Why Aren't We Talking About Pre-Baby Bodies?

Six days after giving birth, I emailed my Pilates instructor: “Let me know when I can come back and see you!” She told me to wait five weeks.

Looking back, I realize how completely unrealistic that expectation was — it was too early for me to be opening this conversation, as my body was still healing from labor and delivery. But staring down at my post-pregnancy belly, in shock over how stretched and open my skin and muscles looked, I knew something wasn’t right. I understood why it was too early to start exercising, but I was also left with the feeling that it was too late. Why, I asked myself, hadn’t I better prepared my body before I got pregnant?

A 2015 study from the University of Michigan compared giving birth to running a Marathon in the way that it taxes the body for hours upon hours at a time. The difference? We train for marathons. Should we be training for childbirth?

I thought I had prepared. I applied oils and creams to stave off stretch marks, and I did some prenatal yoga and Pilates. But the conversations and thought processes surrounding these practices all had to do with looks: bouncing back, losing weight. And anyway, I was prepared to own my post-baby body — with a new baby, surely I'd have much more urgent priorities than a weight change.

By 36 weeks pregnant, I wasn't feeling so strong. Walking had become difficult. I had slipped on some late-November ice and was in excruciating pain. Every step felt like being stabbed in the vagina with a sharp knife. An ultrasound confirmed my baby was fine, which of course I was grateful and relieved about. But...what about me? "It's almost over," was my Ob's only response.

At the suggestion of my doula, I went to a physical therapist and was told I had pubic symphysis dysfunction, or pelvic girdle pain. It's been nearly three years since that appointment and I'm still dealing with pain relating to my pelvic floor. My experience isn't that unique. A 2015 study of more than 1,200 women in the British Journal of Obstetrics and Gynaecology reported that 24% of women were still experiencing pain during sex a year and half after having a baby.

“We always tell clients who are thinking about getting pregnant, the more they prep beforehand, the better transition they are going to have,” says Natalia Hailes, DONA certified doula and cofounder of Brilliant Bodies. “It's almost too late to start thinking about it once you're in it. And the truth is, we see a big difference in outcomes for childbirth and the postpartum recovery when people have taken the time to prep.”

Many experts who focus on the pelvic floor and the musculoskeletal system believe injuries like mine are preventable, if only we prepare our bodies more — and earlier — for pregnancy and delivery. Ahead, let's dive into what that can look like.

We have to change the conversation.

A different conversation around pregnancy and the body — one that focuses on physical well being over appearance — is a good place to start. When I was pregnant, I read the articles and books, I went to classes and doctors. And after all this, I had absorbed tons of information about appearance and weight gain during pregnancy. And then there was an abundance of advice around “bouncing back,” dropping pounds, and returning to exercise and sex. (I've yet to meet anyone who puts those two things on the top of their list of concerns post-delivery.)

When it came to useful advice around healing physically after childbirth: crickets. This information was, by far, tougher and more expensive to get my hands on. It was as if I should've already known what was going to happen, and protected against it.

“One of the things we try to do through our practice is help people understand what to expect during the entire perinatal period,” explains Hailes. “The reality is that pregnancy has a big impact in our bodies, and lots of things can change postpartum in ways that often surprise people. We get asked all the time: ‘Why didn't anyone tell me about this? Why didn't I know I would pee every time I laugh? How come sex is painful now?’ So getting educated is key.”

And much of that education starts with understanding your own anatomy, and recognizing it's not exactly your doctor's job to teach you about it. “I think there’s a lack of education in general given to women about the musculoskeletal changes that happen in pregnancy,” says Stephanie Prendergast, NPP and cofounder of the Pelvic Health and Rehabilitation Center in California. “This focus often doesn't fit into what an Ob practices. It’s not their territory or a routine part of their care, so it just gets completely overlooked.”

Bouncing back is beside the point.

After giving birth, I developed diastasis recti, in which the abdominal muscles separate, leaving a 2.7-centimeter-or-larger gap. If you finger the softness in between the two sides of your ribcage, it's kind of like that, but down the front of your belly where a baby bump would have been. And it looks like a permanent pooch. It's something 37% of people who have a single pregnancy and 67% of people who have more than one experience; I had only heard of it in prenatal Pilates.

“I probably had diastasis during and after my second pregnancy, but I was only diagnosed with it after my third pregnancy,” says Renanit Levy. The mother of three struggled to figure out what was going on with her body between and after having kids. She had been cleared by a physical trainer to start practicing yoga again after that third birth, which she was excited to get back into, but soon enough her abdominal separation returned.

“By the time I realized I had a problem,” she says, it felt like it was too late. She later founded Brooklyn Postpartum to help others navigate the confusion, and she's working with two Pilates instructors to "try to heal for real." It's almost as if the external preoccupation with how we look after childbirth gets in the way of caring for how we feel.

A University of Calgary study found that one year postpartum, 77% of women experience back pain, almost 50% experience urinary incontinence, and 40% experience both. And yet fitting back into some skinny jeans seems to be the post-birth goal we're most expected to keep our eyes on. Angela Vinturache, MD, PhD, a consultant Ob/Gyn who co-authored the study, told U.S. News that many women falsely believe “the body will return, relatively quickly, to the status prior to pregnancy.”

That's simply not always the case. Liz*, 36, learned after trying to get back into fitness postpartum that she had developed urinary incontinence. “I tried to ease back into running,” she reveals. “But the couple times I did any running quickly ended with pee trickling down my leg. It took me a while to learn the anatomy piece of this, and how all of this stuff fits together.”

“Most people,” explains Hailes, “get pregnant without even having a basic understanding of what to expect during labor and birth.”

Abs matter — but it's not about seeing a six-pack.

These issues are rarely discussed in prenatal classes, as Prendergast points out. And then there’s the obvious shortcoming that, by the time you’re in prenatal class, you are already pregnant.

“It takes 10 months to grow a baby,” says Lisa Schoenholt, a certified prenatal and postnatal Pilates specialist and founder of Brooklyn Embodied (where she helped me close my diastasis). “Give yourself six to 10 months to get your body ready.”

As part of that preparation, Schoenholt recommends working to “balance the four layers of the abdominal wall.” She adds, “It’s important to be able to engage each layer, with special attention to engaging transverse abs.” These are deep-layer front and side muscles that help compress the organs and support the pelvis and back. (Wonder what that could be used for!)

Even if you’re someone who looks physically fit and exercises regularly, you may need to reevaluate your approach to fitness when planning for pregnancy. Those with many years of breathing-intense yoga practices and people with six-pack abs aren't necessarily preparing the right body parts for action. “The outermost abdominal layer is the rectus abdominis, which is what you would consider the six pack,” Schoenholt explains. “But if you only have that strong outer layer and can't engage your transverse abs, there is no support during pregnancy. You need to strengthen from the inside out.”

Schoenholt regularly treats postpartum women for issues like back pain, diastasis recti, pubic symphysis derangement, and pelvic floor dysfunction, which causes an inability to control bowel muscles. These all sound like the kind of medical issues you'd consult your doctor about — and you should — but don't end the conversation there. “Doctors are looking out mostly for the health of the baby and the health of the mother, but these issues are about the mother's body. Mom’s physical well-being tends to fall out of focus,” she says.

Which is why, prior to getting pregnant, it can help to seek out the types of specialists that will fill in the gaps left by general obstetric care.

Get to know your pelvic floor.

Jacques Moritz, MD, associate professor of clinical obstetrics and gynecology at Weill Cornell Medicine, says the U.S. lags behind other developed countries when it comes to dealing with the ways women’s bodies change during pregnancy and after delivery. “In most European countries, it is mandatory to have 10 ‘re-education’ sessions of the pelvic muscles after delivery. In this country there is zero focus on the pelvic muscle. Most women are told to go do some kegel exercises, without being taught how to do kegels properly.”

In the absence of any functional post-natal care, an empowered would-be parent should consider their options before becoming pregnant, and try to get their body ready. “Once you're pregnant, there's already too much going on and often not enough time to prep physically and emotionally,” says Hailes. And after the baby comes, forget it. “Instead of trying to find help while tending to your swollen breasts,” she recommends spending those pre-baby months lining up the right support people who can jump in when healing gets weird.

“We always recommend people see a pelvic floor therapist prior to getting pregnant,” agrees Ashley Spivak, DONA-certified doula and Hailes’ Brilliant Bodies cofounder. There, you'd get a personalized assessment of your pelvic floor, and learn exercises for it. "There is such an emphasis on kegels, but the pelvic floor is multi-dimensional,” she adds.

And while many obstetricians will give you the greenlight to work out during pregnancy (generally, exercise during pregnancy isn’t harmful to the baby), it's not the best time for intense running, CrossFit, or deep-stretching yoga, says Schoenholt.

“I'm all about being really gentle with the body while pregnant,” she adds. “I wouldn't do any classes that really push the body.” And just so it's ultra-clear: This doesn't mean exercise is a bad idea. It means it's a really good idea — starting before you even get pregnant.

When you're ready for change, there's no reason to be afraid.

During the months after having my first baby, walking more than 10 blocks was difficult. There was a constant, sharp pain in my pelvis, and my low back was often sore. I was far less concerned about losing a few pounds and increasingly worried that I would never feel better. Even more worrisome was the fact that it felt like I just had to deal with my new status quo; I was alone with it.

“We have romanticized being pregnant and having a baby. No one wants to dwell on the post-delivery issues,” Dr. Moritz cautions.

But there’s a difference between dwelling and being honest. Perhaps, rather than suffering and peeing our pants and shrugging off a worrying chronic pain, there could be a path to empowerment around our bodies. Maybe we could talk about our “baby bodies” — before, during, after — as just our bodies. Ideally, we could push the conversation beyond how we look and refocus on how we feel and function.

“It might feel weird to gain or lose weight, to see your boobs and nipples grow, to get stretch marks, to lose bladder control, or to dread sex because it hurts,” Hailes says.

However, she adds, “Our bodies got us. They are brilliant and resilient and full of surprises. It's important for people to feel good in their bodies before pregnancy and to be ready for that relationship to change while we grow babies and recover from childbirth.”

The more we know, she says, “the better and easier transitions we will have.” And parenting, it turns out, is all about working through transitions.