Doctor — Babylicious by Figur8

Post-Partum: 6 Week Follow Up and Separated Muscles

January 11, 2010 by Shen-Li 4 Comments

I had my six week post-partum follow up with Dr Wong last week. Everything checked out okay. My uterus is back to its original size and position – damn, so my excess belly has nothing to do with the uterus and is just excess flab left over from the pregnancy? Perhaps I should have gone for the urut sessions my MIL suggested after all.

Aside from the belly, I’m still 7 kgs above my pre-pregnancy weight – pre-Gareth weight as opposed to pre-Gavin weight, of which, I am 12 kgs over. Personally, I’ve stopped caring about how much I weigh, but I do care about the fact that there is still nothing I can wear in my closet that doesn’t make me look like I’m still pregnant. I’m pretty sure that by this time after Gavin’s delivery, I was looking pretty decent in my old clothes. Since I didn’t go for the urut sessions like I should have, my only hope now is to start exercising again.

There is are two muscles (rectus abdominis) that encase the abdomen on either side of the belly button. During pregnancy, these muscles can become separated to allow for expansion of the belly to accommodate the growing foetus. As far as I remember from my post-natal workouts at Fitfor2 with Gavin, you are supposed to wait until the gap closes before engaging in the more strenuous abdominal workouts or you could risk causing a hernia. The instructors at Fitfor2 would always check the gap in all postnatal mothers exercising for the first time.

Since I’m not sure if I’ll be going back to Fitfor2 for a while, I thought I’d better check with Dr Wong regarding my abdominal muscles. Although you can still exercise, there are certain exercises you have to be careful about. I wasn’t sure how to check the gap myself, so I asked Dr Wong.

The way to feel for the gap between your rectus abdominis is to lie down on your back and lift your head off the ground. Place your palm against your belly around the belly button area and feel for the gap between two firm ridges. Alternatively, you can follow the more detailed instructions from BeFitMom:

Lie on your back with your knees bent, and the soles of your feet on the floor.
Place one hand behind your head, and the other hand on your abdomen, with your fingertips across your midline—parallel with your waistline— at the level of your belly button.
With your abdominal wall relaxed, gently press your fingertips into your abdomen.
Roll your upper body off the floor into a “crunch,” making sure that your ribcage moves closer to your pelvis.
Move your fingertips back and forth across your midline, feeling for the right and left sides of your Rectus Abdominis muscle.

My gap is about the width of my palm – which explains why my belly is still protruding so much because a small mound protruding at your midline is one of the signs of a separated rectus abdominis. Generally anything greater than two and half finger widths is considered a separation.

So what are the dos and don’ts if you have a separated rectus abdominis?

Avoid any exercises or activities that place stress on your midline, and that stretch or overly expand the abdominal wall.
When exercising, avoid movements where the upper body twists and the arm on that side reaches backward, such as during a tennis serve.
Avoid exercises that require lying backward over a large exercise ball.
Avoid yoga postures that stretch the abs, such as “cow pose,” “up-dog,” all backbends, and “belly breathing.”
Avoid traditional abdominal exercises that work the exterior abdominal muscles, such as crunches and oblique curls.
Avoid all exercises that cause your abdominal wall to bulge out upon exertion.
Avoid rising from a supine position by rolling up and twisting at the same time. Instead, roll first onto your side, and then use your arms to help push yourself up to a sitting position.
Avoid lifting and carrying very heavy objects (according to Dr Wong, the heaviest thing you should carry is your baby – oops! I’ve been carrying Gavin around and more).
Avoid intense coughing while your muscles are unsupported – again oops. To support your muscles when coughing, place your hands across your belly and manually splint your abdomen together during coughing episodes. This will provide needed additional support, and prevent further separation of your midline.

Oh dear, oh dear, oh dear… Looks like it’s a good thing I checked all this up because I’ve been breaking all the rules playing games with Gavin – swinging him around, carrying him, etc.

There are exercises that you can do to help speed up midline closure. Ideally, you should start on these as soon as possible after the delivery. According to BeFitMom, if you wait longer than six months, it is unlikely that you will be able to close the gap. Looks like it’s time for me to get started…

Next post: Getting started on postnatal exercises.

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Filed Under: health, medical, Postnatal Tagged With: Doctor, follow up, Postnatal

2nd Pregnancy: 8th Visit to the Doctor

November 9, 2009 by Shen-Li 16 Comments

I had my eighth visit to Dr Wong on Friday. Vital statistics were good:

Blood pressure 110/70
Urine clear
Weight gained was not so good – 3.5kgs since the last appointment. Gosh I wonder how that happened? *eyes wide with innocence* Seriously though, I did think I was relatively well-behaved.
Baby’s weight: 3.4kg

Ironically, Dr Wong’s palpation of my stomach seemed to suggest that Gareth was not that large, although the scans estimated him to be larger. If we follow the estimations based on Gavin’s pre and post birth weight, it would seem that the scans are also under-predicting because Gavin was estimated to be about 3.8kg, yet he was born 4kg. So based on Gareth’s estimated weight, Dr Wong suggested we should start the induction process in two weeks time – which should be about a week ahead of the predicted delivery time.

Personally, I wouldn’t have minded if Dr Wong recommended inducing as early as next week after a rather traumatic week of pain. That said, the back pain and groin pain seems to have subsided somewhat over the weekend and I’m wondering if all my spring cleaning might have had something to do with aggravating it. Additionally, it has been a rather quiet weekend for us – no going out, no shopping, basically no gallivanting of any sort.

On the flip side, the nipple pain from nursing seems to have escalated to a whole new level – just as my BFF warned. Dang! There I was counting my blessings that I didn’t have it quite as bad, but now even I get shirty with Gavin during our nursing sessions because it feels like he’s perpetually biting me. My mantra has become – “two more weeks”…

Okay, I’m digressing… It appears that the problems and risks associated with large babies aren’t only due to the increased likelihood of requiring a caesarean, but there is also increased risk of birth trauma. I suppose that was a fact that goes without saying since babies born to mothers with gestational diabetes are also large and prone to increased birth trauma, jaundice, etc. If those risks are related to a large baby, then it is only to be expected that the risks are the same for every large baby regardless of mother’s diabetic status or lack of.

So if all goes according to plan, I should be delivering Gareth sometime after November 20 instead of November 29. That is, as long as Gareth doesn’t decide to come out earlier. In the mean time, I’ll be busy packing my bags. Wish me luck.

Filed Under: medical, Pregnancy Tagged With: developments, Doctor, Pregnancy

2nd Pregnancy: 7th Visit to the Doctor

October 17, 2009 by Shen-Li Leave a Comment

As “D” day approaches, we’re now down to fortnightly appointments. The good news is that the results of my fasting blood glucose tolerance test came through with flying colours. Not only do I not have gestational diabetes, but my blood glucose levels are excellent. Great! Looks like I’ll still be able to taste test for The Haute Food Co.

In anticipation of bad news from the doctor, I started exercising and restricting my diet (a tad – I won’t go so far as to say that I was really good, just a little better). It seems to have helped. I only put on one kilogram over the last two weeks which is considered an acceptable weight gain and not excessive.

Gareth, however, remains a large baby. He is still about two weeks advanced in size compared to the average-sized baby at this stage of development. He also currently weighs about 2.75 kg and appears to be larger than Gavin at this stage of development. If he continues at this rate of growth, we might be looking at an early induction (as in before the due date) to minimise the trauma of delivery.

As it stands, we know I can deliver a 4kg baby through vaginal delivery so we can still afford to wait. However, as I recall, it was quite a strain. The thought of delivering an even larger baby is seriously worrying me. If we’re going to have to induce anyway, I figure it will be better to induce Gareth earlier while he’s smaller.

The levels of my amniotic fluid seem to be back to normal range. My health checks are all good – BP 110/70 and urine clear.

Symptoms – it appears I have developed sciatica which is basically nerve pain due to compression of the sciatic nerve that runs from the back down the back of the legs. According to Baby Center, the pain experienced during pregnancy is not sciatica but another similar problem called Pelvic Girdle Pain.

My experience was rather brief and occurred while I was lying in bed and shifting positions. It felt like a shooting pain that ran from my behind down the back of my legs. Based on this description, it sounds a lot like pelvic girdle pain. The pain was not severe and it has only happened a couple of times, so I guess we’ll monitor it to see how it goes.

Baby Center recommends the following to help reduce the occurrence of PGP:

Avoid pushing through any pain. If something hurts, if possible don’t do it. If this type of pain is allowed to flare up, it can take a long time to settle back down again.
Move little and often. You may not feel the effects of what you are doing until later in the day or after you have gone to bed.
Rest regularly, either by lying on your side or sitting upright with your back arched and well supported.
If you find turning over in bed becomes very painful, try sitting up directly from lying on your back. This actually moves your pelvis from an unstable position to a stable, ‘locked’ position. You may find this difficult to do as your bump grows bigger. If you do manage it, it is likely to cause far less pain. Arch your back and tighten your pelvic floor and lower tummy muscles before moving.
When you are walking, arch your back (by sticking your chest and bottom out) and swing your arms as though you are marching. This locks your pelvis in a stable position and activates the muscles responsible for stiffening your pelvic joints.
Avoid lying on your back or sitting slumped, particularly with your legs straight (with your feet up on the sofa or in the bath). If you do have to lie on your back, place a rolled towel under your back, at waist level in order to support your back.
Avoid heavy lifting or pushing (supermarket trolleys can be particularly painful).
When dressing, sit down to put on clothing such as your knickers or trousers. Pull the clothing over your feet and then stand up to pull them up. Don’t try to put your legs into trousers, skirts or knickers whilst standing.
Sometimes sleeping on a softer surface can help. Try placing a duvet under your sheet.
Performing regular pelvic floor exercises and lower abdominal exercises can help to reduce the strain of the pregnancy on your back. To perform a safe and easy lower abdominal exercise, get down onto your hands and knees and level your back so that it is roughly flat. Breathe in and then as you breathe out, perform a pelvic floor exercise and at the same time pull your belly button in and up. Hold this contraction for 5-10 seconds without holding your breath and without moving your back. Relax the muscles slowly at the end of the exercise.

Personally, I did notice an improvement in both back pain and any funny twinges that occur while moving in bed when I did the Pregalates exercises. Although the pain doesn’t go away entirely, it certainly made the difference between having to grunt through the pain while shifting positions in bed and being able to move with a minimum of discomfort.

Interestingly, I didn’t find myself getting quite as much relief from the pain when I did the Yoga Zone Postures for Pregnancy. I don’t know whether Pilates just worked better for me, or if the Pilates exercises in Pregalates were more appropriate for dealing with the discomforts I experienced or if Pilates really is better for dealing with pregnancy discomforts. Nevertheless, I did buy another Yoga DVD called Yoga During and After Pregnancy by Avneesh Tiwari. I haven’t tried it yet, but I’ll let you know how it goes.