third trimester: preparing your body for birth
Birth is more than just a physical event—it is a mental, sexual, spiritual, whole-being experience. Intuitively, most women know this. That’s why it feels daunting. We know that getting all the right information, being in great shape, and having a supportive team are important preparatory elements. We also know that even with the best preparation possible, it will still be a walk through the fire.
If all we knew of pregnancy and motherhood were the images online and in magazines, we might conclude that it is a weight-gain and weight-loss challenge, rather than the powerful rite of passage and total transformation that it is. We are seduced by the idea of upholding the superwoman myth; we see pregnant women and new mothers doing it all, even at the gym and in the yoga studio. Resting and slowing down are hard to show on an Instagram account, but doing a handstand on a cliff at forty weeks pregnant draws a lot of attention and awe.
In many ways, we are rewarded for looking invincible and unstoppable—but it doesn’t benefit our own long-term peace and sanity. Our families and our jobs may really like this superhuman stamina, but most of all, our egos like it. In fact, it’s mostly our egos that won’t let us off the hook.
As women, we receive all kinds of mixed messages about how much exercise we should do and what kinds of exercise are safe during pregnancy. Ultimately, it would be great if we could just tune in and listen to our bodies. However, when so much is changing so quickly, it is sometimes hard to know what our bodies are saying and what really is good for us. When should we push ourselves? When should we rest? What will facilitate more ease both short-term and long-term, and what is just falling into habits? The truth is that what might feel good right now might not be what is beneficial long-term.
EXERCISE JUST ENOUGH
A key to preparing for birth is, indeed, being active. We all lie somewhere on the spectrum from very active to not active at all, and pregnancy is a time to move toward balance. Doctors are famous for telling pregnant women, “Just keep doing what you’re doing, but don’t start anything new.” For the most part, this is wise advice: women can continue doing the physical exercise that they have always loved with some slight modifications. But this doesn’t hold true for everything. If you work at a desk and don’t like to exercise much, you’ll want to start moving more. Movement is just the right medicine for the aches and pains of a growing pregnant body. Gentle exercise, like walking, swimming, or prenatal yoga, are critical to your circulation, your overall body awareness, and a sense of self-confidence that your body is reliable, strong, and supple.
As stated earlier, birth is much more than a physical experience, but you will want to feel connected to your body, to know that it is trustworthy and capable. Connection to your body and a positive birth experience are key ingredients to feeling good, and sane, postpartum. Many women use pregnancy as a motivator to get in shape, while some very active women may be reluctant to—but need to—slow down as they move through their pregnancies.
Many of the women with whom I work are extremely active. Their criteria for being in shape rival that of an amateur athlete. They are in formidable shape, and exercising regularly is a foundational part of their lives. When I ask them about their postpartum plan and what they have identified as resources for when they are feeling stressed, they almost all say yoga, Pilates, or running. Of course, these are healthy options; exercise is a healthy stress reliever, but sometimes it is the only way that women know how to regulate their stress levels. Pregnancy is a time to soften the grip on high-impact activities and heavy lifting, so it is a great time to strengthen internal practices like meditation, so that you don’t require such high levels of exercise in order to get through the week. The idea here is to back off, to learn to rest, and to get more out of less. This will serve you well in the postpartum period when you cannot exercise safely with such rigor.
I get concerned when I meet women who are rigid about shifting their routines, women who say, “I absolutely will not stop riding my bike. And if I find a doctor who asks me to, I won’t work with her.” Or, “My body is feeling great at CrossFit. There’s no reason to stop.” Why is it so hard for us to let go? And then I remember how everywhere we look, we are inundated by images of women’s bodies. While in past generations women dressed to hide their bellies, today women wear formfitting dresses to accentuate their pregnant shapes. Articles get widely shared on social media with some version of how incredible it is that a pregnant woman is still doing a particular activity.
Recently, a fitness company that specializes in prenatal and postpartum fitness released a new logo that is a woman with a big pregnant belly holding a huge barbell over her head. Another popular picture on the social-media fitness pages is a ballerina in pointe shoes doing a flawless arabesque, clearly near or at nine months pregnant. Yoga practitioners regularly post pictures of themselves doing handstands and headstands with a big belly. The message is, Just because I’m pregnant, it doesn’t mean I have to stop what I am doing. I am a superwoman, and the fact that I can still perform as if I were not pregnant proves how unstoppable I am.
These pictures generate huge amounts of attention and enthusiasm. They are ego boosters; friends and strangers chime in to cheer the women on in these amazing feats. We live in a culture that glorifies overdoing, and pregnancy is no exception.
But the truth is, deciding what to do and how to do it while pregnant is more complicated than at other times. It’s important to know that your pregnant body is a changing body and how it is changing. There are different strains and demands on it than there are normally. Your body is producing a hormone called relaxin that softens ligaments and joints. Its function is to help the joints of the pelvis open to make space for the baby to pass through. However, relaxin doesn’t just work on the pelvis. It affects all the joints in the body. Joints become looser and less stable. With joints that are less stable, the weight of the body is more difficult to support.
Compressive exercise, like running and weightlifting, places even more strain on an already unstable foundation. In response, muscles often get tighter to try to provide the support that the ligaments no longer can. When the muscles of the pelvic floor tighten and shorten, birthing a baby becomes more complicated and can contribute to pelvic-floor dysfunction down the line. Even with great form and correct posture, the amount of downward pressure on the pelvic floor that is placed by the weight of the baby together with additional weight or bouncing is often too much for the pelvic floor to withstand.
The challenge for women is that the consequences of overexerting are often not immediate, so we feel like we are listening to our bodies and are then caught by surprise when birth or postpartum recovery, or even menopause, are difficult. We need to develop a long-term view of our health, taking care of our life force and changing bodies so we can use them how we want into old age.
When joints and ligaments are loose, stretching can become easier. Yoga practitioners are often pleased when they are pregnant and can stretch much farther than they could before. What many women don’t realize, because it is hard to feel, is that the added stretch they are gaining is not because the muscles are more flexible but because their ligaments are overstretching. Ligaments are like strong rubber bands, taut and difficult to stretch. However, once stretched, they don’t resume their original shape easily. Overstretching ligaments while pregnant often contributes to lower back and sacroiliac joint pain, as well as prolapse, postpartum.
A study done by PLOS ONE of 1,500 mothers found that 77 percent experienced persistent lower back pain over a year after giving birth, and 49 percent experienced urinary incontinence. And a study published in the American Journal of Obstetrics and Gynecology found similar degrees of lasting pelvic pain in women who had cesarean sections compared to those who gave birth vaginally, which could indicate the pain is due to the time leading up to giving birth, as opposed to the birth itself.
You do not need to be afraid to move. Your pregnant body will benefit from everyday activities like walking, gardening on all fours, and squatting, rather than what we typically default to, which is alternating between sitting and high-impact exercise. If you are a runner, an athlete, or an elite yoga practitioner, the real challenge is not to maintain everything you have been doing. While to the outside eye, the high mileage and intricate inversions are impressive, if you are honest, you probably know that it is psychologically harder for you to stop doing them than it is physically for you to continue doing them.
Remember that this is not a forever adjustment. Truly backing off for the last months of pregnancy and the first few months postpartum will mean that you can return to what you love intact and build to the intensity that you like sooner. This pause will set you up to be able to do what you love longer, without pain, and to have decent amounts of energy sooner after giving birth.
EXERCISES FOR PREPARING YOUR BODY FOR BIRTH AND EASING PREGNANCY PAIN
Below are some exercises that you will absolutely want to do on a regular basis as you get closer to giving birth. These are gentle exercises that take into account your looser joints, your changing body, your lower energy levels, and the ways you can prepare your body for giving birth.
Protect Your Lower Back and Practice Supportive Posture
At some point, every pregnant woman has caught a glimpse of her profile in a mirror or store window and been surprised. A pregnant body is constantly in flux, shifting to redefine its center of gravity. For the body to realign itself to support the new weight of growing breasts and a growing belly, not to mention the softer ligaments that are the base of support for the spine and torso, there is a lot going on!
It doesn’t help that our lifestyles, with more sitting, texting, and computer work than ever, predispose us to the postural adaptations that pregnancy also leans toward.
To compensate for growing breasts, our shoulders begin to round and our heads jut forward. To compensate for the growing belly, many women tuck their tailbones, flattening their glutes and pushing the pelvis forward. Others succumb to the weight of the baby that pulls them into a swayback. All of these habits can create compression in the lower back (see fig. 1).
So what should you do? It starts with awareness. Notice if these postural tendencies are familiar. The truth is you are bringing your prepregnancy posture with you, and pregnancy will probably exaggerate your habits. Make a conscious choice to practice supportive posture. Whether your lower back is already a source of discomfort, or if it’s just to support and keep your spine supple as your belly continues to grow, you will want to practice lengthening the muscles along your lower back. There are several ways to avoid that shortened feeling that causes pain in your lower back.
Awareness starts with breathing, something we are already doing all the time, though not always consciously. Ideally, these exercises are practiced with an exercise ball. An exercise ball is an inexpensive tool that requires us to be making micro adjustments with our internal balancing system, keeping our body more awake than sitting on the ground or a chair does. A ball is also a great tool for birthing and for bouncing on with a fussy baby. If you don’t have a ball, you can still get great benefit from these exercises by sitting up—not slumping—in a chair.
Fig. 1: Postural profiles before pregnancy, during pregnancy, and postpartum
BREATH FOR LENGTH
Taking care of your lower back and maintaining great alignment begins with your breath. This particular breath is for everyone and touches on posture as well as pelvic-floor preparation. I call this the breath for length because it lengthens the curves of your spine.
1. As you focus on your inhalations, allow your ribs to expand first and then your belly to fill. You want to feel your whole trunk expand.
2. Your breath will extend all the way to your pelvic floor, explained in detail below, which you want to drop and spread. For now, you can just allow the exhale to happen. If you have been taught to breathe diaphragmatically, puffing your belly on inhalations, this will be a new approach. To inhale into your chest and ribs, you want to keep your abdominals engaged a bit, so your ribs can fill first. It is important that your ribs move, lift, and expand when you inhale, and it takes practice at first.
3. Place your hands on your side ribs, with your fingers facing each other, and feel your hands move away from each other on your inhale and back toward each other on your exhale, like an accordion (see fig. 2).
Fig. 2
Fig. 3
Fig. 4
4. On the exhale, maintain the lift in your ribs as you pull your belly toward your spine. Then at the end of your out breath, let your ribs relax and return to their original position (see fig 3).
5. On your next breath, when you exhale, coordinate the movement of your abdominals toward your spine with the lift of your pelvic floor. Engage your abdominals toward your spine and draw your pelvic floor in and up at the same time (see fig. 4).
Note: At first, it is really helpful to practice this sitting on the exercise ball if possible because it has a soft and responsive surface, making it easier to feel pelvic floor movement. On any surface, you can visualize your pelvic diamond—the area between your pubic bone, sitting bones, and tailbone (see fig 5). When you inhale, you want to feel your pelvic floor widening and opening to the surface of the ball, and then, as you exhale, feel the diamond shrinking and the pelvic muscles moving away from the ball.
There are many different ways to breathe, but the above breath will help you engage your core and will be an essential touchstone for your postpartum recovery.
Fig. 5: The pelvic diamond
What Is the Pelvic Floor?
What exactly is the pelvic floor? It is a multitiered group of interweaving muscles that surround the lower openings of your body and also serve as a shelf for your reproductive and digestive organs. What does that mean? The first tier of muscles makes sure that sex and elimination are working optimally. The first tier of muscles is important for birth, because the baby’s head stretches them considerably, and if they are too taut or don’t have enough time to adjust, they may not soften enough and may tear when your baby emerges.
The second tier is important because those muscles make sure that your organs are in the right place, which is a pretty vague concept if they have always been in the right place. It is usually only when something goes wrong with organs that we really notice them, and then it’s all we think about. When that second tier of muscles is strained or pulled, the organs start to slip below where they are meant to be, which causes sensations of heaviness and fullness.
CAT POSTURE
Coordinating simple movements with your breath can also provide welcome relief from lower back pain. Try the cat posture (see fig 6).
From all fours, as you exhale, press into the ground, hug your baby toward your spine, drop your head and round your back. Breathe freely into your back as you feel the long muscles of the spine widening. Then, allow your body to make gentle movements, shifting your hips and head from side to side as it feels good. Then, return to a neutral spine, and as you exhale again, round your back. Do this five times, really feeling your belly, your baby, and your back.
Fig. 6: Cat Posture
WALL SQUAT
Squat against a wall, with your thighs at a ninety-degree angle. Press your lower back, shoulders, and the back of your head against the wall. Place your hands on your belly and as you exhale, press your lower back to the wall and feel your hands move closer to each other. Hold the squat while breathing freely for thirty seconds. You may have to really scoop your tail forward to get your lower back against the wall—that’s fine! This is great for keeping those muscles supple and relieving pain in them, but don’t worry. You don’t have to stand like that all the time. Normal standing posture allows for a gentle curve in your lower back. This exercise helps to release taut lower back muscles that will allow you to stand normally with more ease.
UPPER BACK STRETCH
The wall squat and cat posture both provide great immediate relief, but sometimes, discomfort can accumulate. When that happens, there are a few possible culprits. Your upper back may need to lift and open to make space for your lower back to lengthen and so that your diaphragm and pelvic floor have space to move.
To open your upper back, interlace your hands behind your head. Lean your head into your hands, inhale, and look up (see fig. 7). Include your entire upper back, not just your head, in the movement, moving all the way from the bottom of your ribs (without arching your lower back). You should feel more space opening between your baby and your ribs. When you exhale, drop your elbows forward and your chin toward your chest.
Fig. 7: Upper Back Stretch
Stabilize Your Pelvis
As well as the shortening of the lumbar curve, what also might be contributing to lower back discomfort is instability in your pelvic bones. Many prenatal yoga classes focus on hip openers during pregnancy. This can be very helpful for women who are just starting yoga. However, if you are a longtime yoga practitioner, I don’t recommend hanging out in hip-opening postures like baddhakonasana and upavista konasana, relaxing into the even greater sense of opening that is available because your ligaments are becoming looser. As I mentioned above, when ligaments are overstretched it is hard for them to return to their normal length and strength.
This can lead to lower back and sacroiliac pain after giving birth, which takes a great deal of time to alleviate. If your pelvis feels unstable and you’ve got a lot more swagger than normal, you can wear a thin, soft belt, like a yoga strap, around your pelvic bones, at the level of your thighbones, to minimize wobbliness. Many women find it a great relief. If it feels good, I recommend wearing such a belt during yoga practice during the last trimester.
The attention that you place on how you hold yourself now, during pregnancy, will set you up to be able to breastfeed, baby-wear, and walk with comfort after you have your baby, so it is worth your devoted attention now!
Tone and Relax Your Pelvic Floor
“Do more Kegels!” That’s the extent of advice and information that most women receive about their pelvic floors. Rarely are women assessed to find out if they actually need these exercises, taught how to do them correctly, or checked to see if they are doing them effectively. Learning how to find and use your pelvic floor muscles (see fig. 8) will be one of your biggest secret weapons in birth and postpartum. The more familiar you get with this territory, the more you will learn how to both engage and soften these muscles, and the easier it will be for you to find them again after having a baby. Including your pelvic floor is the final piece to your lower back comfort. A proper pelvic-floor exercise will teach you how to pull up and in as well as push down and out. If you want a guided audio practice that leads you through the anatomy as well as guides you to a proper Kegel exercise, go to www.magamama.com/pelvic-mapping and download an audio guide.
Fig. 8: The pelvic floor muscles
The Goldilocks principle applies as much to the pelvic floor as it does to exercise. I have had very few women—two to be exact—come to see me because they thought their pelvic floors were too tight. Almost every woman who comes to see me is sure that her pelvic floor is not strong enough. In fact, the cause of pelvic-floor dysfunction is split almost down the middle, evenly divided between women who could use more support and tone in their pelvic floor and women whose muscles need to let go and relax.
So how do you know where you stand on this spectrum? First, if you are a horseback rider, runner, yoga practitioner, or a Pilates or barre-method junkie, you most likely have a very strong and tight pelvic floor. Your work will be to learn to let go to create an easy exit for your baby and minimize tearing. While you can seek out a pelvic-floor physical therapist to help you prepare for birth—and you can also schedule a post-birth appointment with that professional—there is a lot that you can do on your own to prepare.
FULL-RANGE BREATHING
Again, it starts with the breath. We’ll add a step to the breath for length. While it teaches you to soften your pelvic floor on the inhale and engage on the exhale, there is actually another phase that is crucial to pelvic health—bearing down.
Begin on the exercise ball, if you have one, with the breath for length, and then, on your next exhale, push your pelvic floor toward the ball. Since you are pregnant, and especially if you have a history of prolapse, you won’t want to use your full strength to bear down, but you will want to find the muscles that work to do that. It will probably take some experimentation if you have only ever been pulling these muscles in and up.
Imagine a bodybuilder who does a lot of bicep curls. Her arms are probably permanently bent, even when she is relaxed. If you tell her to straighten her arm, she won’t be able to do so without added weight or pressure. If you have done exercises where you squeeze your inner thighs a lot or activate mula bandha (which is Sanskrit for “root lock” and is practiced in yoga) your pelvic floor is the equivalent of that bent arm—it’s constantly engaged. Pushing these muscles down, as if you were trying to expel a lover, will stretch them, making them more elastic. You will be using these muscles’ full range of motion. In the last month of your pregnancy, you can let go of the contracting phase in the breath for length altogether. Just focus on relaxation and gentle pushing during the exhales.
BALL MASSAGE
Another way to soften these hard-to-reach muscles is by using tennis balls. The pressure will help tense muscles relax. Place a tennis ball on the outside of one sitting bone, gently and cautiously sitting on it. Then roll it around in a horseshoe shape, until it’s on the other side of your sitting bone. Try it on both sides. Oftentimes an impediment to activation or release is simply contacting areas of rigidity or places with which you don’t have easy proprioceptive awareness.
You can also experiment by placing the ball on your tailbone and then tracing your whole pelvic diamond with it. Spend time in the places that feel foreign or very painful, so you can allow time for the muscles to release and widen.
MASSAGE THE PERINEUM
You can also manually stretch your perineal muscles, but please note: if you have been told not to have sex during your pregnancy, then you will want to avoid perineal massage.
Stretching your own perineal muscles can be a little physically awkward with a big belly to contend with, but it’s possible. Prop yourself up at a sixty-degree angle, open your legs, and use a little bit of lubricant on your thumbs. Place your thumbs on the inside of your vaginal opening, about an inch inside, and press straight down toward your tailbone. Hold them down for a minute or so, until you feel a stretch and maybe discomfort but not pain. Then begin moving your thumbs in a semicircle, pausing where there is tension, to encourage and allow the tissue to let go.
You can start at thirty-six weeks, and you will need to do this for at least ten minutes a day to feel a significant difference. Many women come to me for birth rehearsals, during which I do the perineal stretching for them. They usually relate that what I do is nothing like what they were doing by themselves or with their partners. Without knowing the territory in an anatomical way, most people are tentative about stretching the muscles in that area. You want to challenge the tissue and sustain that stretch without being aggressive; the stretch is what will allow for true birth preparation. A moderate level of discomfort is necessary for it to be effective. In my office, I work up to sliding a full fist inside, so that women can gain the confidence, both mentally and physically, that something the size of a baby’s head will be able to fit without incredible pain. Studies are mixed on whether perineal massage is useful, but those results could be skewed because most people aren’t taught how to do it properly.
If you are questioning whether you’re doing the perineal massage right, it’s worth it to schedule an appointment with a pelvic-floor physical therapist or a sexological bodyworker to teach you how to do it and practice with you. This is especially important for yoga teachers, ballet dancers, Pilates practitioners, barre-method enthusiasts, and horseback riders who have extremely strong and tight pelvic floors and are disproportionately disposed to pelvic-floor injuries during childbirth.
If you adequately prepare your pelvic floor, you are creating connection and confidence, are already in touch with this intimate part of your body, and are more likely to trust it when things get more intense. You are also setting yourself up for a shorter pushing stage, which means you are less likely to damage nerves and tissue. Coming through birth in one piece sets you up for a less painful, more joyful, and shorter postpartum recovery.
CROSS-TRAINING YOUR NERVOUS SYSTEM
Even more important than training our bodies for birth is training our nervous systems. Even if you have been walking, squatting, swimming, and visualizing softening and relaxing your pelvic floor, there is almost nothing that can convince this most vulnerable and intimate part of your body to open if you are feeling afraid or threatened. So getting to know yourself and how your physiology works under stress can be one of the most helpful tools you can have during birth. Start with this simple exercise—the one-minute game.
ONE-MINUTE GAME
1. Set a timer for sixty seconds and start it.
2. Imagine one of your favorite places in nature, where you have great memories. As you call forth that image, notice the sensations in your body. Notice how your breath feels. Is it slower or faster, more or less noticeable? Notice how your skin feels. Notice the muscles of your face. What about your pelvis?
3. Stay with that image for one minute and notice how you feel after that short experiment.
4. Next, restart your timer and imagine that you are in a hurry to get out the door in the morning and you can’t find your car keys. You are looking all over for them. You’re going to be late if you don’t find them.
5. Now notice your breath and your heart rate. Compared to your Hawaiian beach or pine forest, it’s probably pretty uncomfortable.
6. Stay with it and continue to notice what happens in your body. How does your skin feel? How about the muscles of your face, your jaw, and your pelvis?
7. After a minute of that, notice your overall state, your mood and emotions, as well as the physical sensations.
When you are in one of your favorite places in nature, it is pleasurable. You feel safe and protected, as though there is nothing to worry about. You don’t have to think about relaxing; you just relax, because the environment is so soothing and comfortable. The conditions are there for you to relax, and so you do. Your breath and heart rate slow down. Your jaw relaxes, and your facial muscles might light up in a smile. Your skin feels soft and porous. On the other hand, when you are searching for your keys, it’s stressful. Your heart is probably racing, your breath is faster or you may hold your breath altogether. Your jaw tightens; your brow furrows. You may feel aggravated, frustrated, or outright angry. At the end of the minute, you’re probably dying to return to the earlier vacation!
The nervous system is responsible for initiating all of the impulses that become actions in the body. Everything from moving your arm to picking up a fork you dropped to sending the message to your bowels to release to regulating your body temperature. Your sympathetic nervous system is in charge of actions. It is responsible for the active phase of the ultradian rhythms. Remember earlier when we discussed how the natural cycles of your body have ninety minutes of action and movement and then ten minutes of rest? The sympathetic nervous system is dominant during the phase of action in the ultradian rhythm.
Your parasympathetic nervous system is in charge of the resting phase of the ultradian rhythms. The sympathetic and parasympathetic nervous systems work together, continually shifting their ratios of activation to create homeostasis, or balance. We need both functioning healthily to have all the energy we need to live the lives we want—and the capacity to rest is part of that.
Under duress, however, our nervous systems function differently. Your sympathetic nervous system is responsible for the fight-or-flight response. This response is designed to protect us from danger, to deal with a threatening situation swiftly either by fighting or getting away as fast as possible. Evolutionarily, it was functional to escape wild animals. But nowadays, for most of us, our fight-or-flight response is overreactive. Ongoing stresses like traffic, jam-packed schedules, and role juggling—stresses that are not actually life-threatening—register as such in the nervous system. This leads to depletion as the body secretes stress hormones like adrenaline and cortisol on an ongoing basis, constantly draining reserves that were designed for only occasional use. You probably felt the sympathetic-nervous-system response in your body when you imagined hurriedly looking for your keys, as your heart rate increased and your focus narrowed. There are also emotions that correspond with the two branches of the nervous system. Depending on how great a threat is or is perceived to be, in addition to how frequently a person experiences this reaction, a person may experience irritation, frustration, anger, or even rage.
When responding to threat or danger, your parasympathetic nervous system also functions differently. Your body may freeze and become immobilized. You can recognize this as the look of a deer in headlights. When faced with something scary, we may become unable to speak or even move. We are stunned. This response is beyond the level of the rational mind. In this state, we can’t force ourselves or be forced to move or talk. A more extreme response of the parasympathetic nervous system is total collapse. In animals, we call this “playing dead.” In humans, this may look like losing control of our elimination functions or passing out. Emotionally you may experience apathy, resignation, fear, or helplessness.
Wild animals don’t experience trauma, while humans and domesticated animals do. Rarely as humans do we allow ourselves—and are we allowed—the chance to go through the complete cycle of activation and deactivation. This process takes time, and in our fast-paced lives, we don’t always take it.
Imagine that while walking down the street, you trip and fall down. Most of us feel embarrassed to fall down, which causes us to skip steps to an integrated recovery. We don’t slow down to notice where or how we are. Without taking stock of whether or not we are hurt or how we are feeling, we pop right up and continue walking, eyes locked forward, so we don’t have to make eye contact with anyone who might have seen us. Our social relationships and self-consciousness can alter our necessary biological responses, so we don’t fully process an experience. Of course, tripping is a fairly mild example, but nonetheless these incomplete responses are cumulative.
The Wolf and the Rabbit
Trauma is a scary word that most of us want to avoid. Most of us either overidentify or under-identify with it. We think either “I’m totally traumatized” or “I don’t have any trauma at all.” The truth is that all of us have experienced trauma. I wish there were a better word for it that wasn’t so daunting or stigmatizing. Trauma is simply part of being human. Fortunately, healing is also a hallmark of being human. The best way to understand trauma is to observe the behavior of wild animals. As you read the following story, I invite you to notice the sensations in your own body.
Imagine a wolf hunting a rabbit. The wolf, salivating and pacing, starts its careful approach, getting closer and closer. At some point the rabbit senses that it is being stalked and stops moving (freezes). If the wolf continues approaching, the rabbit will play dead (collapse). Then, if the wolf is still interested, it will come pick up the rabbit by the neck and shake it around to confirm if the rabbit is dead or not. Predators don’t usually want dead prey. If the wolf is convinced the rabbit is dead, it will simply drop it and run off. When the rabbit senses that the wolf is gone, then it opens its eyes to look around (visual orientation), then its little ears perk up and flash back and forth (auditory orientation). Then, if, through its senses, the rabbit perceives that it’s safe, the rabbit bolts upright, coming up to all fours, continuing to look around in the environment. Next the rabbit shakes, and continues shaking (discharge/deactivation) until a seemingly spontaneous ending when the shaking finishes and it runs off.
When one of the branches of the nervous system, sympathetic or parasympathetic, doesn’t go through a complete cycle, from activation to deactivation, it creates a short circuit. When the system short circuits, it creates a groove or loop, a repeating pattern. Then, when we face a challenging or stressful situation, our system responds in the same way it did in past situations that our body perceives to be analogous. In the above situation of falling down, our social shame sends us into autopilot. Overriding the need to pause, slow down, and recover, we spring into action. If we imagine the frames of an old filmstrip, when we experience trauma, it is as if our mind skips some frames of the film. The body continues on, but there is incongruence between what the body experiences and what the mind records. This fragmented experience results in trauma and an inability to be in the present moment.
GAME OF THREES
Stress and trauma make it difficult to stay in the present moment. When we experience stress, our body and mind replay past memories or project future scenarios. A simple and important tool to help you attune to the present moment is the game of threes. You can do this anywhere, anytime.
1. From wherever you are—your bedroom, the doctor’s office, your bathroom—look around you. Notice three things in the environment: for example, a family picture, a water glass, and a shirt.
2. From this same place, notice three things about yourself: for example, the skin on my face feels warm, I’m excited about this book, my belly is tight.
3. Pause between each object, sensation, or feeling that you have. Go back and forth between what you see outside yourself and what you perceive inside yourself three times.
4. Then notice how you feel overall. What happened as a result of this noticing?
This shift of attention from what’s around you back to what is inside you will help you to stay in the present moment, and remain calm. You may need to actively work with your mind. When it starts making associations such as “family picture”…“my mom is driving me crazy”…“I hope she doesn’t come to the hospital too early”…come back to the object itself. Let the family picture simply be a family picture. If that’s impossible, then find another object that has less difficult associations. Choose the objects with ease, and with this pendulation between your outside world and inside world, allow yourself to be more comfortable and at ease in your own skin.
When it comes to giving birth, we are working with the most intimate parts of our bodies, which requires safety and protection. In the past, that may not have always been what our bodies received. An overwhelming number of women have experienced sexual assault. Others have had unpleasant gynecological exams and procedures, abortions, or miscarriages. When a baby comes through this territory, although it is a “normal” physiological event, birth doesn’t always seem normal to the body. Birth has the potential to trigger one of our nervous-system loops. For example, it may provoke a freeze response in someone who has been sexually assaulted or had previous negative birth or gynecological experiences.
If you are a survivor of sexual assault, or have gone through a difficult journey with fertility, pregnancies, loss, or abuse, seek a counselor who can help you to restore your nervous system’s responses so that you can show up fully empowered for the birth of your child. Somatic Experiencing trauma resolution therapy is a powerful modality that can help you free yourself from the residue of those previous patterns, and arrive at your birth with less carryover from earlier difficult experiences. Having a doula who knows your history at the birth can also be extremely helpful, so that you remain oriented, feel supported, and know what your options are if you start to feel confused or disoriented. People who have a history of hospital trauma might consider alternative birthing options like birth centers or home births, so as not to set in motion previous trauma loops. With awareness and support, we have the chance to avoid further trauma and even repair past trauma. We can have a restorative experience, where our nervous system demonstrates resilience and we emerge from birth more whole and more empowered. This is essential in setting ourselves up for success in the postpartum period.
IDENTIFYING YOUR NERVOUS SYSTEM’S RESPONSE
1. All day long, we respond to little stresses, and they are not always bad things. They are as simple as your phone ringing in the doctor’s office, a friend saying an unkind word, a full e-mail box, or receiving a generous gift or an unexpected compliment. Close your eyes and imagine each one of those scenarios.
2. When you feel what it would be like for your phone to ring in a doctor’s office, is your impulse to want to hide or run out? That’s the flight response. Is your impulse to ignore it and wait until it’s over? That’s the freeze response. Is your impulse to get mad at whoever is calling and interrupting you? These might be split-second responses, but they are helpful at letting you know how your wiring works.
3. Also, imagine that you just had a delicious two-week vacation prior to these scenarios happening. Your reaction would probably have much less intensity.
4. On the other hand, if you had just had a very stressful week, maybe a fight with your partner, or a fender bender, and then one of these scenarios happened, your ability to attenuate your reactions would be much less.
Ina May Gaskin, midwife and pioneer of natural childbirth, is famous for saying, “Open mouth, open cervix.” She is talking about relaxing the jaw to relax the pelvic floor, which allows the baby to come out, instead of clenching and resisting. Clenching the jaw and tensing muscles are sympathetic-nervous-system fight responses. Imagine a dog growling and defending its territory. On the other hand, the parasympathetic nervous system is responsible for allowing sphincters to open and the release of bodily fluids. We need the parasympathetic system working well to allow for pooping, birthing, and orgasming with ease.
Keeping all of this in mind, you can see why choosing the place you feel the safest to birth is important. Just as you want your birth space to feel safe and soothing, you will also want your postpartum sanctuary space to feel safe so you can relax. You will have some unwinding to do from the birth experience, especially if things went unexpectedly, in either a heartbreaking or heartwarming way. A peaceful environment facilitates your nervous system’s recalibration, and in turn encourages your milk to let down more quickly, ensuring an easier bond for the breastfeeding connection.
Another thing to consider is that interventions in the birth process affect our nervous system’s functional capacity. When you are administered an anesthetic, it induces a freeze state in the body. Because the body is rendered immobile, even if only partially immobile, sympathetic responses are thwarted, meaning you can’t move. If you cannot feel parts of your body and you could not move if you wanted to, the body perceives this as a danger. At a physiological level, this perception can correlate with a sense of helplessness and dissociation. On a practical level, this may add up to not being able to say what you want to say to your nurses, doctors, or midwives. You may feel confused or just simply “give up” on your birth plan or on advocating for your wishes.
The same is true for a surgical birth. While the anesthetic, in most cases, relieves or prevents pain, the body is still being cut, which is life-threatening. It is critical that women are able to complete the cycle produced by the anesthetic of imposed freeze followed by shaking as the medication leaves their system and their nervous system recalibrates—just like the rabbit’s did. If you are reading this and it is resonating with you from your life experience or a birth experience, the section “Renegotiating a Birth That Needs Healing” in chapter 9 guides you through steps to begin to renegotiate your experience on your own.
ENJOYING EXPLORATORY SEX
What if I told you that sex could be just as good at preparing you for childbirth as childbirth-education classes are? Well, it’s true.
Sex is one of the most fertile and unexplored territories of childbirth preparation. Opening up to exploring sex also sets couples up for a satisfying intimate life after the baby is born. An active, engaged sexual journey primes your body and mind for birth, motherhood, and a satisfying erotic life.
This is a sensitive topic, and I don’t treat it lightly. Our culture’s conversation regarding sex is so narrow that it is normal for us to experience a mixture of fascination and shame, discomfort and desire, attraction and aversion, when the topic arises. We encounter challenges in expressing ourselves, in having desire without guilt, with regard to our body image and our perception of what is sexy, attractive, and desirable. Many women I work with explain that they feel they understand the power of their sex but do not know how to access it. They feel there is a secret box that holds the keys to a transformative and even illuminated sex life, but they don’t know how to get to them. This idea could be a whole book in itself, because sex is possibly the most potent and untapped tool for healing in our time, but there is a jumping-off point for how to deepen your sexuality while preparing for birth and after.
First, it’s helpful to expand our definition of sex and understand a few things about the difference between male and female arousal. Most people think of sex as penetration, known in the sex-education world as penis in vagina sex (PIV). When we define sex like this, it limits the way we connect and the possibility for new types of pleasure. When we only count sex as intercourse and climaxing, sex can become tally taking: I do you; then you do me. This is a limiting script. Women often feel guilty for taking too long. We fall into ruts, of actions or positions that we know we can orgasm in, and we don’t necessarily explore different possibilities or ways we can experience pleasure.
Our cultural idea of sex is based on the male-arousal trajectory, which is a steady climb and then a sharp drop. This is what is typically portrayed when you see a man breathing and thrusting faster and faster, climaxing, and then falling asleep. Most porn is made for men, so even the women in porn are performing a male-arousal trajectory, building and building to a scream of a climax. But male and female arousal work differently.
Full arousal for men can take as little as thirty seconds to a minute. Female arousal works in rolling waves, ebbs and flows, and full arousal takes about thirty-five to forty-five minutes. This is the biology of how the erectile tissue works. For most women to get to a place where genital touch is a turn-on, it takes more time than it does for most men. While women have just as much engorgeable tissue as men (yes!), ours isn’t nearly as visible, and is therefore more mysterious—to us and our partners. It’s possible for women to have penetrative sex without being fully aroused, and enjoy it even. But penetration without full arousal becomes more difficult, and sometimes painful even, after having a baby. Although the changes in our sexuality can be disconcerting after birth, during the postpartum period there is a huge opportunity to expand our relationship to our own desires, erotic nature, and many new, undiscovered pleasure pathways.
Here are a few ways to expand erotic possibilities that can positively influence your birth experience.
Challenge Your Role as a Giver
Carve out time with your partner to practice receiving nongenital touch for fifteen or twenty minutes. Stick to just receiving, even if it is tempting to make it mutual. Experiment with different types and qualities of touch, such as tapping, light feather stroking, kneading, pinching, and using different body parts to touch with. Use a timer. Pause when the timer is finished and breathe together for one minute. Then, take the time to share one thing each of you learned or that was surprising. (If you are not partnered, you can do this with yourself—experiment with different kinds of touch, like kneading, tapping, patting, scratching on your own body.) If you are tempted to reciprocate or to only be the giver, resolve to change roles on another day. Allow yourself to exclusively receive, which is harder than it sounds for most of us.
Practice Using Your Voice
Allow yourself to make audible sounds. Get used to hearing unexpected sounds that arise from different sensations and from your unconscious. That way, when you are giving birth, your visceral sounds won’t be as surprising.
Express what you like and what you don’t like. If there’s something you really don’t like but have been tolerating, suggest an alternative. Develop your ability to say yes and no, and notice what doing so feels like in your body. If this is a challenging thing for you to do—and it is for most women—the word maybe may have to be no for a while. Get your partner involved by explaining that this is a process for you to get even more in touch with what you really want and love. Avoiding confusion and stopping yourself from the tendency to just go along with things will help you get clearer about what you want and find the power to express what you want—not just in the bedroom but also in your birth experience.
Sex without Sex
This one can be a bit of a hard sell, but it can also be a fascinating exercise that opens your mind and body to new sensations and experiences if you’re willing to try it.
What would it be like to have an hour of sexual play with penetration and climax off the table? That might even sound confusing, because what are you doing sexually, for an hour, without the goal of trying to get the other person or yourself off? What if, instead, sex is about connecting and dropping everything, dropping all agendas? What if it is about following and deep listening? Can you be in the experience, rather than viewing the experience? Are you brave enough to experience the awkwardness of trying something new? If you do get close to a pleasure peak, can you go right to the edge of it, and then back off? Rather than going for the release, allow yourself to stay in the strong sensation, and dial it back. Slow everything way down. Be interested in micro movements. This is intimately connected to building your nervous-system capacity. When you are playing at the edges of your arousal, you are expanding the range of sensation that you can stay with, without going over the threshold into climax. This will help you expand your capacity for sensation
Expand Your Capacity for Sensation
Another way to expand your capacity for sensation is through sensory play. Assemble a basket with different objects like feathers, rocks, straws, oils, sandpaper, yarn, fur, and anything else with an interesting texture or smell. With eyes closed, pick up one of the objects and feel it in your hand. Imagine that you have never felt it before. After about thirty seconds, you will notice a shift. As you roll the object in your hand or slide it along your skin, instead of thinking about the object and making associations with it, you will actually sensorially perceive the object. It becomes infinitely more interesting. You can feel your hand and skin experiencing the object and you can feel the object itself. Continue for two minutes with the object; I like to set a timer, because two minutes can go by quickly or seem like forever. Be curious and find pleasure.
Identifying Your Core Erotic Theme
The idea of the core erotic theme comes from a book called the Erotic Mind by Jack Morin. He says, “Hidden within your Core Erotic Theme is a formula for transforming unfinished emotional business from childhood and adolescence into excitation and pleasure.”
In this process of transforming unfinished emotional business, we can also be the protagonist of our erotic life and construct experiences that are deeply nourishing and satisfying. When we sit in a seat of empowerment with our sexuality, when we practice having and using a voice with our desires specifically related to our pelvis, we engage in magnificent birth and postpartum preparation practice.
Once you know at least one of your core erotic themes, you can take an active role in creating the kinds of sexual connection that you want to have. Some people worry that this might take the mystery out of connection. In fact, knowing a common thread between some of the highlights of your erotic life allows you to focus on experiences that have worked in the past, instead of what hasn’t worked. This key also gives you another piece of self-knowledge to empower you to be proactive in the sex you want with tangible requests. Like most of these explorations, you can do them with a significant other or by yourself. If you have a good friend, you might want to suggest that you explore your core erotic themes together. Sometimes when you share the experiences, they can see commonalities that you can’t. This can also be a great intimacy building practice to do with your partner. Each of you can write down your own experiences and then come together to share what you found. You don’t have to share the details of the experiences, instead you can share the theme or themes you found and anything that surprised or interested you. Start this with an open mind and open heart. And if you are sharing with someone, suspend judgment and criticism; instead feel grateful that they are sharing something so intimate and vulnerable with you. This process is more linear than circular. It may take several times of circling back to the material and experiences that you retrieved to land on a theme. More information may come in your dreams now that you have begun the inquiry.
To discover your core erotic theme:
1. Brainstorm and write down three or four of your most erotic experiences. Don’t judge yourself while doing so. This isn’t a competition for the most outrageous or nastiest experiences you’ve ever had, although you may want to write those down and certainly can. This is about YOU. When you scan back through your sexual experiences, what stands out as exceptional? What grabs you?
2. After you have identified these experiences, go back and write about each one in detail. Describe, rather than analyze, the scene. Who was there? What was the environment like? What interesting details do you remember? Write in a way that someone who was not there could read it and get a sense of what it was like to be there. Tell the story of it.
3. Then, leave the writing overnight or for a day or even two. When you return, read through all of the descriptions. Use a pen to circle or underline key words that stand out as themes between the experiences, rather than within them. What is common to the experiences that you chose? (This step can be hard to do alone. If you have a girlfriend that is willing to go through the process with you, you could read them to each other. Someone else is often able to see themes that we may not see.)
4. After you find clues about a theme, reflect on your current sexual self. Is your erotic theme currently being incorporated into and attended to in your intimate life?
5. Homework: Design a self-pleasure practice that includes an element of your core erotic theme.
6. Extra credit: Invite your partner into an experience that includes a part of your theme.
Building the Buffet
Start a list of your sexual desires. You may begin with what you learned from your core erotic theme to build a treasure trove of your fantasies and ideas about your erotic life. This can be anything from taking a bath with your partner to an evening under the stars to wanting to experiment with a specific sexual position. In my practice, I have noticed that this is a difficult practice for most people to even begin. In our culture, the dialogue about sex is usually limited to frequency (how often?) or technique, sex acts or positions.
If you want to include frequency or acts that you are curious about on your list, that’s great. Also include ways that you would like to feel during sex and curiosities you might have about your own body, your partner’s body, and the fantasies each of you have. I suggest that you each write down your own list and then compare notes, adding them together to create a joint buffet. Know that you don’t have to act these out, although you may want to. Build intimacy by sharing and exploring desires that may seem weird or taboo. Everyone’s idea of taboo is different. I have worked with couples who were too embarrassed and afraid to share their desires for years, only to find out when they did that they were shared. What sweet relief! However, even if they are not shared, there is intimacy in the sharing without judgment. (Note that if you or your partner watch a lot of porn, it will influence your or their fantasies. If only one partner is watching porn, the other is often less receptive to the fantasies the other expresses, especially if the partner can tell the fantasies are coming from porn, which seem manufactured rather than authentic desires.)
Giving birth and the journey of motherhood require losing control on a physical and emotional level. How do you prepare to lose control? You practice losing it just a little bit at a time. Receiving, relaxing about the outcome, expanding your capacity to feel, and being inside the experience will all help you surf the waves of arousal, orgasm, and surging contractions. If you are in a sexual routine, this is a great time to explore sex in a way that will prepare you for birth and expand the possibilities of intimacy and growth. A richer and more diverse sexual connection that explores new pleasure pathways will be an exceptional foundation for the rebirth of your sexual connection postpartum.
SUMMARY
• In preparing your body for birth, stay or get active, but do not overdo it. Listen to your body and your health-care professionals about exercise.
• Practice gentle exercises and stretching that will help you give birth, therefore aiding your postpartum recovery as well.
• Remember that stability is compromised by loose ligaments so watch overstretching and overloading your joints.
• You can practice letting your pelvic floor open up and you can manually stretch your perineal muscles.
• Cross-train your nervous system by alternating between phases of activation and relaxation, doing and being.
• Expanding your sexuality can be an amazing way to prepare for giving birth.
Practices
• Practice the breath for length two minutes a day.
• Download the audio to learn how to do a proper Kegel for birth preparation and recovery (at www.magamama.com/pelvic-mapping). Practice at least once.
• If you are a yogini, gymnast, horseback rider, or Pilates or barre-method enthusiast, emphasize the pushing action of pelvic-floor movement. Consider scheduling a pelvic-health session with a physical therapist or sexological bodyworker for help releasing your pelvic floor before giving birth.
• If you have a history of sexual abuse or hospital trauma, invest in a doula and somatic therapy, such as trauma resolution through Somatic Experiencing, to facilitate your birth process and consequently your postpartum experience.
• Take at least one step outside of your sexual routine by practicing one of the exercises listed above.
Reflections
• Notice where you are in the spectrum of activity—too much or too little—and seek to move toward balance.
• Make a list of curiosities or desires about your own body, your partner’s body, and ways you would like to explore.
• Write down three or four of your most erotic experiences and identify your core erotic themes. Then go back and look at what they have in common. Now create a scenario that includes some of those elements.