There are many great skills for new moms to learn and do in the Fourth Trimester (post-partum). It is extremely important for someone in their fourth trimester to reach out to pelvic physical therapy if they are having pain in the pelvic region, pain with sex, prolapse, or urinary or fecal incontinence. Although these conditions are common, they are not normal and NOT okay for someone to live with.
Did you know? 1 in 7 Moms and 1 in 10 Dads suffer from post-partum issues
Good body mechanics means using your body in ways to create less strain so that you can alleviate pain and prevent injury. They are particularly important for moms during pregnancy and particularly during the 4th trimester. This is a time period when the mom is focused on the baby and is healing from the birthing process and may not focus on their own health.
Here are some tips:
Lifting baby in and out of the car:
Lifting the baby in and out of the car can strain the back and abdominal muscles. It is important to use your thighs for lifting, so bending your knees slightly as you are lifting the baby and carrier into and out of the car is helpful. In addition, place your knee on the edge of the seat if you can. If it is an SUV or large car, try placing your foot on the running board.
This is a position that can often create neck and upper back strain. Always place a pillow under the baby and on top of your lap or under your elbow so that the weight of your arm and the baby is on the pillow. As much as it is tempting to look down at the baby the entire time, make sure you pick your head up and look ahead periodically. Turn your head side to side to stretch your neck as well.
Getting in and out of bed:
This is particularly important for those who have had a C-section but all can benefit from “log rolling”. Getting out of bed: While you are lying on your back, gently bend your knees so your feet are flat on the bed. Roll your ENTIRE body to the side. Once you are on your side push yourself up on your elbow while at the same time your legs go over the side of the bed, acting as a counter weight. Then sit completely up. Additionally, you can press a pillow against your stomach during the entire movement.
Getting into bed; gently lie down on your side while you swing your legs up onto the bed. Once you are on your side, gently roll onto your back like a log, keeping your knees bent. Then you can straighten your legs as you need.
Pelvic Floor Exercise: The most important exercise for the 4th trimester is a pelvic floor contraction (also known as a Kegel). It is one of your core muscles! Pelvic floor exercises are great exercises for everyone but it is very important to note that if someone has pelvic pain, pain with sex or has difficulty trying the pelvic floor exercise they should consult a Pelvic physical therapist as soon as possible.
To perform a proper pelvic floor contraction, it is important to try to use the pelvic floor muscle (the levator ani) by itself. You should imagine pulling your vagina or anus up and inward as if you want to stop pee or poop. You should not be tightening you buttock muscles. Hold for 2-3 seconds if you can, then relax for 2-3 seconds. Relax for longer if you need to. Try to repeat this 10 x in row, 3 x per day. My book, “The Musculoskeletal Mystery: How to solve your pelvic floor symptoms”, explains this in much more detail.
Transverse Abdominis: Another important muscle for building your core strength is the part of the abdominals called the transverse abdominis also known as your “corset” muscles. You can feel them the best very low in your abdominals just an inch inward from your pelvic bones. Start the exercise by lying on your back on the floor with your knees bent. Gently try to roll your belly button toward your backbone while you slowly and GENTLY blow air out through your mouth. You can place your fingertips just inward from your pelvic bones on your abdominals to feel the contraction. Start with only 5-10 contractions and build up to 25 reps over a few weeks. If you have had a vaginal birth, you can start this within a few days of giving birth. If you have had a C-section then you should wait about 6 weeks to allow for healing of the incision. Then you can start slowly and increase as you tolerate.
Of course, walking is always good. You should progress slowly. If you were accustomed to walking 1 mile, start by walking a quarter mile. Take the baby along in a stroller! Over a few weeks, increase your speed and distance according to your toleration.
Use dilators and pelvic wands during your pelvic health PT
Internal pelvic floor stretching can be performed with your finger, your partner’s finger, a dilator, and various forms of pelvic floor massagers (usually an “S” shaped wand that makes it easier to stretch muscles to the side of your vaginal canal or deep where it can be difficult to reach).
“S” Shaped Wands: Internal self-massage is a way to release areas of tension (trigger points) in the pelvic floor muscles by massage and gentle pressure. The pelvic floor muscles can be accessed via intra-vaginal or intra-rectal massage. “S” shaped wands, such as the EZMagic® wand by ICRelief® (pictured here), allows many patients to successfully manage symptoms of pelvic floor muscle dysfunction and pain conditions by enabling access to hard-to-reach areas. The EZMagic® wand by Desert Harvest is made of hypo-allergenic borosilicate, medical-grade glass, which is a non-porous material that can be heated, cooled, and autoclaved.
These wands are used to reach locations that can often be difficult to reach with your fingers. Generally, ”S” shaped wands are used to put gentle pressure on individual muscles for 1-2 minutes for trigger point release. The obturator internus (refer back to the anatomy section) is a good example of a muscle that can be particularly difficult to reach. Since these hip muscles are located at the sides of your pelvic floor, trying to use a straight dilator can often cause discomfort at the entrance. This can be particularly beneficial for patients who have muscle and/or fascial tension that is most often deep or causes radiation of pain out to the hips and the buttocks.
How to care for and store your dilators and “S” shaped wands
It is recommended that you use only warm water and mild soap for hypo-allergenic cleaning or a specially formulated sex toy cleaner so as to not degrade the material of your dilators. Also, it’s crucial to make sure your dilators and “S” shaped wands air dry completely and are stored in a clean bag that allows for proper air circulation.
Use lubrication during your PT and choose the right kind:
When choosing a lubricant for sexual intercourse or to act as a vaginal moisturizer for use when stretching the pelvic floor, the two most important factors to think about are: 1) What is the osmolality of the lubricant? And 2) What is the pH level of the lubricant?
By Ingrid Harm-Ernandes PT, WCS, BCB-PMD
Ms. Harm-Ernandes has been a physical therapist for 38 years and began specializing in Women’s Health 26 years ago. She recently retired clinically from Duke University Health System. She is board certified in Women’s Health (WCS) and Pelvic Bloor Biofeedback. She published “Assessment of the Pelvic Floor and Associated Musculoskeletal System”, in the FPMRS journal in December 2020. In 2021 she published her book, “The Musculoskeletal Mystery: How to solve your pelvic floor symptoms”.