What is the best exercise to perform during pregnancy and postpartum?

Breathing.

Say what?! Your breath is a powerful tool, and one you can use to stabilize and support your body throughout your daily movement and exercise. Breathing is also key for managing intra-abdominal pressure, building strength (from the inside out), and managing pelvic floor symptoms and stress.

Most of us don’t think twice about how we breathe because it happens all day long, around 20,000+ times daily. But, tuning in to where air travels in our body and the duration of our inhales and exhales can have huge impacts on our athletic performance, daily life, and healing timeline postpartum.

 Inhales and Exhales

During a normal breath, the pelvic floor and diaphragm mirror one another.

Inhale —> Expansion

On an inhale, the diaphragm contracts and descends towards the pelvis, pushing pressure and our guts down. This downward movement increased pressure in the abdominal cavity. The pelvis responds to receive this increase in pressure by opening into external rotation (like a flower).

The ribcage should expand 360 degrees. An umbrella opening and closing is a helpful visual since an umbrella opens in a 360-degree fashion.

 In response, the pelvic floor eccentrically lengthens and descends. Think of the pelvic floor like a trampoline, lowering towards the ground, but getting ready to spring back up. The abdominal muscles lengthen and expand outwards slightly.

 Exhale —> Compression

 On exhale, everything reverses. The diaphragm and pelvic floor rise and the abdominal wall contracts inwards. The system is in constant motion as you inhale and exhale all day long.

Pregnancy Shifts this Coordinated System

Pregnancy tends to make the pattern described above a bit challenging. As the baby grows and the diaphragm becomes squished, breathing can become more difficult. The ribs flare to make space for added abdominal contents (hi baby) and pressure, which makes it more challenging for the diaphragm to ascend back up on exhalation.

When the coordination between our inner core muscles is disrupted, we may start to see symptoms arise, such as leaking, lower back pain, and diastasis recti. These are, in essence, a pressure management “leak.”

Learning how to breathe, manage pressure, and coordinate this system is key during pregnancy and returning to exercise postpartum.

Let’s Practice Breathing

Settle in to a comfortable position. I often find side lying or supine (on your back) to be a great place to start. Rest your head on a pillow to keep your neck muscles calm and close your eyes.

Inhales are soft, controlled, and through the nose. Sense your back, sides, and chest inflating with air. Think belly first, then chest.

Inhales should be soft and quiet. Go for a 3-4 second count.

You can place your hands on your rib cage for feedback or use a small band or scarf gently around the rib cage to feel grounded into the floor. Send air into the band with your inhalation.

Exhale audibly out the mouth. Softly for a 4-8 second count. Envision a soft “haaa” exhalation like you are fogging up a mirror with your breath. Allow the ribs to gently melt towards the floor below you.

Putting it all together: Connection Breath 

The Connection Breath takes our breath one step further, integrating a pelvic floor contraction (kegel). Oftentimes with kegels there is a big focus on generating tension, but understanding how to release tension is just as important, both in pregnancy and postpartum. Practicing the connection breath will help you practice how to gain and release tension in the abdominals and pelvic floor, thereby helping regain tone throughout your entire core.

Special note: I highly recommend working with a Pelvic Floor Physical Therapist to get familiar with your pelvic floor and what a contraction and full release feel actually feel like.

How to perform the Connection Breath: The connection Breath can be done sitting or standing, lying on your back with knees bent, or side lying, which is typically where I like to start. I find it easier to feel the connection and expansion of the rib cage on the inhale breath. On the inhale, focus on your 360° degree umbrella breath, allowing your pelvic floor to fully relax and lengthen. On the exhale, think exhale from the bottom up (pelvic floor). I like to visualize the breath like a wave, traveling from my pelvis, to my hip bones, belly button, and all the way up to my ribcage and out the mouth. Inhales are through the nose, exhales are audible and out the mouth, like you’re fogging up a mirror or blowing out through a straw.

Jessie Mundell describes the full sensation using the terms: Scoop, Lift, and Pull. 

Scoop: On the exhale breath think of a scooping sensation in your pelvic floor, gaining tension from back to front (anus to pubic bone). On the inhale breath, relax and release the opposite direction, from front to back. 

Lift: Think of your Pelvic Floor as an elevator. On the exhale, find tension from the base of your pelvis to the crown of your head, slowly lifting up two floors, then release. Important: On your release focus on bringing yourself back to zero before restarting (ground floor). It can be common to stay at a level one or two, holding a bit of tension in the Pelvic Floor. Allow yourself to fully relax. Check out this post for tips on releasing pelvic floor tension.

Pull - Take a moment to find your hip bones on the front side of your body. Imagine there’s a wire connecting those two bony points together - the two sides of your pelvis. On the exhale breath feel those two bones pull close, feeling a sensation of the hip bones drawing together. You should feel a gentle pull in across the belly, and the skin should pull taut (like a trampoline) beneath your fingers. If you notice a bulge, reset. This may be a sign you are overdoing it. I like to incorporate the connection breath in a dynamic warm-up, but you can also practice throughout the week with 1-3 sets of 8-10 reps. You may find it’s pretty relaxing too :) 

I highly recommend practicing the connection breath in different positions to gradually increase challenge.

Supine or side lying —> seated —> half kneeling —> tall kneeling —> hands and knees —> standing

Explore different positions and incorporate your new breathing strategy to exercises in your workouts and daily life as a parent, such as picking up toys. Over time this becomes more automatic. The goal isn’t to think about our pelvic floor forever, but initially we can be a bit more intentional.

Considering the importance of breathing in our postpartum recovery, I also wanted to touch on common breathing mistakes.

The Three Most Common Breathing Mistakes

 1.     Belly Breathing

Belly breathing is primarily breathing OUT on the belly with very little ribcage expansion/movement.  Oftentimes people are taught that belly breathing and diaphragmatic breathing are the same thing, when in fact they are not. The lungs are situated higher up within the upper ribcage, not in your abdomen. While diaphragmatic breathing does include a slight expansion of the belly area, the primary focus should be on expansion of the chest and upper back.  

Belly breathing can have a significant impact on diastasis recti healing. If we are breathing out on the belly all day long, we may be putting a lot of additional pressure out on a healing abdominal wall. This can make healing more challenging.

Quick tip: Posterior expansion is a huge piece for diastasis healing, so each breath is more evenly distributed and not only moving FORWARD on the belly. Check out the breathing drills below.

 Belly and Chest Rise and Fall
The goal is to have expansion in both areas. Lie on your back, elevate your feet, and place one hand on your abdomen and one on your chest. Inhale for 3-4 second count and tune in to where you feel air travel. Do you only feel your chest expand? Belly only? A cue I learned from Aleena Kanner is “belly first, then chest.”

2.     Accessory Muscle Use / Breathing UP

In this scenario, individuals are utilizing muscles like the sternocleidomastoid or scalene (neck muscles) to PULL air in. You may also notice an arching of the back and elevation of the shoulders. This breathing pattern is very sympathetically driven – very stress/ fight or flight oriented. The problem too with relying on secondary respiratory muscles is that this is not the neck’s primary function.

Breathing UP and overusing the secondary muscles is often associated with a lot of neck and lower back tension and doesn’t give our diaphragm an opportunity to do its thing as the main breathing muscle.

3.     Inability to fully exhale

Many individuals only exhale half the amount they should. It’s not uncommon for me to say to clients, “keep exhaling, keep exhaling.” With a full exhalation we will see the lower ribs internally rotate (drop down). If we can get a good exhalation the diaphragm will ascend back up and get in a better position for the next inhale. Hard to take a good inhale when you’re not getting a good exhale.

A good rule of thumb is to think about exhaling longer than you inhale, which also taps into our parasympathetic nervous system.

 Breathing: What is the goal?

A more even distribution of breath, finding expansion in a 360 degree fashion. Belly first, then chest expansion, and upper rib cage movement side to side. When the ribs can expand our core system can function better!

Check out these social media posts for a visual and breakdown.

Breathing: a few things to look for

Mastering the breath using props

You can also check out this 4-Part Breathing Progression 

As a coach, I love to guide pregnant and postpartum clients on reestablishing the communication between the core/pelvic floor, learning how to breathe and expand into areas of compression, and bring these strategies into a strength training environment/workout.

Curious to see how this gets applied in training? I’d love to chat! I offer one-time fitness consultations (book HERE anytime), semi-private/group training, and personal training in San Diego + virtually, as well as DIY programs.

Feel good mama!

Xoxo,

Erica