Birth trauma can take many shapes from physical wounds to boundary violations - of consent, of bodily integrity, of social or emotional intimacy. Many women have expressed to me feelings of having failed, of being damaged, weak, incompetent, or broken following a traumatic birth. Often the experience of pregnancy and birth can stir up earlier life traumas, insecurities or struggles with body acceptance, disordered eating, control, and self-love.
In even the healthiest pregnancies and most empowered births, a woman enters motherhood and the nonstop demands of caring for a newborn, from a state of depletion. After 40 weeks of growing a new human within her body, she undergoes the labor of childbirth, multiple surges of uniquely powerful hormones, and a total shift in identity and priorities - all while learning how to nurture a precious and vulnerable infant. When a woman enters motherhood traumatically however, her task is amplified, and confidently embracing her new role is often a challenge. Birth trauma - physical and/or emotional, which often go hand in hand, can contribute to the prevalence and severity of perinatal mood and anxiety disorders (PMADs).
One profoundly effective and accessible treatment strategy that can serve as a thread in the tapestry of healing for women recovering from birth trauma, is therapeutic exercise.
Working as a prenatal and postnatal trainer for over a decade, I have seen firsthand how a daily practice of core strengthening, breath work and restorative movement can empower women with the tangible, embodied experience of their own strength, resilience and calm during an anxiety-ridden and sleep deprived fourth trimester.
I’ve also seen women heal those birth wounds much later, grateful to finally be pain-free, or to have recovered strength and function years after navigating the challenges inherent in pregnancy and birth.
Exercise affects our hormones and our brains
Not only does exercise enhance mood, it affects our bodies on multiple levels...everything from hormones to brain chemicals called neurotransmitters. This is why ample evidence demonstrates the role of exercise in supporting mood and mental health.
Exercise is first and foremost an act. An act of self-love.
To move is to actively choose life, health, recovery. Exercise grounds our bodies and focuses minds in the present moment, a welcome relief from ruminations on the past and worries about the future. On a fundamental level, engaging in exercise affirms our well-being, and exercise that coordinates with the breath helps our bodies metabolize stress hormones while stimulating our parasympathetic nervous system to facilitate a state of calm. The combination of restorative breath and movement cues our bodies to process the residue of imprints that trauma leaves behind in our sensory and hormonal systems. After a trauma, we are often terrified of the sensations in our own bodies, so re-connecting with the traumatized areas in a safe environment at a self-directed pace is key to regaining a sense of safety in the body.
Core and breath work: reclaim, rebuild, reconnect
Strengthening the deep core, the tissue that has gone through the most dramatic stress and transformation during pregnancy and birth, is particularly powerful from both a biomechanical and emotional standpoint. Our core embodies our sense of personhood, autonomy and femininity. Within days of experiencing what it feels like to reconnect to those deep core muscles, to consciously engage and relax, to recruit and release, women gain strength, improve core health and function, and they experience the power of their own resilience. On a practical level, therapeutic core exercises decrease back pain, improve urinary stress incontinence (no more leaking when you sneeze or jump), reduce symptoms of pelvic prolapse, decrease pain during intercourse, and boost body confidence, all of which enhance quality of life while alleviating several factors that contribute to social isolation.
Equipping mothers with practical tools and coaching to heal their core from the physical traumas of pregnancy and birth also addresses the helplessness that often accompanies traumatic experiences. During a trauma the body is immobilized or unable to respond protectively. For this reason, purposeful movement is an essential component of healing from trauma because it invites the body to participate in the creation of a new psychological imprint.
This empowers a holistic recovery by bridging both physical and emotional aspects of our experience.
Not all core exercises are created equal
Many common exercises, such as crunches, sit-ups, boat pose, and even some classical mat Pilates moves, can inflict harm on the very tissue we are working to heal postnatally. It is very important to seek out exercises that specifically rebuild the deep core muscles while protecting the back, pelvic floor, and the connective tissue that runs along the midline of the abdomen. I provide more detail here about how to evaluate whether an exercise helps or hinders core health, along with practical tips on how to modify common exercises to make them safe. In most cases, safety comes down to the quality of core engagement and pairing exertion with exhalation. Because I coordinate every movement with a breath, the women I coach not only benefit from a decrease in intra-abdominal pressure, facilitating the recovery of both their pelvic floor and abdominal muscles, but they also harness the parasympathetic nervous system to relax, release and digest.
Exercise offers an empowering tool to mothers as they reclaim and rebuild wholeness following a traumatic birth. With practices that can fit into the pockets of time that present themselves in a day, we can engage in small yet powerful steps to heal our wounds and open our arms to embrace the joys and challenges that motherhood presents.
Postscript: Many thanks to Kim Fraser-Harrison for her thoughtful and engaged conversation as I organized my thoughts around this topic. I appreciate your insights as both a practitioner and a new mother.
Leah Keller is a certified personal trainer and the founder of Every Mother (formerly The Dia Method), a fitness system and mobile app with tailored exercise programs for every stage of motherhood. Keller has more than two decades of fitness experience. She coaches women of all ages through evidence-based workouts to improve core strength, function, and total body health. Every Mother is endorsed by medical and birth professionals worldwide, and it is featured in the 2019 book The New Rules of Pregnancy. Keller currently lives in San Francisco with her husband, daughter, and baby boy.