As a pregnant woman, incontinence, big belly discomfort, and the possibility of tearing during labor can be valid concerns. Fit For Birth uses a sequence of exercises called Belly Training to help.
Belly Training® prepares pregnant moms for the pushing stage of labor as well as reduces incontinence, prevents tearing, and minimizes discomfort from an overly extended belly. Belly Training focuses more in depth on the core musculature. Remember, the diaphragm is the top of your core, the pelvic floor muscles are at the bottom, and the transverse abdominis (TVA) wrap the sides (Figure 4).
Figure 4: The Core can be thought of as a box whose top is the diaphragm, bottom is the pelvic floor, with TVA wrapping all sides, along with the deep multifidus in the back. (Primal Pictures)
The core is considered to be the center for all movement in the body and primary stabilizer. Just before you reach out to pick up the groceries, the core should engage in anticipation. With every step, walk or run, the core should engage to absorb shock. As the major shock absorber, it cushions the knees and low back from absorbing the blows. Proper function of the core equates to less joint pain, improved balance, less chance of injury, and much greater overall strength. When the core engages as it is supposed to, it pulls the torso inward, protecting the spine and substantially increasing the amount of weight one can lift. All muscles in the core should contract and stretch in harmony as activities are performed. The core connects the upper, middle, and lower body, allowing the three parts to work together in proper function.
The problem today is that the core doesn’t properly engage in many people, a problem made worse in pregnancy. In many cases, instead of creating a natural corset, the core either doesn’t engage in time or engages incorrectly. This places extraordinary loads into other joints and muscles throughout the body, who try desperately to manage forces they were not designed to handle. Belly Training® prevents faulty core mechanics and re-establishes proper patterns.
Belly Training® consists of five exercises. The first two exercises teach you to master your TVA. Bringing awareness and strength to the TVA muscle can make the pushing stage of labor easier and shorter. This muscle creates intra-abdominal pressures which may aide in moving baby through the birth canal. These muscles also are directly responsible for preventing discomfort caused by an extended belly. Women who have a conditioned TVA find that their bellies at nine months are smaller than their previous pregnancy’s at 6 months (Figure 5).
Figure 5: The photo on the left shows Gabriela’s second pregnancy at 6 months…a large tummy. The photo on the right shows Gabriela’s third pregnancy at 7 months…her Belly Training® program kept her tummy naturally much smaller and more comfortable.
If you think of your breath as having four parts (inhale, pause, exhale, pause), now you will practice increasing the time it takes to exhale. Your slow exhale can count 1, 2, 3, 4, 5 and so on, up to 10 or more if possible, never really holding the breath. While your exhale occurs, you are to “draw in” your belly button and sides of your belly, making your waist as small as possible. Specifically focus on “drawing in” the area below your belly button. You’ll know you’re really mastering the exercise if you start to feel a deep abdominal “burn” or fatigue while exhaling. Try to create a deep core fatigue. Practice 5-10 times each day. (Figure 6)
Figure 6: Extended Exhales. Remember to slowly and calmly “draw in” from below your belly button.
At first, breathing in and out through the nose, rather than the mouth, encourages core musculature to activate more effectively. Later, learning to exhale with mouth wide open helps prevent tearing. This is likely due to a neural connection between different circular muscles in the body.
Imagine that you take your nice, slow 10 second exhale, but perform it in three quick bursts. That’s called a Triple Piston. Never inhaling between pistons, your objective is to rapidly exhale using your tummy. However, don’t think of this so much as breathing exercise; try to force air out using the muscles of your tummy, specifically below your belly button.
First, start with a Single Piston: Take a nice deep inhale, and then make one exhale burst, performed faster than a usual exhale. Think of using the muscles below the bellow button to contract. Then inhale slowly. Continue for 10 repetitions.
Once you master this, you may move to a Double Piston: Take a nice deep inhale, and then make one exhale burst that takes the first half your breath and then a second exhale burst that takes the second half of your breath. Once mastered, you may move to the Triple Piston: three rapid exhale bursts followed by a slow inhale. Yogi Masters are able to take their piston breathing into the hundreds, but a good number to aim for in one repetition is 5-10, and aim for 5-20 repetitions.
The next three exercises in Belly Training® teach mom to master her pelvic floor musculature so that she can reduce incontinence and prevent tearing. Pelvic floor musculature refers to a series of muscles that make up the urinary and anal sphincters (Figure 7). Strong muscles are needed to prevent urine from leaking out of your bladder, especially as baby puts pressure in this area. Ability to relax and open these muscles can give you the control necessary to prevent tearing in this region during childbirth. Ability to perform a pelvic floor contraction was dubbed a “Kegal Exercise” after gynecologist Doctor Arnold Kegal who concentrated on non-surgical approaches to gynecologic problems.
Figure 7: Strong awareness of the Pelvic Floor Muscles is needed for preventing pregnancy incontinence and tearing during childbirth. (http://www.allina.com/ac/pregcc.nsf/page/KegalExercise)
Three Kinds of Kegals
Performing a pelvic floor “Kegal” contraction should feel like when you are in mid-urination and then suddenly stop. For a stronger contraction, think about pulling your uterus far up inside you or clenching an object inside your vagina. Practice with partner is an ideal method to obtain feedback as you get stronger. Practice one of the following Kegals each day.
Contract your pelvic floor for 1 second and then actively relax (open) your pelvic floor for 1 second. Continue for 10-50 kegals.
Kegals Extended—Hold 20:10
Contract your pelvic floor for 20 seconds and then actively relax (open) your pelvic floor for 10 seconds. Attempt to increase the intensity as the contraction goes on, and especially toward the final few seconds. Perform 2-3 kegals.
Kegal Elevators—Level 1, 2, 3
In this most advanced pelvic floor exercise, elevators will teach you how to contract and relax your pelvic floor in stages. Imagine the hardest you can possibly contract your pelvic floor is “level 3.” You will contract just to level one for a second or two, then contract to level 2 and hold for another few seconds, then contract fully to level 3 and hold. Then, you will return to level 2 for a moment, then level 1, then completely relaxed and open. This entire cycle of “drawing your uterus” up and down is one elevator. You may repeat 2-3 times.