As always, the content of this blog is offered for informational purposes only. Please seek proper medical advice when recovering from any surgery and returning to a yoga program.

The fourth trimester is full of ups and downs. You are over the moon with your new little love and absolutely sleep deprived.

And your body has gone through and is continuing to go through massive changes.

The pressure dynamics in your abdomen have completely shifted. Your abdominal muscles have been elongated and need to remember how to work again. Your pelvic floor muscles may feel weak or tight. You may be experiencing urinary or fecal incontinence or pelvic organ prolapse.

C-section

If you had a C-section, your abdominal wall is cut through. This means the four layers of abdominal muscles (rectus abdominis, external oblique, internal oblique, and transverse abdominals) have been disrupted and need to figure out how to optimally function again.

And even though your baby has not been birthed through the vaginal canal, the pelvic floor muscles are still affected. You may be less likely to experience urinary or fecal incontinence or pelvic organ prolapse after a C-section compared to a vaginal birth. But the relationship between breathing, the abdominal wall, and pelvic floor muscles is still highly interconnected.

Diastasis recti abdominis (DRA)

Transverse abdominals with march
If you have a diastasis recti abdominis (DRA) postpartum, you will have difficulty generating tension through your abdominal wall. Read this post on diastasis recti abdominis to learn more about what it is and exercises to help get you back on track.

Though your body goes through a lot during a pregnancy, delivery, and fourth trimester (postpartum), there are several warm-ups and yoga postures that can be helpful in addressing these issues.

But where do you start with getting movement back into your body?

Breathe mindfully

Taking long, deep diaphragmatic breaths is helpful for many reasons.

When you allow your belly to expand as you inhale, you are getting gentle movement into the abdomen. The slow mindful breathing stimulates the parasympathetic nervous system and promotes the calming “rest and digest” vibe.

Some of my patients stick their bellies up forcefully to try for a big, deep breath. The breath we are going for is more subtle. We want a full, slow and gentle breath, rather than a pushed breath. Think of allowing the belly to fill rather than forcing it to push out.

Dirga three-part breath

The Dirga three-part breath is very therapeutic for the nervous system, diaphragm and pelvic floor muscles.

  1. Allowing your belly to start to fill slowly and softly.
  2. Bring your attention to your rib cage. Notice your ribs expand and widen, like a bucket handle.
  3. Feel your collarbone floating up towards the ceiling, which you may not need to accentuate if you are a chest breather to begin with.

Breathwork during the fourth trimester

Open your upper body

You know the old song about how all the body parts are connected? (“Hip bone is connected to the thigh bone…”) It’s true!

Whatever you can do to open your shoulders and upper back will positively affect your breathing and relieve aches associated with caring for your baby.

Try loosening up your neck by tilting your head to the right then turning your chin toward your right shoulder. Continue the movement down toward your sternum and over to the left, creating a half circle. Reverse the circle and repeat if you’d like.

Another quick and easy way to free your breath is to move your shoulders. You can try shoulder blade squeezes or shoulder rolls.

For shoulder blade squeezes, move both shoulders back to open your chest. You can also try holding your shoulder blades back, clasping your hands behind your back, and pressing your hands down to get a stretch.

Shoulder rolls (done like it sounds: circling your shoulders forward, up towards your ears, back, and down) can be paired with an inhalation on the way up and a sigh on the way down.

Strengthen your core

After your medical provider offers clearance, perhaps around day two, start to find your transverse abdominals (TA) again.

This can be challenging because your abdominal muscles have been lengthened and your abdomen will still feel bloated. Your TA is the deepest layer of abdominal muscle and acts like a corset to the front of your abdomen, creating stability for your spine.

Inhale to prepare, then exhale and imagine bringing your ASIS (anterior superior iliac spine or hip points) together. This is one cue and not all cues work for each person. Here are a list of cues to try.

ASIS, also known as hip points or anterior superior iliac spine

Imagine:

  • Zipping up a pair of hip hugger pants
  • Pulling your lower abdomen toward your spine
  • Your lower abs are squeezing in like a sponge

Coordinating the pelvic floor muscles

Finding your pelvic floor muscles again can be equally as challenging.

Check out the Breath Cues guide for a cheat sheet on what the pelvic floor muscles do during the breath cycle. Inhale, then as your exhale bring your pelvic floor muscles up and in (doing a “Kegel“).

Imagine:

  • Pulling your tailbone towards your pubic bone
  • Pulling your tailbone up towards your belly button
  • Lifting a lentil with the labia
  • Stopping the flow of urine
  • Stopping the flow of gas

You might have noticed that if you engaged the transverse abdominals your pelvic floor muscles also activated, or vice versa. This is exactly what we want to happen!

Sometimes, postpartum, we will start training one muscle group in isolation, one at a time. The goal would then be able to engage both the pelvic floor and the transverse abdominals at the same time, without breath holding, and during movements like picking up your baby. Read more about how to do kegels in this blog.

Get your spine moving

Moving your spine can feel so good, especially moving into flexion. Try Cat and Cow Poses:

Dustienne Miller in cat pose

Cat pose

When we move into Cat Pose we go into spinal flexion (curling the spine). Visualize the tailbone reaching towards the head as we create a C curve.

Dustienne Miller in cow pose

Cow pose

When we move into Cow Pose we go into spinal extension (arching the back). Visualize the tailbone reaching towards the ceiling.

If you have had a C-section, be sure to follow your doctor’s instructions and not pull on your incision. For example, if you are releasing into Cow Pose and you feel your stitches pulling, this is too far into the pose.

After you have full clearance for lengthening the scar, you might play around with exploring deeper into the posture.

Restore

Try and keep your body as limber as possible. This is really tricky between sleep deprivation and the static holding positions you find yourself in. You might find restorative yoga postures to be helpful when you are too tired to move.

Supine Twist is a gentle rotation posture and chest opener. You can grade the amount of rotation by adding a bolster or pillow under your knees to get the appropriate amount of stretch for your body.

Supine twist with a bolster

  1. Lay on your back with your knees bent and feet flat.
  2. Inhale, and bring your knees to the left.
  3. Exhale, bring your knees back to center on the inhale.
  4. Repeat bringing your knees to the right.

Stand strong

After the baby has left your body, your proprioceptors that tell you where your body is in space, need to be retrained. You need to tell yourself to bring your rib cage over your pelvis again. You can practice this in Mountain Pose.

Mountain yoga pose

Warrior 1 helps you lengthen the front line of your leg when you are ready for it. You can grade the amount of stretch you get by having your legs closer together.

arrior 1

Warrior 2 allows for strengthening, grounding and lengthening of the inner thigh. Again, you can alter the leg separation distance to make it feel best for you.

Warrior 2 yoga pose

Always listen to your body. Avoid moving in painful ways. Less is more in the healing phase. Be kind and gentle to your body just like you care for your newborn.