Postpartum Concerns | Why Can't I Do a Situp? And what about Incontinence?

 Dr. Kat Vigo assessing my pelvic alignment (photo by my daughter Kate)

Dr. Kat Vigo assessing my pelvic alignment (photo by my daughter Kate)

After I had my first daughter, I was maybe 6 months post partum when I finally worked up the nerve and determination to start exercising.

She was born via cesarean section and my incision caused me a great deal of pain for several long weeks. Even after it healed, there was a part of me that kept worrying that the pain may come back if I exerted myself too much.

I was grateful to have only a newborn back then. Working in the birth world as a birth photographer here in south Florida, I really feel for my clients who have to have a repeat cesarean, (a c-section with the second birth), and have a toddler at home who is experiencing all kinds of vulnerability at not being the only baby in the house, but mom cannot pick him up because... how many weeks do you wait to pick up your toddler after a csection? Doctors say... usually nothing over 8lbs for the first 6 weeks.

But Kat Vigo, Doctor of Physical Therapy specializing in Obstetrics in south Florida says, "the truth is they need to progressively gain their core strength in order to tolerate heavier weight. So the answer isn't solely based on time that has passed since the surgery, but more so about what level of stability has been recovered."

As soon as I felt that first pain at attempting to do a sit up, I instantly gave up. It scared me! I thought, what if I rip something open? I was a first time mom. I had no idea what is normal and to be expected. I wasn't aware that below the surface of my skin, my abdominal muscle wall had separated to make room for my growing belly, and that the muscle did not return to its antepartum state, causing a condition called Diastasis Recti. Due to lack of resources and education, my fear of the unknown caused me to completely stop exercising.

Fast forward three years, when I had my second daughter via repeat cesarean section (this time ensuring I would have a gentle cesarean - more on that here).

Several months post partum I started exercising. To my surprise, I experienced no discomfort or pain, and was able to enjoy the challenge of cardio fitness. But several months into my new fitness regimine, I had a paralyzing realization. I wasn't sure if I was testing my abdominal wall properly for Diastasis Recti. I did the online recommended self diagnosis test and felt I could fit a 3 finger gap in between my abdominal wall. Fear set in and I stopped exercising. Again.

Until I met Dr. Kat. 

 Dr. Vigo (left) and I (right) after our second post partum treatment plan visit (photo by my daughter Kate)

Dr. Vigo (left) and I (right) after our second post partum treatment plan visit (photo by my daughter Kate)

I met Dr. Kat Vigo through my favorite south Florida doula, Lisa Raynor. Every time I'd meet Dr. Kat over the last few months, we would talk about how women should not suffer in silence from sciatica pain or round ligament pain or incontinence during pregnancy as well as after. She would explain how these conditions are treatable with the correct prenatal and post partum physical therapy support from a licensed professional like Dr. Kat.

I really started to believe in the work she does with her prenatal and post partum patients, the more she spoke about it. 

So finally, Tuesday of this past week I had Dr. Kat come out to my home for a home visit for the first time!

I don't know what I was expecting, I really thought its this super uncomplicated quick easy peasy diagnosis and treatment plan thing, an in and out 5 minute visit. But Dr. Kat sat down with me and asked me to tell her about my pregnancies with both of the girls, she asked how I felt the pregnancies impacted my body, how I feel now and where are my areas of concern. I explained to her how I had polyhydramnios with both pregnancies (which is too much amniotic fluid during pregnancy) which complicated things a lot because my abdominal wall separated even more than usual. I told her how I felt after both pregnancies, the complication with not being able to exercise after having my first daughter, and then feeling my abdominal wall separated after having my second one. 

Dr. Kat then proceeded to check my pelvic health by seeing how I stand, what happens when I stand on one foot, tilt a certain direction, bend over, bend back, feeling the vertebra in my spine as she moved along, and all the while I was thinking to myself, wow, I had no idea that all of this goes into my post partum health! I was pleasantly surprised by how thorough her assessment was and how nothing was overlooked.

It was only after Dr. Kat did a thorough assessment of my post partum body alignment that she began to assess my abdominal wall for muscular separation.

To my surprise, her assessment told us that my abdominal wall was not separated!

I was so surprised and relieved!

I felt like I should have never tried to self diagnose, I had no reason to discontinue exercising. No physical pain or discomfort. I was ready to go!

During our evaluation and assessment, Kat did discover that I have weakened gluteal, hip and abdominal muscles. So I couldn't wait for her to return today and work with me to plan a thorough treatment plan to strength these muscles and get my body back on track for my personal health and fitness goals. 

 Dr. Kat Vigo brought a resistance band, post partum 3 Panel Abdominal Rehab Splint, and balance ring to our second home visit

Dr. Kat Vigo brought a resistance band, post partum 3 Panel Abdominal Rehab Splint, and balance ring to our second home visit

Upon returning to my home for my subsequent visit, Dr. Kat re-evaluated my pelvic and core alignment to ensure that nothing had changed over this past week. Then she proceeded to walked me through my personalized treatment plan.

While she was teaching me the very first core abdominal routine, I realized how challenging it was because of my weakened abdominal muscles. This was actually a good thing. In this moment I thought about all the youtube videos I had found over the past year that I felt were very engaging - and realized that they actually were not.

It wasn't until Dr. Kat assessed my body's specific weaknesses and started to show me specific routines that honed in on my body's needs that I realized, every woman needs a personalized post partum evaluation. 

With my own exercise routines I would have been focusing on the wrong core goals for my body.

During one of the routines, I started feeling some pressure in my neck that ran up through my upper jawline and into my forehead. And for a moment I thought, this isn't all too pleasant. So I told Dr. Kat about the pressure I was feeling, and she immediately indicated that this was not suppose to be the case. We paused the routine and she helped me recompose my body to focus where I should be putting the center of my muscular strength to correct the routine.

After the routine I told her how I'm so glad that she did that because I would have been doing it incorrectly and been uncomfortable and she replied, "it was key that you communicated with me through the entire treatment plan that way we were able to make the adjustments necessary for you."

 Dr. Kat Vigo showing my daughter Kate some core strengthening techniques

Dr. Kat Vigo showing my daughter Kate some core strengthening techniques

With my poor short term memory, I really worried I wouldn't remember all the exercises in my treatment plan, but Dr. Kat reassured me she would be sending me a guide with all the exercises to help me through everyday's routine. Sure enough, this evening I got an email inviting me to view my treatment plan which included extensive diagrams and photos, as well as instructions walking me through every routine we went through in person this afternoon together. Way more than I was anticipating - and even an option to print. I feel so prepared and confident to do this on my own now!

After such a thorough and personalized experience myself, I highly recommend getting in touch with Dr. Kat Vigo if you are in the south Florida area, especially if you are pregnant or in the post partum stage and you are experiencing any discomfort or complications. Below, you can watch one of Dr. Kat's videos to learn more about how she works with women.

To contact Dr. Kat Vigo please visit her website: www.painless-pregnancy.com