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mybumpbirthandbeyond · 3 years

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Operation Abs of Steel

It’s crazy to think I’m at this point already. I genuinely feel like I’ve blinked and I’m back at the start again. Only this time is so different; this time, I am informed; I have the most incredible team in place already so I’ll be seen so much quicker; and I know what’s to come.

I have probably thought about the first two in person consults since falling pregnant. The first two being my first with Lyndsey, and my first with Gráinne. They are the official starting point for rehab this time around, and will tell me exactly what my separation looks like after a second pregnancy. This is the comparison point for any progress up to the date I have surgery. These will be the hardest hitting – the reality check of how far I have to go and how hard I will have to work. This is the start of an even longer road….

Prior to any consults, I wanted to get started. Most people are probably getting the measure of me by now: I don’t like to sit and do nothing and I like to work hard. The fact that I felt so much better more quickly this time, just increased that desire. I had been in touch with Lorna from Ur Mama Strength (I had done her classes until I was about 35 weeks pregnant). She kindly sent me the postpartum guide she sends all her pregnant women which gave a guide for things like connective breath work, walking and mobility for the first 6 weeks postpartum. I did that as well incorporating some of the stuff I had been doing right up until the week before I had Emily from prehab and of course, my pelvic floor exercises.

The checklist of things that physios look for was in the back of my head when I started. First of all, could I properly carry out the connective breathing and was there any sign of rib flare? I never had rib flare last time and I certainly didn’t pick that out this time either. The appearance of my tummy in general was awful when breathing – wrinkly skin just like an elephant, mind of its’ own, loose skin that is paper thin. Aesthetically, this definitely appears worse this time. I knew I would have to do a self-assessment at some stage and I was pretty nervous about that. I knew it was bad and probably as bad as last time, but the thought of finding out how bad, somehow made me apprehensive.

My hand continued to sink and sink telling me there was little to no tension. I had to use two hands to measure the gap between the rectus muscles and even that wasn’t enough. It seemed to be about 11 fw + at the widest point at rest. This is more or less exactly like last time – the only difference was I didn’t self-assess last time. Knowing that, I had a bit of wobble starting exercises again. Staring at the same ceiling I had for the best part of a year before I fell pregnant, but knowing I was back lying on my back really overwhelmed me. Knowing how long it took, and how much hard work I put in to get to where I was, it was pretty difficult to imagine being able to do that again, starting from scratch. But I shook it off. What made me progress last time to the point that I did? Not sitting around feeling sorry for myself that’s for sure (though I allowed myself that once or twice on the really bad days). It was gritty determination, competitiveness, stubbornness, and unwavering resolve that got me to where I needed to be. I couldn’t change that about me if I tried so there’s no way I won’t get back to where I was, if not even further.

Prior to my first in person consult, I had a virtual consult with the team. This was actually scheduled for the week I had Emily, thinking it would be my last one before the baby was born. When she arrived early, we decided to push it a few weeks. We ended up looking at a few things. I’m not entirely sure what they expected to see, but one of the exercises was one Antony said many people would be shocked by at 2.5 weeks postpartum. I struggled to see what was shocking about it – without meaning it in a boastful way, it felt easy. The good news was the initial signs were promising – I was clearly managing to generate tension and control the pressure well considering where I was at. We booked in my next consult for after my appointment with Lyndsey.

In the lead up to my appointment with Lyndsey, I started to test my ability to manage the pressure based on what I had done in the virtual consult. Headlifts felt fine and I also did a few more challenging things like birddog and introducing resistance to some of the exercises. Most of the time I could see the exercises were manageable. Birddog was a funny one – it felt like there was lots of pressure, but it didn’t feel that different to being in standing. It was pretty hard to feel and do the exercise at the same time so I got my husband to check – by this point he’s about as knowledgeable as I am! (though I still have the edge 😉) We agreed that gravity didn’t help and it was likely any additional pressure was not doming, but the weight of my organs falling forward. One of the many things I have learned from my physios is the pressure is visible when I am just standing doing nothing – that’s why my tummy protrudes. If that’s the case, if there is little to no change when doing more challenging core exercises, what’s to stop me from doing those exercises? I can’t prevent or stop the pressure when standing or sitting down, so what’s the difference?

It’s lessons like that that have made the world of difference to how I view this journey. I have learned so much already, and despite not knowing a thing last time, I wouldn’t have risked trying anything until I was seen by someone who was qualified to tell me. This time, I know enough to try things myself without bothering my physios for a simple yes or no.

My appointment with Lyndsey felt like an exam day in some ways. I had this nervous apprehension and kept clock watching until the appointment time. Don’t get me wrong, I am excited to see what happens as time goes on, but as I said, the first appointments will be the hardest. I think my experience of being asked when I was due the previous day hadn’t helped. You feel ashamed, self-conscious and like crap to put it bluntly. It knocks your confidence and just demonstrates how much work there is to do.

I had been really worried about prolapse this time around. There’s something about being blissfully ignorant that can be comforting. The fact that I see posts on prolapse all the time and how your chances increase the more children you have, did not help. That’s probably a positive indication of how much more readily available this information now is on social media. My birth was very lucky in that I only grazed this time instead of needing another episiotomy so it had made a lot of difference, but there was still an initial heavy feeling for the first few weeks. I had stopped bleeding earlier than I had with Cailean, but I’m pretty certain I’ve already had a cycle as I started bleeding again almost as soon as it had stopped. Us females are so lucky….🙄🤦🏽‍♀️

I had been doing my pelvic floor exercises as I said, but I was still a bit worried when it came to the pelvic floor check. It’s so integral to the core and what will be my rehab, that it was important to know exactly what was going on. Thankfully it was good news – good contraction and release, no damage to the muscle and no indication of any prolapse. My endurance could be better, but I’ll build that back up again, just like I did last time.

The tummy assessment was unsurprising. 11fw + was what Lyndsey also found at rest. Tension was awful as her hand also sank down to my bowel. On contraction when I did a crunch, above the belly button was 4 fw, at the belly button was 8 fw and below was 6 fw. Lyndsey had the impression my tummy looked better in standing but we both agreed there was next to no elasticity in the skin, particularly above my waistband and below my belly button. As Lyndsey pointed out, this could get worse as we improve the tummy itself and the only way this will be fixed will be when I have surgery.

I was asked to fill out the outcome measures as a mark of where I’m at mentally. I have been filling in two regularly for Gráinne, but by the time I’m finished, I wouldn’t be surprised if there wasn’t a single pelvic health outcome measure that I haven’t completed!!

We were then able to go into the hospital gym to try out some exercises. Lyndsey had spoken to Gráinne and they had come up with a plan. It once again dawned on me how lucky I am – how many people do you hear of who end up with a team of physios all more than willing to collaborate and work together in your best interests? Unbelievable.

The basic exercises all have their place, but as I’ve said before, they are the ones I hate – they make me feel incapable and like I’m really weak. I expected to do progressions of these – such as introducing resistance to the likes of clams or glute bridges. The fact I was able to do things like birddog with resistance, bear holds and lunges with theraband was a pleasant surprise – I was starting at a further point than last time. To me, that indicates things will hopefully move quicker, and I will progress sooner, which is everything I hoped for this time around. The reigns are firmly on at this point so I’m only to do rehab 3 - 4 times per week, but I expected that. Plus, it’s harder to fit in with two kids so probably not a bad thing!

I came out of the appointment with my confidence back. It’s amazing what seeing someone in person and being able to try things out while being assessed does for your mindset. I had taken being in person consults for granted. I think the toll my second pregnancy had taken on me mentally during lockdown and the fact I had only been seen twice in person throughout the entire duration had also played a part. Don’t get me wrong, I have made great progress through previous virtual appointments, but when you’re dealing with something physical, there is no substitute for someone being able to put their hands on you.

Getting started was one of the most important things to me. The apprehension of not knowing what the diagnosis was and where I would be rehab wise, was only going to be counteracted by the fact I would be back in control once I got started. I am the master of my own fate now – the progress will be dependent on me putting in the work. As I’ve said before, this is what I thrive on – the pressure I put on myself to succeed and the fact I will work harder than ever to ensure that I do. The goals I have set this time around are ambitious and will be challenging, but I have plenty of time and to be honest, I need a challenge to remain focused. Rehab 2.0/Operation Abs of Steel starts now.

#mybumpbirthandbeyond #postpartumrecovery #postpartum #secondtimemum #diastasisrecti #rehab

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