Liz Cuttica is a personal trainer in the prenatal and postnatal space. We waste no time here! She walks us through the mechanics of the body, including all the shifts between the pelvis, pelvic floor, and rib cage (and more!). From the "how-to" of pushing to her top three fitness priorities for pregnant mamas who want to stay in proper alignment, avoid pain, and stay strong—this is jam-packed full of incredible knowledge!

Let’s dive in!

Q: Tell us about your journey—as such an active person—to having your first baby?

A: I had such a different mindset seven years ago when I was pregnant than if I were to get pregnant again. At the time, I had the mindset of “I’m not going to let this pregnancy ‘get in the way’ of my workouts, my teaching, my job, and what it is that I love.” So, I kind of had this push-through, power mentality and, in my opinion, did everything I could to have a safe pregnancy. I asked my doctors if it was okay that I was teaching all of these classes and working out, and they said to just keep doing what I was doing or, if I did it before, to keep doing it.

I had a pretty easy pregnancy physically. I had a little bit of SI joint pain, though I didn’t know what that was at the time. I went to a physical therapy facility that gave me some exercises. I was doing a great job with them and no longer had the pain. I went back a couple more times in my third trimester for them to show me things to do to prepare for birth. So, I thought I had a good handle on it.

My water broke at 39 weeks and three days. That day, I took a barre class. I was active. I worked out six days a week. The labor ended up being 36 hours. I didn’t have a birth plan. I didn’t really even think about it. I didn’t have a doula or anything. I trusted medicine. I just didn’t want a c-section.

My labor wasn’t progressing, so they gave me Pitocin. My water broke, but I wasn’t dilated—so it just went on. I went in on a Saturday night and, after about 36 hours, Monday morning at 4am, the doctor called it after the baby got stuck after pushing for four hours. They said this was going to end in a c-section—so, exactly what I did not want to happen.

So, I ended up having a c-section and my recovery was pretty awful. After laboring for 36 hours and pushing for four and ending with a c-section, I essentially gave birth two different ways. So, I was really sore and I had a major surgery. I just had this thought that I did everything I could and I was so active during my pregnancy that I would just pop the baby out. I had a lot of trauma involved with the birth and I had a really hard time accepting that that was my birth. I felt like I was not an active participant. I thought I was so active that I was just going to have this baby and I wasn’t prepared for everything else. I felt like my body had failed me.

At that point, during my postpartum recovery, about six months out, I still didn’t feel right. But I didn’t really know how to get back to where I was strength-wise. I had lost all of the weight because I had undiagnosed postpartum depression. So, I wasn’t trying to lose weight. I just did not feel like I was strong and I had a lot of back pain. At that point, I knew I needed help but I didn’t know who to turn to. That’s how the whole journey began.

Q: What were some of those things that were “off?”

A: It was a lot of my core strength. I noticed that I couldn’t do a roll down. I always had to go to my side to push myself up. At the time, looking back, I also wasn’t loading the tissue, so I wasn’t getting stronger. I didn’t know how to safely load the tissue at the time. I was almost scared of movement. I kind of disassociated from my abdominal area because of the surgery. It felt numb—and still to this day, a little bit numb. I get c-section scar massages to this day, so I’m still working on it. I didn’t have a connection to my core and, at the time, believe it or not, didn’t really understand or think about what the pelvic floor muscles were because no one had talked to me about it. I didn’t even know pelvic floor physical therapy was a thing at the time. I just felt like it wasn’t my body.

Q: What were some of the first things you were tipped off to that made you feel more supported and also teach and help other women?

A: At the time, I was teaching group fitness. I had gone back to teaching group fitness at a bunch of different boutique studios in Chicago and people had known that I had had a baby. So, all the women started coming up to me and asking what I did and how to do it. Inside, I was still fighting depression and having a hard time with my c-section so, in my head, I was thinking they don’t want to do what I did because what I did is I failed myself. I don’t have any advice to give. But I wanted to know what I could share with them so no one would have to go through what I went through.

A lot of women use movement as a stress reliever. It gets us out into community. It’s our friend. It’s our jobs. It’s so much more than a workout class or a run. For me, it eased my anxiety. I know a lot of women struggle with that when they just give birth to a baby and can’t work out, but also need something because they feel so anxious.

So, it was at that point of me going through it and knowing what I went through that early postpartum period when you aren’t supposed to work out and don’t get the green light from the doctor. I was just having other people turn to me. I figured, if this is my job and I’ve gone through so many different trainings with maybe a chapter on pregnancy, but nothing on postpartum, and I’m having a really hard time figuring this out for myself, I can imagine how the average woman feels whose job is not movement and fitness.

Q: What are some misconceptions?

A: Oh, she’s a female. She must know what’s going on. Oh, she’s had a kid, so she must know. I actually had a client come see me for the first time yesterday. She’s 31 weeks pregnant with her second, and she has a trainer she sees three times a week who is pregnancy and postpartum certified—but he’s a guy, so he doesn’t really understand. I asked her to show me the breathing she’d been working on and how she’d been engaging her core, and she had no idea what I was talking about. I knew I was in trouble when the second she walked in she clicked her apple watch ready for a workout. I thought she was going to hate me and ask for her money back at the end of the session. But before we do anything, we have to make sure we’re doing it right and safely. She had a shallow breathing pattern, which means when she took a deep breath, all the air went up to her shoulders and neck. She was contracting her abs forward, so I saw tenting and doming of her belly and her belly button popped right out. That’s a sign that you are not managing pressure in your abdominals. This is what I teach so you can feel your diastasis postpartum and also not contribute to putting pressure on your pelvic floor, because that doming, that pushing out of the belly button, is telling you that you’re putting too much pressure on your abdominal wall, which could also go into your pelvic floor and cause leaking, pelvic organ prolapse, or make those worse or keep them from healing. Every pregnant person is so different, so the compensations are going to be very different for each person. It has taken years and hundreds of women to get to the point where I can see those. It’s important to learn this stuff for yourself and not just rely on other people to tell you.

Q: What are some of the first things you walk someone through once they have a belly?

A: What I want them to know at the end of it—I don’t want them to come to me for a workout for an hour; I want these women to leave feeling more confident in owning their body and know what to do to modify. I try to teach because I want them to have as much information as possible and explain the why behind it. I tell them there is no such thing as a safe exercise, and there is no such thing as an unsafe exercise. It does not matter. Four people could all be in a plank and working different muscles depending on posture and other things going on. So, what I tell them is that it all comes down to how they are executing the exercise.

The things I want them to check off are:

1. Am I breathing? Am I able to take a deep breath? It doesn’t mean that every single move you have to get this huge deep breath, but are you able to get 360 degree expansion of your ribcage. When you go to put your hand on your ribcage, your thumbs in the back and pointer fingers in the front, when you go to breathe, can you get your ribcage in the front, the back, and the sides to open up 360 degrees? That is what breathing with your diaphragm is. How are you breathing?
2. How is your alignment and posture? How we have our posture is going to determine what muscles we are using. I could have my pelvis slightly tipped forward in what’s called an anterior tilt, which is when your pointy hip bones are further forward than your pubic bone. This is a very common posture, especially during pregnancy because your belly is growing and the hips are falling forward—and it stays postpartum. When the hips fall forward, your abs are in a position to not fire and your back is in a position to fire for your abs. Also, instead of using your glutes, you’re probably using deep hip rotators, which are the tiny little muscles in the back of the hip that cause a deep butt pain and sciatic pain. All that stuff will determine which muscles you are using. You should have a neutral pelvis when your pubic bones and your pointy hip bones are in the same level and plane and one is not further forward than the other. That’s really hard to do when you’re pregnant, so you have to start the exercise off using some abdominal muscles to switch your pelvis into that neutral position. If you’re already going into a squat without giving yourself a little bit of a brace, a light abdominal brace to change your pelvis to neutral, when you go into that squat, you’ll get no glutes. You’ll get all quads, all back, no core, and probably some pain.
3. Where is your ribcage? A lot of times, when our pelvis is tipping forward, the ribcage is going to be spilled open. If you look at yourself in a sports bra and yoga pants in profile, you want your bottom part of your sports bra and top part of your yoga pants to be equal distance all the way around from one another, parallel. When you’re in an anterior tilt, you’ll notice your bra line will be on a downward diagonal and your pant line is going to be moving down. You want the distance between your ribcage and your hips to be the same and to keep it the same. That’s just bringing your ribcage over your pelvis. Why does that matter? Because when you line up the ribcage over the pelvis, you’re actually lining up your diaphragm and your pelvic floor. When you go to take those deep breaths, you’re actually getting your diaphragm and pelvic floor to communicate with one another so it can naturally contract and release, and your core can naturally contract and release.
4. The most important—but the hardest to teach and monitor—is how are you managing pressure? We manage pressure in our abdominals on a daily basis. When you know you’re going to go pick up something heavy, you’re going to kind of brace your core a little bit. If you’re picking up just a piece of paper off the floor, you’re not going to overly brace yourself. If you have a heavy box, you’re going to know that you’ll have to manage pressure. Your little toddler is coming over to you and going to kick you in the stomach. What do you do? You brace your abdominals. So we manage pressure on a daily basis. What happens is pressure is going to go to the path of least resistance and where we are weakest. The two places we’re weakest are down that six pack line, the linea alba, the connective tissue that holds the rectus abdominis together. As the baby grows, that little sheet of fascia and connective tissue just starts to separate. It doesn’t split. Your abs do not split. The fascia just stretches and thins. One hundred percent of people have a diastasis at 40 weeks on their due date. Everyone is going to get a diastasis, so the goal during pregnancy is not to avoid a diastasis because you can’t prevent it; the goal is to manage your diastasis. That means that line is going to be where we’re weakest, that’s where we have holes. And then we have holes in our pelvic floor. So, when I say manage pressure, that is when I am going to be constantly using my hands on my abdominals in a plank, in an overhead press This is why I like single arm variations because I can have one hand on my abdominals so I can feel what’s going on so there’s no pushing forward, and I want to think about hugging my baby up and back. I also want to think about pressure in my pelvic floor, so there shouldn’t be that urge to pee or poop or heaviness. That is going to be telling you that too much pressure is going down on your pelvic floor—which, if you can picture like a netting, it hangs, it’s muscles that are intertwined that support the rectum, the bladder, and the uterus between your pubic bone, your sits bones, and your tailbone. That diamond. Those all sit right there. So, if I’m putting that added pressure down, that connective tissue and those muscles start to give and that’s when you start to get the organs starting to descend from the body, which can cause leaking and a whole bunch of other incontinence.

So, we just want to make sure that we’re being mindful of those things. I think if you’re not told those things, you’re not going to think about them. So, when we’re asking what to look out for, it’s really how you are managing pressure—and no one can tell you how to manage the pressure except for yourself.

Key Takeaways: 360 Breathing. Neutral pelvis. Ribcage stacked. Manage Pressure.

Q: So, once you kind of have that mastery in pregnancy, then you have to go through birth. What questions come up for people when they’re thinking about actually pushing?

A: I never thought that I would ever be talking about birth prep because I just thought I wanted to tell women how to work out well during pregnancy. But, here’s the thing: When you work out well during pregnancy—and what I mean by well is working on the breathing, working on the alignment, working on actually lengthening the pelvic floor because most (99%) of the women I work with need to work on lengthening their pelvic floor and letting it go versus kegeling—it just makes birth easier. I say that because I’ve had numerous clients that will send me a message from their delivery bed of the baby saying how much better it was than they thought. I get choked up and goosebumps because this is why I do what I do. I just never thought it would be helping them deliver.

My whole point is, if you start early and get your body ready—everything that I’m talking about with the breathing, the alignment, the posture, the pressure management—it’s all stuff you’re going to take with you beyond baby. Even if a male comes to see me—he has a core and a pelvic floor too, so I’m going to teach him all the same things.

I would say, when women come to me and ask me to help them get ready for birth, what I tell them is that everything we’ve already been doing is helping them with birth because we’ve been working on lengthening the pelvic floor. For context, when you get your ribcage to open up in a 360-degree manner, it actually opens up your pelvis. So, a lot of women who have a tight pelvis can actually fix some of the tightness by opening up the ribcage. So, you can’t really address a pelvis if you haven’t yet addressed what is going on above at the ribcage. So, if they have this really tight ribcage muscle that does not open—which is a lot of us from sitting all day and driving and being in poor posture, we can’t get our ribcage to open up right away—then you can’t fix a pelvis and get it to open.

The constant clenching of the butt, we want to avoid that as much as possible. That’s a very common thing that happens in pregnancy, because if the abdominals are shutting down because they are getting very long because the baby is growing, something has to support the pelvis. So, one of the muscle groups that kicks in is going to be the clenching of the glutes and deep hip rotators. If you don’t know if you’re clenching, squeeze your butt, squeeze it more, and then release it. If you feel that release happening, then that’s telling you you’re clenching. The constant clenching makes the muscles in the pelvic floor tight—and tight does not mean good. It means dysfunctional and that it cannot lengthen. So, what happens to many pelvic floors is they are stuck in this constant tight position, the short position, and they cannot lengthen.

So, what happens at birth is the pelvic floor doesn’t push the baby out. The uterus actually pushes the baby out, so a tight pelvic floor can prolong labor and also make it really hard to get the baby out. I think that was my problem. It’s all about the deep breathing and letting your pelvic floor lengthen, and also knowing when to push and timing that with usually an exhale. You want to make sure you are getting deep breaths because you want to be able to get your pelvis to open.

There are three stages of labor with the pelvis. The baby is going to go through the top part of the pelvis or the inlet, then the mid-pelvis, and then the outlet. So, there are different exercises you can do depending on where the baby is. So, if you’re working with a doula, they can help guide you through that. So the first stage, you’d want to sit on a ball and rock your hips forward and back and in circles. If you’ve ever heard of curb walking—where you’ve got one foot up on the curb, one foot down—that is to get the baby through the mid-pelvis because it’s got to have this shearing to get it open. Then, the very last part is when you want to be doing things where you’re internally rotated. So, if you picture your knees in, feet out, and pushing, that opens the base of the pelvis.

If you think back to old school times, most women give birth on their back—but when you give birth on your back, the bottom of the pelvis is actually stuck, shortened, and closed and you want to be able to open it. So there’s a lot involved.

If someone takes one piece away, breathing is going to be the most important thing because it’s going to help you in pregnancy, help get you a stronger and more functioning core and pelvic floor, help you in delivery, and it’s the first thing you can do postpartum to reconnect your core and your pelvic floor to get them to start communicating again. You can do that on day one of your postpartum recovery.

Q: Take us through some of those postpartum things.

A: I look at it in phases. So, the very first phase is going to be like the first week to second week after giving birth. The first couple days, if you don’t have time to breathe or you forgot because you’re so sleep-deprived, totally fine. But the first thing that I want everyone to start with is just have it stacked. So, as you’re holding the baby, feeding the baby, whether you’re bottle feeding or breastfeeding, put a pillow right behind your back when you’re in your chair. That’s going to give your brain some feedback as to where you want to start to get the breath going. Because your back has been so tight for so long because the abs had to let go, so the back muscles aren’t going to move and we have to get them to start moving. So, you can push your back into that pillow and take your other hand or another pillow and push it up against your belly. If you take a deep breath and your back is so tight but your abs are so relaxed because the baby was in there and there is nothing to fill up that space, all the air is just going to go out the front—which is really not what we want to do and what we want to prevent. So, breathe into your back as much as possible. If you can do three breaths at a time, I would just start there. 

Then, just start with mobility. That’s going to be angel wings to get the shoulder blades to move on the ribcage, some twisting, and things that are going to just feel so good especially after being in this hunched over position. The upper back pain that no one tells you about is awful.  Do really light exercises on your back and breathe and activate your core and pelvic floor. Just start to coordinate everything because coordination of the pelvic floor, the breath, and the abdominals is one of the hardest things. It’s going to feel a lot different. Your body feels a lot different pregnant than it is postpartum. So, you have to relearn everything that’s going on. 

Week two to week four is starting to introduce bodyweight like bridges and lunges, but nothing crazy or weighted. Just start getting the body moving. Then, you just progress from there. It’s all light.

I look at it as we need to be moving. Our bodies need to be moving and have the mobility, otherwise we’re going to lose it. You should not be beating yourself up at this time, but if you plan on starting to work out at that six week mark and you haven’t done anything for six weeks, that’s a long time. Not to mention, your body went through major trauma. If you broke your elbow, you would have a follow up and be written a script for physical therapy and your doctor would see you in a week. But you have a baby and they’re like “I’ll see you in six weeks” and you have to beg for your physical therapy script.

Don’t think because you did it pregnant you can do it now, because your core is actually stronger at 39-40 weeks pregnant than it is postpartum. If you think of it in a length-tension relationship, you have your abdominals, they are long, but you have the baby in there to fill it up, so you’ve got some tension on the abs. Now the baby is gone and the abs are still really long, so you’re actually weaker after you gave birth. So, you have to give yourself time and grace and start building your groundwork and foundation and start layering it on little by little.

I believe there is a mental aspect that is so important to a postpartum woman because they don’t feel like themselves. Fitness is part of a lot of our identities, so I want women to be able to resume activity for the community and time away from the baby, but know they will be doing breathing and toe taps on the bench when everyone is doing something else—and you have to be okay with that. I want people to move how they love and to feel confident doing it in all stages. It’s a part of your life, so let’s try to make it work for you without hurting yourself.

Q: Are you seeing more first- or second-time moms?

A: Right now I have 27 women in a cohort, and 21 are pregnant with their first—which is unbelievable. Here’s what’s even cooler: Four women are not pregnant or postpartum, but just one day want to be pregnant. In the last two years, I’ve had around five women every time that just want to know all the stuff.

The biggest question I get asked is when someone should work with me. I say right now. The earlier you can learn the breathing stuff and alignment and start to do it in your everyday life—not just in your 45-minute workout—the easier it’s going to be, because it takes time and a lot of repetitions to get it.

_____

This blog post was written based on kozēkozē Podcast Episode 356: The Physicality of Pregnancy & Postpartum with Liz Cuttica.

If you’d like to listen to the conversation first-hand, tune in here.

_____

kozēkozē Updates

• We’re making real progress on our hero product, the Nipple Diaper, and cannot wait to bring it to market for all the postpartum, engorged, breastfeeding moms!
• We’re still waiting to hear back from a TV show!