Pregnancy Blog 2: Three Months Post Partum

Sacroiliac Sprain

At least this time I know what it is. That pain I suffered with for six months after the birth of my daughter, I was able to identify at six weeks this time. I again have a sprain of the sacroiliac ligaments on the left hand side. Painful, but manageable. The hard part is my ego.

It’s so hard not to be able to do the postures normally. Now that I’m not pregnant or immediately postpartum, I just want to be able to do the class. I was set up in front of a new student yesterday and all I could think was, “Don’t copy me!”

Since puberty, I’ve always had issues with my left hip. Apparently the hormones and weight changes of pregnancy cause a sprain for me in the ligaments in the SI joint. Since the sacroiliac joint is a load-bearing joint that is not intended to move much (outside of pregnancy) any time it does move, it is incredibly, searingly painful.

For any of my lovies out there with postpartum SI issues, the main goal in practicing is stabilization of the joint. You can’t push it in any postures that flex the hip deeply, or that rotate or extend the spine deeply, particularly when the hips are fixed (floor bow, camel, spine twist). Pushing through the pain there, will only aggravate the sprain. The only thing to do is go easy in those types of movement, but keep the buttocks and hamstrings strong and flexible and give the area time to heal.

Stretches to the iliopsoas muscles and piriformus can help. Certain supplements are supposed to aid in healing ligaments. They take a while. That’s why sports therapists always say a broken bone is better than a sprained ankle. Remember, too, that there will still be some relaxin in your body for nine months postpartum, making your ligaments softer than normal.  It is wise to wait the entire nine months (even if it starts feeling better) before looking for more depth in those particular postures.

Judah is still sleeping better than Bella did for the first two years of her life, so I’m feeling pretty good otherwise. Spring is coming and who can’t be happy about that in New England?

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Breastfeeding and Bikram Yoga: Postpartum Concerns

I’ve had a lot of questions from students lately about postpartum recovery, breastfeeding, and Bikram Yoga. This pose will address a lot of those questions.

When can I return to yoga?

Most physicians recommend you wait at least three weeks postpartum before resuming yoga to allow your pregnancy hormone levels to drop, as they do dramatically at two weeks postpartum, and stabilize.  Some want you to wait six weeks until the placental scar is fully healed. With that said, who wants to look at their postpartum body in the mirror with a pad stuffed in their spandex? You may want to wait until your flow is reduced to panty-liner levels.

You’ll also need to take into consideration how you are feeling, sleeping, and recovering.  If what you’re doing causes your flow to increase that is a sure sign you are doing too much, so slow down. Personally, I returned to classes five and four weeks postpartum with my two pregnancies, but had been doing some yoga in my living room since three weeks PP to help alleviate the Hunchback of Breastfeeding. As long as you are practicing with mindfulness, yoga is an adaptive practice you can make safe at any time.

Benefits

Your yoga practice is a wonderful tool to return you to your body. Not just your pre-pregnancy weight, but to help your spine, joints, hips, rib cage, and abdominal organs return to their normal places, sizes, and alignment. Your practice will help straighten your posture as you strengthen your back and abdominal muscles against the common pregnancy kyphosis (hunchback) and lordosis (sway-back).

Pregnancy is hard on your body, but so is having an infant. It is difficult to find time for yourself and you spend most of your day in ergonomically-compromised positions.  When you’re not hunched over changing diapers and cute little onesies covered in the latest blow-out, you’re hunched over breastfeeding. If you’re not hunched over, you’re probably lugging a car seat over one arm or wearing baby strapped to your body in a wrap or a sling. When you’re not doing that, then you’re probably on the toilet trying to pee and simultaneously breastfeeding and talking on the phone while contemplating what you can stuff into your gob because, Damn!, this breastfeeding makes you hungry. If you formula feed, then kudos to you because you have to wash bottles in the middle of all of this. Your yoga can help to keep you strong so you don’t suffer the aching back, sore neck, and headaches that plague a lot of new moms.

In addition, the practice gives you an incredible endorphin rush that helps to improve your mood. Simply being able to take a couple of hours to yourself, for yourself, by yourself, when no one needs something from you is critical to make Mommy a happy, loving, productive mommy. After my son was born, I remember thinking one day, “Do I have postpartum depression?” The next day I took my first class back and was on top of the world. It’s amazing what a little time to yourself and some exercise can do for you.

Loose Joints

The hormone relaxin that helped your body get ready to open and stretch your pelvis during delivery remains in your body for nine months postpartum. The levels reduce significantly in the first six weeks, and continue to diminish over the first nine months. Relaxin softens the ligaments in your body. Ligaments hold your joints together. Looser ligaments means looser joints.

To be clear, this looseness means your joints are not held together as well as they used to be. It does not mean you will be more flexible.

What this means in your practice is that you’ll need to be aware of the limits of your joints for nine months postpartum. As women, we tend to be more flexible than men and can often skate by in class on our flexibility and put a lot of extra strain on our joints.  This is detrimental to the body (postpartum or not) and now is a good time to erase those bad habits. Instead, concentrate on developing the strength in the muscles that support the joints, especially the weight-bearing joints. This is particularly important in one-legged, standing balancing postures. You must equally contract the quadriceps and hamstrings muscles over a straight knee joint to “lock” the knee. They antagonize each other and result in a strong, stable knee.

It is common (but not normal) for women to experience discomfort in the sacrum and hips after pregnancy. Good chiropractic care can help with any misalignment caused or exacerbated by your pregnancy, but good practice in the yoga room can help to support this area as well. In backward bends, firmly contract the hip muscles to support the sacrum and stabilize the lower back. Don’t try to push through pain in the sacrum in deep back bends or forward bends that rely on strong flexion of the hip joint, and don’t over-do it in hip flexibility exercises like lotus and pigeon before nine months postpartum.

Weak Abdominals

Your abdominal muscles are not just weak from the activities and exercises you couldn’t do while pregnant, but also because they were just stretched over a huge watermelon for nine months. It takes time for them to contract and retract to their normal length, then they still have to strengthen from there. You may notice when you completely relax them that it looks like there’s still a grapefruit or a cantaloupe sitting in there. Be patient. They will tighten up. Concentrate in class on really pulling in on your abs in all of the poses. Picture your abdominal muscles pulling the four corners of your belly (top two hip crests and the bottom of your ribs) together toward your belly button and back toward your spine. This should get them to engage like you want.

It may not feel or look like much is happening, but it’s repeating the action that leads to strengthening and results whether you can see it today or not. The only posture you don’t use the abdominals in is wind-removing pose.

You may also notice that postures you didn’t realize your belly affected are significantly harder. The abdominals stabilize the lower back. When they are weak, this makes postures like balancing stick and locust much more difficult. They also flex the spine and rotate it. You may find your depth is limited or more challenging in the head-to-knee postures, rabbit, triangle, spine twist. Again, don’t worry. It’s hard, but its just what your body needs. Remember, you’ve got to have a strong belly to avoid the postpartum back pain that so many women suffer unnecessarily.

Breastfeeding

Once baby can go 2-3 hours between feedings or is taking a bottle, you can resume your practice (with the support of your care providers, of course). You’ve probably already learned how much more water your body needs when breastfeeding. The same applies in the hot room. This is not the time to test your mental strength to refuse water. You may not need it mentally, but your body is making milk the whole time and needs water to fuel the process. Make sure you’re drinking a minimum of 16 ounces of water in class and more before and afterward. This may require you to have certain points where you stop and remind yourself to take a drink.

But they’re sore! Your breasts, I mean. It takes six weeks for a breastfeeding mother’s fluid levels to stabilize (in the entire body, not just your breasts). That’s why pregnancy-induced carpal tunnel syndrome bothers women until then and why the bra you bought when your milk came in is a little too big when your baby is two months old. Your breast size increases due not just to milk production and mammary glands, but also because of inflammation in your breasts in the beginning of each new nursing experience. Even for mothers who nursed a toddler their entire pregnancy. As this recedes, the soreness in your breasts usually follows and you can return to normal execution of the postures.

If they’re sore and you can’t lie on them, do the pregnancy Savasana or even the pregnancy modifications for the belly-down series. Some women with recurrent blocked ducts, mastitis or supply issues may need to do the pregnancy Cobra series for the entire breastfeeding period. If you’re not bothered, you can try the Cobra series, but may want to start the postures on your elbows while the rest of the class sets it up. Continue like this until your breasts are no longer sore.

Losing Weight

Whether we want to admit it or not, we all want to lose the “maternal fat stores” from pregnancy. Madonna used a regimen of Bikram Yoga to lose the baby weight from her pregnancies.

It is a rigorous series and burns a lot of calories, so it makes sense to use it to aid you in your quest. Online calculators and testing done at Stanford University indicate a per-hour calorie consumption during Bikram Yoga of 350-650 calories for a 150 pound woman. More in-depth study done in 2013 at Colorado State University showed the level of metabolism during class is closer to 330 calories per class. If you are breastfeeding, please remember that it is not recommended that you consume less than 1800-2400 calories per day without adverse effect on your supply. On the days that you practice, you will need to supplement your food supply to reflect an additional 300 calories at a minimum.

With that said, for some women, the weight falls off them while breastfeeding. For others, they hold onto their fat stores the entire time they are nursing. This seems to be a genetic phenomenon. If you’re eating well, exercising and not losing please be easy on yourself. There’s not much you can do about it. You’ll be rewarded in long run by all of the benefits your children receive along with your sweet milk.