Training Post-Natal Women

Post-Natal training review for trainers to understand the body durring and after pregnancy.  These are my lecture notes.

1.Content includes:

Rectus abdominous separation at the linea alba

Mastitis, inflammation of the breast tissue

Perineum, (small cut to be made in some cases)

Strains on ligaments and muscles surrounding pelvis and in particular the pelvic floor.

Hormonal changes

Relaxin released by placenta

Lower back pain due to weak abdominal muscles if separation does not reduce in the weeks after birth.

Incontinence due to stretching of pelvic floor muscles or perineal trauma.

2.

In early pregnancy pelvis protects baby within its bony framework.

Later in pregnancy the pelvis bones support and hold its contents underneath like a sling. During pregnancy the joints of the pelvis become flexible due to the relaxin hormone. The pelvis has about 36 pairs of muscles attached to it. Pelvic outlet is enclosed with the pelvic floor muscles.

3.

Pelvic Floor: its main roll in pregnancy is to support the abdominal organs and the growing baby. The pelvic floor encloses the pelvic outlet and is made up of layers of muscles that stretch like a hammock from the lower limb of the pubic arch to the base of the spine.

When the pelvic floor is trained the hammock becomes stronger and more secure for the baby. This relieves the pressure that would otherwise be on the joints of the pelvis eg. Sacroiliac Joints.

4.

Pregnancy hormone (relaxin) softens ligaments and supportive tissue, thereby reducing stability of joints throughout the body.

This is desirable, as a little more 'give' within the joints of the pelvic girdle allows more room for manoeuvring when the baby enters the pelvic girdle, engages and settles into the delivery position (usually head down).

The increase of body weight, increasing lordosis (extra curvature of the lumbar spine) and change in centre of gravity all produce more stress for joints around the body. Any exercise must take into account the increased dangers to joints, especially in the pelvic girdle and spine.

There should be no impact during exercise regimes, no jumping up and down where the impact would be transmitted through the joints.

Relaxin hormone also affects the 'stretch' part of a fitness class. The unwary trainer can exploit relaxin hormone and potentially destabilise joints even more. As ligaments have a poor blood supply it may be months before the ligament returns to its pre- stretched normal length and gives joint stability once more.

The effects of relaxin linger on from 3-5 months post-natal in the body, even though the placenta was delivered after the baby.

Post-natal classes and general exercises should be structured with the effects of relaxin hormone in mind that is minimal impact, maintenance stretch techniques and emphasis on pelvic floor exercise and abdominal work adaptations.

5.

During pregnancy Oestrogen and Progesterone relax the smooth muscle of the uterus, bladder, intestines and veins. Oestrogen and Progesterone are also partly responsible for the fluid retention common during pregnancy.

After birth the levels of Oestrogen and Progesterone drop within minutes and are often very low by the second day. This returns the tissue to its original state but can result in mood changes after birth such as feeling that life is meaningless, feeling unable to cope, tearfulness and irritability. An exercising, post-natal mother can expect the following benefits.

New goals, a sense of purpose/something to aim for.

A release of chemicals into the blood associated with improved mood, sleep and memory (they are called opioid peptides and include endorphins and serotonin).

Improvements in muscular and heart and lung function, increased blood flow and neurotransmitter efficiency to the brain and muscle relaxation.

These all make the post- natal mother feel physically better.

6.

Diastasis- The separation of the rectus abdominous muscle at the linea alba.

Can become a problem for a new mother as the loss of strength and tone can increase the curve of the spine causing back pain and leg pain.

This can be rectified by exercising the abdominal wall.

7.

Incontinence due to stretching or compression of pelvic floor muscles or perennial trauma. Women who develop this in the postpartum period regain continence in the following 3-6 days. If recovery is taking longer then exercising the abdominal wall and pelvic floor muscles is advised.

8.

Mastitis- Inflammation of the breast tissue normally caused by a cracked nipple or duct blockage. Germs get into the breast milk and cause it to go stagnant.

If training a woman with this condition be sure she does not overheat. Recommend that the baby be fed before the work out as lactic acid builds up gets into the breast milk. It takes 1 to 1.5 hours for the body to get rid of the lactic acid.