5 Important Considerations When Training New Moms

Birth and motherhood have their share of ups and downs. As fitness and health professionals, we have an important role to play in a new mom’s physical wellbeing, as well as her mental and emotional wellbeing. There are often circumstances affecting a mom’s physical health after birth that impact her mental health, and by coaching her through these, we can have a profound impact on her overall quality of life.

Before I started working in women’s health and pelvic health physiotherapy, I hadn’t considered asking moms about the details of their birth (e.g., did she have any birth trauma?) In all honesty, I had never even come across pelvic organ prolapse before!

We now know that a mom’s birth experience can significantly affect the way she trains. Here are five important questions fitness professionals can ask when taking a new mom as a client.

1. What Type of Birth Did Your Client Have and Was There Any Birth Trauma?

As a coach, you're in a unique and important position to listen to and learn about a mom’s birth story. Because of this, you can help guide her exercise progression as well as make any necessary referrals.

A note: speaking to a woman about her birth story can be joyful for her to share, or it can be delicate or potentially even traumatic for her. Always start these conversations with empathy and probe gently. For a deep dive into how to discuss a client's birth story with her, click here.

It’s important to know what type of birth your client had, i.e., if she had a vaginal delivery or a Cesarean section. Remember that, for many women, there's still a stigma around C-sections, so it’s important to be mindful and sensitive about this, as well as to remind your client that there is no shame in any type of birth.

Birth is birth, whether the baby exited from the vagina or from the abdomen.

If a woman has had a C-section, there are a number of things you'll need to consider, such as the impact the incision may have on movement and on her core stabilizer muscles, particularly her breathing diaphragm and her transversus abdominis muscle. You'll need to know how her incision scar is healing and whether she has been cleared to exercise at her six-week check-up.

If a woman has had a vaginal delivery, there a few more sensitive things you'll need to consider, such as if she had a traumatic birth. This could be an emotionally or physically traumatic birth, or both. An important question to ask is if she had an assisted vaginal delivery, i.e., were any forceps or vacuum used, as this increases her risk of having some type of birth injury^1,2.

You should also find out if the new mom experienced vaginal or perineal tearing. If she reports third or fourth degree tears, you'll need to check if she has seen a pelvic health or women’s health physiotherapist/physical therapist, as this is classified as obstetric anal sphincter injury and warrants a referral.

2. Does Your Client Have Any Bladder or Bowel Control Problems?

Regardless of whether the birth was traumatic or not, a new mom may experience issues such as incontinence or changes in her bladder and bowel function, and chances are she hasn’t discussed this with anyone. This could be because she's embarrassed that she's leaking, or it could be because she's been led to believe that leaking after birth is “normal.”

As a coach, it's important to listen and advise your client that incontinence after birth is common, but is never normal.

In the US, approximately 50 percent of women are affected by urinary incontinence and approximately 9 percent of women are affected by fecal incontinence^3,4.

Either urinary or fecal incontinence can be signs of pelvic organ prolapse, so it's essential that this is diagnosed, as you'll need to modify your client’s exercise program accordingly. Fecal incontinence could also be a sign of obstetric anal sphincter injury, and weakness in the anal sphincter muscles. It's important to refer any woman who reports incontinence to a pelvic health physiotherapist for an assessment and targeted management plan.

When training new moms, encourage them to let you know as soon as they experience any bladder or bowel control problems, especially if it's during the training session or afterwards. Continuing through the exercise if she's experiencing symptoms is a sign that either her muscles (such as the pelvic floor muscles) are fatigued or that there's another underlying issue, like pelvic organ prolapse.

3. Does Your Client Have Diastasis Rectus Abdominis?

Almost all pregnant women will develop some degree of diastasis rectus abdominis (DRA) by the end of their pregnancy, so it's important to check if your client still has DRA, especially since 40 percent of women will still have it at six months postpartum⁵. Many new moms are concerned about the appearance of their stomachs, as well as the presence of an abdominal separation.

66 percent of women with DRA will also have at least one related pelvic floor dysfunction, such as urinary incontinence, fecal incontinence, or pelvic organ prolapse⁶. By assessing for DRA, you can ensure that the training program you create for your client will improve her abdominal wall impairments and encourage the use of the core muscles.

For a client with DRA, incontinence, or pelvic organ prolapse, it's necessary to train her core stability muscles, including her breathing diaphragm, pelvic floor, transversus abdominis and multifidus. You're ideally placed to improve the stability and strength through her abdomen and pelvis, thereby reducing the effects of the DRA.

4. Does Your Client Experience Any Pain?

Approximately 50 percent (and up to 90 percent) of pregnant women experience back pain, pelvic girdle pain, genito-pelvic pain, or any combination of the three^7,8. Women may continue to experience pain after birth, and women may also develop pain after birth. Your client’s training program needs to account for this, without worsening her pain.

Back pain and incontinence have also been shown to be related in pregnancy and post-birth, and research suggests this is due to the contribution of the trunk muscles to continence and lumbopelvic control⁹. As a fitness professional, your training program is crucial in strengthening the woman’s muscles to help her overcome her back and pelvic pain as well as her incontinence.

It's important to integrate the appropriate activation of the deep stabilizing muscles —along with the other global muscles — into your client’s training program. This includes the client’s ability to use her breathing diaphragm throughout the workout as well as her pelvic floor, transversus abdominis, and multifidus during exercises.

Back pain, pelvic pain, and particularly genito-pelvic and sexual pain can be associated with a pelvic floor that's non-relaxing or overactive, rather than a weak pelvic floor. In these cases, you should refer your client to a pelvic health physiotherapist for further assessment and treatment.

5. Has Your Client Exercised Before?

You should of course consider if your client has exercised before or during pregnancy, what type of exercise she has done, as well as what type of exercise she wishes to return to. This will help guide your exercise programming so that she can reach her goals efficiently.

Remember to ask your client if she has ever done pelvic floor exercises or transversus abdominis exercises before seeing you. If not, or if she doesn’t do them correctly, you'll need to teach her the basics of diaphragmatic breathing and engaging these core muscles before moving on to strength training.

As a fitness professional working with new moms, this may seem like a lot of information to consider. However, asking these questions will ensure that your client is able to progress her exercise program safely and effectively. Working alongside a pelvic health physical therapist and making the necessary referrals will ensure that your clients get appropriate pelvic floor and pelvic organ prolapse assessment, which will in turn help guide her training program.

Encourage all new moms to have a pelvic floor assessment done with a pelvic health physical therapist at six to eight weeks postpartum or whenever possible. With new moms, an “inside-out” approach is best.