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Workshop #3779

Traumatic Birth Recovery

100 min - Workshop


Birth is a natural process that many women will experience, however, 90% of women who give birth report feeling some sort of trauma through their pregnancy, labor, or postnatal period. In this workshop, Georgia Burns shares how you can use Pilates-based movement to assist in the recovery from trauma in postnatal women. She talks about the emotional and physical trauma that might experience and how you can work with your clients to support a healthy recovery.


- Learn about the stages of trauma is a postpartum woman

- Learn how to create a safe environment for women to heal from birth trauma

- Learn exercises to support a healthy physical and emotional recovery

In case you need to skip this section due to emotional triggers, Georgia discusses miscarriages from 1:01:58 until 1:03:48.
What You'll Need: Mat, Yoga Tune UpĀ® Balls, Bolster

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(Pace N/A)
Jun 02, 2019
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Chapter 1

Anatomy Review

Hi, my name's Georgia Burns and I'm happy to be here at Palladio's any time to share my c-section and traumatic birth recovery program. And today we're going to do a teacher training workshop and I've got two guests here to join me and I will let them introduce themselves. And You Aaron? Yeah, my name is Aaron Griffin and I teach here locally in Santa Barbara. I cone a studio and we, um, have, uh, prenatal and postpartum classes there.

So I just wanted to get additional information to support this population coming through our, um, studio as well. And I also have two kids, um, a 12 year old and a nine year old and they were big babies that I will say. Uh, hi, my name is Jennifer Tillett and I've been teaching [inaudible] for 20 years in Los Angeles and I'm doing a teacher training program now and I have actually not been pregnant myself, not had children and, but having had a lot of pre and postnatal clients, I want to get as much information as I can so that I can relate to them and have the most information to share with them. Hey, lovely. Thank you so much ladies for coming and joining me here today. So again, thank you so much for joining me today and thank you for watching at home. Um, what I really want you to know at the end of this workshop is really how to work with the stages of trauma. So we're going to go through three different main stages of trauma and how to best relate to women and how to support them through the experience.

I want you to learn how to create a really safe environment. So people feel that they're able to talk to you, that they feel like you have the tools and the knowledge to really support them, not just in their body through plots, but also emotionally through the experience. And also I want you to learn the exercises that are safe and safe really soon after the birth, um, and that progress all the way through the first year of postpartum and on. So let's move on to our anatomy review. This is not an anatomy course, so we're not gonna go too much into detail, but really use the anatomy more to bring in imagery.

And how to connect safely to the abdominals, into the pelvic floor. So if you look at the anatomy of breathing, the active breathing is really the only part of our bodies that we do automatically. But we also have free will and we can control. So that makes it essential in healing trauma because the deeper you breathe, the more you can release and relax all the tension that's in your body. So as Flonase instructors, we know this, but it's really important to bring that into our sessions, especially after a traumatic experience and uh, allow body to relearn how to let go a little bit, how to relax after, um, a lot of tensions has formed in your body just briefly, but the Vegas nerve and, and how it really relates from your mind, from your brain and into your abdomen. It is stimulated by deep exhalation.

So taking that big breath in, finding the diaphragm really expanding and then fully releasing the breath is essential to what we're doing. So if you take nothing else from the class, it's how to exhale in a really controlled and releasing way. I want to just take a moment and before we go any further into our workshop, let's just take a moment, close our eyes, take a breath and try not to change anything. I want you to notice where you are breathing naturally and I mean there's obviously a California traffic and we're filming and there's different stresses in your day and especially after having a baby, you might be exhausted, your client is probably frazzled and we're not going to ask them to change anything, but we are going at notice in their bodies where the tension is. So let's just take a moment here. Close your eyes. I don't change anything. Take a breath and then just releasing gently. Again, we're not going to change anything.

We want to notice are we breathing into the chest? Are you breathing deeply into your abdomen, the back of your rib cage, expanding to your hips. Take tension when you breathe. Just take a moment here to notice where your natural breath is. And when I'm working with my clients, I'll often ask them to do this and I will watch and you'll see whether their chest breathing, belly breathing. And it's going to give you a lot of good ideas of where they're at in their recovery and in their process. Okay, so let's take a moment and maybe just jot down a note of where you found your breath.

Okay, so the anatomy of the lungs, the right lung has three lobes and the left lung has two. So we naturally can take a bigger breath on the right side. This again, not really anatomy based course, but we are gonna use that to bring some awareness and some deep imagery into the body. So keeping in mind that the branches of your lungs reach deeply all the way into lungs and expand and contract. We're going to do our next breathing exercise here.

And this is one of my favorites is just deep lobe breathing. So let's take another moment here. Books aside, close your eyes. We're going to take one hand to the right side and one hand just below the rib cage on the left. And I want you to, with your eyes closed here, take a breath into your right hand and expand. And as you exhale, just drop the shoulders, release and relax. Now try breathing into your left hand.

Really feel the branches reaching deep into your fingertips and relax. Feel if there's more expansion on the right side. Yeah. How the left side expands as you bring your awareness into it. Release now, try both sides, expanding evenly, [inaudible] and then relax. Okay.

So we really want to feel different low breathing, good imagery, just to bring it into people's awareness. And it's kind of a bit of a tricky way to get them to breathe more deeply without saying. Breathe more deeply. Okay, so the diaphragm, this is an essential muscle. Again, as blood as instructors, we know this is what is going to stimulate the biggest breath, the most expansion in your body. So you can see the image here of a balloon. And we really, really want people to be thinking about a three dimensional breath. So as we start with our clients, as we start our sessions, it should always be based on finding where the tight spots are and how to facilitate that breath through the diaphragm.

So an image I like to use as a balloon cause it because it expands in all directions evenly. And so if you can just bring your hands just below your belly buttons slightly and you can picture your diaphragm like that dome here. And as you breathe in, you're gonna really feel how the diaphragm contracts and moves down or the ribs move up and out and your lungs expand. I feel that balloon expanding three-dimensionally and then you exhale and allow the breath just like a balloon to seep out. So we're not going to force any breath, we're just going to let it seep gently.

So as you inhale, that balloon expands three dimensionally front, side and back. And then as you exhale, just let it seep. Again, we're not putting any tension into the abdominal, especially at the very beginning of a postnatal experience. We don't want to put any extra pressure into this abdominal space. Okay, relax reliefs. When we talk about the abdominals, we know there are a lot of layers, but the layer that I want to be really most conscious of is the transverse abdominis, the ta or TVA. This is a layer that, especially in a c-section, but also in a vaginal birth can be, um, stretched beyond its limits. And there's, uh, quite a bit of damage.

So putting extra pressure into this, of the girdle or spanx or whatever, as bloody as instructors, we use these images to contract the transverse abdominis. We want to make sure that the very beginning of recovery that we're actually not doing that, that we do want to bring awareness to the transverse. But any contracting, putting any extra pressure into this abdominal space can cause a lot of pain and actually create more damage and it's just, um, better to bring awareness into it. So the first stage of any recovery, that first one to four months, we want to make sure that we're not doing any of the zipper or girdle things that create extra abdominal pressure. So, um, what I think the best thing for me is visualizing the space without contracting. And you'll have to be really conscious of your clients because a lot of people do not work that way.

And another really strong way to do it is to use your fingers and place them gently on somebody's body so they get the tactile sensation. So everything is so personal. We'll find different personalized pelvic floor exercises. And this transverse abdominis needs to be personalized. So when you're working with your client, you might start with visualization.

If it's not working, move on to a gentle tacto cue. Remember that we never want to put extra pressure here. So keep away from the zipper and the course set in stage one of recovery, one of my favorites is to visualize a color and I wouldn't suggest any color to my client. I would really allow them to think of the color because a lot of times that'll give you another clue as to where they're at in their recovery. A lot of times if someone picks a color, like red, orange things are a stronger colors can be really experiencing something that they haven't yet processed. Um, I mean not always.

Of course they might just really like red, but it can give you a clue as to where they're at in their recovery. Um, so it's really nice to have them choose a color. So I will have you do that if you want to put your books aside. We're going to take a moment here and we're going to visualize the space, a rectangle starting right at the base of the ribs, moving down along the and across just below the belly button. And I want you to visualize this rectangle keeping nice and lifted will take a nice long 3d balloon breath into expand. And as you exhale, let the breath seep gently and visualize the rectangle lighting up any color you choose. So as you inhale, that balloon expands front side, back evenly.

And as you exhale, see if you can visualize the rectangle lighting up, big breath in, three dimensional, balloon expanding, and then the rectangle lights out. We're not putting any pressure into the space, we're just visualizing. Okay? So if that worked for you, great. If it didn't, you can use that same idea with the tactile cue of just laying your fingers very gently on your client's abdomen. Of course, asking for permission first. Uh, as we progress through the phase of the stages of trauma, um, we can start to do more gentle activation. That cue of a corset or your spanx, a Zipper, uh, the cylinder compressing or one of my favorites is using a scaffolding to hold up your, you know, ribs from your hips and finding a nice deep tension there. Start with awareness. Okay.

The pelvic floor and breathing. So the pelvic floor is, um, sling of muscles that just lays in the bottom of your pelvis and really reacts to your breath. So anytime we're starting to move, we want to make sure that the pelvic floor is coordinated and working, especially after, especially after a vaginal birth, but also after says Arion, the muscles have been seriously taxed. There's so much pressure that's being put on them off for 10 months, uh, that you want to make sure that you're able to activate the pelvic floor before you start to walk, before you start to pick up a newborn or older children or, uh, even getting in and out of a car can be really, really hard on the pelvic floor. So the first stage is finding that awareness of your pelvic floor. There is definitely not one pelvic floor cue that is going to work for everyone. Some people will have very, very tight pelvic floor after birth and some will have very, very released pelvic floor afterbirth.

This is something where a pelvic physio is essential and should be seen by everybody. Um, so we can support that as PyLadies instructors. But it's really important that you, you make sure that your client is seen by a pelvic physio. Here's a beautiful picture of the pelvic floor. The simplified way to think of the pelvic floor is really the urethra and the vagina and the anus. Okay. And after having a baby, it's really a good time to use those words to use the anatomical words where don't need to shy away from it. Maybe in a group class where there's men and there's different populations, it's not the time to use those words, but after birth, women are ready to hear it and it makes sense and it keeps it clear and concise and that's when we want to be using the right words to make sure that they actually are finding those three separate points.

Personalized pelvic floor, every single body is different. Every single pelvic floor has experienced something totally different. My pelvic floor being pointed and I'm entering a lot of pelvic floor exercises, very, very, very tight and contracted. And if I were to go in and start doing, um, you know, lifting my blueberry over and over and over again, I would create a lot of pain and tension in my body. And we want to make sure we're not doing that with our clients, especially not as an automatic, you know, cookie cutter.

Here I'm in a private session and got a lift, a blueberry. We want to make sure that we are asking our clients, you know, where's their pain? Um, this is why we want to know what type of birth they had, what the experience was like if there was any tearing or prolapse or um, you know, any of the complications. So important to be talking to our clients about their birth experience before we get into deep, um, pelvic floor work. So it's essential that we're not just tightening and lifting the pelvic floor, but also releasing the pelvic floor every single time that we do a pelvic floor exercise. So, um, let's do a couple pelvic floor exercises here. So find a place where you're comfortable and you can feel the sling or that Hammock of muscles that is at the base of your pelvis.

And let's start with the urethra. And um, you're going to start to feel a flaxseed and I want you to really imagine that you're pulling that flaxseed up through the urethra and then you're releasing it back down. As you inhale, you want to really feel the downward, I don't want to say press more release of that Flexi. And as you exhale, that gentle just lift. So then we'll go to vagina and the holes a little bit bigger. So we're going to think of a blueberry and we'll just gently pick up the blueberry with the vagina and then release open up so it drops as you exhale, you're gonna pick up the blueberry and open and drop it. Okay. And then we'll move back a little further in the body.

And you're gonna think anus, marble, bigger space. Okay. Hopefully I'm your space. At this point we're going to lift a marble and then release and gently, and again, we're not going to bear down or do any pushing, but we want to really get that sense of opening up and releasing. So those three are all important parts of the pelvic floor and we want to make sure that we can differentiate. So spending this time, I've spent at least 10 minutes at the beginning of my postnatal session with my client, working on getting the diaphragm active, finding that act awareness of the TVA. And then now I want to find some parts of the pelvic floor right after birth.

That might be really challenging. So I'm not going to send a ton of time on it, but I do want to spend enough time that they are perfectly clear and aware that there are three different spots that we want to be able to lift and release on command. Then we want to be able to get all three. And to me, my favorite cue out of a figure eight and that just brings everything together. So let's see if we can find a figure eight. It's for gonna. Take a nice long breath in and let everything open up. Just like a figure eight bubbling wider. And as you exhale, pulling that figure eight in towards its own center in hell and let it stretch open and relax and then slowly folding that figure eight in to the middle. So again, I've given you a huge list or a bit of a list here of different cues that you can try. And throughout the program, I've got all different cues for pelvic floor activation and release kind of peppered throughout so you can pick and choose and definitely try more than one or two with your client and never just go with here's my blueberry and that works for everyone because it won't. And um, we want to make sure, and one of my very favorites here is the jaw and the tongue out for releasing. So a lot of women know to do their kegels and lift and lift and lift, but knowing how to release through the jaw and then release through the pelvic floor work together so well. Um, and it really triggers women to be able to let go of that tension in their job, but also into the pelvic floor.

So that is a huge pelvic floor release exercise that works so well. Um, let's try that one together. Okay. So you're gonna sit up and you're going to find a jar release here. And if you can just close your eyes for a moment and visualize the base of your pelvis, like a jaw opening and releasing, same as through the mouth and your tongue can gently soften and plumping in the mouth. And then thinking about that as the pelvic floor plumping releasing in the pelvis. See if you can find that on both ends.

So you breathe in really opening up jaw and pelvis. And as you exhale, just nothing, no tightening, just allowing for release. Essential afterbirth here. So the next point to really be focusing on is what physiotherapists will often call the perfect pelvic floor. So perfect just stands or power endurance, repetition, how fast and then the ECT exact coordinated timing. So that's when you're dealing with women who are like, oh, I sneeze and peed a little bit. Okay, so there's pelvic floor dysfunction going on. Again, that needs to be definitely pelvic physio. But there are things that we can just benchmark. We can look at, can you hold your pelvic floor in for five seconds?

Can you easily release that? So having this little acronym will give you an idea of how to talk to women and how to say this isn't, I mean this might be normal, but it doesn't have to be you. You can go and we can work on this. You can go to the pelvic physio, come back, decide is your pelvic floor tight? Is it loose? Is that uh, is there something else going on? Is there a prolapse? Is there scar tissue? Um, and then we can deal with that as a party.

As instructors, we can work with that throughout the exercises. Um, but until we know we, we can't, so that's where the perfect pelvic floor really comes in. You can say to somebody, in a scale of one to 10, what is your sensation in your pelvic floor? Kay. Does it take a while to feel it? Do you even feel it? I have a close friend who does not feel her pelvic floor ever before children, after children, doesn't know where it is. And that's where we get into. Let's find which cue works for you. Is it the jaw? Is The flower blooming?

What is it that is your personalized pelvic floor cue. Um, repetition is how many times in a row. And then we want to find is the coordinated timing there. If you are running or on a trampoline or sneezing, can your pelvic floor automatically engage and work how it's meant to work? Let's put it all together. I'll use a different cue. Now for each of the layers we want to make sure that we've got, um, the diaphragm, that transverse abdominis and the pelvic floor working really well together in a coordinated fashion. So let's take a moment, find a nice, uh, seated position so that your hipbones feel anchored.

And as you breathe in, feel your balloon expanding front, side and back. And as you exhale, that abdominal space can light up and almost like a straw, you're going to suction the pelvic floor gently up into your body as you inhale, as if releasing pressure in the straw, let go of the pelvic floor, expand through the abdominals. Exhale good awareness lighting up through transverse abdominis and the straw six sections of pelvic floor up release and let the pelvic floor go. Big Breath to expand. Let's try it one more time. As you exhale, just build awareness into the transverse abdominis by touching or lighting up the rectangle. Feel that stress suctioning up through pelvic floor and then let it go. Let it drop and release and relax.

So if we take nothing else from the workshop, it's how to coordinate those three points to rebuild the core. Those should obs. One more note about that is they should be tried in every position. We just did seed it, but we want to make sure that we are trying supine and pad, especially standing, um, where there's a lot of pressure already. Okay. So just a quick bit about Fascia.

Your Fascia is a full body suit that transfers water around. Your body, reacts to tension and stress and really holds all your muscles in place. So especially after pregnancy, there's a lot of changes that have happened to the Fascia. There was a baby there and then all of a sudden there's not. So there's a loosening and we really need to, um, bring the elasticity back into the fashion. Um, so throughout the program I do a lot of body rolling.

Just using tennis balls. You can use a foam roller, anything that feels you know, good in your body. Um, and it's really important to spend some time in on the Fascia because that will create, um, a sense of release and relaxation in the body after, um, the emotional and physical stress of birth. So let's go to our pregnancy, our anatomy of pregnancy. See this beautiful picture, how the body changes in pregnancy is quite drastic. And it's interesting because it takes 10 months to get to the peak, you know, of your pregnancy and then it takes one day or in some cases for um, uh, to not have this, uh, fluid. The Placenta, the baby, the change is drastic and happens so fast. It's, it can be really a shock to the system, the hormones, and then your milk coming in.

It's just one change after another can be extremely emotional, extremely scary and uh, extremely beautiful. So I've included a graph of the stages of labor and this is here because I want you to really understand the emotions behind labor. If you talk to your client and find out that they made it into, you know, active labor, but at that point didn't progress and ended up with a c-section. There are different emotions that go along with that. They didn't get to have the excitement and the adrenaline and that huge push of crowning and my baby's coming and I did it. And it's, it's really a whole nother level of hormones.

Um, or maybe you did have somebody go through the entire stage and you just need to know that. You need to know where they are in their labor, where they were in their labor, when things, you know, when upside down or if it didn't, if it was beautiful and um, either way you need to know, you need to know their birth story, which might not come to your first session with somebody. It might come down the road, but we want to create a really open environment where they feel like maybe they can tell you the first day, maybe they'll tell you three months later, but you really want to make sure that you can create that environment where they feel safe to tell you this is what happened, this is how I felt about it, because that's going to change how you are structuring your [inaudible] session.

Chapter 2

Postnatal Complications

And then of course, the postnatal complications, emotional complications, physical complications, and how police can help the emotional complications of childbirth. It's complicated, right? Uh, you have your baby and it should be a really special moment. I feel like a lot of women have been, you know, waiting and preparing and they've got a room set up and they've got everything ready for their newborn and they've just been through the hardest experience of their life. Again, whether it's a beautiful birth or a traumatic birth, whether it's a planned c-section or a emergency, um, it's really challenging. It's hard. It's, it's really, they call it labor for a reason, right?

It's work and it's really hard to connect to someone who has caused you a lot of physical pain. So more mothers than will admit, um, will have trouble bonding with their babies. And we hear about the baby blues and we hear about postpartum depression, but it's not talked about as, um, acceptable and there's a lot of shame behind it. So our job is to not make moms feel like martyrs or heroes for doing what they did, but really accepting that this is normal. And I'm here to listen and I, I want you to know that no matter what you're feeling, it's okay.

It doesn't have to be shameful. It doesn't have to be lonely. There's a whole list of emotional complications. PTSD is, is really common. Flashbacks, um, the lack of social support. Um, I know in Canada we actually have quite a bit of social support and don't have to go out and find it and I'm not quite sure how it is in the states. Um, but I, I feel like it's probably not a, as great as it is in Canada. Um, but finding social support is essential. There's nobody who can raise a baby, whether traumatic or not. Through the experience.

Nobody can raise a baby on their own and be emotionally, uh, okay. It's really hard and it's exhausting. There's no sleep and everyone cares about the baby and nobody cares about the mom and the recovery. And um, that's really where we come in. We are the social support. If a mom can come in and have a class where she can chat with other moms or with us as our, as their instructor and do the private session and really be understanding of what is could have possibly happened and how they're possibly feeling. And it really allowed them to lead with their feelings and, and talk to us. I think that's, that's where we come in. We can be the social support.

We can reach out and after and after a parent or after a mom has a baby, it's really nice to send that email or even to make the phone call or, uh, even a text and just say, are you okay? Is there anything I can do? It makes such a huge difference. Even if they don't respond or even if they are like, no, I'm fine, I'm fine. To fine. Reaching out to a new mom is, it's so special. It really makes a huge difference and they will feel it and they will really appreciate it.

And I think that's something that as polities and charters we can do, we can definitely reach out and be part of that support system. The physical complications we can, we can definitely help with after seeing a pelvic physio. Um, there are definitely things we can do as, as instructors, it is a good idea to partner with a physio. Um, it's a good idea to make phone calls to your client's physios and make sure that you know exactly what's going on in the body. We have so many great exercises that we can use to help women here, but if you don't have that partnership, if you don't feel comfortable making that phone call or sending the email, then we can't help properly. We can't do internal examinations. Uh, we can do simplified diastasis testing, but we need a physio to do the proper testing. So we know is there, what type of prolapse am I dealing with? What's the tearing situation?

Where's my client at? So, you know, making sure that we're sending someone to the right person and then talking to that person to make sure that as a team, we're taking care of this woman. So that's what we can do. Also keeping in mind that breastfeeding can be extremely emotional and challenging for a lot of women's. So to be very mindful of that, here's a lovely picture of the different types of prolapses you can see in the normal uterus and the normal body here. Um, everything's quite lifted. The pelvic floor hammock is really helping to support these organs and then the possible things that can happen during labor.

The next one, tearing another beautiful illustration of what can happen and what women are really dealing with. Um, the different degrees of tearing and how that affects somebodies life. It's not just, you know, four, three or four week process where that's healing. That can be forever, that can be, um, made worse by putting that intra abdominal pressure. So we have to be very aware of what we're doing. And that's why the visualization or the gentle touches super important at the beginning, um, when the body's just starting to recover and it's sorting itself out, we don't want to do any damage by, by asking someone to bear down or brace. Um, and then diastasis is a condition that is very normal that has to happen during pregnancy to allow space for the baby to grow.

And it's just a separation of the abdominal sheath. And again, every woman will experience this. It's just a matter of what happens when the pregnancy is over. Is it causing pain? Is it coming back together naturally? And again, putting that intra abdominal pressure can, can be very, very detrimental to the abdominals. So we will talk about a couple of ways to make sure that the abdominals are staying stay safe and that we're building from the inside out and creating a really safe environment for the abdominals to heal properly.

This testing should definitely be done by a pelvic physio. However, by doing the simplified version, we can have a benchmark of where our client is and if it's getting better or worse, and and how to know and how to spot should it be stopping this exercise right now. Should I pull back a little bit? And that in itself is going to help your client feel so safe and so supported just to have your eyes on them saying, I can tell you this is okay. We're, we're doing this together. And there is definitely a point in your recovery when you can see a little bit of doming and it's okay and it's functional diastasis. And we'll talk about that again in a moment. Let's, let's do a little of this simplified evaluation and I'm going to show you on my own body because I have a bit of a diastasis still happening a year later. And I'll show you how we can do a really simplified testing just so you have a benchmark for your clients. Okay? Okay.

Chapter 3

Simple Diastasis Evaluation

So now we're gonna do a simplified diastasis evaluation. So it just, again, it should be done by a pelvic physio, but we're going to get a benchmark for our clients. So we have an idea of what to look for just to make sure that we're not putting extra, uh, intraabdominal pressure and causing any damage. So we're going to start by just taking two fingers and we're going to feel with no activation for the tone right at the base of the ribs, right above the navel. And then just below naval, we want to feel what the tone is like. Okay. So my main concern is the tone of the space in between the sheets of the rectus.

So at that point I'm going to keep my fingers vertical. I'm going to take a long breath in, three, three dimensional inhalation. And as they exhale, I'm going to find my pelvic floor and transverse abdominis activation. I'm going to do a little bit of a head lift. And then with my vertical fingers, I'm gonna feel for the, the halves of the rectus and the space in between. I'm going to feel right here. I've got about a two finger gap and about one knuckle deep.

So I really am concerned about the tone less than the actual spacing. I'll do the same thing around the middle. I'm going to activate ta and pelvic floor. Again, feel here, I've got about two fingers, but one knuckle deep. And then below my belly button I have really good tone. I have no space and no knuckles deep.

So my diastasis it right through the middle. And if I don't activate my ta in pelvic floor, you can really see the domain that you really don't want to see in your client. Okay. This is a definite like pull it back. Go back to getting the coordinated t and m pelvic floor activation. So let's go ahead and I'll give you guys an opportunity to feel here if you want to feel with no activation. Exactly.

Yeah. You feel quite deep there. And then I'll take my breath, uh, activate first pelvic floor and then give that a go. Yeah, make sure you're really vertical. Your fingers. Okay. And again, we're really looking for the tone rather than the space. Okay. And you can even feel when I release my transverse and you can see it. And then when I activate there's no domain and yeah, it's about two fingers wide and about one knuckle deep here and then below.

Nice. And even

Chapter 4

C-Section Incisions

so the incision of a c-section is actually a very complicated, there's a lot of layers that are cut through and this is important for us to know because the layers stick together and create a lot of scar tissue, which especially with the Fascia can cause referred pain into different parts of our clients. So this is important to know. If someone comes in with lower back pain, it might have a lot to do with the incision at the front of their body. So something we can do as plays instructors is a scar massage. We can really help mobilize that scar tissue. And I just want to go through the layers of the c-section so you can really get an idea of how many layers have been cut through.

And there are different types of cuts that have happened. So the first layer being skin is just a long incision along the skin. They're quite big. Underneath is the fat layer and they cut again just a horizontal line across then the Fascia, slightly smaller incision. Then we get into the rectus abdominis.

And this to me it was really fascinating and really changed the way I looked at the c-section because they are no longer doing this horizontal cut. They actually do just a really small incision in the middle, almost like a, a bit of a t shape and then the surgeon will actually put two fingers in side of that and stretch the, the hubs apart. So it's really not surprising that people with c-sections have more significant diastasis that that can, you know, really cause more dysfunction and pain. And just something to keep in mind that stretch is, is not a natural bang. It can create a lot of scar tissue. So under there, the next layer, it's a very um, thin, transparent layer and same thing, they just reach into a tiny incision and then open it up.

It's more of a vertical incision. Peritoneum don't know if I'm saying that right. Then the uterus, they go back to that horizontal incisions is the bladder. They just move it down out of the way. There's the uterus and then the amniotic sac, that horizontal incision and then in their baby and they, all right. So all of these layers get stuck together. Okay. Where there should be a very natural glide of each layer.

They become adhered and we can, we can help that. We can create some movement and create some fluid, um, and really help with a massage. So I'm going to show you how you can help your client. You can show them how to do a self massage, but also a really special thing that you can do with your client if they're open to it, is you can do a massage for them. So I'm going to show you on my own scar and I'll have you follow along just on your forearm.

Okay. So when you're starting a scar massage, we want to start with a desensitization. So you can use a toothbrush or makeup brush, any type of just gentle brush. And we'll start just below the incision, giving a little bit of a brushing action. Exactly if you follow along just below the incision.

And then above a couple of times and then you can go across and remember that any scar tissue, it doesn't just move in one direction that we want to make sure that we are breaking up the scar tissue in all directions. So I Chris Cross up down on all diagonals, every position. And I'm even doing little circles just moving along the incision. So once you've done that, you can put your brush aside. And we're gonna work with the skin layer here still. So again, I'm going to take my fingers and do little circles just below the incision below.

And then I'll do the same above and I'm working quite gently because again, we're working with the skin layer. So after your little circles we're going to do a shearing now. So you're going to take your hands one up, one down and try and pull the skin apart. And again, this is so gentle cause we just want to work with the top layer. So I'm just sharing and trying to move the skin off of that lower layer.

After a little bit of sheering up and down again, side to side in all directions, you can roll or walk your fingers along the incision you'll feel where there's a lot of scar tissue and you'll feel when it lets up a little bit. And these are the points where you've a lots of scar tissue that you can spend a little bit more time and really work into that good. You can do little circles right through there. So any real action where you're playing with the scar at this level is great. The important thing to think of is that you're working gently on this top skin layer. After that, we're going to move to the layer deeper to the muscle layer.

So I'm going to do the same thing below my incision. I'm going to take two fingers and do deeper circles. I'm going to push a little bit harder below the incision and work little slower circles. So as you move deeper, you want to make sure that you're moving more slowly and you want to make sure that your client is still comfortable pressing down on the outer edge of the incision. And then you'll follow that up by doing your deep little circles across or along the line of the incision as well. Nice and deep. Then you'll do that shearing action again, working with that muscle layer.

So it is quite deep and slow. Good. You can do, you're rolling. And when you start to get into this rolling into this deeper muscle layer, it's a good idea to start to bring some creams, some oil, something that is going to um, make it a little bit easier to get your fingers to actually roll through it. So at this point, when I'm working into the muscle layers, when I'm going to introduce some cream. Okay, great.

Then I'm going to take my scar nice and deep and I'm going to pinch and Paul Pinch and Paul Pinch and Paul just trying to here the skin layer from the muscle. Good. So once I've gone and done that quite a bit and it feels deep and comfortable, you might take it into the next level. And this again is really based on your client's comfort level, but the Oregon's are also quite stuck to the different layers that have been cut through. So in this position you would go quite deep and very slow. Again, I'm going to go below and deep and little circle below and deep and little circle. And these are way slower. I'm going below, I go above and then I go along the incision site.

You can do the same pinch, but I'm taking way more again and I'm trying to pinch and lift, pinch and lift. The shearing is same again, so much slower and way deeper. Trying to move past the scan, past the muscle and get into that orange again. Layer. Our uterus has been cut here too, so we want to make sure that we're working deeply with that scar massage, massage. So the entire massage should take about five minutes and should be done every day because scar tissue can really change up to two years after the c-section. So we want to make sure that we're checking in with it often. So even if you're a client comes in once a week, you want to make sure that each time you're checking in and making sure that it is the scar tissue is loosening up a little bit, that the residual pain is fading and that you're finding some some depth to your scar massage. And it's important to do it.

It's important to show them how to do it really. You can play with the scar in any way. Getting all the muscle fibers change. I've just showed you a couple of little techniques, the pinching, the crisscross, the shearing, but the important thing to remember is the layers. So I start with the skin layer, I move a little bit more deeply into the muscle layer or I added some oil or cream. And then after that I went really slowly, deeply into the Oregon layer of my skin scar massage. So try that with your clients and see how it creates a real bonding experience with them and an openness where they can emotionally release a little bit as well as physically feel better in their bodies.

How can pull ideas help? We want to make sure that we're staying within the scope of our practice, so things that we can do as plot is instructor or really promote breathwork. We want to make sure the diaphragm is moving effectively as well as activating or bringing awareness to the transverse abdominis and the pelvic and really learning how to coordinate those muscles together and also for that scar mobilization because this is really something that is self care where your clients can do to themselves. You're really just giving them a tool. We can do this with our clients. There is no a really special technique.

We just are playing with the layers to help to break up some scar tissue so we can just pull out these instructors, do this to our client after of course, asking their consent and making sure they feel comfortable. Really important to show them how to do it so they can do it every day to themselves. And then you can come back and do check ins. And with my clients, I really only do the first two layers. I'll do skin and muscle and the organ I leave for themselves to find that depth because it is quite deep and you want to make sure that, um, they're comfortable.

Chapter 5

Stages of Trauma Recovery

So now we're gonna look at trauma and the different stages of trauma recovery. So we, we experience trauma in our bodies and it is almost like a loop that just keeps coming back and there's no real closure and that's where it starts to really affect the quality of life.

So it's very hard for a person to feel safe. It's, it's hard to, um, regulate emotion. So someone who's experiencing trauma is going through so much in their mind that they might have outbursts, they might be, um, very quiet. And there's things that we need to look out for with our clients to make sure that we're supporting them as best we possibly can. So I think the first thing to note is that we as part as instructors need to know where to guide our clients.

Going to a pelvic physio for their body is essential and it's really our responsibility to guide them to somebody that we trust or that they can trust. Um, second is somebody was sending our clients to somebody they can talk to, a psychiatrist, a psychologist, somebody that can do counseling, um, to make sure that their emotional wellbeing is being taken care of. Our job is to sit and listen and to support a woman, we need to know where to send them to make sure that they are being treated um, by a professional. So there are three main stages, two, trauma, recovery, um, safety and stabilization is really our priority in the first four months after a traumatic experience. And when we're saying the first four months, that's really the first four months that we are dealing with a traumatic experience. So I've had some women come in and say, I had a baby 20 years ago and are in that first stage. They don't feel safe.

They maybe have issues in their body that haven't been dealt with and they have fear still in their bodies. Flashbacks and nightmares. Um, things of like ps PTSD are very, very common after a difficult birth. And these are things that we can support. So zero to four months doesn't mean when your baby is four months old. It really means when you start to deal with the trauma that has happened in your body, the second stage remembrance in morning. So, uh, about four to 12 months postpartum.

The routine phase when things start to get a bit of a groove going, this is when we can start to really talk about the birth story and really acknowledge what happened when women tend to open up a little bit more after they feel like they're safe and they have a safe place to talk about it. So that second stage is really important to, to be there, to listen to a new mom. After that, the reconnection and inter integration phase is about a year postpartum after a mom has felt safe, has really dealt with her birth experience and is ready to progress into their life again as themselves. A lot of moms get lost in that first year and become all about baby. So for me, in my body, that really means I want to do a teaser again. I really want that in my body. I'm not there yet. Um, my baby just turned the year two days ago and I'm not in that third phase.

I'm in the second phase where I'm talking about it and I'm mourning the loss of that birth that I really, really wanted. But I'm working towards that next phase. And physically that means I want to do a teaser without pain and that's where the functional diastasis comes in. I might say a little bit of doming and can work with it. I want to be able to come back to work. I want to go out with my friends.

These are all like the emotional things that I've worked through, the stages of trauma, and I'm preparing myself for the third phase. Now I want to give you a couple of ways to talk to women about trauma because it can be really hard. Things that you think are helpful can actually be quite triggering and more painful. So when talking about trauma, we have to understand that women are stuck in this loop. We can't Yank them out of it. We can't try and fix anything for them. It's our job to give them a judgment free place to, to be. So that might mean talking, that might mean crying.

It might mean just doing the exercises and moving on that day. Um, but we really have to let the woman decide and she needs to lead. She really needs to feel empowered and in control. So our job is to give her the parameters of a safe exercise so that she feels she knows what she can do. And from there she can feel comfortable to move onto the next stage where maybe she can start to ask questions and share the birth story.

I really want to highlight. Forced exposure can be painful and detrimental to the healing process. If someone doesn't offer up their birth story, it is not our place to make them tell us or to continuously ask. We can say, how are you feeling today? More open ended questions are really important and are great to facilitate that openness, um, and create a safe environment.

But we never want to give leading questions that make someone feel like they have to share something that they're not quite ready to share yet the more safe, safe they feel in the environment, the more likely they are to share the experience. Um, we definitely don't want to fix anything and we should always guide a woman to see a professional for their help to, to really make sure that they are being supported. So a couple of things, not to say it's not your fault. So even though that might seem like a really nice thing to say, like this isn't your fault, it really brings that idea of fault into the woman's awareness. And it can be quite, um, painful to hear those words even. Um, be grateful. You have the healthy baby again, that sounds really nice, but they probably are pretty grateful but really wish that it didn't happen that way and are mourning the loss of the idea of that.

Those first four months of, of you know, loving their baby and being automatically connected. So that's something that we just really want to stay away from the same. We don't want to, uh Oh next time will be better if someone said that to me, I would instantly start crying cause I, I will not have a next time. That is not an option for me. And um, I don't want to hear that. I also heard a lot of times people saying, oh, you're a hero and the things you went through for this baby.

And to me that really felt like I'm, I am, I'm a sham. I've done something wrong here because I didn't have a choice. It was not, I was not a hero stepping up and I'm going to be in labor for four days and my no body's going to do this. Um, I would have given up. I think if I had an option and to hear that I'm a hero made me feel inadequate. And so those are things just to keep in mind when we're talking to our clients. We don't want to put extra pressure or stereotypes, um, or, or things that, um, aren't really true.

Okay. Things that we can say that really help our, I am sorry you're going through this. That's, that's what you can say. You can be compassionate and say, would you like to talk about it? Let's let, let the woman decide how can I help? Or You can talk to me are really open ended phrases that put no judgment on a woman and really allow conversation.

So just to be mindful of the things we're saying to new moms because a lot of times even if they put on a brave face, they might not really have that experience. So feelings associated with birth trauma are very, very real. There's a sense of shame, um, a lot of women more in that loss. I know I did. I really wanted to have a natural childbirth and it's really painful. And it is scary to think that I could have died and left my children and those feelings happen. And I know when I started talking about it with the mothers in my circle who I had known for years, I started saying, I'm, I'm, I was afraid that I wasn't going to make it.

I was gonna leave my children without a mother. Oh, what a women said to me, Oh my God. I felt that. And the fact that we were together all of a sudden was amazing. We were, we felt empowered as a group. We felt like they hadn't talked about. And I have known these women for years and they never felt comfortable enough to say, these are my fears. I felt ashamed. I felt scared and I felt alone. Even though I have a supportive partner and I have my mom and I have whomever to help me, these are feelings that are really common after birth, after traumatic birth and after c-section.

I also want to talk about having a miscarriage. People who have had miscarriages are postnatal. If you have conceived, you have grown a baby in your body. The new, our postnatal, those hormones come into your body immediately. Your body changes your breasts bigger, your your entire world changes. So even though they might not have a baby at the end of it, these clients are postnatal and we might not know, but again, we need to really be sensitive to that.

The really common feelings behind having a miscarriage. Again, there are so many hormonal changes. There's a social stigma where they don't want to talk about it. So for me, I really want to say to women who come in, is this your first pregnancy? Not Baby. Okay, Kay, do you want to talk about it? Are you ready to talk about it? I'm here to listen because that is a postnatal client and we are going to work in the same way because having a miscarriage is traumatic.

There's a lot of sadness, numbness, anger and guilt. I know that a lot of people will say, oh, the baby wasn't meant to be. Oh, there was something wrong with the baby, which again, can just be so hard on a mom because I can, their body sales did something wrong to their baby. It was her fault. So avoiding any sort of judgment or stigma or putting those stereotypes on a woman are essential for safe recovery. So the first thing I do with a postnatal client is create a sense of mindfulness and do this. I will often say a poem, do some deep breathing and just take a moment to listen to the sounds around me.

So you can try this in different ways with your clients. You can give them the option, whether it's um, any one of the sentences, sound or smell, sound is really easy to relate to. So I often will use that with people. But sitting quietly in a room listening can be very, very challenging for many. So it's a good place to start to see where your client will react.

And also we'll give them a tool, uh, something to work with. And in the middle of the night when the baby is crying and screaming and will not go to sleep and they are exhausted because they have been awake for 27 hours straight, using mindfulness will give a new mother as strategy for dealing with that stress. So when you are in that position of the baby's crying or you don't have enough hands to take care of everything in your house or um, the physical complications, um, being in the hospital, being stuck in bed, not being able to move, taking that moment of mindfulness and really allowing ourselves just to listen and come back to the sound is a good way to be instead of being in a doing mode. So let's actually take one minute and listen and see how that changes our breath. Okay.

So bringing ourselves back into the room and noticing there's a bit of a stillness in our bodies now. And for me it listening, every time my mind drifted a little bit, I went back to the buzz of the camera and I could just hear that and it would bring me back into my moment and really creates a sense of safety in the body. Just being allowed to sit for a minute, being allowed to listen, and just knowing that your mind will wander and that's okay. That's really okay. And we're in this like nonjudgmental place where as the mind wanders, we're triggered by the sound again and we can come back into the moment and go back into the breathing.

So this mindfulness can help a woman in that first year forever having children because there are so many stresses, children yelling and screaming and the danger that they can get themselves into and not having dinner ready can be a lot. So just giving them that technique of one minute, nothing is going to explode, but you can own that moment can really bring a sense of safety and stillness into somebody's body. So now I want to go into the actual program of exercises that we can do with a postnatal woman. [inaudible]

Chapter 6

Exercise Program: Classes 1-4

now let's get into the exercise program. C-Section and traumatic birth recovery program. This is a six part series.

The first two are really intended to be done directly after birth. They're bad exercises that have been approved by a physio therapist and who are actually adapted from bed exercises that I learned while working at Toronto General Hospital. I was working with people with lung and heart transplants. So I really took those exercises and thought if they can do them after a c-section, they're very appropriate. It's um, we're gonna use mindfulness body rolling. We will do scar massage, diastasis testing.

We'll start to integrate strength and uh, how to progress. So acceptance, function, release, connection, strength and transition. Those are the six classes that I've just put together as guideline that you can use with your clients who are at the stages of labor. Class one is acceptance. We have a lot of limitations at this point. This is within the very first couple of days of coming home from the hospital, um, where you might reach out to your client knowing that they've had a difficult birth or even if you don't know, it's a good idea if you have a prenatal client to reach out and see how they're doing at this time.

If you have a really close relationship and they ask you to come and do a home session, these are safe bet exercises that you can do with your client. Um, they will really give, um, release to the pelvic floor relaxation to the abdominal space and they will help a woman feel empowered and knowledgeable about what they should and shouldn't be doing. So the goals of the exercise are really to prevent atrophy. Atrophy will start after three days of not using a muscle. So very important that we go in and we start to move the muscles gently, stretching, gently activating and make sure that we're not creating any more tension than is necessary, especially at this point.

Mothers are often nursing around the clock and not in great position doing that. So the muscle focus is here. You can see we really want to focus on releasing the, the packs lats. We want to make sure that we're feeling that we are supporting these muscles, that women are overusing this first exhausting period of postnatal life. So let's go and try and exercise.

Let's lie down on our backs and make yourselves comfortable. If you're working with a client at home or if they're doing this on a video, Skype calls, anything like that, you want to make sure they're in a really safe and supportive position using pillows behind their head and possibly even under the knees to make sure that they're comfortable and against supported. So let's bring our hands just to the abdominal space with your thumbs right at the base of the ribs and your little fingers just reaching down towards your hips. We're going to take a nice, long full breath into the hands and expand three dimensionally. As you exhale, let the jaw soften or leafs and open your mouth slightly. Take a nice long breath into your hands as you expand and as you exhale, just feel how your tongue plum bends and softens in your mouth.

Take a big breath in, expand as you exhale, the tongue softens. Can you feel your pelvic floor gently release. Let's try that one more big breath expand and then I release. Tried taking your arms straight out to a t shape out to the side. Then do your elbows. Your fingertips point to the ceiling. That's right.

From here, you can allow your fingertips to sway back towards the floor behind you. Good. Now we don't want to go too far. We want to feel a natural stopping points. If your client feels any tug or pain to their incision, you know that's where you need to stop. And then slowly rotate the arm bones back up so your fingertips point to the ceiling and then let them sway down towards your toes.

Try inhaling is your fingertips way back all the way towards your ears, and then reverse up to the ceiling and down to the toes. Okay, last time, fingertips up and back and then exhale, really releasing the jaw. Sees the pelvic floor can soften as your arms. Rotate all the way back down. Good. Let your arms stretch down towards your legs. At this point, I want to do an exercise that might not be familiar to us as [inaudible] instructors. This is a bet exercise called quads overruled.

So we'll need a pillow for underneath our knees. So I'll grab a couple of bolsters and place them underneath my clients legs. There you go. One, two. So now that we're in this position, you're going to let your legs lengthen out. So the knees are actually supported by the pillow.

We want to make sure our feet are just laying flat on the bed. Your shoulders are wide and you're going to work with that same nice restorative breath to big breath into expand. And now as you exhale, you're going to pick up your right foot, keeping your knee connected to the bolster. So we're not lifting our leg, we're only lifting the foot in this position. Your quad or your leg is completely supported. There's no extra strain on your pelvis, but you're activating your quad and you're lengthening your hamstring.

So this is a really important exercise for someone who's been lying down or in a seated position in bed for a long time. So inhale as you lower the foot and as you exhale, lift the left foot again. Keep the leg connected to the pillow or the bolster. Find it activation by pulling your kneecap up the front of your thigh. Find that quad tightness and length through the hamstring and then release your foot back down. Take a nice long, full three dimensional breath in.

As you exhale, gently lift the right foot, only find the quad. And here flex your right foot. Finding just a little bit more length through the hamstring and then point the toes before releasing your leg back down. Take a big full breath in. As you exhale at your left foot lift, pull up on the front of the thigh, tighten the quad, flex your foot, point your toes and release all the way back down. So a really safe, gentle exercise that targets and very important muscles when we've been lying down in a not great position for a long period of time.

Okay, so let's move on to the next class. I'll get you to take these bolsters out from underneath your legs. I'll bring them to the side. Alright, so our next class, the focus is function. After having a baby, we still have to do your everyday tasks. A woman needs to use the bathroom and maybe climb stairs. Also we might have other children we need to care for and it's really empowering to know safe, ergonomic strategies for doing that without hurting yourself.

After having a baby, your doctor or midwife will say, don't lift anything heavier than your baby. However, they're not going to tell you how to do that. In what position does your body need to be? Also, if you Google how to lift a baby after having a c-section, there is no information on that. So let's show women how to safely and ergonomically lift a baby without putting strain on their incision and their back. So let's just use this bolster as our baby. So there's a couple of strategies we could use. Yeah, that's great. Um, couple of strategies we can use.

We can always lift the babies that up to be higher, but that is not a great solution. So the best thing we can do is change our body positioning to safely lift our baby. So to do that, we're going to make sure one foot is very far forward and one foot is very far back. My base of support is wide and I've got a neutral spine. So anytime you're going to lift a load, you're going to bring your body down towards your load, your baby picking up and bringing it very close to your body to start with. And then bringing yourself all the way back up and then doing the same to bring it back, maintaining a neutral spine, keeping the load close to your body before bringing it down and then bringing yourself back up.

So in this class we will use that ergonomic positioning to do some strength building exercises. So I know when I had my son, I had to hold him a lot, constantly every single day and I still wanted to do some strength building exercises so that, um, I was building strength and trying to recover from my c-section. So holding your baby and then working that Ergonomic lifting and carrying position is really important to incorporate into your baby mommy classes or if you're doing private sessions to really show them there's some strength building that can happen while carrying less than 10 pounds, ideally. So some lunging, some squats, holding your baby. There's all really a big array of exercises that are safe strength building in the program that you can look at and are familiar as plot these exercises. So in this class we're going to talk about release mini use tennis balls or I've got my yoga tuneup balls here to really roll out tense places in the body. There are some typical places that are easy to roll out that anybody can do and actually body rolling is one of these really safe practices that you can have your client do because they're putting their own body weight into it.

It's very, very hard to injure yourself doing body rolling. The only things that we need to look out for are places where the integrity of the skin isn't quite healed for, for example, alone along the scar. If you see any visible bruising or if you can see any like grimacing or points that feel like or look like, it's causing your client pain, you can pull away from any of that. We just want it to feel good and body rolling shouldn't be a painful experience. There's so much tension after a birth that body rolling can help release and relax and very tight muscles.

And this is a good way to guide our clients through starting at the bottom and working our way up all the way and really looking for unexpected places where there's tension. Because tension is one of those things that you might feel, oh my neck is really sore, intense. You might not notice another spot. But once you start to explore, you really find those points. So this is where you can give your clients some cues as to, okay, I want you to find the places where you feel tense, but now why don't you try rolling the ball along your jaw or along the front of your shoulder, even at the intercostal muscles of your rib cage. So really searching the body and finding places that you wouldn't normally think of when your body ruling, um, is a really great way to release tension.

A couple of things to think about with body rolling is that you want to move your body over the ball. You don't want to move the ball over your body. We're not using it as an the sash tool. We are using our body weight to shear the layers of your skin and Fascia. So in this class in class three, I really liked to start this class with mindfulness, with using the sounds of the room, often a poem and deep breathing.

At that point when a client is really relaxed and really able to take in the release, that's when we can introduce the balls. So let's take one of the balls and let's just explore through the bottom of your foot. You can place the ball right down and just press the arch of your foot into the ball so you can start again with that skin layer so it's not so, so deep. And as you press more force into the ball, you want to move more slowly. And again, the deeper you go, the more slowly you want to move. And I'm moving my body over the ball and not other way around. And we want to create a sense of sharing to break up the layers.

So that will create a really deep awareness in your body as well as relaxation. Okay, let's move on to the next class connection. This is coming up into a really challenging part of having a child is a mother is exhausted and she might still be in pain. There's a lot of thoughts to process a lot of emotions and a lot of hormones going on in the body. Uh, you've heard of mommy brain, right? So having a connection to your body is very challenging, especially into the abdominals when there's been this massive stretch and then rebound. So in this portion of the program, we want to gain some coordination and we want to really make sure that we are correctly engaging the transverse abdominis with the pelvic floor and getting that safe activation so that we can rehab the core effectively to later build more strength, remembrance and mourning stage of trauma. In this portion, you can talk to your client quite a bit.

We want to find a lot of relaxation and release. And this is where we can start to do exercises like opposite limb, reaching a really coordinated breathing, finding that perfect pelvic floor where you are doing at Staccato breaths. Uh, lots of little lifts of the pelvic floor, really detailed releasing of the pelvic floor, connecting pelvic floor to ta, finding those different coordinated actions in all different positions. So let's come up onto our hands and knees. Yes, your right hands are directly underneath your shoulders, knees directly underneath your hips, and try to stay really tall on your arms and maintain a neutral alignment through your spine. As you breathe in, we really want to feel the abdominals doming down towards the floor.

And as you exhale, really poorly abdominals in towards your spine, creating that feeling of a brace or almost like spanx tightening around your middle. Inhale, expand. Try not to arch your back as you do it. Exhale and lift the belly button up in towards your spine CV and find that pelvic floor activation. Big Breath in. Expand like a balloon three dimensionally and as you exhale, belly button lifts. Find the pelvic floor activation. Now let's try to do that five times fast. We're going to take a long breath in.

New Expand. I'm five sharp axles. [inaudible] this time we're going to do the same thing. We're going to add the pelvic floor connection to it. Big Breath in to expand with pelvic floor ready? Yep. [inaudible] good. Relax, release. Have a seat.

So that's just one part of really connecting pelvic floor and different breath patterns. So this is the time to practice that gained some strength, gains some confidence and start to really get the mind body connected. Again,

Chapter 7

Exercise Program: Classes 5-6

class five strength. This is the time when we're past the real recovery portion of our exercise and we're starting to transition back into our more typical potties exercises. This is where we want to get back into the workout. Um, so I've really created this portion on the reformer, but you can definitely do it on the map. We've got a muscle focus. You know, core integration is going to be essential on this part. We want to make sure that we're doing our diastasis checks really consistently. We have to que breath every single movement. We cannot skip it, which is not only going to create a really healthy core, but it's going to keep yourself and your client very present.

They will feel safer and they will trust you if you're queuing every single time. If you miss it, then they will miss it. This is, this is the time when you really need to be diligent about queuing, pelvic floor and ta activation. And so really important thing to think about in this class is doing close chain activities is gonna uh, will help give you that strength and security shouldn't really, um, irritate complications such as prolapse or diastasis. We wanna make sure we're staying really safe, but building those core muscles. So we want to make sure our glutes are strong, our abdominals are well coordinated and our lots are strong or pecs are open as a whole list in your book of muscles to focus on in classical exercises, on the reformer that you can use. Keep in mind, closed chain is essential here. We don't want to open it up quite yet. So what I've been doing mostly is on the reformer had been doing side lying jumps.

This is really important that you do your diastasis checks just to make sure that your client is feeling really connected to the breath. You're queuing your breath every single time and your comfortable just drawing it back a level. So there is no reason to feel like you have to jump. You can just push your foot bar or your jump board away and you can always bring it back and then maybe next week you can try a couple of jumps and then maybe the week after you don't. But you need to be really watching for the diastasis, for increase in pain, increase in symptoms and just know that every day is different.

So one day you can do it, the next day you can't. But sideline jumping is a really safe way to build strength and get a bit of a sweat going, which is what I think at this point in recovery what moms really want. They want to feel like they're working out. They're able to do something that is more vigorous and creates heat in the body, um, that still safe. So side planking and sideline jumping are typically approved exercises for diastasis, for prolapse. However, everybody is different.

So it's super important that we are doing our checks, making sure that our client is comfortable and feeling really safe. So if you don't have a jump board or a reformer, you can start to be on the stability ball and doing bouncing that way and see how that connection to the pelvic floor and the transverse abdominis stays connected with that. Bouncing action also creates a nice amount of heat. So class six in the series is the final class that should really bring us into a not postnatal polities class. So this class of called transitions, I typically do it on the Cadillac because it will give you a lot of support, but also you can do a lot of very open chain activities. So after about the year mark where you've been working actively on processing and rehabbing the core, you've got a good connection to transverse abdominis and pelvic floor and all that's connected. It's time to do open chain activities.

Put your legs in the straps feel like you can maybe do a teaser again after not being able to do it for a long time. In. This is where I really want to talk about functional diastasis. After the year mark, you need to start working with clients that the exercises that they love, it's something for their emotional wellbeing as well as for their physical body. You need to do forward flection. We need to do things that are going to put pressure in this abdominal space because in real life they are going to have abdominal pressure and they're going to need to do that.

Forward flection it's it's essential to living so the Cadillac is a very safe place. You've got the rollback bar to give you that extra bit of support. You'll get a good view if during flection, if there's doming and functional diastasis will be if there is a little bit of domain but there's no pain, there is no increase in symptoms. It might be okay to do a little bit and then see how it feels and then the next week assess. We can do a little bit and check in. This is the time to do it.

This is the time to do the exercises that your clients love and want to do and really support them in it and let them know that a little bit of doming can be safe. A as long as there's no pain and it's not making things feel pressure down into the pelvic floor. So in this section I have done, um, monkey teaser roll back pretty much all the exercises that we love with a little bit of support and a lot of checking in. So this exercise, a class you might stick with for another year or after, after that first year and it might only take six weeks, it might take two days. You don't know, you just really have to look at each body and assess, are we ready to move on to the, uh, group class? Can I go into, you know, advanced sweat reformer class that, that I really want to do? And this transition class is a really good way to assess and see if we're ready for that.

So after the year mark of consistent work emotionally and physically, um, it is time to start pushing the boundaries, start open chain activities with checks and moving forward into the exercises that our clients really love in my body. I am almost there and I'm super excited. There's lots of different exercises that you can do that are in your book. So check those out. So in conclusion, all of these classes come together to really support and new mothers through the first year of their postpartum experience, especially those, um, with trauma and c-section who need support, encouragement, and to feel very safe in their bodies emotionally and physically.

We want to leave women feeling safe. That is the number one thing. We cannot move forward if we don't feel safe. We also want to feel educated and empowered. So just by telling someone this is okay and this is why we'll give them the freedom to move forward in their progress and in their class. And they will be able to assess themselves whether they should be going into a group class or sticking with privates or whatever they need to do in their own bodies. Always always stop.

If you are feeling an increase in pain or symptoms, I cannot stress that enough. It is always listen to your body, listen to your clients' bodies. What I hope you have taken from this course is that you can understand that there are stages of trauma and how to work within each stage. We want to always create a really safe environment for women to heal from a birth trauma. And you've got a whole bunch of exercises that are safe to progress through from day one to forever postnatal and for emotional and physical recovery.

So I, I've also added in the book a couple of international resources for support. So there are 1-800-NUMBERS. There are websites and I can't stress enough the importance of Facebook groups. They are places where women come together and talk about their experience when they actually can't go out yet when they are stuck in bad and don't have anyone to talk to. But those groups are women, like minded women who are experiencing things at the same time and you can really support each other. So the more a woman talks about her experience, the better. The more people she has to share with, the better she will feel and the better her healing recovery will be. So thank you so much.

Thank you so much for joining me, everyone on this very special journey for myself and I hope for you and please feel free to leave me any questions or, uh, things that you're interested in and I will always respond and actually want to take a moment now and just ask questions from my, my group here.

Chapter 8

Q & A

So now I'm just going to take a moment and take some questions from my guests and I will hand the mic over to you, Aaron. So one thing that I was thinking during this is, um, for [inaudible] instructors to, um, have like, what is the first sign that, that that client may need additional support, um, whether it's emotional support or, um, to go back to say their physical therapist that they've been released from, what would be signs that they need to go back? Great. Well, it's a really awesome question because I think especially for emotional support, it's so different for everyone that things to look out for. I think I mentioned right at the very beginning of the workshop, the color we were, we were looking at that color that someone's chosen and it might mean nothing, but it might be something that makes think, okay that is a really aggressive color. Like maybe okay, that's just something to file into the back of your mind.

Other things to think about if your clients is all of a sudden not making eye contact with you anymore, if there's a lot of crying, sometimes that can be amazing and that is a really positive sign of release. Sometimes it can be really painful so you can assess that and if it feels like too much, that might be a sign of either them losing control or hiding and really retreating. And those are little signs for you to say, maybe it's time to look for some emotional support. And then for physical support, we definitely any increase in pain or symptoms, um, things where they're like peeing a little bit or there's pain with sex. Um, anything that is pelvic floor dysfunction right away we should be referring back to our pelvic physio.

And really that relationship needs to be between three of you. So your client and yourself, you should have a relationship with a pelvic physio to make sure that you know, um, where your client is in their progress. Thank you. Question. Yes. Um, I have a question about, um, specifically I had a client who developed a hernia as she was carrying twins and um, we've done a lot of work and she's gotten very s uh, much more connected with their pelvic floor and her ta and her, um, diastasis has definitely diminished. Great. But what about the hernia? That I think is still there, but I can still feel sometimes this is a pelvic floor physio right away. If, if you're working with their pelvic floor physio, they will give you exercises to avoid and to do so.

Any Indra abdominal pressure will put a lot of [inaudible] hernia. It's very important that you are following the advice of the pelvic physio. That's with anything really. That relationship is key in this whole process of recovery. All right. Thank you ladies.

Thank you so much for joining me and thank you so much everyone at home who's watching and ladies behind the camera. Thank you.


This is an excellent and intelligently organized workshop on this important topic! Thank you, Georgia for this empowering information! I am currently working with pelvic floor physical therapists. This work is  is rewarding and powerful! Well Done!

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