Each woman's journey into motherhood is unique, and this is never more apparent than in the postpartum period and the months following. Your experience with pregnancy and birth, as well as your domestic circumstances, will make your recovery distinct from anyone else’s.
Your body is your best guide. Choose rest over exertion until you feel your energy increase. Make walking, relaxation, and deep breathing practices as much a part of your life as possible. You will also need to focus on strengthening the core muscles affected by pregnancy and delivery. The techniques outlined below will help you with this. Gentle bandhas (bonding movements) will lay the groundwork, and you can begin them right away.
Four to six weeks later, and after your bleeding has stopped, is the time to begin more dynamic work with these muscles. By the third month after delivery, according to your comfort, you can begin to work more intensely to regain whatever strength and stamina you may have lost during pregnancy.
Phase One:
Both your pelvic floor muscles and your abdominal muscles have been stretched and weakened during pregnancy and birth, and it is to your advantage to begin to lay the foundation for their recovery as soon as the day after delivery. You can do all of the Phase One practices in bed if you need to.
Mula Bandha
In mula bandha the muscles of the pelvic floor are drawn in toward its center. To adapt this practice to postpartum recovery, focus on tightening the muscles of the pelvic floor around the vaginal opening (the master sphincter muscles). Check to see that you are isolating the muscles in the pelvic floor and not using your abdominal muscles or your buttocks. This area may be sore, or you may not feel very much at all, but gentle conscious movement now will promote healing and sensory recovery.
Level 1.
Squeeze and release the muscles. Keep your jaw relaxed. Repeat 5 to 10 times, and work up to 5 to 10 sets. (This is also called a “Kegel exercise.”) Coordinate this contraction with breathing by squeezing on the exhalation and releasing on the inhalation. The challenge is to gradually tighten and gradually release. Working toward this controlled refinement makes this exercise interesting.
Level 2.
The practice of mula bandha also involves a lift, which can be applied to the muscles of the vaginal barrel by tightening them while working the hammock-like muscles of the pelvic floor.
As you slowly exhale, contract the pelvic floor around the vaginal opening; now lift the pelvic floor and tighten the lowest section of the vaginal barrel; continue to lift and tighten the middle of the vaginal barrel; and maintain the lift of the pelvic floor as you tighten the uppermost section of the vaginal barrel. As you slowly inhale, release the upper portion; then release the middle portion; and then release the lower portion and pelvic floor. Begin with 10 repetitions. Gradually work up to 5 to 10 sets that can be spaced throughout the day, or done all at one time.
If you can create the mental image of an elevator going up and down from the ground floor it will be helpful. At first this practice may seem too subtle. But if you practice and use your imagination, articulate strength in this area will develop. Remember to isolate the contraction to the pelvic floor and vaginal muscles, leaving the abdominal muscles and buttocks out of it.
At the end of the practice, gently contract the pelvic floor once again to leave the muscles in a supportive position. Strength in these small internal muscles will be the basis of strength in the larger more external ones later on, and will help keep the reproductive organs in place.
Uddiyana Bandha
During pregnancy the abdominal muscles are stretched to make room for the growing fetus, and the central seam of connective tissue, the linea alba, between the two portions of the lengthwise abdominal muscle (the rectus abdominis), has softened to allow this muscle to drift slightly to each side. In this first phase of recovery it is important to gently shorten the abdominal muscles and encourage the connective tissue to knit together at your midline.
Uddiyana bandha is done by pulling the abdominal wall in toward the spine. Because the pelvis is unstable immediately following birth, it is best to do this practice on your back at first. Then practice the kneeling version.
Pull the belly button in toward the spine. If you have had a C-section this may pull on stitches, so make it an easy, gentle movement. As you pull in, place your fingers on each outer side of the abdominal muscles, about 3 to 4 inches from your midline, and apply gentle pressure toward the torso’s center line.
Coordinate this gentle contraction with breathing by exhaling as you pull in and press toward the midline, and inhaling as you release. Begin with 5 to 10 repetitions and gradually work up to 5 to 10 sets spread throughout the day.
Makarasana (Crocodile Pose)
Doing the crocodile pose with a pillow under your pelvis can help the uterus return to its former (non-pregnant) size and proper place in the pelvis.
Lie prone with the forearms placed under your forehead. Spread your legs so the entire front of your body can be supported by the floor or bed. Place a pillow or folded blanket under your pelvis and center your uterus over it. If you have stitches from a C-section, work with the support higher, and eventually move it down as the incision heals. Remain in this pose for 10 minutes.
Phase Two
After four to six weeks (and after bleeding has stopped) you are ready to begin to further retrain your pelvic floor and abdominal muscles.
Balasana with Mula Bandha and Uddiyana Bandha
An adapted child’s pose will put the two practices from the first phase—mula bandha and uddiyana bandha—together.
Sit on your shins and bend forward to place your forearms, one on top of the other, on the floor in front of you. Place your forehead on the forearms, and lift the pelvis off the calves. This position will give you good sensory feedback and provide the muscles of the pelvic floor with a slight challenge.
Slowly exhale as you squeeze and pull up the pelvic floor. Continue the contraction through the entire vaginal barrel. Retaining this contraction, pull the abdominal wall back to the spine. Slowly inhale as you: (1) release the abdominal wall; (2) release the vaginal barrel (from top to bottom); and (3) release the pelvic floor.
Just as with the earlier exercises, 5 sets of 10 repetitions spread throughout each day is adequate. More can be added if desired.
The hormones that permitted the continental drift of your pelvis for delivery are no longer affecting your ligaments, and so the next step is more dynamic strengthening of the abdominal wall.
Lie on your back and lift your head; if you feel strain on your pelvic floor, or if you can fit more than a finger between the set of lengthwise abdominal muscles, you need to keep working with the Phase One practices.
Ardha Navasana (Forward-Facing Boat Pose)
This pose has many variations. For our purpose here we will break it down into two parts: upper and lower. Pay attention to isolating the abdominal muscles while performing the pose.
Half Forward Boat (Upper)
Lying on your back, curl your chin to your chest. Reach the arms toward the knees and lift the upper back off the floor. Lift the shoulder blades off the floor while pressing the lower back into the floor. Slowly lower the upper back and shoulders. Breathe out as you lift and in as you lower. (Later you can lift as you breathe in, but this will put more pressure on the pelvic floor.) Five to ten repetitions are a good start. Keeping the lift low will ensure that you are working the abdominal muscles and not the hip flexors.
A variation that will include more of the abdominal wall is to curl up and reach diagonally across the body. Alternating, reach the right arm to the left knee, then the left arm to the right knee, keeping the chin to the chest. Again, 5 to 10 repetitions are a good start.
Half Forward Boat (Lower)
Using the abdominal muscles to lift and lower the legs when you are lying on your back is a good test of your progress in strengthening these muscles. You must be able to keep the lower back pressed into the floor to ensure you are not masking abdominal weakness behind hip flexor strength. If you can manage to exhale and add a pelvic floor contraction (mula bandha) each time you reach a leg away from your torso, you will be supporting these strengthening movements internally.
Lying on your back, begin with your knees folded in to your chest. Lower the right foot to the floor and then lift it; repeat with the left foot.
Extend each leg as you lower it to a 45º angle, and then draw it back to the chest, bending the knee. Check to make sure you are keeping the lower back flat on the floor.
Extend each leg and lower it to a few inches from the floor, then draw it back to the chest, bending the knee.
As this exercise becomes possible and eventually easy, try it with both legs moving together.
Phase Three
Regaining overall body strength after pregnancy and childbirth can take some time, especially in light of the demands of being a mother. But by the third month after delivery you may be ready to work these strengthening postures into your schedule. Add the following six poses to the two practices in Phase Two. If you cannot practice them all at one time, do them as you can throughout the day.
Virabhadrasana (Warrior Pose)
Stand with legs wide apart. Pivot your left foot outward 90º and the right foot inward 45.º Bend the left knee so that the torso faces forward as you lunge. Extend the arms out to the sides at shoulder height and look over the left hand. Breathe fully. Hold the pose for three full breaths or longer as you gain strength. Repeat on the other side.
Sankatasana (Chair Pose)
Stand with feet spread apart wider than the width of your hips. Inhale and reach the arms out to the front at shoulder height. Exhale and bend the knees. Sink down as far as you can while keeping the heels on the floor. Do not descend farther than a 90º angle at the knee. Hold, breathing evenly. Inhale as you rise out of the pose. Exhale as you lower the arms.
Adho Mukha Shvanasana (Downward-Facing Dog)
Begin on your hands and knees, with the hands under the shoulders and the knees under the hips. Tuck the toes under, exhale, and push the pelvis upward as the legs straighten. Open through the front of your armpits and reach the heels toward the floor. Stay here for three deep breaths or longer as you gain strength.
Chaturanga Dandasana (Four-Limbed Stick Pose)
Lie prone. Tuck your toes so that their undersides make contact with the floor. Bring the elbows in tight to your sides and clasp the hands together in front of the neck. Press the forearms into the floor as you press down through the toes to lift the body off the floor. Straighten the knees and keep the spine elongated. Pull the navel back to the spine and breathe fully. Do not allow the breath to become rapid. Hold as long as you are comfortable. Repeat once.
A more challenging variation is to place your palms on the floor at chest level and lift the whole body a few inches off the floor in this position.
Chaturanga Dandasana (Four-Limbed Stick Pose)
Lie prone. Tuck your toes so that their undersides make contact with the floor. Bring the elbows in tight to your sides and clasp the hands together in front of the neck. Press the forearms into the floor as you press down through the toes to lift the body off the floor. Straighten the knees and keep the spine elongated. Pull the navel back to the spine and breathe fully. Do not allow the breath to become rapid. Hold as long as you are comfortable. Repeat once.
A more challenging variation is to place your palms on the floor at chest level and lift the whole body a few inches off the floor in this position.
Dvipada Pitha (Bridge Pose)
Lie supine with your knees bent, the soles of the feet on the floor. Exhale and as you feel your abdomen move back toward the floor, lengthen your spine by reaching your tailbone (coccyx) away from your torso. Curl your tailbone up between your thighs until it lifts your pelvis off the floor. Continue to lift the pelvis so that you create a long stretched line between your neck (which is on the floor) and your knees. Hold to your comfortable capacity, breathing fully. Exhale to roll down, lengthening your tailbone. Repeat this movement several times.
This series focuses on restoring strength to the areas of the body most affected by pregnancy and delivery. It also improves integrated muscle tone throughout the body. By adding more repetitions, lengthening the time you remain in the pose, or increasing both of these aspects, you can continue to strengthen the body beyond this initial practice.
With a new baby, you are making many adjustments in your life. If you are unable to practice this series all at one time, do each practice when the opportunity presents itself during the day. Persistent, gentle effort will yield results. The progress you make may be subtle, so keep at it and don’t give up!
Jaime Stover Schmitt, Ed.D., C.M.A., has taught yoga for over 20 years and has maintained a private practice in yoga and movement therapy for the past 10 years. She has two children.
January/February 2000