The Women's Journal

5 Things Everyone Should Address Postpartum

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By Dr. Janelle Antonio, PT, DPT, CLT

You’ve had your 6-week wellness visit, got the go ahead to return to life and exercise, but where do you start?

Guidance is commonly to go slow, but there are actually specific things you should know! Breathwork, alignment, how to start abdominal exercises, what our hips need, and how to have a healthy pelvic floor should all be talked about in the 4th Trimester!

Sometimes our body speaks loudly to us with pain, urinary leakage, or an ab separation, and your practitioner encourages physical therapy. Other times, when these aren’t present, we can feel disconnected with our body.

You don’t need intense exercise in order to make a big impact on how you feel. Something as simple as breathing can make a big difference in pain and leakage symptoms! This is because the way we breathe directly impacts our pelvic floor muscles. Our diaphragm and pelvic floor are made to contract and relax together. When we cough, sneeze or laugh, these are pretty forceful exhales, and this is why the diaphragm and pelvic floor work in harmony. Our breath pattern can change as we go through pregnancy, so it’s one of the first things we want to address in postpartum months.

Our bodies adapt beautifully to make more room for our babies. Sometimes these changes naturally reverse back, and sometimes our body needs guidance. If the alignment of our ribs and pelvis stay wide, it can make it hard for your abdominals to work. Can you imagine doing bicep curls with your arm way behind you and the bicep on a stretch when working? Abdominals feel the same way, it’s really hard for them to work if the bones they attach to are not optimally aligned. Improving your alignment and mobility before strengthening will make your exercises more effective!

A big question is always what ab exercises to start with, and yes it matters! Working on your lower abs before others, is a key component to healing. These muscles play an important role in pelvic and low back stability, healing ab separations and having a healthy pelvic floor. Pushing yourself too fast or trying to do exercises that your body isn’t ready for though, can make ab separation and pelvic floor issues worse, even if it wasn’t that bad to start with. Take it slow and remember that just because you can do something, doesn’t mean you should.

Now let’s talk about your hips! As posture changes in pregnancy, weight shifts forward. This makes muscles work differently to hold us up and to move. Sometimes certain muscles start overworking, and others don’t work as much. Postpartum exercises can be similar to what you did before pregnancy but they should be done with a different intention. A visualization, foot placement or a thought to cue into a certain area, can drastically change how an exercise helps you.

Now to the pelvic floor! I commonly hear, “When I cough or sneeze, I have a little bit of leakage, will I be okay if I just do some Kegels?” Try to avoid this! Too many Kegels can result in increased tone of your pelvic floor and then these muscles can’t work very well for you. Learning how to relax the pelvic floor is just as important as contracting. Picture a trampoline, you want it to be able to relax downward so it can spring up and contract for you when needed.

Your postpartum recovery can be just as unique as your birth story. Meeting with a physical therapist that specializes in postpartum care is highly recommended. Small group classes can also be a great place to start for those that may not have specific symptoms, but are feeling disconnected from their body and/or have questions on where to start.


Dr. Janelle Antonio is the owner of Lotus Rehabilitation, and has built a practice around helping women to feel in control of their bodies, and to feel their best. She offers one-on-one physical therapy sessions and postpartum classes for new mothers. She was born and raised in Delaware, and obtained both her undergraduate and Doctorate of Physical Therapy degrees at the University of Delaware. In 2009 she obtained her board certification in orthopedics. She is also a Certified Lymphedema Therapist and a Prenatal and Postpartum Corrective Exercise Specialist.

Her areas of specialization include but are not limited to: pelvic floor therapy, prenatal and postpartum care; Lymphedema management and rehabilitation of patients undergoing treatments for breast and H&N cancers; lymphatic drainage and rehab after liposuction and cosmetic procedures.       302-598-8592

226 West Park Place, Suite 12, Newark, DE 19711

Services Include:

•Rehabilitation and lymphatic drainage post cancer treatments

•Pelvic floor therapy

•Pregnancy and postpartum therapy

•Lymphatic drainage after cosmetic surgery

Postpartum Small Group Class:

(weekly one-hour for 4 weeks; 3-month online access to exercises)