Baby

Labor varies form woman to woman; even in the same woman labor each is different. Some labors are very fast, lasting only a few hours; some are average in length [about fifteen or sixteen hours for first time mothers and seven or eight hours for women who have had babies before]; some are very long, lasting a day or two. Some start slowly and then speed up unexpectedly; others start rapidly and then slow down. The amount of pain and fatigue varies also. It is best not to have definite expectations, but to prepare yourself for the wide range of possibilities.

Many factors play a part on how long and hard; labor will be. You can influence some of these factors but not others.

Factors Influencing Labor

Factors you cannot control

• Size and shape of your pelvis
• Size and shape of baby’s head and shoulders
• Baby’s station, presentation, and position*
• The condition of your cervix when contractions begin
• The power of your contractions
• The amount of rest you have between contractions
• Some aspects of your general health and your baby’s well-being

Factors you control, to some extent

• Your emotional state and attitude toward birth [anxiety, fear, and tension versus optimism, confidence, and relaxation]
• Presence of helpful, caring partner[s]
• Knowledge of what to expect
• An environment and professional staff that help you feel secure and well cared for
• Good care of yourself [including good nourishment and health habits]

* Station refers to how low the baby is in the pelvis.

Presentation refers to which part of the baby’s body will come first [usually it is the head, but on occasion it may be the buttocks, feet, or even a shoulder]

Position refers to location-on the right or left side of the mother-and the orientation-anterior [towards the mother's front], posterior [toward the mother's back], or transverse [lying crosswise]-of a given part of the baby, specifically, the occiput [back of the head], brow, chin, shoulder, or sacrum [the bone at the end of the spinal column]. For example, if the baby’s position is left occipitoanterior, the back of the head is on the left , pointing toward his mother’s front.

As you recognize your life to adjust to having a baby, do not forget your own requirement to have some time for yourself, however difficult it may be to schedule. You need private time to be a person in your own right and not only a parent, a homemaker, a spouse, and perhaps an employee. You need the time to build and maintain the self- esteem that makes you effective in all those roles and effective at being yourself. You need time to exercise, to groom yourself, to read, or to work on a hobby… or to look at sky or water and let your mind wander. Finding this time will probably never be easy for you again, but it will continue to be very important that you do find it. Always look on it not as a luxury or a reward, but as an obligation to yourself. You won’t always be able to have the hour or more that would do you the most good and be the most enjoyable, but you’ll find that even a few minutes snatched from a busy day will refresh you.

If you are a early riser, at your best in the morning, you may enjoy a few minutes of peace and privacy over a cup of coffee before the rest of the family is awake. Your baby’s daytime naps may give you some precious time. Even later, when you may not feel the need to sleep every time your baby does, nap time should be for you, not for housework. Evening is a wonderful time for a leisurely bath, even for a good read in a warm tub.

And evening is probably also the best time for a quiet hour or two for spouses. As important as it is for each to have some solitary time, it is equally necessary for a married couple to spend at least some time together alone.

* Hospitals and doctors vary on this. For some it is optional; others believe every woman and baby should have it. You will need to investigate the policies in your area.

Recovery time is very individualized. It depends on what kind of shape you were in before and during pregnancy, in addition to how much effort, effort, time, and planning you are now willing to give to your body. If your abdominals were strong and if you exercised them regularly before and throughout pregnancy, one to two months-at the most, three months-should see you back to normal.

On the other hand, if your abdominals were not strong and you did not exercise them regularly, then it will probably take between six and twelve months of regular exercise to become a better you. [These time frames assume that you are performing abdominal exercises four to six days a week.

What if you took up regular exercise for the first time in your life during pregnancy? This does give you something of a head start. However, the advancing growth of the baby did not allow as adequate workout of the abdominals as if you had also exercised before pregnancy. In this case, the return of strong, firm abdominals should take between three and six months [which is still much faster than someone who neglected to exercise in pregnancy].

If you never put into action your resolve to re-strengthen your abdominal wall, there is no telling how long the process will take. In fact, some women’s abdominals never return to their original shape. The truth is that it takes action on your part to improve your figure. A slack set of abdominals will probably mean you will have a lot of backache and fatigue.

The abdominals do forty percent of the work involved in supporting the trunk of your body as you move through your daily activities. If they are doing only ten percent, the back muscles will pick up the food-or attempt to anyway. The back muscles are responsible for sixty percent of the work of keeping the body upright and helping to lift, move and bend. Increase that workload by ten to thirty percent and the muscles respond by fatiguing faster ["tired back"], and by having painful spasms, especially in the lower back. Sometimes the back muscles become so tight that the angle of the normal pelvic tilt is changed. These tight muscles squeeze or press on the nerves coming off the spine in the lower back area. These nerves, in turn, divide and branch out to each leg. Pain may be felt in the lower back, one or both buttocks, and one or both legs, [upper or full length]. Don’t allow this problem to decrease the joy of those first beautiful months with your new baby.

Other factors to consider is estimating recovery time and how much weight you gained and how much your abdominal wall expanded [partially due to the size of the baby and how you carried the child]. Diet, the amount of rest you are currently getting, and the types of activities you’re involved in must also be considered.

After delivery, the abdominal muscles are always loose and soft. The abdomen looks and feels like gelatin, which can be quite a shock. It is important to check the linea alba between the rectus muscles for separation, called diastasis. The opening between the muscles may be slight or so large that the uterus or abdominal contents can be felt bulging through the opening.

Since there must be a good balance between back and abdominal muscles, a large diastasis will eventually cause backaches [and possibly radiating leg pain] jut from moving through the normal day’s activities of caring for an infant or managing a full-time job at or away from home. If no corrective attempts are made to close the opening, reestablishing muscle balance and strength, there will be little support for a subsequent pregnancy. Posture will be poor and many aches and pains will develop, all from lack of abdominal strength.

Check for diastasis on the third or fourth day after delivery. Until this time the area will feel too slack for you to get an indication of the state of the abdominals. Also, you will have had a few days worth of abdominal exercises to help improve your strength.

To check:

1. Lie on your back, with your bent. Place the fingers of one hand on your abdomen covering your navel [your fingers should point toward your pubic bone]. Apply firm pressure…
2. Inhale deeply. Then exhale slowly and at the same time lift your head and neck slowly. As you lift, you’ll feel each of the rectus muscles tighten and pull toward the center [toward your fingers].
3. Check to see how many fingers will fit in the gap. One or two finger widths are normal and to be expected, this will gradually decrease with exercise. Three or four finger widths will require special attention from you to repair and rebalance the muscles.
   Don’t hesitate to ask for help from a nurse [preferably a registered nurse] or your physician if you have difficulty checking your abdominals.

The following special exercise is very effective for closing a large diastasis. Raising just the head in this exercise ensures that only the rectus muscle will be activated. As they become stronger you will be able to lift your shoulders, thus working the other abdominal muscles, also, it is important to strengthen the rectus muscles first, thus ensuring their stabilization and alignment as the other muscles come into play.

Repeat this special exercise often, at least fifty times a day. To speed progress, do ten each hour you are awake. Remember to use slow, controlled movements, resting whenever you feel the need. The gap should be back to the normal half an inch within a week or so. If you do fewer repetitions than those recommended above, closing the gap will take longer.

Because the other abdominal muscles are attached to the rectus muscles and because the abdominals in general are week and out of balance, avoid the following exercises, which will serve only to increase the diastasis: [1] those rotating the trunk of the body. ["Waist twists"], [2] those twisting the hips, and, [3] those that cause the trunk to bend to the side ["waist or side stretches"].

If you breathe out while raising your head and shoulders, the intra-abdominal pressure will not be increased [as it would be if you held your breath.] Increased intra-abdominal pressure would just increase the diastasis which would defeat the whole purpose of the exercise and just add time to the muscle rehabilitation.

Do not let the abdominal muscles bulge. Tighten your abdomen at any time you strain.

Do at least fifty times a day.

1. Lie on your back with knees bent. Close your hands over the abdominal area so you will be able to pull the muscles toward the center of the abdomen as you slowly raise your head.
2. Take a deep breath. As you slowly exhale, lift your head [and later your shoulders, to a forty-five degree angle], at the same time pulling the muscles together with your hands. Return your head [and shoulders] to the bed or floor.

Much literature has been written on the benefits of aerobic exercise. The benefits we are most concerned with here are those specifically dealing with a new mother. Those benefits are increasing stamina and endurance-the ability to do more but feel les tired-and decreasing body fat.

Decreasing Body Fat

After delivery and with exercise, your body will slowly begin losing some of stored fat it laid down during pregnancy. How much you accumulated during the nine months depended on your percentage of body fat going into the pregnancy and the kinds and amounts of foods you ate during pregnancy. The leaner your body was, the less likely it is that you laid down large fat stores. Hereditary factors also come into play.

After delivery, the fat stores will gradually decrease over a period of four to six months. There are no miraculous changes that occur within the first six weeks, as many sources lead you to believe. You may notice a difference in your body during the first two weeks after delivery, when much of the accumulated pregnancy related fluids is lost through urination. After that, it’s up to you.

Breastfeeding women initially lose weight faster than women who bottle feed. However, because of the hormonal factors in operation throughout breastfeeding, their body fat level remains slightly higher, their breast tissue weighs more, and they retain a small amount of extra fluid beneath their skin as a reserve. As a result, breastfeeding women tend to weigh about three to seven pounds than their pre-pregnancy weight during breastfeeding, regardless of efforts of losing weight. Having taken that fact into consideration, if you still don’t seem to be losing the weight you expected to lose, take a good look at your diet and calorie intake. A diet with excessive amounts of sweets and fats will not help you return to your pre-pregnancy weight easily. Check with your physician if planning a reducing diet while breastfeeding: many breastfeeding women can lose weight on seventeen hundred to eighteen hundred calories a day and still maintain a good milk supply; others must have two-thousand calories a day to maintain an adequate milk supply. Making milk itself takes up lots of energy [hence, uses up calories]. Add aerobic activity for twenty to thirty minutes a day, five or six days a week and you will lose weight.

Breastfeeding should not be seen as an impediment to recovering your pre-pregnancy figure-or as an excuse for not trying. On the other hand, don’t let the fear of extra weight gain keep you from breastfeeding in the first place. The few pounds of weight that can be attributed to breastfeeding will be with you temporarily; the benefits of breastfeeding will be with you forever.

Remember, it may take four to six months for your body fat to start dropping. A daily nudge with aerobic exercises will start things happening. Be patient. Many answers still lie ahead of us as more and more studies are being done to help us understand the mechanisms of the body that just gave birth to new life. One thing is absolutely certain: having a new baby is not an excuse for looking or feeling out of shape.

Reverse Sit-Up

Start with five and increase gradually.

1. Lie on back with knees bent and arms at sides, palms down.
2. Keeping knees bent, raise legs until knees are past level of breasts or above face. Raise buttocks toward upper body. Head and shoulders stay flat.
3. Return to starting position and repeat.

Note: You may notice a tendency to press down or grip the floor with the hands, or you may feel a strain in the neck or upper shoulders as you attempt to reach the desired height with the knees. This will disappear as you become stronger and more relaxed with the movement. [Remember to breathe with this exercise]
This exercise works the lower fibers of the rectus muscles as well as the external obliques. To work the horizontal fibers you should also perform the reverse trunk twists.

Reverse Trunk Twists

Start with five and increase gradually.

1. Lie on back with arms out at sides with legs raised ninety degrees from the floor. With knees bent slightly.
2. Lower legs to right and touch floor with outside of foot. Shoulders and arms must remain on floor at all times.
3. Return to starting position and repeat, alternating sides on each repetition. [After a time, you will probably notice increased flexibility of your midsection while performing this exercise.]

Advanced action:

Begin with same starting position, but with legs straight out. Legs should remain straight as they are lowered to side. Be sure to press your back to the floor as you come toward the center each time.

Note: If your shoulders come off the floor as you drop your legs to the side, have someone hold them down. This person should be on all fours with his or her hands on your shoulder joints [not the neck area], arms straight and shoulders directly above yours. As flexibility and strength increase, you will not need assistance.

On the advanced exercise, if you have difficulty in keeping the legs straight because of tight hamstring muscles bend your knees slightly but keep the legs together. The more the knees are bent, the easier it is to do this exercise. Doing it in the straight-leg position is the most effective so try to work up to it.

The reverse trunk twist works all portions of the external and internal obliques, tightening the front and sides of the abdominal wall much more than any other abdominal exercise. This exercise also strengthens the spine because it uses the small muscles-both the deep and the surface muscles-that hold the bony vertebrae together and twist the spine. Strengthening these muscles will ease the typical overuse backache and may help prevent injuries that occur when quick twisting movements are executed.

The U-Seat

Start with five and increase gradually to a maximum of twenty.

1. Lie on back with arms behind head, knees bent and feet on the floor.
2. At the same time, raise head and begin raising knees towards chest. As the head and knees are in motion, begin raising shoulders and buttocks off floor. Continue both actions and try to touch knees to chest. At the end of these movements, your pelvis and upper body should be off the floor. Do not push head and neck forward with hands-simply rest head in hands, letting the shoulders do the work.
3. Return to starting position and repeat.

Note: Knees should be brought up quickly but smoothly using the abdominals to develop momentum, this action makes it easier to raise the pelvis. Think of it as two steps [1] raise head and knees, then [2] raise shoulders and buttocks. This timing allows for proper coordination and smooth movement between pelvis and chest.

When performed correctly and smoothly, the U-seat exercise maximally involves both the upper and lower portions of your abdominals.

Once you have completed the appropriate exercises for after your type of delivery, gradually replace the post-delivery exercises with the ones you did during pregnancy. These exercises also work all the muscle groups that are important during the postpartum period, with no muscle or joint strain. The pelvic rock, which can now be done while lying on your back with your knees bent, will improve your posture and ease back strain. It is wonderful for working buttocks, abdominal and pelvic floor muscles all at the same time, and provides a great back stretch. Remember to do it slowly with control and gradually increase the time you hold the tilt.

Begin with the first eight exercises for Strengthening Exercises for Pregnancy & after Delivery. When you feel comfortable with these, gradually increase the repetitions, and then add the remaining four exercises. Gradually increases your repetitions with these also, letting comfort be your guide. Don’t rush through them. Be sure to warm up [walk or march in place for three to five minutes] and then stretch for five minutes before beginning any floor exercise. Turn on music with a strong, regular beat. Music will help you move smoothly, make time pass quickly, and add an element of fun.

Extra Help

The following exercises are good for a stubborn protruding abdominal wall [potbelly].Because the rectus muscles are long, vertical muscles that run from the breastbone to the pubic bone, you need to have exercises that cause action at both ends of them. To shape and to strengthen these muscles, at least two exercises must be performed. Reverse sit-ups and reverse trunk-twists. The reverse sit-ups can be alternated with the U-seat, or all three can be done at each session. For all these exercises begin with five of each and gradually increase the repetitions as you get stronger. The key to success is controlled movements, with no “sling and fling” moves.

 

Warm-up Stretch

 Walk

Cool-down Stretch

Weeks 1 & 2

5 - 10 Minutes

5 minutes slowly

15 minutes briskly

5 minutes slowly

5 - 10 Minutes

Weeks 3 & 4

5 - 10 Minutes

5 minutes slowly

30 minutes briskly

5 minutes slowly

5 - 10 Minutes

Weeks 5 & Onward

5 - 10 Minutes

5 minutes slowly

45 minutes briskly

5 minutes slowly

5 - 10 Minutes

• Remember: Walk with your pulse in your target zone.
• Never exercise to exhaustion. End your workout at the point at which you feel you could go on for another ten minutes.
• After delivery, start at Week 1 Listen to your body-it will tell you how fast to progress.

Women often say, “I already walk a lot just caring for the baby, and I’m very tired. The last thing I want to do if I have some spare time is walk-I just want to sit down and relax or nap!” But walking while caring for the baby is a lot of stop and start movements, never really going very far from one place to another. What is needed is slow, steady, rhythmic movement for a period of five to fifteen minutes uninterrupted. This kind of activity, after you get over the initial tiredness of doing it for the first few times, will actually give you energy and release you from being tired and sluggish.

When to Begin or Resume Aerobic Exercise

This depends on a number of factors, such as how fit you were before giving birth, whether delivery was vaginal or abdominal, whether there were any complications, how much sleep you are getting, and what your emotional reaction is to the birth was.[Some women take, days, weeks, or even months to work through unexpected or unpleasant birth related events. They may feel sad, angry, or depressed. Emotional factors may sometimes prevent women from taking hold of her situation and following through with desired action].

General guidelines are as follows: If a woman exercised regularly for eight to twelve weeks before delivery, she can safely resume moderate aerobic exercise ten to fourteen days after an uncomplicated vaginal delivery, or approximately twenty-one days after a cesarean delivery. If a woman had a high fitness level before pregnancy and exercised regularly all through pregnancy, she will probably find it comfortable to begin short, brisk walks during the first week after a vaginal delivery, or after the second week after a cesarean delivery.

Whatever aerobic activity you choose to begin with, be sure to monitor your pulse; work at about sixty percent of your SHR for the first few weeks. Do not start a level of seventy to seventy-five percent. Remember that you have just had a baby [and if by cesarean, major surgery as well]. Remember also, that you are almost certainly getting less sleep than usual. Start your exercise program at sixty percent and work gradually to seventy-five. If you are new to exercise, take twelve weeks to make this transition. To develop stamina and endurance and to retrain your body to burn fat as fuel, you never need to work at a pulse rate higher than eighty percent of your SHR. The old “no pain, no gain” slogan is not true-pacing, regularly, and persistence are the keys to successful exercise.

The very best guideline for resuming aerobic exercise is to tune into your body. And remember, never exercise to exhaustion. If you find yourself tiring, slow down and stop. End your workout at the point at which you could go another ten minutes. Learn to pace yourself.

This is the time to think about joining [or rejoining] an exercise class. A pregnancy/new mother class is ideal. You have the support, advice, and caring of women in your same life situation. Although you may not do all the exercises in the class during your first weeks of attendance, getting out of the house, forcing your self to be organized, being with other mothers, and being in a formal class can do you wonders, beyond the benefits of the exercises themselves.

Begin the day of delivery [as soon as you return from the recovery room]. Do them in bed. Perform them until you are up on a regular basis.

Deep Breathing

Five times every hour you are awake.

1. Breathe slowly and deeply to expand the upper, middle, and lower portions of your chest.

Huffing

Two or three times every hour you are awake.

This is especially important if you had general [gas] anesthesia. In response to the anesthetic, the lungs produce mucus, if which not removed, can clog the small air sacs and breathing tubes of the lungs. “Huffing” should be used instead of coughing.

Here’s how:

A huff is a quick outward breath. It is like saying “ha”-a short, quick breath, with force from the abdominal muscles. The outward breath must be done quickly. Otherwise the force is not sufficient enough to dislodge any mucus. Spit out the mucous you cough up, don’t swallow it.

If huffing still doesn’t bring up any mucous and you still hear a rattle in the chest, try deep breathing again to loosen it.

With huffing, the abdominal wall is pulled in instead of out; therefore, huffing is more comfortable than deep breathing. Still, you may want to support the abdominal wall with your hands or a pillow. Be reassured that the stitches will not be pulled out.

Foot Exercise

Five times every hour that you are awake.

1. Do five ankle circles to the right and five ankle circles to the left. Make them slow and big. Repeat with the other ankle.
2. Slowly point and flex the foot. Repeat with the other foot.

Pelvic Floor Squeeze

Twenty a day, moving toward sixty, in sets of three or four. Begin when the catheter is removed.

1. Lie or sit [later you will be able to stand] comfortably with the legs apart. [The farther the legs are apart, the more challenging.]
2. Thinking about the vagina and perineum. Tighten the pelvic floor as if to lift the internal organs or to stop urination in midstream. Hold as tightly as possible for a slow count of three [gradually work up to a count of ten]. Be sure to breathe.
3. Relax completely.
4. Note: Because these muscles fatigue easily, repeat in sets of three or four squeezes throughout the day, anytime, anywhere.

Concentrate on the sensations of tension and lifting, relaxing and lowering within the pelvis.

Leg Squeeze

Three times every hour you are awake.

1. Lie on back with one leg bent and the other leg straight with the foot flexed.
2. Slowly press the straight leg to the bed and tighten all the muscles in that leg, gently pulling the toes toward the face.
3. Repeat with opposite leg.
4. With both legs straight and ankles crossed, tighten all the muscles in your legs-press knees down, tighten thigh muscles, and squeeze the buttock muscles. Hold while you slowly count to five [don't hold your breath].
5. Release.
6. Repeat.

Note: If needed, prop yourself up on pillows.

Pelvic Tilt

Three to five times every hour you are awake.

1. Lie on back with knees bent and heels close to buttocks.
2. Inhale and press your back to the bed. Hold for a slow count of five [working toward ten]. Concentrate on pressing the back to the bed by using your abdominals-do not push with the feet. For an extra benefit, squeeze your buttock muscles and the pelvic floor.
3. Relax, and then repeat.

Note; Slow, controlled movements are the key to success with this exercise. In the beginning, abdominal pain will let you do only a third or a half of this movement. That’s fine-listen to your body. Improving pelvic circulation is important-do the best you can with this movement. As your body heals more and more each day, hold the tilt longer and longer. Remember to breathe. Add a pelvic floor squeeze to.

Add on Third Day

Bend and Straighten Legs

Repeat variation A three to five times, twice a day. Using comfort as your guide, progress through variations B and C to variation D as soon as possible.

Variation A

1. Lie on back with both legs bent, feet flat on the bed.
2. Slowly straighten the right leg and bend back to place.
3. Repeat with opposite leg.

Variation B

1. Lie on back with one leg bent and the other leg straight.
2. Slide the bent leg out straight and then back to a bent knee position.
3. Repeat with the straight leg, returning to a straight leg position.

Variation C

1. Lie on back with one leg bent and the other leg straight.
2. Bend one leg as you straighten the other [Both legs are moving at the same time, slowly in opposition.]

Variation D

1. Lie on back with both legs bent.
2. Move both legs down and up at the same time.

Add on Seventh Day

Head-Up Lift

Three to five times twice a day. Add more as comfort guides you.

1. Lie flat on back with no pillows, knees bent.
2. Press back down [pelvic tilt], inhale slowly and lift just the head. Hold for a count of three.
3. Lower head and relax.

Note: Using comfort as your guide, progress to lifting head and shoulders on exhalation. Concentrate on lifting head and shoulders as a unit toward ceiling, just an inch or two of floor. Do not thrust head forward on the lift.

Begin the day of delivery, while in bed. Do them on the floor once home.

Head Curl Up

Begin with five to ten twice daily, move toward twenty.

1. Lie on back with knees bent and feet close to buttocks. Press back down. Inhale slowly and deeply.
2. Exhale slowly; at the same time lift up just the head. Hold as you complete the outward breath.
3. Relax.
4. Repeat for a total of five times.
5. Note: Do this as many times during the day as you can. Then progress to head and shoulders curl-up.

Head and Shoulders Curl-Up

Begin with five twice daily, move toward twenty.

1. Lie on the bed or floor, with knees bent and feet close to buttocks. Pres the back down and inhale slowly and deeply.
2. Exhale slowly, at the same time, lift head, and then shoulders. Hold as you complete the outward breath. Perform slowly with control [no jerky movements]. Head should stay in line with the spine, do not throw hawed forward! The “lift” comes from the shoulders and should be straight up, about six inches maximum, face toward ceiling.
3. Relax, return to starting position, and repeat.

Pelvic Floor Squeeze

Do sixty or more each day in sets of three or four.

1. Sit or stand comfortably [you can do this exercise in most positions]. The farther the legs are apart, the more challenging.
2. Thinking about the vagina and the perineum, tighten the pelvic floor as if to lift the internal organs or to stop urination in midstream. Hold as tightly as possible for a slow count of three [gradually work up to a count of ten]. Be sure to breath.
3. Relax completely.

Note: Because these muscles fatigue easily, repeat in sets of three or four squeezes throughout the day, anytime, anywhere. Concentrate on the sensations of tension and lifting, relaxing and lowering, within the pelvis.

Pelvic Tilt

Begin with ten a day and work toward twenty.

1. Lie on back, with knees bent and heels close to buttocks.
2. Inhale and press back to the floor. Hold for a slow count of five [working toward ten]. Concentrate on pressing the back to the floor by using your abdominals-do not push with the feet, for an extra benefit, squeeze your buttock muscles and the pelvic floor.
3. Relax, and then repeat.

Note: This is a wonderful stretch that will help relieve a tired or achy back.

Bend and Straighten Legs

Start with ten a day, progress to twenty. Start with Variation A. Using comfort as your guide, progress through Variation B and C to Variation D, as quickly as possible.

Variation A

1. Lie on back with both legs bent, feet flat on bed or floor.
2. Slowly straighten the right leg and bend back to place.
3. Repeat with opposite leg.

Variation B

1. Lie on back with one leg bent and the other leg straight.
2. Slide the bent leg out straight and then to a bent knee position.
3. Repeat with the straight leg, returning to a straight leg position.

Variation C

1. Lie on back with one leg bent and the other leg straight.
2. Bend one leg as you straighten the other [Both moving at the same time, slowly, in opposition].

Variation D

1. Lie on back with both legs bent.
2. Move legs down and up at the same time.

Body conditioning and toning should be started in bed, the day of delivery. The sooner you start, the sooner your body will respond with firm, toned muscles, especially pelvic floor and abdominal muscles. Follow the exercises as shown in “Exercises for immediately After a Vaginal Birth” or “Exercises for Immediately after a Cesarean Delivery,” depending on the type of delivery you had. Unless you experienced multiple complications and find yourself extremely fatigued, you can begin performing these movements as suggested.

Once you get home, don’t wait to exercise until the baby is asleep. Just lay out two blankets-one for each of you-and begin. The baby will enjoy the movement, the music and your smiles. If baby tires, she’ll drop off to sleep, whether there is music on or not. Get moving-don’t wait or waste precious hours or days!

If your physician says not to exercise for six weeks or more after delivery, show her the list of exercises you want to do. Do not just ask to “exercise”-be specific. These exercises are so gentle and safe that she will probably give her consent. If, however, your physician feels that even these exercises are inappropriate for you just yet, of course follow her advice.

The Pelvic Floor

When thinking of exercise after delivery, most new mothers think of a flat abdomen as a first priority. Actually, the pelvic floor should receive prime attention, with the abdominal muscles coming in second. Strong pelvic floor muscles ensure good support of internal organs and sphincter control [urethra, rectum, and vagina]. They also ensure pleasurable sensations during sexual intercourse for the both the woman and her partner.

After vaginal delivery, the pelvic floor may be bruised, swollen and tender. After a cesarean section, it may be lax, with loss of tone or elasticity from the weight of the baby and months of sluggish circulation. Initial attempts of tightening or “lifting up” the muscles of the pelvic floor immediately after delivery are often accompanied by surprise-you feel little or nothing! Many times, muscles have been torn or cut and nerves have been damaged. It’s no wonder there is little sensation. Perhaps too, the structure of the pelvic floor was surgically repaired. Exercise can improve all these situations by [1] alleviating discomfort [although it is uncomfortable at first to even gently squeeze those muscles] and [2] improving circulation to the area which will increase the oxygen supply, remove waste products, decrease swelling, and promote the prompt return of urine control.

If you neglect this important area, the muscles will remain stretched and loose. They will become further weakened as you resume your usual schedule. The sooner you start after delivery, the faster the muscles will respond. Waiting will only result in more time and effort being necessary than would have been required if you had started immediately after delivery. You have only benefits to gain.

The Abdominal Wall

Right after delivery, you may wonder if your stomach will ever be flat again. If you begin an exercise program early [within twenty-four hours of giving birth] and are fiercely persistent with frequent repetitions of the appropriate exercises, your stomach will indeed be flat once more.

The abdominal muscles that we feel and notice the most often are the rectus muscles. They are long, slender muscles located along the center of the abdominal wall. They run vertically from the end of the sternum [breastbone] and the lower ribs to the pubic bone. There are right and left rectus muscles, which are separated by a band of fibrous connective tissue about half an inch wide that is called the linea alba.

The internal and external oblique muscles lie on the sides of the rectus muscles. They cover the waist-a hard area to tighten even when you haven’t had a baby. The external obliques cover the front and the sides of the abdomen from the rectus muscle to the back muscles. The external obliques are attached to the ribs at the top edges and have a wide area of attachment, running from the lower eight ribs to the front surface of the pelvis and on down to the pubic bone.

The internal obliques are located directly below the external obliques. Their muscle fibers run at almost a ninety degree angle to those of the external obliques, most of them nearly horizontal. The internal obliques run from approximately the waist area down to the pubic bone.

All this may sound unnecessarily technical when you just want to have a flat belly again, but getting to know how your body is put together will enable you to understand how the exercises work and what kinds of exercises are needed to “renovate” those muscles after delivery. Getting in touch with your body and learning to listen to it are primary steps in getting started.

The lower ends of the rectus muscles go through a slit in the deep abdominal muscles before they become attached to the pubic bone. When the rectus muscles are relaxed as they are when you walk and move around, they follow a curved line; they become straight only when they contract [when you consciously and tightly hold your stomach in].

Hereditary factors come into play in the deposition of fat in the lower abdomen, even when weight is lost and body fat is at the ideal level [twenty-two to twenty-four percent for women]. Even then, because the rectus muscles are curved and become small deposits of fat are stubbornly held in that area, most women find that their “stomach” is slightly rounded.

Health and Well-Being of Mother and Baby

This postpartum period is an exhilarating, exhausting, rewarding, tearful time of discovery. Often thought of just six weeks of recovery until you are “back to normal,” the postpartum period actually extends a full three months. At the end of this twelve month cycle, the physical and psychological aspects of the new mother-body and mind-have reached a new level of adjustment. Your physical appearance, feelings, and attitudes are a direct reflection of your efforts. Your rewards can be great.

You will probably never be your “old self” or “back to normal” again. Your body underwent an enormous effort to grow and give birth to [and perhaps now feed] your new baby. But you can be on your way to a new and better self!

Rest and Relaxation

This may sound like a contradiction for the postpartum period-a time that is often associated with sleepless nights, baby blues, tears, and fatigue. Babies get hungry around the clock at two to four hour intervals-more often if they are breastfed because human milk is digested faster and more easily than cow’s milk. So mothers [and many fathers] find that they get only one or two hours sleep at one time, if that! Ongoing sleep disturbances-for days, weeks, or even months at a time-can leave you feeling cross, irritable, and depressed. When you are this tired even little problems become difficult to solve, and it’s hard to make decisions about even the smallest things. In the extreme, especially for those individuals who require more sleep than others, disorientation and confusion set in.

Yet it can be a time to tune into your body and use part of the natural scheduling of your day to release the tension. If friends or family offer help after the birth, let them take over the cooking, grocery shopping and housework. [Have them cook a little extra each time and freeze it in boilable bags. With a bit of planning and thought, you might not have to cook for a week or more after your help has left.] Your help should mother you, while you mother the baby. Continuing the relaxation techniques learned in your prepared childbirth classes is extremely important. There is less uninterrupted time for yourself, so make the most of the time you do have. During feedings take a few deep breaths and clear your mind-just enjoy this quiet time and free your body of tension. [If you're nursing, be sure to have a glass of water or juice nearby to sip, since you may get thirsty] as soon as you lay the baby down for a nap, lie down yourself; walk directly from the baby to your own bed or couch. Resist any temptation to clean up or catch up on chores or calls; otherwise, before you know it the baby will be up again and you won’t have a chance to relax.

The postpartum period is a time to reset priorities and decide what is really important to you personally. You’ll find that six months from now you won’t remember how clean your house was, or if dinner was on time, but you will remember if you were tired and frazzled or peaceful and rested, enjoying this special time.

Rest and relaxation are the complement of a fitness program-you must have both to rejuvenate your strength and vitality.

With goodwill and a sincere desire for communication, you may very well be able to take the best that your parents and other older relatives have to offer and tactfully teach them the best of what you know, without lowering your standards or sacrificing your values. First, use the many available resources to back up your opinions. We all tend to believe what we read, and women of the older generation held doctors and experts in high regard, so show Grandma the passages in books and magazines that reinforce your opinion. Quote your pediatrician to her. Share with her the literature you have from organizations such as the La Leche League (International, USA, Canada) and the National Childbirth Education Association. Tell her what you’ve learned from people whose opinion she respects-you neighbor, whose children she always admires, or your sister or sister-in-law. Sometimes simply stalling is a good technique. Thank her for her advice, and say and do nothing more about the matter. Or “forget” to try her method, or tell her you’ll probably “start soon.” With good humor and consideration, you can probably work things out with Grandma so you at least approach the ideal relationship, in which you are working together for the benefit of your child and in which the child is more important to both of you than each other’s opinions about child care are. Bear in mind that the ultimate benefits of your rapport with Grandma will go to your child, whose relationship with her is priceless.

The bottom line in dealing with Grandma or anyone else is that you are the parent, an intelligent and well informed person, and you have the right to determine what is best for your child and to raise him or her as you see fit. In the end, if you have to, you can remind these people that they chose their ways and you will choose yours. Of course, all this is easier with acquaintances or strangers, who will perhaps surprise you with their audacity in telling you what to do or asking you impertinent questions about the way you are caring for your child. You do not need to justify your actions to such people; you can avoid confrontations by simply thanking them politely for their interest and going your way.

Do be sure that you are actually being criticized before you react. Remember that the more insecure we are, the more we tend to infer criticism when none was intended, and that we all tend to overreact to situations in which our children are concerned. There are few issues important enough to force confrontations with relatives and friends.