Pregnancy and postnatal abdominal bracing
Learning to brace or actively contract (i.e. gently and accurately tightening) your abdominal muscles is important during pregnancy. Bracing will help you keep your muscles toned so they can support your baby and reduce the strain on your back. Strengthening your abdominal muscles this way during pregnancy will make it easier for you to regain your muscle strength and tone after your baby is born. Pregnancy and postnatal abdominal bracing can be done as an exercise and also used in your day to day life.
Pregnancy abdominal bracing
It is not suitable for you to continue with traditional abdominal exercises such as sit ups and curl ups while you are pregnant. Many of these exercises mainly work the outer abdominal muscles and can also put downward pressure on the pelvic floor muscles, which may cause them to weaken. After the birth, strengthen your pelvic floor with your lower abdominal muscles first, so that it can hold as you lift, before resuming sit ups and curl ups.
Bracing involves contracting your deep abdominal muscles by gently drawing in the abdominal muscles below your belly button toward your spine and up slightly, holding this position for as long as you comfortably can.
Many women do not brace correctly, often pulling in the muscles too hard while also holding their breath, so it’s a good idea to check your technique against the following tips.
- Lifting your pelvic floor first can help you to connect to your lower and deeper abdominal muscles, as they are ‘wired’ together. When they are working well, you will feel your pelvic floor lift and the abdominal area below your belly button draw in.
- Aim to do this without holding your breath. Stop if you hold your breath – this means that you are pulling in too hard and need to refocus and practice the more gentle technique.
- You are aiming to feel the lower half of your abdominal muscles (below the belly button) contract. You should not feel that you are sucking in the muscles under your ribcage, otherwise you are mainly working your upper abdominal muscles.
- Feeling downward pressure on your pelvic floor muscles means that your technique is incorrect and you should seek further advice.
- If you find it hard to feel your pelvic floor and lower abdominal muscles working together, do them as separate exercises.
- You should feel no pain or discomfort while bracing.
- If you are still unsure, have your technique checked with a continence professional.
As your baby grows, your abdominal muscles need to hold and support extra weight. In particular, the lower abdominal muscles need more attention as your pregnancy progresses. To focus more on the lower muscles, place your hand on your abdomen, below your belly-button. Gently pull your abdominal muscles away from your hand. If this stops or changes your breathing, you are trying too hard and you should stop and start again more gently, so you can hold in your muscles as you breathe.
Bracing can be done sitting, standing, on hands and knees or lying on your side. Many women in the later stages of pregnancy find the hands and knees position allows them to more easily feel their muscles working.
Once you have mastered the technique, bracing exercises can be done easily in any position and during daily activities. This means you can do it many times a day without setting time aside to exercise.
Once you are able to brace or actively contract the muscles for 3–4 seconds, aim for 3–4 repeats. Increase to 5-second holds repeated 5 times, building up to 10 seconds, repeated 10 times.
Once you have built to this level, you can increase your hold time, bracing for as long as comfortable during daily activities such as standing in a queue, doing the dishes, getting up from a chair, rolling over in bed, walking, pushing a shopping trolley and lifting.
Postnatal abdominal bracing
Start by drawing in the muscles as soon as you are comfortable, within the first few days after the birth. Ensure that you focus on the lower half of your abdominal muscles, as outlined for pregnancy abdominal bracing. Some women find this is easy to do and are able to draw up their pelvic floor muscles at the same time. Others find that they need to stop and concentrate on abdominal bracing and pelvic floor muscle exercises separately. Use the method that works best for you and check your technique with a midwife or the physiotherapist who visits you on the maternity ward. Women who have had a caesarean section can gently draw in the muscles for support when they move, and start using bracing as an exercise within 4–5 days after the birth.
Initially, it may be easier to do abdominal bracing exercises while you are lying on your side, sitting (including when you are holding your baby) or standing. As it becomes easier to brace your abdominal muscles, you can draw them in while pushing the pram, lifting or changing the baby, hanging out the washing or grocery shopping.
Seek advice from your doctor or health professional if you feel any discomfort while doing this exercise.
Bracing your abdominal muscles as an exercise can be progressed and made steadily more challenging as you improve. Focus first on holding in your muscles during daily activities and increasing the hold time to at least 10 seconds. As this becomes easier and you build on your hold time, you will be ready to progress to other exercises that will further tone your abdominal muscles and improve muscle control and strength around the pelvis and spine.
One exercise that places minimal strain on your back is to sit on a chair, bracing your abdominal and pelvic floor muscles as you slowly lift one leg (not too high). Try not to move your hips or body and be sure that you feel no downward strain on your pelvic floor. Breathe normally as you do this, and then lower.
Build up to 10 repetitions on each side, making sure you do each one well.
There are many progressions of postnatal abdominal muscle exercises, so carefully consider the program you choose to follow. By progressing too quickly or missing out on the correct stages of progression, you may be left with an underlying weakness in the deeper abdominal muscles and hence, less low back support during exercise. Progressing too quickly or doing the wrong exercises can also place downward pressure on your pelvic floor muscles.
You should feel you have control over holding and maintaining your abdominal brace throughout any abdominal exercise. If you feel any strain on your back, pelvic floor or abdominal area, the exercise is too hard for you at that stage. Abdominal muscle exercises should not cause bulging of your abdominal wall.
Returning to your normal shape after the birth may take time and effort. Your abdominal muscles have been stretched for months during pregnancy. Weak abdominal muscles can contribute to the development of back pain. Weakened abdominal muscles, combined with returning to sport or your usual exercise program too soon, increases your risk of developing back or pelvic pain.
It is worth taking the time to learn how to prevent back and pelvic pain after your pregnancy. Imagine the difficulty you would have in caring for your newborn baby with a back injury! Seek help from a health professional if you have back or pelvic pain as this can also interfere with your pelvic floor function.
Reproduced with kind permission from The Pregnancy Centre