Most pregnant women will come into contact with a physiotherapist for one reason or another; commonly due to back or groin pain from pelvic instability around the third trimester, or to hire a TENS unit for pain control during labour, or to assess and rehabilitate pelvic floor and inner abdominal muscles after natural delivery or caesarian-section. However, there are more important things to know about having a baby than just the physical stuff.
Physios treat so many pregnant women that even if they or their partner have not gone through the life-changing experience themselves, they often have good insight into the difficulties of the birthing process itself, the changes it causes in the body, and the support services or treatments that can make this experience less traumatic, stressful or painful.
While all good hospitals will suggest that women or preferably women AND their partners attend “Baby classes” to educate them about the biological processes that occur during natural birth, and to prepare them for the intensity of the experience and the days that follow, this author believes that the information given in these classes should have some more practical knowledge ie “So we have a baby – now what?”. This blog post is an attempt to collect some of the more commonly imparted wisdom about the weeks before and after the event that will change your life forever.
Before Baby Day
Back Pain and Groin Pain: Many women experience the agony of pelvic instability related to bearing a child. It is predominantly caused by a womans body starting to increase production of relaxin, a hormone that is important in preparing the endometrium for pregnancy, and maintenance of early pregnancy – but also has the effect of relaxing the pelvic ligaments (sacroiliac and pubic symphysis). The production of this hormone reaches it’s peak at 14 weeks gestation, and certainly some women experience the onset of back pain as early as this, however for most the problem doesn’t become severe until the expanding baby stretches their inner abdominal muscles and pelvic floor past their optimum length and they struggle to support the back and pelvic joints any more. Coupled with this is the forward shift of a womans centre of gravity, resulting in the pelvis tilting forwards and more strain on the lumbar spine and sacrum. Commonly this can result in slipping or spraining of pelvic joints from normal daily activities, typically rolling in bed, putting on socks, getting out of the car or chair etc. Physiotherapists are trained to be able to assess the normal movement of these joints and mobilise any found to be too stiff, as well as providing supportive taping or bracing to provide external support where the instrinsic muscles are struggling to do this anymore. In some cases just a few treatments will fix the pain, but commonly it persists as the baby grows and the problem worsens requiring regular treatment for pain relief.
Clinical Pilates: If started early in the pregnancy, Clinical Pilates offers a solution for the weakening of overstretched pelvic floor and inner abdominal muscles, minimising the risk of significant pelvic instability as the pregnancy continues. It needs to be started early while the abdomen and pelvic cavity are not overstretched and becoming compromised, and while laying on your back and groin exercises are not contraindicated. It is both safe for pregnant women(right up to 36 weeks or so if no other complications are present) and incredibly enjoyable, ensuring the birthing process is strong and effective and recovery afterwards is swift.
Hospital Bag: Some women prepare this weeks in advance, some at the last minute, but there are some things that you should not forget to take. Don’t leave it to your partner to organise clothes, toiletries, hair brush etc because they’ll invariably get it wrong. Add to this the emotional roller-coaster of the post-pregnancy hormones and this can be the cause of some major hospital friction. From the physio perspective, we ensure that women have access to and experience with a TENS unit, tubigrip, and other tidbits of advice. TENS is drug free pain relief using electrodes on the back, and many women can labour to almost full dilation with only TENS and the occasional puff of gas. Tubigrip is a compression stocking, and just as we used them on swollen knees after knee surgery, external compression of the abdomen helps reduce swelling, after pains as abdominal organs settle, and especially if caesarian is necessary this can offer wound support. Aside from these we can help with pain control techniques such as mental imagery, and advice for breast-feeding support such as using Fenugreek for increasing lactation. This is available at health food stores, and though there have been too few formal scientific studies to give strong evidence for it’s effectiveness it does appear promising (click here for more information).
During Baby Day
TENS: One of the most effective methods of drug-free pain relief, the use of TENS (Trans-cutaneous Electrical Nerve Stimulation) is well established to be safe and effective, and many of our patients need little other than this and some gas to deliver their babies. This is not to say you need to be disappointed if you require other pain relief, it is not a competition. The best birth-plan is a flexible one.
Massage: Physios are able to teach partners how to massage effectively for relief of back and abdominal pain, and which positions are the safest and most helpful to achieve this during labour.
Mental Imagery / Mindfulness: While these techniques are not solely the domain of the physiotherapist, we have more experience in managing the painful patient by combining these techniques with optimum physical preparation to ensure that the intensity of pain during crowning is most manageable, and that women are just dealing with their pain, rather than fear of pain as well.
After Baby Day
Tubigrip / Compression Shorts: Certainly while in hospital and for the first 7-10 days afterwards some tubigrip worn around the abdomen is not only helpful to reduce swelling (often women are crestfallen that they’ve gone through such a big ordeal, and find that they still look five months pregnant!), but also to improve comfort and mobility afterwards. Getting up and moving reduces your risks of complications, and tubigrip will help you feel more comfortable doing this. Compression shorts are probably better a week or two after as they can be an effort to get on and off, but will support not only the abdomen but the pelvic floor as well. These are claimable on most private health with a referral from a physiotherapist.
Breast-feeding set up: So you’ve survived three to four months of back and groin pain, and can now look forward to THAT pain disappearing, however we commonly see women return at four to six weeks after the birth with neck pain and headaches. This is due to the excessive and prolonged neck and upper back flexion that is adopted while breast or bottle feeding. Advice on best ergonomic set up with pillows, different holding positions and some stretches to do once the little angel is sleeping can all be of real benefit in reducing this pain.
Use of Lactation Consultant: It seems reasonable to think that breast-feeding (since without it our species would have died off long ago) should be easy, natural and enjoyable. For most women, it is anything but. It can be painful, frustrating and emotional and since it is so important to the development of your baby’s immune system, health and the bond between mother and child, every resource should be implemented to try to make it work. Lactation consultants are an invaluable resource and should be consulted early to establish proper feeding, which can lead to proper sleeping, and this makes everyone happy. If you are not aware of a local consultant, ask the hospital or your physio for contact details.
Pelvic Floor Rehabilitation: We’ve all heard it’s necessary, otherwise trampolines are a no-go zone for the rest of your life, but there’s more to it than this. Just being aware of your pelvic floor and doing your “Kegel’s” is important, but this stops short in many cases of being adequate for full recovery. Your pelvic floor is a sling made of muscles from the left and muscles from the right that join in the middle, but each side has separate nerve supply and so it’s possible to have one side inhibited due to pain or damage during birth. When you just squeeze your pelvic floor you’ll feel something happening down there, but it requires more in depth assessment to work out if you’re contracting both sides evenly. This does not have to involve internal pelvic assessment, and can be done fully clothed, so it does not have to be as confronting as you might think. Typically this would start a few weeks after delivery, ensuring time for healing before exercises commence, and is JUST as important for women who’ve had caesarian delivery, as the inner abdominal and pelvic floor slings work in tandem. This is why even women who have not had natural delivery can find they have difficulty controlling the flow or urine, or have frequent urges to go to the toilet.
Bathing: It is relatively easy to manage the weight of a new-born infant lifting in and out of a bench top bath or basin, but they don’t stay this weight for long! As bubs gets heavier, you’ll have to consider the set up for their nightly bathing routine, which is such an important part of the night-time routine, getting them ready for sleep. Initially a bath resting on top of a bench in kitchen or laundry, with a sling-type seat for the baby to rest on is helpful. Since babies can’t control their trunk in sitting until about six to eight months old, you will need to always have a hand on their back and supporting their neck. This position can be challenging after a few minutes. Ensure you have all the shampoo and face washers close, consider switching sides on alternating nights, be aware of activating your core to support your spine. Try to stand and stretch regularly (so long as this can be achieved supporting the infant) and use your other arm on the bench to support your trunk if it not actively washing or tickling your baby.
If you’re recently pregnant, planning a family or are counting down the days until your bundle of joy arrives, give us a call and we’ll support you through the process.