Author: Rachel Tinius

While we hope that no one would have to find themselves in this space of loss recovery, we’re grateful to be able to help support you in a program designed specifically for you, the loss parent. This program was created as a tool to help you extend your recovery and return to fitness after your loss. 

We’ve provided programming as well as educational articles to help guide you during your recovery. The programming is split into 2 different tracks, each based on your body and postpartum timeline. A quiz has been provided for you to help you decide which track best fits your needs at this time.  

While you may not need or want to dial your fitness all the way back, being intentional in your return to exercise can help your body recover and help you maintain your long term health goals. 

No matter whether you’ve experienced an early miscarriage, a stillbirth, or infant loss, your loss and your ability to get the recovery support you need matters. 

Do you need to rehab your core and pelvic floor after a miscarriage or stillbirth? 

Yes. If you’ve experienced a pregnancy, even if the pregnancy ended in loss, a progressive return to fitness that prioritizes core and pelvic floor health can help your body recover and help you maintain your long term health goals. 

With pregnancy comes changes in the body, including hormones, postural adjustments, size of the uterus, constipation, etc. These changes can lead to an increase in pressure on the pelvic floor. 

Increased pelvic floor pressure from pregnancy, even if only for a brief time period, can lead to an increased risk of core and pelvic floor disorders such as incontinence, pelvic organ prolapse, or diastasis recti. 

Returning to fitness after pregnancy or infant loss isn’t a black and white event. You can speed things up or slow them down based on how you’re feeling in the moment and what you need in your recovery. Take your time and take what you need from this program to help you in your healing journey. 

Casey Thomas-Hardesty, MS 

Casey is the owner of Two Peas Wellness. She specializes in core and pelvic floor health as well as returning to fitness after pregnancy loss. 

In August 2021, I found out I was pregnant after a few months of trying. I was elated. Our family plans were falling into place perfectly. Two weeks later, I started to bleed. I called the doctor understanding I was having a miscarriage. I grieved appropriately, and with hope, soaking in friends who experienced miscarriages stories, “the next time we got pregnant, we had no issues!” 

A few months later, having drenched my sadness and stress about the loss in high dosages of hope, I was pregnant again. Remembering my friends’ stories and relying on the internet’s reassurance that this pregnancy will stick, I was all in. Until a week or so later, I was bleeding, again. 

This time, a gray and anxiety-filled cloud began to follow me. I was irritable unable to manage my reactions easily. I wanted to isolate from loved ones trying to help. Not only was I late to work most days, but also I wasn’t engaging in my work as deeply. Our house was dirtier and my son ate a lot of chicken nuggets as every task felt extremely tedious. Despite getting a good nights sleep, I felt tired all the time. My thoughts transformed from hopeful to fearful. Thankfully, as a therapist, I knew these symptoms were beyond my typical grief and stress reactions. It was time to seek help from a professional. 

Experiencing sadness, low mood, increased worry, the desire to keep to yourself is normal and even to be expected following a miscarriage. However, if you notice (or others notice) a more profound change in mood and functioning such as: excessive worry, increased fear, crying spells, hopelessness, helplessness, guilt, shame or self-blame, inability to perform routine duties, decreased desire to engage in hobbies, changes in eating or sleeping, or thoughts of suicide, this may be an indication of a more complex mental health issue. There are therapists who specialize in perinatal care and multiple support groups online and in person to help you. You are not alone.   

https://www.tommys.org/baby-loss-support/miscarriage-information-and-support/miscarriage-support/grief-and-mental-health#:~:text=Going%20through%20miscarriage%20can%20be,mood%20changes%20and%20difficult%20emotions.

https://www.acog.org/womens-health/experts-and-stories/the-latest/finding-emotional-support-after-pregnancy-loss#:~:text=Be%20sure%20to%20seek%20help,muscle%20tension%2C%20sweating%2C%20or%20nausea

While not as likely to happen with earlier term loss, lactation can occur with later term miscarriage, stillbirth, and abortion. If you’re experiencing lactation after your loss, it’s important for you to know that you have options for what that process looks like for you. 

Your breastmilk will likely begin to come in within a few days after your delivery and continue to be present for days, weeks, or even months after stopping hand-expressing or pumping. Symptoms of lactation may include tender and engorged breasts and leakage of milk. There are options to help you with pain management including over the counter pain relievers, hand expressing small quantities of milk to reduce pressure, and cold compress.  

Contact your medical provider if your breasts are warm and/or red, you have a fever, body aches, or chills, or if you’re experiencing white or bloody discharge from your nipples. These could be signs of mastitis or another type of infection requiring treatment. 

Stopping milk production 

There is no current universal guide to stopping milk production, but you can help to lessen the discomfort of symptoms while supporting your body to stop stimulating milk production as soon as possible. This process typically takes 7-14 days. 

• Wear a supportive sports bra 24 hours a day 

• Apply ice packs to the breasts 

• Limit hand-expressing or pumping in an attempt to relieve engorgement symptoms. The more often this is done, the more your body is stimulated to produce breast milk. 

• Avoid stimulating the nipples as it stimulates milk production 

If you’re experiencing discomfort or distress with lactation, contact your medical provider to see if other pharmacological options may be available for you. 

What to do with breastmilk 

With hand-expressing or pumping, there are several options on what to do with the resulting breastmilk. Some loss parents may find different options more helpful and healing to them on their journey. 

Discard 

Any milk stored or produced may be discarded. 

Donate 

A certified lactation consultant can give you local options for donations, including milk banks, as well as discuss the screening and donation process with you. You may be able to donate milk that you’ve already produced or even continue to pump for a period of time to produce more milk for donation. 

Kept as a memento 

There are companies available that are able to turn breastmilk into wearable keepsake pieces such as jewelry like beads or pendants. 

You may also choose to keep the breast milk stored in the freezer as a memento or until you are able to make a decision on what to do with it at a later date.  

Your body has been through hormonal, emotional, and physical changes throughout your loss. Lactation may be another step in that process for you. If you find yourself in need of additional bereavement or lactation support, please reach out to your provider so they can get you in contact with the appropriate resources. 

Casey Thomas-Hardesty, MS 

Casey is the owner of Two Peas Wellness. She specializes in core and pelvic floor health as well as returning to fitness after pregnancy loss.  

The way you breathe during your exercises can have an impact on your pelvic floor. 

While some pressure downward into the pelvic floor is normal, excess pressure or bearing down can lead to pelvic floor disorders such as pelvic organ prolapse, incontinence, and pelvic pain. To help reduce your risk of these pelvic floor disorders as well as to help minimize current symptoms, it is important to reduce the excess pressure placed on the pelvic floor. 

Some strategies to help reduce excess pelvic floor pressure may include breathing pattern changes, alignment adjustments, foot placement, position of exercise within your workout, added mobility, pelvic floor relaxation, etc. 

Below are different breathing patterns that you may find beneficial to help you connect with your pelvic floor and reduce excess pressure on your core and pelvic floor. 

Diaphragmatic breathing 

With diaphragmatic breathing, the goal is to fully expand your ribcage 360 degrees to allow your diaphragm full movement on inhale and exhale. Think of where the lower band of your sports bra is placed and work to expand out into that band in all directions with your inhale. 

By allowing the full expansion, you can practice syncing your diaphragm movement with your pelvic floor and using your breath to create a lift or relaxation of your pelvic floor as needed. Diaphragmatic breathing also allows you to help better manage the pressure within your core as a whole and allows you to reduce pressure on your core for those with diastasis as well. 

Oftentimes, having feedback is important when learning to do a diaphragmatic breath. You can use an exercise band placed lightly around your ribcage, lifting belt, or even tightening your bra one extra notch to help give you tactile feedback on where to expand your breath into. 

Exhale through the movement 

Once you have been able to practice diaphragmatic breathing, the next foundational breathing pattern is exhaling through the entire movement. This is typically what we recommend to most people when returning to exercise after a loss or after a core or pelvic floor disorder diagnosis. 

This breathing pattern asks you to take a diaphragmatic inhale before you start the movement then exhale through your mouth (like you’re blowing out a candle) through the entire movement. 

As you become more proficient in this breathing pattern, you may be able to move faster by exhaling through several repetitions of the movement. 

Squat example: 

• For a squat, you would take a diaphragmatic inhale at the top of the movement. 

• As soon as you start to squat down, you would begin your exhale and continue your exhale until you were back to standing. 

• Depending on your load and comfort level, you may be able to continue your exhale through multiple reps of the squat. 

Exhale on exertion 

Exhale on exertion is another foundational breathing pattern that allows you to relieve excess intra abdominal pressure during your workouts. This pattern asks you to take a diaphragmatic inhale as you start the movement and start your exhale just before the exertion portion of a movement. 

Squat example: 

• For a squat, you would do a diaphragmatic inhale on the way down 

• Just before you reach the bottom, you would start your exhale and continue your exhale through to standing. 

• This breathing pattern won’t allow you to move as fast as exhale through the entire movement and therefore may be better suited for heavier loads or slower tempo exercises. 

Neither exhale through the movement or exhale on exertion are better than the other. Try them both to see which one you feel more comfortable with. You may even find that one pattern works for one movement while the other pattern works better for others (ex: exhale through the movement with squats but exhale on exertion with deadlifts). 

Casey Thomas-Hardesty, MS 

Casey is the owner of Two Peas Wellness. She specializes in core and pelvic floor health as well as returning to fitness after pregnancy loss. 

In order for your pelvic floor to maintain optimal function, it must be able to relax. 

Since tension isn’t isolated, if you’re holding tension in other areas of your body, you may be holding tension in your pelvic floor as well. Areas of tension related to the pelvic floor: 

• You grind your teeth or clench your jaw 

• You carry tension in your shoulders 

• You squeeze your glutes all day long 

• You suck in your stomach throughout the day or “engage” your core with every exercise 

Other signs of potential pelvic floor tension: 

• Trouble fully emptying your bladder or bowels 

• Pain with tampon insertion, intercourse, or orgasm 

• Pelvic pain 

• Incontinence 

• Back pain 

Because the pelvic floor needs to be able to relax in order to function properly, it’s important to add in periods of relaxation both with exercise as well as sprinkled throughout the day when presented with chronic stressors. This may look like diaphragmatic breathing, mobility, lying with your legs up the wall, or even reducing the intensity of your workouts. 

Mobility in your workout 

Adding mobility to your warmup can help you elongate the pelvic floor and surrounding muscles and gain stability in end ranges of motion, thus helping you reduce your risk of injury and feel less symptomatic. The key here is stability and control. 

Try these mobility exercises as a warm up for your workouts or when you need the extra relaxation after periods of increased tension from stress, long periods of sitting, or an increase in your activity levels. Go slow and try to get as full of a range of motion with these exercises as you can for now. 

Exercise: Adductor rock back 

Perfect for: Squats, deadlifts, step-ups, lunges 

Exercise: Shinbox rotation 

Perfect for: Squats, deadlifts, step-ups, lunges 

Exercise: Thoracic rotation 

Perfect for: Squats, overhead press, bench press 

Exercise: Wall angels 

Perfect for: Overhead press, bench press, squats 

Exercise: Hip CARs 

Perfect for: Squats, deadlifts, step-ups, lunges 

Casey Thomas-Hardesty, MS 

Casey is the owner of Two Peas Wellness. She specializes in core and pelvic floor health as well as returning to fitness after pregnancy loss. 

While kegels and transverse abdominis (TA) contractions are popular in core and pelvic floor recovery, it’s important to understand both how to perform these contractions and when they should be used. 

Like any other muscle group, the core and pelvic floor needs a balance of both strength and relaxation for optimal function. Consistently over recruiting the core and pelvic floor muscles can lead to an increase in symptoms – including incontinence, an increase in prolapse symptoms, pain with intercourse, low back pain, etc. 

The kegel 

How to do a kegel 

A kegel is the term used for a pelvic floor contraction and its release. 

When assessing yourself, you want a slight contraction and a lift of the pelvic floor with a kegel. You don’t want to see the bearing or pushing down on the pelvic floor. You also don’t want a contraction so hard that it brings in all nearby muscles, ex: you don’t want to be squeezing your abs and glutes. If you see that hard of a contraction, try doing less next time with your kegel and see what happens. 

Internally, you want to feel an even contraction that gently squeezes all all around the vaginal canal and lifts inward into the body. Again, this doesn’t have to be a maximum level contraction. You’re looking for something gentle. After the contraction, you want to feel the muscles letting go and relaxing. 

The relaxation portion of the kegel is an important step that many people miss. When you are dealing with stress and grief, you are more prone to pelvic floor tension. We don’t want to add to that tension with a constant contraction of a kegel without release. 

When to do a kegel 

Ideally, you aren’t going to be performing a kegel with every exercise. 

Sometimes kegels while lifting help, and sometimes they don’t. It’s a matter of playing around with it and seeing what feels best and what helps you perform the best. 

Before you kegel, try adjusting your breathing strategies as a first line of defense in getting your pelvic floor a little extra lift in your lift. Whether you go with exhaling through the whole movement or exhale on exertion (the “difficult” portion of the exercise) depends on what feels more natural and supportive for you. 

Sometimes, especially at higher weights, early postpartum, or when newly diagnosed with a pelvic floor disorder, you may feel more comfortable and supported adding in a kegel as well. 

When adding in the kegel, be sure to match the tension in your pelvic floor (the kegel) to the effort of your lift. Not every exercise will require a maximum effort contraction. For example, the effort of performing a body weight squat vs the effort of squatting with a 50lb kettlebell are different. The effort of the kegel should match that as well. 

The transverse abdominis contraction 

How to do a TA contraction 

Take a big diaphragmatic inhale expanding your ribcage 360 degrees around. On exhale, GENTLY draw your hip bones together. Like a kegel, your goal isn’t maximum effort. You want a very gentle contraction and lift of the muscles. 

To check yourself, place your fingers just inside your hip bones. Don’t press – that will cause too much pressure and have you likely over contracting to feel anything. When you do the exhale and TA contraction, you should feel the skin there sink in ever so slightly and move up. Again, these aren’t drastic moves. 

When to do a TA contraction 

The TA contraction is something that you’ll want to know how to do, but you don’t want to have to consciously think about it when exercising. We suggest TA contractions during the warm up breath work and core exercises throughout the recovery program. 

Don’t be afraid to play around with kegels and TA contractions throughout your workouts to see what works best for you. There’s no requirement to contract with every single thing you lift just as there’s no rule that says that you shouldn’t add in an extra contraction if you find that it serves you better. 

Casey Thomas-Hardesty, MS 

Casey is the owner of Two Peas Wellness. She specializes in core and pelvic floor health as well as returning to fitness after pregnancy loss. 

Core and pelvic floor health is an important part of recovery after loss. Understanding your core and pelvic floor, your tendencies, and how to work around those tendencies can help you reduce symptoms, minimize risk of complications, and have a positive impact on long term health. 

What is your core? 

Your core is more than just the abdominal muscles at the front of your stomach. Rather, your core is a system of muscles that work together for optimal function. It can be helpful to think of your core as a canister, including: 

• Diaphragm – manages pressure from the top 

• Transverse abdominis – deep wrapping muscles 

• Pelvic floor – supporting your pelvic organs (uterus, bladder, and bowel) 

When you inhale, your diaphragm naturally contracts allowing your lungs to fill with air. At the same time, your pelvic floor lowers or lengthens, and your belly relaxes. 

On exhale, your diaphragm relaxes, pushing the air out of your lungs. In other parts of your core, your transverse abdominis contracts and your pelvic floor contracts and lifts. These are super gentle contractions that you may not even feel happening, but the system is important to be aware of when it comes to counter any tendencies that you may have and decrease symptoms as you move throughout your daily activities. 

Core, pelvic floor, and exercise 

Maintaining an appropriate level of tension in the pelvic floor allows you to have the strength necessary to hold the pelvic organs in place while also allowing the relaxation necessary for urination and bowel movements. 

While it may seem that you want a strong pelvic floor, it’s more important to have a coordinated pelvic floor, one that can respond appropriately to the task at hand. Ex: when you squat, sneeze, or run. Too little strength, too much tension, or too much pressure generated in one area can lead to potential issues like incontinence, pelvic organ prolapse, or diastasis. 

Using exercise to help your core and pelvic floor symptoms 

Breath holding 

Are you someone that holds their breath all the time, bearing down, or sending pressure out into your abdomen? If so, how can we redistribute that pressure using your breath so it’s not concentrating in one spot? 

As you work through the exercises in this program, one way to manage tension is to play around with exhaling either through the whole exercise or through the portion of exertion (the straining or hard part of the movement). By timing this exhale, you’re allowing your body’s natural system to take place where the pelvic floor slightly lifts on exhale. You’re not looking to have to do this with every rep of every exercise. The goal is to make it automatic so you’re not thinking about it forever. 

Tension 

This time of recovery after loss can be stressful and traumatic for many people. With that stress can also come an increase in tension. Do you find yourself with your shoulders raised, glutes clenched, or clenching your jaw?  Tension isn’t isolated. Holding tension in those areas can mean tension in your pelvic floor too. 

To support this, we’ve added mobility and pelvic floor relaxation with every workout. You may want to reduce more tension by not squeezing your glutes when you squat, not doing a kegel while you’re jumping, or relaxing the belly in a run.  

Your core and pelvic floor play an important functional role within your body. By becoming aware of these tendencies and learning how to adjust pressure and tension, you’re also able to use the core and pelvic floor for positive impacts in your health. 

Casey Thomas-Hardesty, MS 

Casey is the owner of Two Peas Wellness. She specializes in core and pelvic floor health as well as returning to fitness after pregnancy loss.