don’t want your postpartum harder.” So I think, had that been highlighted, I think it… Yeah, I think it would have made a difference.

Adriana: So hopefully those out there listening who do a lot of exercise are not being put off by this topic, but rather listening with an open mind and curiosity to see how they can improve their situation to actually have that better birth— ’cause that’s the point of it. We all want to have an easier, smoother birth!

So how would exercising during pregnancy make labor more difficult?

Deb: Oh, there are so many ways! So let’s jump in. So, first of all, we wanna make sure that we want a balanced pelvis, ’cause a balanced pelvis is gonna make more of a balanced uterus. So there’s so many exercise things that can create imbalance in the pelvis. So let’s start with this psoas muscle. So those that don’t know, it’s a muscle that goes from T12 (your thoracic 12) kinda down along the lumbar. It runs behind the uterus and attaches to the lesser trochanter of the femur, kind of that upper thigh bone. It’s responsible for… A lot of people call it the “hip flexor,” so it will bring your legs up and down, like spinning or running. You can imagine the thigh bone, hip lifting and lifting and lifting, and that’s psoas tightening. So things like spinning and running, a lot of these barre classes where they’re doing these huge kicks, all that’s tightening the psoas. And when we tighten the psoas— if you can imagine, it runs behind the uterus— and we’re trying to keep the uterus balanced. If it torques the uterus, that’s gonna prevent baby to find optimal fetal position, as well as descent.

So we want baby to be able to kind of descend and corkscrew down, but if the… if a tight psoas is preventing that, baby may not descend, baby may start to get more stuck or just never really hit optimal position. So tight psoas, many people have— whether they’re even athletes or just more of a sitting person— y’know, sitting also brings the psoas in a tightened position, so we really wanna be mindful of a tight psoas. I hope I explained that well enough to be able to visualize!

Adriana: No. Yeah, absolutely. So what are some things to do to have a more relaxed, less tight, or balanced psoas?

Deb: There’s fantastic yoga positions. There’s also the Webster technique— I don’t know, I’m sure you know about that chiropractic technique. I remember with my own second labor pregnancy, I went to my chiropractor around Week 36 and going once a week after that, and she had me do this interesting exercise where I brought my arms over my head and because my right arm was… It came up slightly shorter than my left. She’s like, “Oh, your right psoas is shorter or tighter!” I’m like, “You can tell that from bringing my arms overhead?!” So I did a lot of the Webster technique, but Gail Tully and Spinning Babies also has some psoas releases. But yoga, we do a lot of very mindful psoas relaxing.

Also, the interesting thing about the psoas is it’s so prone to stress. So if we’re creating stress and anxiety, it’s also going to kind of clench up. So we want to keep the psoas well-stretched and try to keep it kind of supple and juicy.

Adriana: Mhm. Very good. So we talked about the needing a balanced pelvis, because it balances the uterus… And you talked about the psoas muscle. Are there other things that help balance the pelvis?

Deb: Yeah, we also wanna be mindful of the piriformis. So, I’m throwing a lot of anatomy out there. So I hope some people, those that are already into yoga and, y’know, birth probably know a lot of these. So also a tight piriformis— so that’s a deep rotator muscle, it goes from the sacrum and it runs to the greater trochanter of the femur (the kind of outer thigh bone) and when it’s tight, that can pull the SI joint (the sacroiliac joint) out of alignment. So if you think about the pelvis, we’ve got the two big hip bones, and then the sacrum connecting it in the back. When those are out of alignment, it can create a harder time for the baby to descend.

But if we want to think of the outlet of the pelvis, if the sacrum’s pushing into it, the baby’s head can actually get caught on that rim. So, if we have this tight piriformis that’s pulling on the sacrum, that can create misalignments. So when we hear about these women that are having these really long labors and things are just moving really slow, stall out— it’s usually baby position. So tight piriformis is another of those causes of the pelvis being out of balance. And that happens with so many pregnant women because we think about the S-curve of the spine, when we get that deeper lumbar curve— and we’ve all seen the pregnant women start to waddle, the feet turn out— that’s creating that tighter piriformis.

So one of the biggest culprits: barre classes. It’s all about external rotation, all sorts of leg lifts, “Keep squeezing the glutes!” Anything we’re overly squeezing is making it tight and tight doesn’t mean it’s strong— it just means tight. So we wanna be really mindful. So there’s a few exercises in yoga that we do… But if someone’s not interested in yoga, a really easy one to do at home is if you take a tennis ball and you put it in, you sit on it and kind of push it into the glute and roll around on it, there’s usually kinda this deep, tight, kind of burning spot that the tennis ball can help release. 

Or a massage! Massage is another great way to try to release the piriformis. I’ve had some massage therapists get their elbows in there and kinda dig around to try to release that. But a lot of us have a tight piriformis, but yet all these over-tightening things… Because we’re doing, y’know, a lot of these exercises we talked about are relatively new. We think we’re creating this strength. We’re actually creating too much tightness.

Adriana: Yeah, and I… y’know, the best way I have to explain that, and more specifically, is with Kegels, right? There’s this idea of Kegels, Kegels, Kegels, do Kegels. It’s perfect! And now, let me see if I’m explaining this properly… So the Kegel is just a tightening, and sure you want strength, but really a strong muscle is a toned muscle, not just a tight muscle. So doing the Kegels just tightens and actually shortens the distance between your tailbone and your coccyx, no, your front bone, pubic bone (the one in the front, that’s where the baby is gonna come through). So you actually want that space to be able to open up wide. And you, by tightening and doing Kegels, you’re just making it tighter, like, a more difficult door to get through. 

Deb: Absolutely. And Kegels often are just… People think of Kegels like you said, squeezing. But one way it’s often described is “Squeeze if you’re stopping the flow of urine.” But that’s just the urethral sphincter, y’know, that’s really just the front. If we’re really squeezing everything, that’s even worse. So if someone needs pelvic floor work, we wanna create balance.

You are totally right that we don’t wanna just tighten, tighten, tighten. We actually wanna create— I think of the pelvic floor kinda like a springboard. It should be bouncy! That you want to have a toned muscle, that has give and flexibility. We don’t want a muscle that’s so shortened and tight that it can’t stretch and we don’t want a muscle that’s so long and flaccid it can’t support. Your pelvic floor really needs to have… It’s like a shock absorber. So if you think about the whole pelvic bowl— and that’s the springy foundation— every time someone walks or sneezes or coughs, there’s a downward pressure of the pelvic organs and we want to kind of spring back up and support, not just tighten.

Another thing that can happen with an overly tight pelvic floor is that can create a harder time pooping—  which is then going to/can cause hemorrhoids, that can cause (the more someone strains) it can also cause incontinence for someone if they’re too tight. So it really needs to be balanced. And yeah, the idea of just tighten and tighten, that’s really a fallacy. A lot of women are actually hypertonic. They don’t need more tightening. They actually need to learn to relax the pelvis.

Adriana: Oh yeah. Let’s talk into how you can do that. And I, as you were talking about the pelvic floor, having it be like a bouncy springboard, I was “You want your Goldilocks pelvic floor. It’s just right, not too soft, not too hard.

Deb: Yes. I mean, that’s so right! Not too tight, not too loose, perfectly springy. So a few ways that we can actually stretch the pelvic floor… So first I’ll even teach you to figure out “Do you even have a tight or loose pelvic floor?” There are a few ways. One, you can actually palpate your own pelvic floor. So if you can find your sit bones, ischial tuberosities, those bones in which you’re sitting upon, and if you start to massage kind of the inner ridge or inside the sit bone towards the perineum, if it’s tender and it hurts when you’re pressing on it, it’s too tight. If you can kind of palpate all through there and nothing, you’re probably more balanced or hypotonic. 

Another way someone can tell is incontinence can happen with a tight and a relaxed pelvic floor. Most people think, “Oh my God, I’m having incontinence. Let’s just Kegel more.” And sometimes that’s making it worse. So the kinda general understanding is if you are sneezing or laughing or coughing or jumping or running around and you have some incontinence, you’re probably hypotonic and need a little more support, and that’s “stress incontinence.” But if you’re having what’s called “urge incontinence” (where people just don’t make it to the bathroom on time), that’s usually associated with a tight, short muscle where it’s almost spasming, so that’s hypertonic. So some people that are having that, they’re like, “Oh no, I’m leaking! I’m gonna Kegel more,” and then they’re just shortening and tightening the muscle. I hope that makes sense!

Adriana: Yeah, and I did not know this!

Deb: There’s different kinds, yeah.

Adriana: Yeah! 

Deb: Yeah, and so we wanted… I’ll also talk about how to actually do pelvic floor balancing. So to stretch the pelvic floor a few really easy ways… And the first really easy way I teach if someone’s kind of new to it, it’s just deep diaphragmatic breathing. So when you breathe, if you’re doing normal respiration, when you inhale your lungs expand your respiratory diaphragm, which is kinda like a dome (I think of it like a jellyfish). It drops and spreads, and then there’s slight downward pressure of the pelvic organs, on the floor, and that creates a spreading and widening of the pelvic floor. Then when you exhale, your lungs empty, your respiratory diaphragm domes back up and it creates, like, a little vacuum and it lifts the pelvic organs and creates, like, a dome in the pelvic floor.

So the pelvic floor and pelvic diaphragm should move together. They should both inhale and drop and spread, and exhale, there’s a natural lift. So if someone can focus on a deep, relaxed, diaphragmatic breathing way to the pelvic floor, just that natural downward pressure, not you’re forcing it, you’re not trying to like press anything or bulge the pelvic floor, but just deep diaphragmatic breathing should start to create a little bit of length in the muscles. So that’s one really simple way that everyone can do. Everyone can breathe. 

That, yeah, I mean everyone can do. You can do it driving your car, you can do it sitting on the subway. The problem that some of these— as we’re talking about, going back to exercise— some of these things that we’re constantly hearing in things like barre class (and I heard this in many, y’know, yoga classes that I haven’t really enjoyed some of the instruction in), “Navel to spine. Navel to spine.” Or people teach themselves to hold their abdomen all the time. So they’re creating that intra-abdominal pressure, which is putting pressure on the pelvic floor. So when we hear, like, “Okay, only breathe up in the upper chest,” you’re losing the opportunity to get some natural stretch of the pelvic floor. So we’re creating more tightness from trying to create this image of like, “I’m gonna keep my belly always in.”

Adriana: Yeah, and when you breathe up on your lungs all the time, you’re actually telling different signals to your nervous system. It’s actually more stressful.

Deb: Yeah, we’re in that “fight or flight” all the time, which we know is not good. We don’t need to run… We run on adrenaline enough. We don’t need to run on adrenaline and, y’know, while we’re just working on breathing. So another way, if someone’s into yoga, the idea— like, something, like, in down dog, lifting and spreading the sit bones, or a forward fold, lifting and spreading the sit bones, so that again, you create some length. ‘Cause a lot of times, again, we think Kegels just squeeze the vaginal muscles, but we wanna be able to think of kinda that whole diamond shape of the pelvic floor, having the ability to stretch between the sit bones, from pubis to tail. So if someone’s actually needing support, just squeezing the urethral sphincter is really not doing it.

I think, again, kinda the pelvic floor, a dome that— if you were to have to tone— you do it on the exhales, the inhales to stretch and release. But the exhale, we’re thinking of drawing your sit bones together, drawing your pubis and tail, and trying to dome and lift the perineum, so you’re not just squeezing as if you’re stopping from peeing.

So it’s a little… It’s a different balance than just, “Oh, I gotta squeeze. I gotta squeeze.” It’s an inhale to stretch and an exhale to engage (and engage is different than just “squeeze”).

Adriana: Right. Right— engaging is just, y’know, sensing movement towards. It’s not, like, “as hard as I can.”

Deb: Yeah, we don’t wanna go for, like, “Oh, I’m gonna squeeze everything in.” We’re probably overdoing it. So yeah, we wanna be able to have— again, go back to this jellyfish idea in my mind, like, you can visualize the undulation. Like, the inhale, it drops and spreads. The exhale, it lifts and domes. And so we’re engaging, we’re creating muscle work— but we’re not just squeezing, squeezing, squeezing until we’re blue in the face.

Adriana: Yeah.

Deb: So, yeah, a tight pelvic floor is not helpful for birth!

Adriana: What do you think about, squats— and squats done, y’know, properly?

Deb: I was gonna say… I’m like, “Let’s talk about squats.”

Adriana: Let’s talk about squats! Y’know, with making sure your knees are… don’t go in front of your toes, and that your feet are not, y’know, angled out (but parallel), and that you go down and don’t lift your heels, go down as far…

Deb: It’s a great… Yeah, I mean, if as long as the heels are supported (you hit something huge about that), the feet are parallel, because a lot of people are going to start squatting, turning their toes out in an external rotation, and that’s actually taking the sit bones closer together. So that’s actually shortening the muscles, as well as creating less space if someone wants to use this for birth, y’know, a birthing position.

I think squats are fine, but the thing we have to be really mindful of is, if we understand baby position, because when we squat paralleled, we’re opening the outlet of the pelvis. If a baby’s breech, I wouldn’t wanna shove the presenting part, that may not, y’know, if it’s a—

Adriana: —feet or—

Deb: Yeah, ’cause if, y’know, maybe they have a provider that’s going to deliver a breech, but here in New York City we don’t have too many, so I’d wanna understand the position of the baby. But it’s a great pose to stretch the pelvic floor. And it’s a great pushing pose, because it does open the outlet of the pelvis more than, y’know, birthing on your back.

Adriana: And what I like about the squats is, like— if done properly and having checked that it’s appropriate for you— is, I feel, like talking to you about this inhale-relax-exhale-engage that you’ve mentioned. That you go down, if you’re sticking out your sit bone, right? Not tucking, but really out, then as you go down, you’re opening and—

Deb: —stretching, yeah.

Adriana: You’re tightening, engaging.

Deb: Toning, engaging, yeah. And that’s the other thing you totally hit on the head there, that many people squat and they tuck their tailbone. And so if you look around— ever since I’ve been studying the pelvic floor, people are now gonna know my secret— I look at people’s postures, feet and tailbone, and when you see a really tucked tailbone, there is probably a really hypertonic pelvic floor. So if we tuck the tailbone, we’re creating more of that tightness. So you’re absolutely right, kind of swing the tailbone back and think of widening the sit bones.

Adriana: So I think we’ve gone into, very specifically, the parts of the pelvic floor, and I wanna talk about how to take that into your exercise practice, and what you’re already doing and what other exercises to do, to avoid, like, more from a broader point of view, not just so narrow into a specific position or exercise. You mentioned that stuff like running or cycling that can tighten the psoas muscle— so clearly that’s something to be avoided or balanced with some good stretching of that muscle. 

But as a practice, in general, are there some exercises— aside from running and cycling and barre— that should be kind of avoided or lessened? Or, like, weightlifting— what do we think about that?

Deb: I think weightlifting… It can create, y’know, when a lot of people hold their breath when weightlifting and push down on the pelvic floor, I think that’s not gonna be helpful. That can lead to some prolapse. I also don’t think holding your breath when pregnant is a very particularly good idea. We get a lot of professional dancers coming to my studio— ’cause we’re not far from Lincoln Center— so when we’re working with people that are en pointe, that’s also gonna be a very tight pelvic floor situation. Now, granted, that some people, y’know, that’s what they do— but the further along they get, they shouldn’t be jumping and spinning so much.

So looking at things like: Were you a gymnast? Were you a dancer? Y’know, are you already very lifted and tight? Those are probably the main things we see. Also, as you mentioned horseback riding before, like, y’know, things that are squeezing that, the adductors (the inner thighs), that’s gonna lead to too much tightness.

But the main ones I do see around… I would say be mindful of spinning, of running. I know a lot of people do run. I start to pull that back a little bit. What’s another one? Those are the main ones. And barre classes. And it was interesting, I remember when I was pregnant with my first— and as I mentioned, I was taking crazy spin classes— I had my teacher say to me, she’s like, “Y’know, for some reason all my ladies end up with C-sections.” And I’m like, “Well, that won’t be me.” But I was so close to it. So I really think, y’know, to be mindful of how we’re overly-engaging. 

And I know you mentioned CrossFit at one point. I’m not very familiar with it, but I do know it’s weightlifting to the point of extreme fatigue. So I’d be mindful of something like that. And heavy weightlifting, I was recently reading about, I think it was like 20% of people that still did very heavy weightlifting, that led to a lot of diastasis, which is gonna lead to some compromise of the pelvic floor as well.

Adriana: So explain what a diastasis is.

Deb: Oh, sure. So rectus abdominal diastasis is when the rectus abdominals at the front are no longer connecting because the linea alba, the connective tissue, has lost its integrity. So it needs to have some natural tension, but if we have all this abdominal pressure pushing forward and the rectus are separating, well, all the muscles are separating and we lose that integrity. There’s a gap. It could be, y’know, a small gap (one finger), up to five/six fingers, and we need to have the canister of the abdomen well-contained. So if we start to create that separation of the abdominal muscles, it can lead to some pelvic floor compromise.

Adriana: So things like crunches…

Deb: Yeah, no, don’t do those!

Adriana: Something to completely avoid, ’cause you already have this baby growing and everything, like, pushing those muscles to their limit, stretching them out.

Deb: Yeah, y’know, and I’ve been to the gym and I see pregnant women do it, and, y’know, it’s not my place to go up and be like, “Well, y’know, by doing those crunches you can create more problems.” But if anyone’s ever done any sort of crunch when pregnant, even, like, jackknifing up, their belly gets this little point forward, I call a little shark fin. That’s a sign that there’s some abdominal separation. Some yoga can cause that problem too, y’know, deep backbends, twists, all that can create some problem with separation of the abdominal muscles. And that actually goes back to what you were saying with tight pelvic floor.

I forgot to mention that yoga— there’s a lot of yoga that talks about this thing called mula bandha, where it’s an engagement of the pelvic floor all the time. Y’know, so if we’re always engaging, we’re never gonna release. So yeah, if deep backbends, deep twists, crunches, weightlifting… Unfortunately for second-time moms, we think about, you know, picking up the first child, pushing a heavy stroller, trying to pull it up… And so we have to be really mindful of how we can better support our bodies.

Adriana: And I think it’s great to let people know that you’re, like, take away the “should”s, of “I’ve been able to do this all the time and now I can’t,” and feeling less than or like you’re failing because, really, your body’s changing so much. You’ve increased your blood volume 50%. You have relaxin going through your whole body, making you a little more wobbly and more prone to falling and just looser joints that could create easier injuries. You have to kind of respect where your body is at at that moment.

Deb: You do. And I think it’s really hard. I think, y’know— and I’ve watched this with yogis, and, again, I kinda put myself in this category, and dancers and athletes— if someone’s worked so long on their craft (y’know, whether it be yoga, dancing, or their technique of running) and all of a sudden they have to change it, it’s really kinda showing, “I’m changing myself,” y’know, “I’m all of a sudden transitioning.” 

It’s like when someone becomes a mom and all of a sudden you have a different identity. And if someone’s identified with their yoga practice or their dancing and now they have to give it up, it’s really emotionally hard. So trying to find a way to accept, surrender, and find people that are gonna support that surrender. ‘Cause I can’t tell you how many people congratulated me in spin class, like, “You’re doing great!” y’know, “You’re still on that bike!” It would’ve actually been helpful for someone to be like, “Hey, whatcha doing? It’s okay to let it go. It’s gonna be there after.” Y’know, I think we’re just so hard on ourselves.

Adriana: So if you do have a tight perineum and tight muscles, what are some of the things that happen during labor that can make it more difficult? So you did mention “failure to progress,” which is a nice, enormous umbrella, right?

Deb: Yeah, that’s a big one. Y’know, so if the pelvis is misaligned and imbalanced and the uterus is imbalanced, it’s going to cause, y’know, just a long, slower labor. And not all care providers and hospitals are gonna give the time to let baby work itself out. So we can have… The uterus is torqued— I’m sure you’ve heard it, intrauterine constraints. So we’ve got these ligaments that are attached from the uterus to the pelvis, and if the pelvis isn’t aligned, well they’re pulling on that uterus. So if you can imagine the uterus kinda like a big balloon, and all of a sudden one of the tethers is pulling it out of alignment so it’s no longer even, that’s gonna have a deeper problem with the way the baby descends and even the alignment of the cervix. 

So here we are, we’re not progressing even with Pitocin, y’know? And things are then baby’s not descending, y’know? So the mom’s gonna start to then get anxious and nervous. And we already talked about the psoas— what happens with, y’know, anxiety— y’know, it fires it into “fight or flight.” 

And then, so say you actually do get baby descended and you’re making some progress. And then we have this tight pelvic floor, and maybe it’s not even evenly tight, y’know— baby’s head could be asynclitic. Or, as you mentioned, it’s kinda like pushing a door open that’s really shut. So mom’s finally getting the rotation and the descent, and now she has to hit the pelvic floor and have a rotation for a head to come out… Well, the head’s not really rotating as well, ’cause that pelvic floor’s really tight. Y’know, you might have a care provider that sees a really tight pelvic floor and says something like, “Y’know, we might have to do an episiotomy,” or “We might need to have more of an instrumental birth,” because it’s really hard to let that pelvic floor stretch.

So it’s coming back to balance. We need to be able to have the body a little more… It can be strong, but supple. So we want to try to have mom have an easier birth. And also think if we’re really tight and she’s pushing for a long time, that can lead to prolapse— and no one wants to deal with pelvic floor and pelvic organ prolapse postpartum.  Y’know, again, you don’t want her to feel like she’s peeing all over herself as she’s trying to take care of her baby!

Adriana: Absolutely. Nobody wants that. And when you were talking about the head, y’know, not being able to rotate because of a too tight pelvic floor, it, it reminded me as well that if you’re pushing for a long time, this baby’s head is then suddenly getting a lot of unwanted forces pushing for, y’know, ’cause you’re trying to push down and the door is tight at the bottom and so this little head, this little neck, they’re being kind of smooshed and squeezed and—

Deb: —then think of what that’s gonna do for breastfeeding!

Adriana: That’s it! It affects everything, right?! Because then you might have a baby that has torticollis or that has… y’know, needs an adjustment or craniosacral therapy or something to release those things. That we don’t think about.

Deb: Yeah, exactly. And some people may be like, “Oh, craniosacral, sure.” But other people like “Cranio- what?!” like, that wouldn’t even occur to them. And like, “Why is baby’s mouth not latching? What’s going on at the jaw? Why is the suck too strong? Too weak?” and then they may give up on breastfeeding.

Adriana: And then you— if breastfeeding is what you wanted to do— you feel like a failure.

Deb: Yeah. And again, here, now she’s a “failure,” if not breastfeeding. And her pelvic floor’s tight and she has diastasis. I mean, like, we don’t want… We want mom’s entrance into this new journey and this new experience to be a welcomed one, not where she’s feeling beaten down, y’know? And as she just went through this war of labor. All this is really just to help the pregnant person enter this new phase with a little more ease.

Adriana: Yeah. And it is a time of ease, of being gentle with yourself. I know, I know. That doesn’t fit into what we’re used to, in, culturally, y’know, this drive that we constantly have: “What do you mean I’ve got to slow down?” And I feel like I say this to ad nauseum, like, it is so important for you to internalize that and give yourself grace and know that it is okay to be slow, to take your time, because your baby actually is gonna force you into that slower time. Baby time, everything takes ten times longer than you think it could.

Deb: Even just just getting out the door! I tell my pregnant students that all the time, like, enjoy the fact, if you wanna go get a coffee and bagels, you just put your shoes on, walk out the door. It doesn’t happen like that once baby’s there, y’know? Now it’s a half an hour just to get your shoes on and make sure baby, y’know, hasn’t blown out its diaper. 

Adriana: Right?! And you were mentioning before, of the possibility of having an episiotomy, because once the baby finally descended and got there, that those muscles were too tight. And I’ve gotta say, as the doula, I have seen that. It’s not something that we’re hypothesizing here. I don’t know if it’s been your experience too.

Deb: So, yeah, there was a moment during my first birth where my homebirth midwife (which I’ll tell you, doesn’t usually go there) said, “Would you want me to cut an episiotomy?” And I literally thought, “Oh my God, when would a homebirth midwife offer that?” Clearly something was not stretching and opening! I didn’t end up needing it, but there was a little moment of panic, of thinking, “Why is she offering this?” y’know, it’s not… that’s not usually where a homebirth midwife’s going to go. Y’know, that’s not usually part of their repertoire of techniques they use.

Adriana: No, not at all. Had you been… Had baby been crowning for quite a bit?

Deb: Oh, yes. Yes, very long. And, like, the crazy— and I think as a doula you’d appreciate this— I kept asking with every contraction what his heart rate was, because I was concerned, y’know? We were crowning for so long. I’m like, “Tell me! Tell me its heart rate.” Like, “Do you need to know?” I’m like, “Yes I do.”

So, y’know, we don’t want that for women. Fortunately I didn’t need that. But as you’ve seen, if it’s really tight, the episiotomy is gonna cause scar tissue— y’know, you can have a deeper tear. We don’t want that for women.

Adriana: No, no, nobody wants that. Definitely something to be avoided. And so Deb, let’s look forward a little bit more. We’ve been focusing on the birth— and you did mention a little bit of how recovery can be, if you have… Like, what does an ideal recovery look like, and how can having too much of a tight pelvic floor (an unbalanced pelvic floor) hinder your recovery?

Deb: Well, there’s gonna… There could be some prolapse, there could be some pelvic floor prolapse. So if mom was pushing for a really long time, it can cause the organs to release into the pelvic floor. Especially if we think about all those ligaments that— sorry, not the ligaments— the hormones that are creating softness in ligaments, so they’re descending anyway. And then when you’re pushing for a long time, you have that downward pressure. And if the ligaments overextend, then all of a sudden maybe you’re having bladder prolapse or even a little cervical prolapse or rectal prolapse. And then she has to work on healing from that.

My own experience and that of many of my students was pelvic floor rehab, y’know, and then doing pelvic floor exercises, and it takes a while to get back. And a lot of moms want to, y’know, get back on their feet mindfully after. But if all of a sudden focus is on, like, “How can I support my pelvic floor?” It’s harder to transition back to regular exercise. So there’s pelvic floor stuff that can happen.

If her pelvic floor is really tight and she’s pushing for a long time, that can also create the diastasis I was talking about. So we don’t want mom feeling her body was trashed after. So I think that the transition back to postpartum exercise needs to be slow and mindful— that we don’t wanna start running again, pounding on that compromised pelvic floor. We want to give time for the body to support… Get back to its normal state.

Adriana: And how long could that take? I know that it’s like a really broad question, but…

Deb: It could be years, for some people. Depends on what’s going on.

Adriana: Right, but you know how we have this horrible postpartum care where before, when you’re pregnant we’re, y’know, asking you to come in every week so we can check things out and then afterwards you don’t see you for—

Deb: —six weeks. Yeah, I know. Isn’t it kinda crazy though? Like, so here we are seeing you, y’know, once a week and then all of a sudden after like, “Oh, see you in six weeks!” And I did some research, that one of… that six week period’s actually the highest occurrence of major situations with the postpartum body happening, like preeclampsia, y’know, even cardiac arrests. So it is a little crazy that we have such a gap. 

But when someone should start exercising again, I think they need to be mindful of their bleeding, yeah. I’ve had students come back like ten days later and I’m like, “It’s great that you got out of the house, but I can’t have you doing this.” And if they do, I have them do a restorative class.

So we need to be mindful of the bleeding, And for the c-section, that’s major abdominal surgery; we need to wait at least six weeks. So I say, look at what your body’s feeling capable of doing. As you mentioned, like, that whole six weeks, very quick meeting with the care provider, usually it’s like, “Okay, you can just jump right back”— but when can anyone, all of a sudden, the day turns six weeks and all of a sudden you’re off running again? So I think we need to really pay attention to “How does the body feel?” What kind of signals is the body giving as opposed to the mind and ego like, “I need to exercise. I need to get back to my pre-pregnancy body.” So we need to look at the bleeding. Is there incontinence? Is there a heaviness in the vagina? How does the back feel? How does her own energy feel?

Adriana: Mhm. Because you’re probably not sleeping that much. You’re probably getting not that great of nutrition, unless you are being really mindful and active and have great support around that.

Deb: Mhm. Absolutely.

Adriana: I’m one of mind that sleep comes before exercising!

Deb: Yeah, especially ’cause if you are gonna exercise and you’re tired, what kind of workout are you really gonna get? You’re probably better off catching up on your sleep, feeling better, and then having a shorter workout.

Adriana: Absolutely. And I really love what you just said about listening to your body, not your ego, and just touching in with what’s going on, because pregnancy was nine months where everything changed and you had a baby, and then all those muscles that were stretched really far are all deflated and they need some time to, y’know… it’s hard to even figure out how to re-engage those sometimes.

Deb: The muscle tone drops during postpartum. The estrogen drops dramatically, and if someone’s breastfeeding, their body’s in actually a postmenopausal state of estrogen. It’s really low, so muscle tone is decreased. So here someone is, y’know, the pelvic floor is having more decreased support, their body’s still changing, because if they’re breastfeeding, their breasts are huge. There’s often fatigue. We really need to be more respectful of that postpartum body. That way when someone is feeling the energy, they can get back to their workout slowly and mindfully— ’cause if we go back too early, we’re just going to injure ourselves and it’s going to be that much longer to get back to what we love.

Adriana: Yeah. And so much more frustrating. Yes, absolutely, yeah. Yeah. What other things should people be mindful of or do you recommend they pay attention to?

Deb: I think they need to pay attention to their posture and, y’know, how they’re holding their baby. And if they’re breastfeeding, they can cause a lot of neck strain. So be really mindful of how you know what they’re doing in their daily life now that’s gonna be different. So that they can’t just kind of jump right back into life— like, their body’s different, they’re different, their whole experience is different. And just to be okay with that.

Adriana: What are some of your favorite resources around this topic?

Deb: Oh gosh, okay. Which one to go to?

Adriana: You did mention Gail Tully and Spinning Babies— and I will link in the show notes.

Deb: I’m also a big fan! I have a teacher I’ve been studying, with Leslie Howard. She is pelvic floor all the way. She’s based in San Francisco, in the Bay Area. Her pelvic floor teacher training… It’s fascinating. I mean, I was already a pelvic floor geek from my own experience, but her work is really great and I think she has a book, I think it’s called, like, Pelvic Liberation. So I go a lot to Gail Tully, to Spinning Babies. I check in with Leslie. And then I just keep finding as much research as I can.

I have a few PTs that I work with in New York that if I ever have questions, I reach out to them. I feel like they know more than your average care provider, which is also something maybe to keep in mind, that a lot of women just talk to their care provider about “What I should and shouldn’t do” and even the state of their pelvic floor after, and that’s not their specialty. They’re not actually trained in that kind of thing. 

So I would say if someone has some questions, of the state of their pregnant body, check with the physical therapists that specialize in women’s health. So those are the people I tend to reach out to if I have questions or something’s come up that I’m… I haven’t been able to figure out on my own.

Adriana: And I definitely recommend people to go check out a pelvic floor specialist, even do a check-in while during pregnancy, just to see what your baseline is, and then the recovery. And I know it sounds excessive, but, y’know, in France, everybody gets this!

Deb: I was just gonna say that! Yeah. I was like… I’m like, “Well, if we were from France, it wouldn’t be such… so excessive,” because they get eight weeks of postpartum PT.

Adriana: Exactly. So it’s something that everybody should be doing, and I know that requires a mental shift. But, y’know, figure out what you can do for you, and— like you said, those great diaphragmatic breathing exercises, like, those are really a good way to start connecting with your body back afterwards during postpartum, right?

Deb: Yeah. So if someone is during postpartum having some problems with their pelvic floor and they want to start to find some of that pelvic floor toning, I recommend doing it on your back with your hips elevated so that they can start… They can have gravity pull the weight of the organs off the pelvic floor so they can start to find those muscles again, so it’s not like they’re already weight bearing as they then try to find the muscles. I learned that from my PT and I do that with all my postpartum women. 

I lift the pelvis on a block so that they can then have that elevation. And you can do this at home! You can do this as soon as they want to start to feel their pelvic floor again.

Adriana: That was my question— it’s not like they’re lifting their hips up on their own.

Deb: Oh, no. Yeah, like, shove a pillow— shove, like, two pillows underneath. You don’t need a massive height, just a little bit of a height. So one of the things I do with my students is I have them find the pelvic floor first on blocks, then I take them down, then I have them do transverse abdominal exercises to find those muscles again, and then I combine the work. So now they’re starting to find some gentle transverse and some gentle pelvic floor, really finding that core again. So not jumping back and trying to do crunches or, y’know, lots of planks— really being subtle to get the stability and then move forward into whatever exercise they wanna do.

Adriana: Yeah. And connecting with that deep level tissue, like you were saying before, of those ligaments that connect the uterus, and bring things back.

Deb: Yeah, and the problem is a lot of people when they think abs, they wanna get that kind of instant burn, which is more your rectus abdominals, or six pack— but the deep transverse, that’s really where it’s at, about stability and support, y’know? So if we can create that support, it’s going to help decrease diastasis as well.

Adriana: I love it. That has been a… This is a packed, packed episode. Thank you so much!

Deb: I know it’s very anatomy-based, so if someone does like anatomy they’ll be like, “Woohoo, we love it.” And some might be like, “What? What is she talking about?”

Adriana: Well, and no… I mean, anatomy is where it’s at, it’s physiology. You’ve got to understand it. The more I learn about the body, the more amazed I am, and the more things make sense— of why you wouldn’t go, at six weeks, “Let me see if I can get back to lifting some weights.” It’s like, “Wait a second!” Your Jenga tower? The base is a mess. You can’t start putting things up at the top. You gotta line that up!

Deb: I love it. “Your Jenga tower.” That’s awesome.

Adriana: Your Jenga tower, yes. Ah, Deb, thank you so much for being on the show today. It’s been lots of fun!

Deb: Thank you!

Adriana: That was Deb Flashenberg, who is the founder and director of the Prenatal Yoga Center in NYC and is also the creator and host of the Yoga | Birth | Babies podcast— and I was also a guest on Deb’s podcast where we talked about Finding Birth Flow Within a Hospital Setting. If you want to listen, find the link in the show notes. You can find Deb on Instagram @prenatalyogacenter or learn more at prenatalyogacenter.com

And you can connect with us @birthfulpodcast on Instagram.

In fact, if you are not driving, it would be lovely if you would take a screenshot of this episode right now and post it to Instagram sharing your biggest takeaway from the episode. Maybe it was the different types of urinary incontinence! Make sure to tag @birthfulpodcast so we can see it and amplify it.

You can find the in-depth show notes and transcript of this episode at birthful.com, where you can also learn more about my birth and postpartum preparation classes and download your free postpartum preparation plan. 

Also, if you find this podcast to be an invaluable resource for you, the best way to support us is by taking any one of my perinatal classes, doing one of my doula workshops, or trying out some of the wonderful products made by our sponsors. This is what allows us to continue doing this work. 

Birthful is created and produced by me, Adriana Lozada, with production assistance from Aysia Platte.

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CITATION:

Lozada, Adriana, host. “Can Exercise During Pregnancy Make Labor Harder?” Birthful, Birthful. December 14, 2022. Birthful.com.