Updated: Aug 28, 2020
Learning to control your intra-abdominal pressure is a veritable super power during the childbearing year.
What is intra-abdominal pressure?
It's is a fancy-sounding term for the pressure that builds up in your abdomen during any and all activity (although to varying degrees). Kind of like the pressure that supports the thin metal walls of a soda can. It’s totally normal and natural.
When intra-abdominal pressure is managed well, your body uses this pressure to generate stability around the spine and through the torso. Good pressure management is essential to generating power and strength in exercise or daily activities. If pressure is not managed well, your body will find ways to disperse pressure and create stability. That’s when we start to encounter core and pelvic floor conditions (like prolapse or diastasis recti) or aches and pains elsewhere in the body (like lower back, hips or even shoulders and knees!).
Pregnancy throws a wrench in our body’s innate pressure-management strategies - leading to a lot of the common pregnancy aches and pains. Relearning these strategies is often the first step in postpartum pelvic floor rehab.
But what if you learn these strategies earlier? What if you learn them during pregnancy?
If you can manage your intra-abdominal pressure well, you can use it to stay strong and supported during pregnancy. By mastering good pressure management strategies, you reduce your chances of developing the long-term core and pelvic floor dysfunctions that can show up postpartum. You can even harness these same strategies to support your pushing efforts during delivery, although that’s another post for another day.
What’s the crux of it? Breathing.
Yup, that’s it. Breathing (well) to manage your intra-abdominal pressure is your super power during your childbearing year. It is THE tool that allows you to tap into the function of your inner core and bring it back (or keep it!) online. In fact, mastering your breathing during pregnancy is one of the most effective things you can do to set yourself up for a strong postpartum recovery.
How do you do it? On your inhale, let your rib cage expand and let your belly and pelvic floor relax. On exhale, gently contract your pelvic floor. It's simple in theory but if you've never thought much about your diaphragm and pelvic floor, it can be a little tricky to master. Lucky for you, I've written up some pretty detailed guides. You can check out The No B.S. Guide to Breathing for Strong Pregnancy and Postpartum which takes you through, step-by-step, how to coordinate your breathing and pelvic floor. You can follow up with this post that explains how to adjust your strategy if the basic version isn't quite right.
There are no guarantees in life, but it is certainly the case that you can stack the deck in favor of a strong postpartum recovery during your pregnancy. Breathing is the first place to start. But then what?
Here are 6 additional things you can think about during pregnancy that will help kickstart your postpartum recovery.
❥ Minimize unnecessary stress on your pelvic floor and core by applying your shiny new breathing strategies when you exercise or exert yourself during daily activities. For example, you might exhale and contract your pelvic floor (also known as the Connection Breath) during the effortful part of a movement (like, rising from a squat or picking up a bag of groceries). This coordinated and intentional breath mimics a reflexive muscle firing pattern often lost during pregnancy and helps your body to manage the intra-abdominal pressure associated with physical efforts.
❥ Build awareness of your pelvic floor. Learn key symptoms of core and pelvic floor stress. In a nutshell, these symptoms include leaking of urine (or anything else), pain (in your vagina or perineum), pressure through your pelvic floor and perineum and peaking or doming of your abdominal wall. These symptoms don't necessarily indicate anything catastrophic, but they can be early indicators that your pressure management strategies need a tune up. If you experience these symptoms, I recommend seeking support from a pelvic health physical therapist.
❥ If you exercise regularly, consult with a qualified pregnancy personal trainer to ensure you are exercising appropriately for your stage of pregnancy.
❥ Learn to relax your pelvic floor so that you can relax it during labor contractions. A lot of people assume that during pregnancy they should be "doing their Kegels". A Kegel is normally thought of as just a pelvic floor contraction and during pregnancy, it's super important to consider the other side of the coin. During pregnancy, your pelvic floor is working extra hard to support the growing weight of your uterus and so it doesn't always need to do extra work. Chances are, you need to learn to relax your pelvic floor. Only a pelvic floor physical therapist can tell you if you need to do pelvic floor contractions to build strength. But everyone can likely practice pelvic floor contract and relax cycles with the goal of learning coordination and "letting go". If you can consciously relax your pelvic floor during the second stage (pushing stage) of labor, you may be able to minimize strain on the pelvic floor.
❥ Research strategies to minimize pressure on your pelvic floor and perineum during delivery. Consider taking a childbirth education class and learn about ways to use breathing and body position to facilitate labor as well as different ways to push out your baby. Work with a birth doula and a pelvic floor PT to explore laboring positions in which your pelvic floor is maximally relaxed.
❥ Even if you aren't having any explicit problems, establish care with a pelvic floor PT. Line up a pelvic floor PT appointment to coincide with your 6 week OB check-up. During pregnancy, pelvic floor PTs can teach you perineal massage, teach you to relax your pelvic floor, help you find laboring positions that work best for your body and address any pesky pelvic floor symptoms (like leaking, pelvic pain or sensations of pressure in the perineum or vagina). Postpartum, these providers are uniquely qualified to assess the condition of your pelvic floor and evaluate your readiness to return to exercise. These providers can often have long wait-lists, so I recommend booking the appointment before you have your baby.
The weight of the growing uterus puts stress on the core and pelvic floor; there’s no denying that. But, by breathing well, tuning into your inner core and minimizing the stress on your core and pelvic floor during your pregnancy and labor, you may reduce the risk of incurring the type of damage or strain that leads to a long-term injury or dysfunction. If you begin your recovery from a place of less strain and/or injury, your recovery is likely to go more smoothly.
All of this said, please remember (although it’s not fun to hear), you can do ALL THE RIGHT THINGS and still incur a complication during your pregnancy or childbirth. Please give yourself grace and know that the resources exist to support your postpartum recovery.
Learn how to dial in your breathing strategy to harness control of your pelvic floor and feel stronger in your workouts. Download a copy of The No B.S. Guide to Breathing for a STRONG Pregnancy and Postpartum.
My Bumps and Bells blog has been selected by Feedspot as one of the Top 100 Postpartum Blogs on the Internet 🥳🥳! See the rest here!
My mission is to make sure that having a baby is not a reason why you can’t do all the things.
Contact me if you have questions about exercise or pelvic health pertaining to pregnancy or postpartum. I work with people locally (Seattle's Eastside: Redmond, Bellevue, Kirkland and surrounding areas) and online to develop personalized pregnancy and postpartum personal training plans. I also offer labor support (doula services) within the greater Seattle-Metro Area.