**This is a repost of a classic Informed Pregnancy Project article.
“The squat is the queen of pelvic floor exercises, so you can ditch all of the kegels and start squatting each day!”
As a yoga teacher and doula, I have discovered that healing the core postpartum does not require hundreds of kegels and crunches. In my experience, the body does much better when slowly building on a solid foundation. This begins with relearning your body after the changes of pregnancy and childbirth.
Your core consists of your diaphragm, the muscles of the abdomen and low back, and the pelvic floor (the hammock of muscles at the base of your pelvis that stretch from your pubic bone to your tailbone).
Here are step by step instructions on how to feel these muscles and begin to bring them on board in all of your daily movements.
Breath Awareness – The first step in regaining integrity in the core postpartum is to simply reconnect to it with your breath. These are the very first exercises you can begin right after having your baby. There are two types of breathing to practice.
Pelvic Breathing – Gently inhale into the bowl of your pelvis. Notice the bones of the pelvis and the muscles in between. See if you can feel a slight expansion as you inhale and a relaxation on the exhale. There is no need to add any squeezing or tightening, just sense the muscles.
Belly Breathing – Gently inhale into the low belly. As you breathe in, let the belly soften and expand. As you exhale, allow the belly to relax back to its resting state. Note: Many people are used to sucking their bellies in when they inhale and pushing them out when they exhale. It may take a bit of practice to learn to reverse this way of breathing. You can think of softly blowing air into your belly, like blowing up a balloon on the inhale and the air leaving on the exhale.
Find Transversus Abdominis – Your transversus abdominis (TA) is your own inner belly band. It is the deepest abdominal muscle and wraps from the low back around to the front of your midsection. It is a large muscle that runs the length from your low ribs to your hip bones. The TA supports all of your abdominal organs and your posture.
Need more Informed Pregnancy? Click to check out this related podcast episode!
Sit up tall with your back against a wall or straight back chair for support. Inhale into your belly as you exhale. Imagine an inner corset wrapping from back to front, and hug these muscles toward your midline as you draw your belly back toward your spine. This is different from the habit of sucking your belly in that many women are used to. Instead, the belly button draws back, and the ribs and hip bones move toward the center. It’s a hugging in rather than a sucking in.
Posture – Now that you’ve found your TA, you can use it to support you as you move around in the world, and you will strengthen your core simultaneously. Engage your TA about 25-30% of the time while sitting, feeding your baby, and walking. While lifting things or standing up from sitting, engage your TA as much as 60-70%. Build up to using your TA more and more over time, and continue to breathe into your belly and side waist. Avoid the pitfall of over stiffening and not breathing.
Walk – Walking is one of the best exercises for toning your pelvic floor, and when you bring your TA on board, you’ll also be building abdominal strength. You will also be getting some cardio and enjoying fresh air. A good pair of sneakers with arch support will make all the difference. Walk around barefoot as much as possible when you are at home and around your yard.
Squat – The squat is the queen of pelvic floor exercises, so you can ditch all of the kegels and start squatting each day! Here’s a way to come into a squat that is easy on the knees. Stand with your feet a little bit wider than hip distance, and allow your toes to turn out about 45 degrees. Engage your TA, bend your knees enough to keep the spine straight as you fold from the hinge at your waist and bring your hands to the floor. Then bend your knees completely, dropping your butt toward the floor. This will take you into a full, low squat. Be sure that the toes and knees are pointing in the same direction. If your heels do not touch the floor, fold up a yoga mat or blanket and place it underneath them.
Postpartum recovery is a gentle and patient process. Be sure to balance any exercise with lots of rest, water, and a variety of healthy foods. Time is one of your best partners in restoring your core. Instead of focusing on what your body used to be, celebrate the subtle changes toward strength and health that happen over time.
Lara Catone is helping to establish the field of sexual wellness as a yoga teacher and somatic sexologist with a specialty in women’s health. She has attended nearly 50 women in birth as a birth doula and midwife assistant. In 2011, she began development of the Restore Your Core Program that includes nonsurgical approaches to diastasis recti (abdominal separation) and pelvic pain and dysfunction.
Lara trains fitness, birth, and medical professionals in her progressive approach to core health. She has a thriving private practice in Venice, CA and teaches workshops and retreats worldwide. Lara recently expanded her global community through the launch of an online studio with live webcam classes. Her mission is to empower radiant health and pleasure. Visit www.laracatone.com for musings and educational media as well as videos of transversus abdominis (TA) and pelvic floor exercises.
“I must admit, after I gave birth, the last thing I thought I would have to worry about was feeding my baby. I had always planned to breastfeed. My mother nursed me for two years and bragged about how fat my siblings and I got from her supply. As expected, my baby latched right away, but it hurt. I was told by the labor and
delivery nurses that pain was normal, even though it was surprisingly similar to my delivery pain. The pain continued, and by the end of the first week, my nipples were bleeding, and my baby was hungry all the time.”
A Pregnant Surgeon
I discovered I was pregnant at the end of my Ear, Nose, and Throat residency. I have to admit, the timing wasn’t ideal. I was working 125 hours a week, with much of that time spent doing surgeries in the operating room. My specialty is small and mostly male, and back then, maternity leave was nonexistent. Even so, there is never a good time to have a baby when you’re a female surgeon. I was determined to make it work.
My pregnancy was uneventful, except for the weight gain. Free to eat with abandon
I packed on fifty pounds. Between wearing extra large scrubs that hid my girth and clogs
with ample space for swollen feet, I barely noticed. When colleagues told me I was all belly
I believed them.
What I did notice was that as the pregnancy progressed, I became filled with joy. The hormones raging through my body gave me a sense of peace and hope. I calmly dealt with angry attendings. Belligerent patients got my full attention. It was as if the four previous years of sleep deprivation and anxiety were wiped away by all the estrogen. And then I went into labor.
I should back it up a bit here. The day before I gave birth, I was working at a hospital 20 miles from my apartment in the Bronx. Two weeks overdue, I waddled into the operating room to the horror of my attending.
“I am an ear surgeon,” he had said. “I don’t know how to deliver a baby.”
Lucky for him, I was able to work the entire day, drive the twenty miles home, go out for a spicy Italian dinner–this will be important later in the story–and go to bed. Around 11pm, I thought I had to go to the bathroom. That was my first contraction. After about an hour of steady, lower back contractions, I asked my husband to take me to the hospital. When we got there, the first question the triage nurse asked me was if I took Lamaze classes.
“I’ve run ultramarathons,” I answered. “I can take pain.” Or so I thought.
Once she brought me in to the triage area and strapped on the tocometer, my contractions accelerated to once a minute. I barely had time to breathe through one contraction before the next wave hit. An hour later, upset I couldn’t sit still for a good heart rate reading, the nurses prepared to send me home. I was a first time mom-to-be and barely dilated. As I stood up to change back into my clothes, my water broke.
Labor Pains
What followed was a blur. I was wheeled into another room and given an IV. OB/Gyn residents rushed into the room and told me to start pushing. With each push, my baby’s heart rate dropped precipitously. They tried using a vacuum. They brought in more residents. Then a doctor I’d never met wheeled in a cart full of metal objects. “Finally!” I said, assuming he was the anesthesiologist bringing me an epidural. “I’m Dr. B,” he said. “I don’t usually cover your doctor, but the residents asked me to give them a hand.”
He pulled out the biggest pair of metal spatulas I’ve ever seen. I had no idea how they could possibly be used to give an epidural.
“This is gonna hurt worse than anything you’ve ever felt before,” he said, very seriously. “Now, I want you to close your mouth and push.” I don’t remember the pain. I remember seeing the color red. And burping up spicy red sauce from the night before. After what felt like hours (but was probably 15 minutes), my daughter was born.
The time from first contraction to delivery took less than three hours. Suddenly, I was a mom.
Tune in to Dr. Linda Dahl’s interview on the Informed Pregnancy Podcast here:https://bit.ly/3JXZHkX
Nursing Problems
I must admit, after I gave birth, the last thing I thought I would have to worry about was feeding my baby. I had always planned to breastfeed. My mother nursed me for two years and bragged about how fat my siblings and I got from her supply. As expected, my baby latched right away, but it hurt. I was told by the labor and delivery nurses that pain was normal, even though it was surprisingly similar to my delivery pain. The pain continued, and by the end of the first week, my nipples were bleeding, and my baby was hungry all the time. I nursed every hour for an hour, but she still needed more.
At our two week pediatrician visit, I was told she had lost a little weight. When I complained about how painful breastfeeding was, the pediatrician assured me that, just like the early weight loss, the pain was normal. My OB/Gyn brushed off any discussion of breastfeeding. As she explained, her job ended once the baby came out. After four weeks, I visited a breastfeeding class. Unlike the other babies, mine fell asleep on the breast after only a few minutes. The other babies were also fatter, and their moms didn’t have scabbed nipples. When I weighed my daughter after her feed, she had only taken in a fraction of an ounce, unlike the 2-3 ounces taken in by the other babies. The worried lactation consultant took me aside and encouraged me to see a private consultant.
The private consultant wasn’t much help either. After spending a small fortune, I left with no answers. She was unable to get my daughter to latch on any better than I could, and as it turned out, there was no sense in trying. After only four weeks, my supply had dwindled. Not even the hospital-grade pump I rented helped. For the next four months, even though I attached myself to it religiously, my supply stayed low at only two ounces for the whole day. Then, my supply dried up. I had to call it quits, blaming myself for failing at something that was supposed to be easy.
I wish I could say my story is only my story, but, unfortunately, it is the story of countless women. Even though 83% of U.S. moms try to breastfeed, only a dismal 40% are able to do it exclusively for three months (even less for six months). Those who manage to breastfeed often struggle through pain, infections, and hungry babies. It was my failure paired with the lack of medically accurate advice that led me to dedicate a large part of my current medical practice to breastfeeding. Over the last nineteen years I’ve developed a paradigm to assess breastfeeding moms and babies and offer them treatment options.
Breastfeeding is just like everything else in the human body, but it isn’t treated that way. It may be natural, but nature is imperfect. Medicine is supposed to heal that imperfection, but in the case of breastfeeding, these issues have been largely ignored. I look forward to changing that, and you should (demand it) too.
Dr. Linda Dahl is an Ear, Nose, and Throat doctor and breastfeeding specialist who has treated over 23,000 mom/baby dyads over nearly 20 years in practice in NYC. She has developed a new paradigm in the assessment, diagnosis, and treatment of breastfeeding challenges and recently published her second book on breastfeeding called Better Breastfeeding: A Doctor’s Guide to Nursing Without Pain and Frustration. For more information, visit www.drlindadahl.com.
“D-MER (Dysphoric Milk Ejection Reflex), she told me, is a specific condition that is often confused for postpartum depression but is distinct in a number of ways. Its defining characteristic is that the intense and often overwhelming negative feelings are confined to a short period directly corresponding to a new mothers breast milk “let down” or milk release.”
Always Learning
A few years ago I clicked on a random Facebook post about a cognitive condition called Prosopagnosia, also known as face blindness. Until that point I had no idea that I was seeing the world in a very different way than most people, and that there was a specific condition describing my experience to a T. At once the first 40 years of my life made so much more sense.
Now, twenty-ish years into my family focused Chiropractic career, I’ve seen most of the challenges that pregnancy, childbirth and postpartum present for people but a recent patient experience opened my eyes to how many conditions exist but have yet to make it into the public sphere of knowledge. And not for lack of people experiencing them.
During a session, one of my clients mentioned feeling depressed when she breastfed her new baby and I wondered if she was suffering from Postpartum Depression, however the distinctive characteristic of her experience was that, although it was extreme in nature, the only time she felt it was when she breastfed her baby. Luckily, my wife, Dr. Alyssa Berlin, PsyD has been working with perinatal clients for about 20 years and she had answers.
What is D-MER?
D-MER (Dysphoric Milk Ejection Reflex), she told me, is a specific condition that is often confused for postpartum depression but is distinct in a number of ways. Its defining characteristic is that the intense and often overwhelming negative feelings are confined to a short period directly corresponding to a new mothers breast milk “let down” or milk release. I had a long consultation with Dr. Google to learn more about the specific details of D-MER. In my searches, I came across Alia Macrina Heise, a D-MER expert both as a sufferer and an educator, writer and advocate. The work she has done in compiling data, looking for answers and spreading information about this condition is the leading source of information available today.
We had an extremely informative discussion on my podcast, Informed Pregnancy, and you can listen to that here: https://bit.ly/3zCOelS
Postpartum depression is characterized by classic signs of depression such as depressed mood, severe mood swings, excessive crying, intense irritability and anger as well as difficulty bonding with a new baby, fear that you’re not a good mother, and other related symptoms. Postpartum depression often starts within the first few weeks after giving birth and, like classic depression, is felt all or most of the time over a long period.
D-MER is distinct from postpartum depression because although it shares symptoms – sufferers often describe feeling sadness, dread, anxiety, anger – these feelings are specifically triggered by milk let down and start about 30-90 seconds prior to milk release when a mother’s breast releases milk during feeding, pumping or spontaneous milk ejection reflex (MER.) These feelings usually last no more than two minutes, returning with each individual letdown. The rest of the time, when the nursing mother is not having letdown, she feels fine with no reported symptoms of depression.
Also unlike postpartum depression, D-MER is not yet considered a formal diagnosis because there have yet to be formal studies with consistent results. There is however, a wealth of anecdotal evidence much of it collected and synthesized by Alia Macrina Heise and presented in her book “Before the Letdown: Dysphoric Milk Ejection Reflex and the Breastfeeding Mother.”
Addressing the Cause
So what causes D-MER? We actually don’t know yet. One suspect is hormones. During a milk release sufferers experience an abnormal drop in Dopamine (the hormone responsible for feelings of pleasure and reward among other things,) a rise in Prolactin (a hormone responsible for milk production,) and a spike in Oxytocin (the hormone responsible for helping milk release as well as complex social and emotional related chemical reactions.) All three of these actions happening together when a breastfeeding mother’s milk lets down is thought by some to cause the intense temporary feelings of dysphoria known as D-MER.
Whatever the cause, it is a real problem affecting people all over the world and I feel privileged to be able to shed some light and spread some information on such an important subject so sufferers know they’re not alone. When I found out about Prosopagnosia, I was glad to have a name to help me define and explain my experience and that is what I want for those who experience D-MER.
If you or someone you know is experiencing symptoms of D-MER, you can find more information and resources atwww.d-mer.org
Dr. Berlin is an award winning prenatal chiropractor, childbirth educator, and labor support doula as well as the host of the Informed Pregnancy Podcast where each week, parents, birth professionals, and parenting experts weigh in on a full range of topics surrounding the perinatal period. Dr. Berlin runs a successful perinatal wellness group in Los Angeles, CA with his wife Dr. Alyssa Berlin with whom he shares four kids, two guinea pigs, and one dangerously smart Aussiedoodle.
,Postpartum depression is well known among those who work with new and expectant parents but what many don’t know is that it’s just one of many perinatal mood and anxiety disorders (PMADS). There are many different ways that these mental health issues can present, but they affect male and female parents alike. The mainstream perinatal industry is set up to identify and address the mental health needs of new mothers. This is extremely important to address but the system often fails to recognize similar mental health issues for non-birthing partners and new fathers. There are a number of reasons this dynamic took shape and just as many reasons it needs to change.
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Parents of all genders often reference their own upbringing when cultivating a parenting style. This creates an interesting dynamic for male parents in particular as older generations saw more traditional gender roles which often involved men leaving much of parenting to the women. Today, men are not only allowed but encouraged to engage with their children on a deeper emotional level as well as take part in the grittier aspects of parenting such as diaper changes, meal planning and prep, and laundry and cleaning. This new and more nuanced parenting dynamic is a positive step forward but can be difficult for men to adopt, without a modern paternal role model.
In addition to a lack of modern parenting role models, studies show that men often have fewer and less satisfying friendships than women. Men struggling to create a comfortable role for themselves within their family unit are further hindered by the lack of a support system outside the home. Pregnant women are encouraged to join pregnancy support groups and mommy-and-me groups (gratefully evolving into parent-and-me groups) for after the baby is born. But men are often left to fend for themselves. For these reasons parenthood can be isolating for many new fathers.
New mothers and birthing partners are commonly given mental health assessments at the hospital before bringing their new baby home, however the same cannot be said for new dads and non-birthing partners. Even in situations where labor has been traumatic and the new mother is screened for PTSD, the non-birthing partners are not, even though they often were witness to or a participant in the trauma involving their partner and infant.
,This dynamic is especially unfortunate when considering that men are often conditioned by society to ignore and suppress their emotions. A lot of men have internalized the idea that they have to deal with mental health issues alone and without professional help. These men are exactly the group of people who need mental health professionals to extend a hand and check in, but that is not yet common practice.
Another important issue is that the majority of PMAD related studies have been focused on females until just recently. When a population is excluded from studies, it’s obvious that the findings won’t be indicative of that group’s behavior. Depression in men tends to present as anger or aggression, so their partners and even the men themselves don’t understand or identify those behaviors as a sign of depression and in turn, don’t reach out for help. When left untreated, perinatal depression can lead to interpersonal problems, withdrawal, substance abuse, and even suicidal ideation.
,The good news is that there are things we can do right now to address these issues. One big to-do is self education – you’re doing it right now by reading this blog! If you are a birthing partner, you can help address your partner’s needs by asking for mental health screenings through your healthcare provider. You can encourage your partner to reach out to and maintain close friendships outside of the family unit. You can encourage your partner to talk about their feelings surrounding parenthood, pregnancy and labor, and your relationship together. There are also a number of support groups for men and non-birthing partners that you can find online or in your community.
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If you notice signs of depression or other PMADs such as anxiety, OCD, or PTSD in yourself or your partner, please know that you are not alone. We all need help sometimes and help is out there if you know where to look. One of my best pieces of advice is to reach out to a trusted friend, or family member, birth-related practitioner, childbirth educator, or doula to help you connect with a maternal or paternal mental health therapist in your area. Your feelings and experiences are valid and you don’t need to suffer on your own. Men are parents. It may sound obvious but until the perinatal mental health industry fully acknowledges that men need support too, it’s worth repeating.
,Confidential support for people in distress, 24/7 ,SAMHSA’s National Helpline
,1.800.662.4357 (1.800.662.HELP)
,Treatment referral and information, 24/7
,Crisis Text Line
,Text “HELLO” to 741741
,Connects to a crisis counselor, 24/7
FindTreatment.gov
,Find a substance abuse or behavioral health treatment facility near you.
,References:
,Craig F. Garfield, Greg Duncan, Joshua Rutsohn, Thomas W. McDade, Emma K. Adam, Rebekah Levine Coley, P. Lindsay Chase-Lansdale. A Longitudinal Study of Paternal Mental Health During Transition to Fatherhood as Young Adults., Pediatrics,. 2014 May; 133(5): 836–843. doi: 10.1542/peds.2013-3262
,PMCID: PMC4006439
,Paulson JF, Bazemore SD. Prenatal and Postpartum Depression in Fathers and Its Association With Maternal Depression: A Meta-analysis. ,JAMA,. 2010;303(19):1961–1969. doi:10.1001/jama.2010.605
,Liana S.Leach, Carmel Poysera, Amanda R.Cooklin, Rebecca Gialloc. Prevalence and course of anxiety disorders (and symptom levels) in men across the perinatal period: A systematic review. ,Journal of Affective Disorders,. Volume 190, 15 January 2016, Pages 675-686
,Nieh HP, Chang CJ, Chou LT. Differential Trajectories of Fathers’ Postpartum Depressed Mood: A Latent Class Growth Analysis Approach. ,Int J Environ Res Public Health,. 2022;19(3):1891. Published 2022 Feb 8. doi:10.3390/ijerph19031891
,ABOUT THE AUTHOR:
Dr. Alyssa Berlin is a clinical psychologist specializing in pregnancy, postpartum, and parenting. She offers private counseling for women individually and with their partners. Dr. Berlin is the creator of ,,The AfterBirth Plan™, a program that prepares couples for what to expect after a baby is born. The workshop teaches couples how to prepare for a healthy postpartum transition for the baby, for each partner, and for the evolving relationship. She combines her psychological background and her doula training to help women and their partners feel empowered and comfortable in the labor and delivery process, both on a physical and emotional level. Dr. Berlin has specific expertise addressing fear and anxiety that may arise before, during, or after birth.
Dr. Berlin is on the Board of Advisors for the International Cesarean Awareness Network (ICAN) and is a faculty member of Maternal Mental Health NOW Training Institute. She conducts live pregnancy and parenting workshops throughout Southern California and online. You can read Dr. Alyssa’s blogs on the Huffington Post where she contributes to PBS’s ‘This Emotional Life” project.
Dr. Berlin received her doctorate degree at Argosy University in Atlanta, GA and went on to become a certified Gottman educator. She is a member of the American Psychological Association. She and her husband, prenatal chiropractor Dr. Elliot Berlin, live in Los Angeles and are the proud parents of four amazing children.zing children.
