Hey!! I’m Ashley and am the mom of 3 littles aged 6, 5, and 3. We had a miscarriage in July last summer and were absolutely devastated.
The pregnancy shocked us as we never knew we wanted 4 kids. Luckily for us, this baby opened our eyes to the love we did had for another child in our hearts. Shortly after we lost our sweet Ashton (named after myself and hubby Tony) we found out that he/she handpicked a sibling for us and we were pregnant yet again.
This pregnancy has been the biggest rollercoaster of my life. From Hyperemesis Gravidarum (extreme morning sickness all day long), migraines, a mini stroke attack, severe anemia requiring 5 iron infusions, gestational diabetes, and all of the other “normal” pregnancy symptoms… on top of tending to the demands of three small children… to the extreme joy of carrying a perfectly healthy baby girl.
Why I’m Glad I Didn’t Say Goodbye
Recently a photo of a little girl hugging her mom before separating from her so her sibling could be born went viral.
The comments I read on this photo varied in opinion from those empathizing with this mother to those thankful for not having had this experience. Nonetheless, there is something to learn from the feelings that come with viewing the photo.
This is where I am going to give you my opinion. I do realize you have not specifically requested it, but in continuing to read this blog, you are agreeing to hear – or shall I say “read” – me out.
It was when I was pregnant with our second son that the idea was presented to me by my doula to have our oldest attend the birth. I have to admit, at that point I had never even considered it. She had very valid reasons on why this can be beneficial, and encouraged me to read Carol Phillips’ Hands of Love: Seven Steps to the Miracle of Birth. After doing so I knew this was the right decision for me and hoped my husband, Kyle, would agree. He was hesitant at first but also read the book and listened to my feelings and needs in having Terryn present. He agreed and we gave Terryn the option to attend. Terryn is a very inquisitive soul and at the age of 3, agreed to join us. We arranged for Kyle’s sister Kirsten to be his support person. When the time came, Terryn joined us at the hospital. This birth was moving along very nicely, but not necessarily at the pace a 3 year old would hope for, so Kirsten took Terryn and brought him back when we knew delivery was near. We used verbiage that was factual and supportive. Anatomy was (and should be) called what it is. We let him know I would be doing hard work and may make noises he has not heard from me before. Terryn sat on Kyle’s lap by my right shoulder while I delivered Canon Gregory Boland into the water at the hospital. Terryn was quiet and still and in awe. He wasn’t scared and in fact, he didn’t cry until the nurses took Canon from me to bathe him. Who knew that at 3 years old, his instinct that baby should be with mom was spot on?
Here is my point: you have options. Because a practice is common does not mean it is normal and certainly does not mean it needs to be your normal. If you are feeling scared, uneasy, guilty, worried, etc. with a practice, then maybe it is best to question what your need is and whether you want to set a new standard or follow an existing one.
Dr. Phillips points out how beneficial it is for siblings to be involved in the birth process and that it can help with sibling bonding and the older sibling not being confused or feeling replaced. This can have a great impact on the foundation of family for them. It also teaches children that birth is normal and not a fearful event.
We have had “the older siblings” at the births of our next two sons as well and I am forever thankful we did.
My hope in you reading this is obviously to consider this for your family but most importantly, taking the driver’s seat of your pre and postpartum experience. There are ALWAYS options and if something does not feel comfortable to you, explore what you are truly feeling and what you need.
These are photos of our boys supporting me during labor and watching Maclin arrive. The woman with the camera is my sister. She got an amazing photo of when only Maclin’s head had been delivered and Kyle captured the boys’ faces at the same time!
Erica Boland, DC
www.birthfitwisconsin.com : @emomdc : www.birthfit.com
Join us for a weekend of lecture and hands on learning to implement into practice immediately!
Proper recognition of pain and dysfunction during pregnancy and postpartum is key to a mother’s return to health. Dr’s will discuss what signs to look for, how to treat and when and who to refer to in all categories listed.
- Recognition of pregnancy related mechanical dysfunction and treatment using the McKenzie Method
- Differentiate and describes types of pain while effectively communicating importance of care continuity to patient
- Assessment and treatment of pelvic floor and diaphragm dysfunction with special emphasis on diastasis rectus abdominis
- Post partum nutrition during exclusively breastfed months and special cases
Located at Eupraxia Gym: Desert West OBGYN 7787 W Deer Valley Rd, Peoria, AZ
Lecture/Lab: Friday, Saturday 8-5, Sunday 8-1
CLICK HERE to download your registration form!
This final post in the three part blog series will help you bring everything together and allow you to move forward with training.
With a strong core, you will be able to effectively and efficiently transfer load. Obviously when I mention “strong core” I am not talking about a six pack. As good as that may look, it screams dysfunction. Sit-ups and crunches should be banned in all 50 states. Yes, I am serious. When I say strong, I am talking about moving with activation of your diaphragm, pelvic floor, and all abdominal and lumbar musculature with proper movement patterns as mentioned in Part 1 and 2 of this series. During pregnancy, I work with women to train for the “big event.” This means assessing women in movements she is frequently doing and making sure they are being done well. Any movement that exacerbates an already present diastasis needs to be avoided. This applies to both pregnancy and postpartum. For any of you that have already trained for any event, you know that great training leads to better recovery. Birth is the biggest athletic event of a woman’s life, and – trust me – you will appreciate a quicker recovery.
While the exercises demonstrated in the functional progression video seem simple, I guarantee you will find the challenge in actually performing these clean movements; especially as you are just starting. It is crucial to focus on the movement itself and not how many repetitions or sets you are getting in. Once this foundation is solid, resistance and weight can be added to the extremities. (Watch for videos coming soon.)
Focused core work should be done on a regular basis and I recommend adding at least one of the functional progression steps into each warm-up as well as spending 2-3 days per week moving through the entire progression. This may be body weight only or with resistance and or added weight.
Why should you continue to work through this progression and what will this help? Other than the obvious benefits listed in the previous blogs, it will be helping you literally all of the time. To prove this to you all you need to do is answer one question for me: How often do you breathe? Okay, point proven. Really though, it is that important. Yes, I could go on about the benefits of strength training and the benefits of hiking or biking or even running and how your core function is DIRECTLY related to each of these, but I will not. I will not because when it comes to core health, it does not matter what form of activity you choose. You need this stability to walk to your car. Hell, you need this stability to sit at your desk all day.
As chiropractors, my husband and I work with all levels of athletes (females and males), from amateurs to world champions. It can be humbling when the weights are taken away to perfect these basic movements. But time and time again, we see the benefit. Performance gains are made faster and injuries are reduced. Gaining this stability and strength can help to reach performance levels that may even be beyond what our athletes expected. And truly, we are all athletes; the variation is to what degree we utilize our athletic capability. Again, birth is the biggest athletic event of a woman’s life! Improving “performance gains” in birth means improved labor outcomes and “reduced injury” translates to faster healing postpartum!
Your body is incredibly intelligent and you will move from point A to point B if needed. The question is whether you are both effective and efficient. If you are moving with compensation (or birthing with compensation) instead of function you are setting yourself up for injury. You may not see the side effects of compensation immediately, but I guarantee you will eventually. The side effects show up in numerous ways: shoulder injuries, knee injuries, low back pain, neck pain, pelvic floor dysfunction, DIASTASIS!
Compensations, also known as poor movement patterns, lead to what I call “energy leaks.” This is a forced (instead of smooth) transfer of load, taking more energy and causing decreased performance. If you are healing a diastasis postpartum, know that leaving this untreated is not without further issues. DRA not only causes troubles for mom but can potentially affect future pregnancies, including positioning of baby and labor. When we apply this idea of forced transfer of load instead of smooth transfer of load, we’re talking about physically transferring the load (weight) of your baby from internal to external.
Please look at the big picture. Your body moves as a whole unit. Train it that way. Whether you want to move heavy weight, run a mile, walk up a flight of stairs to work, or give birth, you need your entire core to be stable! An injury will cause you to realize how much your core is needed in EVERY. SINGLE. MOVEMENT. As you return to or start activity, this is work you should continue to improve for the rest of your life. Implement these changes. Pay attention to the form you are perfecting during your core work and make sure it is as clean when you deadlift that weight from the ground. It is going to take being mindful to make this habitual, but you will reap the rewards.
Ideally, you won’t know the full extent of these rewards because ideally, years from now you will still be implementing these functional movements and making time for this habit instead of worrying about bathroom stops on your one hour drive, peeing your pants at the bottom of a snatch, and last but not least, your “gap” will be filled.
Share this information with others. Be part of this paradigm shift by exposing others to information that can truly be life changing.
Remember, postpartum lasts a lifetime and movement is life. Do not settle or own dysfunction because you are female, age X and/or have had children. You deserve a quality life and this is certainly going to help you achieve that!
QUICK TIPS REFERENCE LIST
Top 3 Exercises for Pregnancy:
Top 3 Exercises for Postpartum:
Avoid: (During pregnancy and postpartum)
Poor Posture & Prolonged Sitting
ANY exercise that aggravates DRA (this may include, but not limited to, planks, push-ups, and pullups)
Please, if you have any questions at all, then I encourage you to set-up a phone consultation with me, or we can schedule a consultation in person at Coulee Health. I’m super eager to discuss all things pelvic floor and core related. And, I’m even more motivated to help you get moving again. After all, MOVEMENT IS LIFE!
-Dr. Erica Boland, DC
Mother of 4
As discussed in Part 1 of the DRA blog series, in order to understand how to heal diastasis and properly train the core, we need to understand how our bodies were made to function in the first place. Babies are born with immature motor patterns. You will notice newborns tend to have knees tucked and hands and arms often flexed close to body and even near the face. Development begins with the drive to learn more and explore the surrounding environment. As babies are exposed to lights, sounds, and touch, they have the desire to discover more of this world and begin to integrate different parts of their body into learning.
Babies are not taught to roll, hold or grasp objects, sit up, crawl, or walk. Movements do, however, occur in a typical sequence and it is crucial that each milestone is met. Our movement patterns in the first year of life are the basis for function in movement as adults. As we watch the movements of babies and toddlers we can teach ourselves. If milestones are not met, the area is not used properly with movement patterns and can lead to problems later on. For example if support on elbow during tummy time, rolling or crawling does not happen, the scapula (shoulder blade) is not secure within movement and can eventually lead to impingement issues or even tears in the rotator cuff, etc. This is also one reason a patient can have surgery on that same shoulder and end up with the same problem. If the movement pattern is not addressed, the problem remains. Meeting milestones seems exciting as the little ones progress but the saying holds true “let them be little.” Let them do it on their own and do not push before they are ready.
Thumbs move from inside closed fist to outside closed fists
Eye contact begins
Support on elbows
Can rotate head without moving trunk
Spine starts to upright from mid to upper back
Start support on opposite knee and elbow (helping to begin closure of DRA)
Diaphragm flattens and mature breathing patterns begin
Free hand grabs objects but cannot cross midline
Hands can touch hips and groin
Oblique muscle activation occurs
Able to roll from back to belly
Can grab feet with hands
Can bring toes to mouth
Rocking from base of support on hands up to all fours: video example
Start to creep forward with use of upper body
Oblique sit occurs (first elbow and down thigh, eventual open hand and down thigh)
Further crawling development
Stepping forward to standing
Side walking along furniture
Stand freely after standing with support
Walking between objects (side to side)
Walking in sagittal (forward) plane
Stand independently from “bear” position
The movements attained in the first year of life are the foundation of all basic human movements. Following a major event like childbirth (or surgery or other major trauma), re-learning these movements IN ORDER helps heal the body as well as establish a solid foundation to build strength on. The diaphragm is used for both breathing and postural support. At 4.5 months as the diaphragm flattens and a more mature breathing pattern begins. When addressing the core, especially postpartum, the first step is establishing a strong breathing pattern. (Check out Dr. Mumma’s video here.) This is key in reconnecting to your core. After creating a human in that space for the the majority of a year, a woman needs to discover her new normal. Working on diaphragm activation can and should be done in the first day after birth while bonding with baby. This does not mean you need to start exercise but just focusing on what you are already doing, BREATHE!
12-16 times per minute: BREATHE.
In through your nose, out through your nose or mouth, filling your entire abdomen with air. When you inhale, your chest should not rise, but rather your belly should expand 360 degrees. This begins the healing process of the postpartum period internally.
Healing of the core needs to come from within. This occurs only after proper diaphragm activation which is a movement downward of the diaphragm during inhalation and upward during exhalation. From the outside, there will be expansion of the chest and abdomen in an outward direction as opposed to a dysfunctional upward motion of the chest and shoulders, as you saw in Dr. Mumma’s video above. As diaphragm moves downward, abdominal and lumbar musculature are contracted eccentrically (bracing outward, NOT SUCKING IN) and simultaneously counteracted by pressure of the pelvic floor. How awesome is it that we can gain a strong core by doing exactly what the baby just born will be doing?! Start with diaphragm activation, gaining proper intra-abdominal pressure, and move through the sequence of developmental movements, and the core will be strong enough to support day to day movements and eventually more vigorous exercise.
Functional Progression Demonstration Video
Breathing and movement patterns need to be discussed before birth and definitely assessed postpartum. Change is needed. It starts NOW.
As a practitioner, my work with pregnant and postpartum women continues to grow. This is where I not only see the literal gap in the body’s system (DRA) but also see the figurative gap in our system.
Consider this scenario: mom has baby, mom and baby are both healthy, mom presents for postpartum check up and pending no major issues is “cleared” for exercise. The evaluation being done of the core function at the postpartum visit is minimal at best and often completely overlooked. In fact, full movement patterns are never assessed. There is occasionally a check for diastasis rectus abdominis but not the entire core function. This leads to mom turning to online forums for help with a “gap” in her stomach or she may have been told to do crunches and sit-ups to help. The fact that our society has made “mommy tummy” a marketing ploy is an entirely different topic.
Let’s think about this though. In a hospital setting, as most births in our country are, practitioners are allowed limited time with patients as it is. For them to take on a thorough, functional physical would not only add appointment length but also require further education. My opinion is this is the point that collaboration in postpartum care must occur. Furthermore, my experience has proven time and time again that restoring core function in the immediate postpartum period launches moms into better recovery postpartum and overall better movement patterns. Long term, this leads to everything from less leaking when she sneezes (or runs, or laughs) to reduction in neck and back issues.
Beyond that, when assessing and treating the DRA, we must recognize that this is related to the entire movement patterns of the mother and not the diastasis alone. Sit-ups, crunches, holding the belly together during a contraction of the abs, and “zipping” the waist are not exercises that will be relatable to true movement. These are exercises towards strengthening single muscle groups and while they may seem to be beneficial temporarily, long term problems are likely to remain. We do not decide to get up from the chair and use transverse abdominus to walk to the yard. We also don’t consciously think about using our pelvic floor to stand at the park and watch our kids play. We need these muscles to be working together without conscious thought and in order for the muscles to work together they need to be trained through movement patterns we will use. Often that means taking it back to the basics of moving like a three or four month old infant. Trust me, even athletes moving heavy weights are humbled by this training and while they may be frustrated at the idea of dropping their weights, they are happy with the eventual improved strength and reduced risk of injury.
How does this all relate to your pelvic floor? Your core function is directly related to your pelvic floor function (fun fact: your pelvic floor is part of your core). It is actually directly related to ALL movement. Your core is your powerhouse. Without stability in your core, your foundation is off and eventually the pieces will crumble.
BIRTHFIT is education! We refer to the postpartum period as Queen in Training, and expect this specific healing time to last 9-12 months. Postpartum lasts a lifetime, but we want you to focus on the movement milestones to meet as a mother and hold yourself accountable to this. Approach your immediate postpartum period with intention and purpose. Know your body and understand how it functions as one unit. You will heal in less than a year and you will function better than before. If you can grasp this concept and share this with others, together we will create the shift in care that we need.
Dr. Erica Boland, DC
PART THREE… next week, relating core function to training
DIASTASIS RECTUS ABDOMINIS: FILLING THE GAP
Part 1 What and Why of Diastasis Recti
As I search the Internet and question colleagues, hungry for more information, what I actually learn is that we have a problem. The problem is the large gap; both figuratively and literally speaking. The gap in our postpartum healthcare is directly related to the gap in your abdomen.
It is beyond frustrating to see the misinformation marketed to new moms: “lose that mommy pouch” or “get your belly bikini ready” and “simple steps to a six pack.” (Unfortunately, “move well and quit screwing shit up” doesn’t sell as well.)
What is even more frustrating is many of the trusted resources, even the “experts” in the field, are still missing the boat. The consequences remain: misinformation and what I consider an epidemic of dysfunction.
I am sure by now you have heard the term Diastasis Recti or Diastasis Rectus Abdominis (DRA). For the sake of this post series I am going to refer to women. Just don’t forget, men have a core (and pelvic floor) too.
In my time as a chiropractor, doula, BIRTHFIT affiliate, coach, and mother of four I see firsthand the many issues that lead to and come from core dysfunction. It is time we start looking at the system as a whole and healing it that way. I am thankful for having studied Janda, Lewitt, and Kolar’s work. Their work has paved the way for an in depth understanding of how our bodies were born to move.
Within these innate movement patterns lies our answer.
I hope to help you understand this as simply as it actually is. Think about this for a minute: when is the last time you witnessed a baby doing a sit-up? How about “zipping” in his or her transversus abdominis? Nope. Me either. Want another fun fact? Babies are BORN with diastasis. Yes, that’s right. YOU were born with a diastasis and immature movement patterns. Guess what else? Babies heal that diastasis on their own through functional movement patterns. By four and a half months the diastasis should approximate or come together. This is also around the time that baby starts to roll to both sides. Not a coincidence.
No one teaches baby to roll or sit up on his or her own or crawl or squat or walk. We should not be putting them in these positions before this occurs naturally (Stop Interfering with Your Child’s Development). All of these movements are formed as neurological stimulation occurs in the environment. That simply means that baby’s brain is intrigued and wants to learn more about surroundings, hence baby is motivated to movies the most instinctive, natural way. Again, movement is life.
Why then, are we still attempting to look for treatment of DRA and core dysfunction by singling out muscle groups? We are not made to function that way, so hoping to return to full function by rehabbing or training that way is setting ourselves up for failure in the form of continuous injuries or dysfunction.
DRA does not have to occur. It is a separation in the rectus abdominus muscle due to immature movement patterns. Basically, this happens when movement reverts back to that of a newborn infant and can happen for a number of reasons. The simplicity of this concept is actually great news. If we return to what our bodies were born to do, we fix the problem at its roots and avoid simply making the surface look better.
The Functional Progression that I pieced together is not new. It is simply taking the work that I have studied into a fluid movement pattern that is more functional than a Turkish Get-up. The progression addresses the entire core and allows for resistance or weight to be added as normal movement patterns are solidified.
Dysfunction of the core and pelvic floor is much more than DRA and is so common that even upon questioning patients, it is often not mentioned. As founder of BIRTHFIT, Lindsey Mathews states, common does not always mean normal. Peeing in your pants when you are 50 (or younger) because you are “getting older and have had children” is NOT a rite of passage. Yes, it is common. No, it is not normal. And until we start filling our gaps, women will continue to suffer from these issues.
Stay tuned for Part 2!
-Dr. Erica Boland, DC
We have had many inquiries on making kombucha. Here is a little “how to.” To top that, we have 2 Scobys that are looking for a new home! Contact us if you are interested.
Live Scoby (can order online but finding a friend to share is much better J)
1 C. Starter Kombucha (bottle of plain kombucha from supermarket)
1 gallon glass jar
Cheese cloth or thin towel to cover
Rubber band to put around cloth
Organic black tea
Organic or natural cane sugar
1 gallon distilled water
Wash glass jar with white vinegar
Pour in plain kombucha
Rinse hands with white vinegar and handle Scoby gently into jar
Cover with cloth and place rubber band around
Set aside in dark, cool location while preparing tea
Boil 1 gallon of distilled water
Once boiling add 8 bags of Organic tea
Stir in 1 cup of sugar
Let cool to room temperature (too warm and it will kill scoby)
Pour into gallon jar
Recover and place in dark, cool location
May want to mark date brewed
Ferment for 7 days
Funnel to glass pint mason jars
Cover with lid
Refrigerate until ready to drink
OPTIONAL 2ND FERMENT
After funneling into glass mason jars add several small pieces of fruit/spice of choice
Cover with lid and place back in dark, cool location
Let sit for 3 more days
Be sure to refrigerate to cool before opening to avoid rupture of glass due to carbonation
*We have found 4-5 chunks of pineapple in 2nd ferment to be our favorite. Other suggested fruits: papaya pulp, guava pulp, mango, apple, raspberry, prunes, chia seeds. Give it a try!
*First ferment can last up to a month but 7-14 days is best
*Scoby will regenerate on it’s own in which case you can split and share with a friend or start another batch
*After 1st ferment, may choose to have continuous Kombucha to just ladle out on counter
*Whenever touching scoby use vinegar to rinse hands. Make sure ladle and funnel are clean also
*Mini scoby may form in second ferment. This is normal and actually ok to consume!
We are very excited to announce the arrival of our fourth son, Maclin Kyle Boland. Maclin entered our home late in the afternoon on January 27th, weighing 9 lbs. 6 0z. and measuring 22 inches long.
We feel beyond blessed to have another beautiful baby boy in our lives and Maclin’s older brothers are completely in love.
Maclin’s birth story will be posted on BIRTHFIT Wisconsin Facebook page later this weekend or early next week as we relax as a family of SIX!
“Can I be BirthFIT?”
This is a question I recently received from a patient that is a few years, instead of few months postpartum. The answer to that question is, “YES!”
Ideally, women start preparing to be BirthFIT before conception and pregnancy by staying active, eating healthy, hydrating and working on mindfulness and emotional well being. The postpartum series is targeted at women 2 weeks-6 months postpartum. This is simply because this is also the ideal time to heal your body and mind after birth. However, there is no time limit on when that can occur! The fitness portion of the postpartum series emphasizes the strength and improvement of the core. This includes the diaphragm, all abdominal musculature and the pelvic floor. Your core is your powerhouse and proper function sets you up for proper movement patterns and easier transition into or back to fitness. It is never too late to address this!
As women there are many things thought of as some sort of “right of passage” coming with giving birth and aging. This is absurd! Below is a list of just a few issues that are “common but not normal” (and certainly not a badge of honor as a woman) that may develop with improper core function (and can be helped).
Diastasis of rectus abdominis (a split in centerline of abdomen)
Decreased diaphragm breathing
Stress or urge urinary/bowel incontinence
Abdominal trigger points/pain
Frequent or recurring injury during exercise due to decreased activation of the core in unison
As stated previously, it is NEVER too late to become BirthFIT! Do not accept these issues as something normal to deal with. Seek assessment from your local chiropractor and contact your local BirthFIT affiliate!
Please watch for corresponding video to come on Coulee Health’s Facebook page.
Follow Dr. Erica on Twitter and Instagram: @EMomDC