Pregnancy can have a huge impact on our breathing patterns due to the growing baby and this can have a potential impact on our core and pelvic floor* muscles.
When you breathe in, your diaphragm (your breathing muscle) contracts and moves downward to increase the space for your lungs to expand and fill with air. And this downward pressure should result in your abdominal muscles and pelvic floor lowering and stretching to accommodate the movement (so a relaxing of the pelvic floor and a slight expansion of the stomach).
When you breathe out, the diaphragm relaxes and moves back upwards to help force air out of the lungs, which allows the pelvic floor and abdominal muscles to contract and snap back into place to support the spine and pelvis and the stomach will go down/in slightly.
(See the moving version of the image below to help illustrate this).
This synchronized up and down of your core when breathing is often referred to as “Piston breathing” – a phrase coined by Julie Wiebe, an internationally renowned physiotherapist.
If your breathing pattern doesn’t match this (and is what is often characterised by belly, boob or shoulder breathing, rather than rib movement) then your core muscles (so your abdominals, lower back and pelvic floor) are not working optimally. This means that they’re likely lacking stability and the ability to deal with pressure, movement and load as well as they should. This can impact on problems such as lower back pain, pelvic pain, incontinence, prolapse, etc. which tend to be caused by birth trauma or postural changes.
So whilst practicing your breathing might sound a bit noddy, it’s actually integral to birth (as you need to be able to relax your pelvic floor to get baby out), your recovery post birth AND to achieving more from your workouts. It can also have a huge impact on the functionality and look of any “mummy tummy” (see article on Diastasis Recti).
The basics of the Core Breath are:
- Inhale to expand – If you place one hand on your belly and one on your ribs as you inhale you should feel both gently expand/rise OR have both hands on your ribs and feel them move east and west away from one another as you inhale and your rib cage expands (you should feel the pelvic floor soften too, without bearing down)
- Exhale to contract, and lift the whole of your pelvic floor (see below for some help with visualisations) – as you exhale your fingers, which moved east to west previously, should come back together, and your belly and your chest will deflate. This should take about 5-8 seconds.
- Core breathing activates all of the parts of the core so you should feel it in your pelvic floor, deep abdominal muscles and in your lower back.
Sometimes this breathing can feel a bit alien (particularly when you’re trying to coordinate your pelvic floor at the same time) so you may find a visualisation helps:
- Contract the pelvic floor by drawing the front of your pelvis (your pubis), to your tailbone (your coccyx) and pulling your left and right sitting bones together – imagine your pelvic floor is like a drawstring bag with 4 points. Lift the entire pelvic floor up when you exhale and relax it back down again when you inhale.
- Imagine the doors closing on an elevator (squeeze) and then (lift) to the top floor via a brief pause at floors 1, 2 and 3, hold it for a count of 4 at the top and then relax to bring the lift back down, one floor at a time, and open the doors again on the ground floor. (Note that many women find it easier to take the lift up than bring it down, but this will get easier as you regain control. And you can help this along by relaxing your jaw and letting your mouth open).
- Imagine gently blowing out the candles on a birthday cake (on the exhale)
- Put a Pilates ball or cushion between your knees (as the muscles in your inner thighs “talk” to your pelvic floor) and as you exhale squeeze and lift the pelvic floor (this can be helpful if you’re finding it hard to connect).
What you want to avoid:
- On the inhale: (1) belly billowing out; (2) chest and shoulder lifting towards the chin; and (3) ribcage flaring out (your back may arch when you do this)
- On the exhale: (1) Bearing down as this means that the pelvic floor is moving down as opposed to lifting; and (2) belly moving out opposed to pulling in
How do I engage my pelvic floor muscles / how do I know if I’m doing this properly?
To help find your pelvic floor muscles try sitting comfortably on a hard chair and focusing on squeezing and lifting the muscles that would prevent you from passing wind AND those that would stop the flow of urine – don’t do this for real regularly or you’ll impact on your bladder health. Your mission is to do this without moving your bum, your legs or any other part of your body – although you might feel a slight tensioning of your lower abdomen as you squeeze and lift without holding your breath.
If you’re unsure, you can double check that you’re using the right muscles by:
1) using a mirror to see if the area between your vagina and anus moves up and in when you contract your muscles
2) inserting a clean finger into your vagina and seeing if your muscles tighten around it as you engage them
3) similarly, if you’re sexually active, try engaging your muscles during sex and see if your partner can feel them
How often should I do my pelvic floor exercises?
At least 3 times a day tends to be the general recommendation doing a combination of long squeezes (10 sec hold initially) and short squeezes (10 quick reps initially). (The NHS’s Squeezy app can be great for reminding you to do this.) And if you’re exercising with me then I’ll have you working your pelvic floor throughout the session!
Please be aware that strengthening the pelvic floor is not the answer for everyone, however. Some women have too tense a pelvic floor that struggles to relax and so they’d benefit from relaxing and releasing it. Some of the signs of a tense pelvic floor include (but are not limited to): pain (generally or during sex), difficulty emptying your bladder or bowels and constipation.
If you’re in any doubt at all or need more help consider seeing a women’s health physio or getting in touch. The following document from the POGP might also useful and I highly recommend the team at Harborne Physio.
(* Your pelvic floor is a sling of muscles that support your pelvic organs – i.e. your bladder, vagina and rectum, it helps with bladder, bowel and sexual function, trunk stability and mobility, and relaxing/stretching during childbirth.)
[Credit to Burrell Education for the images]