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During pregnancy we experience many different kinds of sensations, some pleasant and some ... not so. Many of us experience some sort of back pain during our pregnancies. The good news is that it’s natural and that your baby is growing! It is very common with occurrences as high as 60-70%. There are a plethora of reasons for back pains during pregnancy but some of the most common include:
During a healthy pregnancy, women are expected to gain anywhere between 12-25kgs. This added weight on the spine in such a quick amount of time may cause lower back pain due to the increased load the spine has to support.
Due to bub sitting right inside our uterus, it can cause a shift in the centre of gravity forward. This shifting centre of gravity can change the way you move and put strain through your body.
During pregnancy the body produces a hormone called relaxin which allows the separation of the pelvis to accommodate the child during child birth. This increased laxity within the pelvis can cause pain
As the baby grows the belly has to accommodate for this growth too. The abdominal muscles will separate in the centre. This separation may worsen back pain.
Emotional stress can cause hypersensitivity and increased tension in your back. You may feel more back pain when you are going through stressful periods of your pregnancy.
Physiotherapy is a good way to help prevent and manage ongoing back pain during pregnancy. A physiotherapist can identify the particular muscle that is causing you pain and can give you management strategies on how to cope with it. Soft tissue and joint mobilisation techniques have been shown to drastically reduce pain as well. As well as being hands on, a physiotherapist can prescribe ad cater specific exercises that will reduce your back pain, they can also recommend what type of external support to use during severe flare ups.
DRA is the acronym for diastasis of the rectus abdominal muscles, which is the separation that occurs during pregnancy to the abdominal muscles, to allow the baby to grow. This DRA occurs usually in the second and third trimester of pregnancy and can remain post pregnancy. It is suggested that post-natal DRA can lead to lower back pain and pelvic instability, and even develop urinary incontinence
The “acceptable” level of separation is less than 2 fingers at the level just below the belly button. You can check how much separation you have with this simple test:
1. Lay down on a hard surface with your knees bent and place a small cushion under your head.
2. Slide your fingers down towards your belly button and sink your fingers into your belly as you pass your belly button
3. As you pass below your belly button slowly sink 3 of your fingers into your tummy feeling your tummy muscles touch the side of your finger
4. Lift your head and bring your chin towards your chest to tighten the abdominals
5. Feel your abdominals squeeze your fingers, slowly remove each finger until you can feel your abdominals slightly pressing on the side of your fingers
6. Whatever fingers remain is approximately how many cm of separation you have
7. It is good to check the area just above and below your belly button too
The categorization of DRA is as follows:
· Normal < 2 fingers
· Mild DRA 2-3 fingers
· Moderate DRA 3-4 fingers
· Severe DRA > 4 fingers
Is there a way to manage this?
YES!!! The best ways to manage DRA during and post pregnancy involves movement education ie learning how to reconnect with your body and allow the deep muscles of your core to learn to work as a team once more. In more sever circumstances external supports may be useful and of course as a last resort surgery is an option.
While activity modifications can be useful in the short term and involve learning how to get in and out of deep chairs and bed, in the long term it is essential to relearn how too effectively and efficiently control and move your body. Exercises that help this learning journey include Pilates - for a more detailed outline of a Pilates journey post pregnancy please read our 'Exercise After Pregnancy' - these sessions will educate your on gentle core activation and pelvic floor exercises and ensure you are doing these exercises correctly!
External supports can help mimic the function of the abdominals, simple supports such as tubi grips and recovery shorts have been known to help.
It is always advised to seek our professional help when it comes to the management and education of DRA at BPS we have a variety of experienced women's health physio's who can help your with finding a solution that works for you, if you would like more information please don't hesitate to ask us a question here!
So you pumped! Baby is here and although you're full of love for your new little family member you're starting to think about ways to get back to loving YOUR body, after all, it's been through quite a lot in the past 9 months! While I want to encourage all new (and seasoned) mums to get back to moving as soon as possible post their birth, there are some considerations to take into account. Everyone is different and everyone's birth story is different. Understanding your birth experience and making decisions that are guided based on your body is imperative for a successful and enjoyable return to exercise after pregnancy!
The basic time frame given by most Obstetricians and Physiotherapists post pregnancy is the 3 - 8 - 12 - 16 week guideline. Which states;
0 - 3 weeks = gentle walking and pelvic floor exercises avoid abdominal exercises
3 - 8 weeks = if all is well gentle low intensity fitness begin gentle abdominal bracing exercises
8 - 12 weeks = if all is well gentle increase body weight exercises and endurance of abdominal bracing exercises
12 - 16 weeks = if all is well gentle increase
16 weeks beyond = return to previous physical activity levels
and while this is a nice starting point, Im sure you feel as I do, that it leave a lot of room for interpretation. What is I had a C - section? What if I had stitches? What if I was incredibly fit right the way though my pregnancy? What if I have never exercised before? What if I have back pain / neck pain / wrist/hand/elbow pain since the birth of my newborn? And probably the biggest question of all, how do I know if I am doing my pelvic floor and abdominal bracing exercises correctly?!?
The Best Advice
The best way to being your journey towards your return to your 'pre-pregnancy' body is with the guidance of a Womens Health Physio (even better if they happen to also be a Pilates Instructor!) There is simply no substitute for an accurate self assessment that will show up the strengths and weaknesses of YOUR body as it is right now. Stats, averages and estimates a great for making sweeping judgements, but every body, every pregnancy and every birth story is different and as such there is no room for a 'one size fits all' approach when it comes to returning to movement after birth. To give you an example of the varieties of situations I see in my day to day work as a Physiotherapist and Pilates instructor let me highlight for you two ends of the spectrum.
Mum A - is 2 weeks post the birth of her first child and comes to visit me for her post pregnancy assessment. I know mum A well as she has been doing Pilates with me well before her pregnancy and carried on doing it through out her 1st 2nd and 3rd trimester. She was also an avid runner and generally looked after her body. Her birth story involved a natural birth with a few stitches but otherwise no complications. Her and bub are doing well and intact bub comes with her to her post pregnancy assessment! We use the real Time Ultrasound to check her pelvic floor recruitment and transverses control in a variety of positions and discover that while she has great PF and TA control in 4 point kneeling and sidling, when she is lying on her back it is not so well controlled and intact her pelvic floor slightly depresses instead of lifting. We also assess a variety of every day movements, walking, sitting, stairs and while her general biomechanics are good she is still feeling quiet loose in her joints at the end of range of some of her movements.
Mums B - is 8 weeks post the birth of her 3rd child (previous 2 natural births) and her 3rd was an unplanned C - section. Her 3rd birth story also involves some back and hip pain as well as some rectus diastisis separation and she admits with two other little ones she was not as diligent with her exercises throughout her 3rd pregnancy as she was with the previous two. I have never seen mum B before, so we take a full history of her movement and past injuries prior to her pregnancies and throughout the last 5 years of her birth stories. Her biggest concern is, although she has been active before and through out her pregnancies, she doesn't class her self as a 'gym junkie' rather she enjoyed walking, yoga and the occasional spin class. She is now concerned that when she looks in the mirror her body does not resemble her pre pregnancy form and although she has tried a few times in the past few weeks to reinstate some activity, she felt concerns with the increasing back and neck pain she is now experiencing. We use the real Time Ultrasound to check her pelvic floor recruitment and transverses control in a variety of positions and discover that while she has great PF and TA control need a little bit of work. We also assess a variety of every day movements, walking, sitting, stairs and find there are some general postural corrections and weakness we could begin to work on.
What I am hoping you understand from these two very different examples is that the 3 - 8 - 12 - 16 timeframe will be drastically different for these two mothers. Gaining an understanding of where you lie on the spectrum early on and understanding what unique strengths and weaknesses your body has experienced will go a long way towards effectively choosing a return to exercise program that will work best for you.
Having highlighted the differences it is also important to acknowledge there are a few 'global rules' that most women should take into consideration post birth. These include;
- Abdominal 'Crunch' like movements really should be avoided for the first 8-12 weeks. This is because there is a certain amount of stretching that occurs, especially in the last trimester, of the abdominal muscles which are target in a crunch. Allowing these muscles time to shrink and close the gap is important when trying to avoid prolonged abdominal separation.
- High Load and increased Intra-Abdominal Pressure should be avoided for the first 6 - 12 weeks. During pregnancy the anatomy of your thoracic canister has gone through significant changes. One of these is the stretching of your uterus to accomodate your growing baby. These muscles and organs do not just snap back to their original shape and although baby may no longer be inside you the weight, size and shape of these organs will take time to come back to their 'normal' shape and size. For this reason it is important to avoid activities which cause increases in intra-abdominal pressure such as running, jumping and some types of heavy weighted exercises.
- Joint Laxity while you may have been aware of the stretching of ligaments in your body during pregnancy it is important to remember that these ligaments also need time to regain their previous tensile strength. So while you might be getting itchy feet remember to take into consideration movements that involve deep end of range movements such as deep stretching, fast direction changes and unstable surfaces and all these things require your body to be performing at optimal balance and coordination which may still be 12 months away for some women!
Fatigue and Tiredness
I hate to break it to you, but if you thought the fatigue and attacks of tiredness were all behind you now that you have given birth, don't get to excited. A new baby means often a new (and drastically reduced) sleep routine. And while this is often just accepted in the world of motherhood, it's effects on exercises are not to be overlooked. If your feeling tired, try sneaking in a quick nap while baby sleeps BEFORE you work out. Sometimes a even a quick 20min shut eye is enough to rejuvenate your body and make your exercise more effective and not to mention safer! If you are struggling to get motivated to return to exercise, try choosing activities that include incidental exercise such as walking to your local cafe, mums and bubs classes which teach you how to safely use your body with your new born, mum and bubs time in the park, even just consciously increasing the number of times you walk up and down stairs with your bub in hand!
All in all, this is a beautiful time for you and your new born, be kind to your body and give it the time it needs to heal and strengthen while not forgetting that movement has many great endorphin and bonding benefits. If in doubt get expert advice! If something doesn't feel right, don't ignore it even if you have friends and family telling you 'it's ok' and 'safe' for you to start exercising. In the same way if your feeling good, challenge yourself, increase slowly and alway listen to your body and use it as a guide! After all, it will let you know if it's enjoying your new movement routine or not!
Unplanned pregnancy entails a lot of consequences and psychological effects. Parenthood is a natural thing, but when it happens suddenly and not in the plan, there would be some problems along the way. For both the mother and child, they will be exposed to different types of risk — health, psychological, emotional, and social problems.
Unplanned Pregnancy and Health Risks
The first and usual problems faced with an unplanned pregnancy are the health risks associated with it. This is especially true for teenage moms who are more exposed to greater risks of maternal death, compared to mothers who are in the right age of childbearing. Unplanned pregnancy could also cause poor weight gain and anaemia, as well as pregnancy-induced hypertension, cephalopelvic disproportion, and even sexually transmitted diseases (STDs). All these risks might put the mother and the baby’s lives at stake; it can also cause caesarian deliveries and labour abnormalities.
Psychological and Emotional Side Effects
An unplanned pregnancy also leads to psychological and emotional side effects, most of which leads to committing abortion. Some women might have a hard time in weighing down their options on what to do with the unintended pregnancy — they’ll have to worry about the difficult and painful experience of abortion if they would choose that, and some people would be giving the woman their judging stares because of such decision. It is a tough decision not only for the mother but even for her partner and other people who are close to her.
On the other side, women undergoing unplanned pregnancies may also experience emotional distress. They are more prone to experiencing anger, suicidal thoughts, depression, anxiety, and uncertainty especially in regards to their decision for that matter.
Who is most vulnerable to these effects?
Women have different reactions to unplanned pregnancies. Some would feel glad and relieved but some wouldn’t, and that all depends on each one’s situation. The ones who are more prone to experiencing these effects are the following:
- Women who went through previous psychological and emotional problems
- Women who are forced or coerced to do an abortion
- Women with different religious beliefs, moral and ethical views
- Women who don't have support from their partners
- Women from disadvantageous backgrounds
One great factor about the vulnerability of a woman to these effects would be her personal beliefs about the baby inside. If she is someone who believes that it is not a baby until it is born, she is going to have less of a hard time in experiencing the emotional consequences. But if a woman believes the other way around, then she is more likely to experience emotional and psychological distress.
Things to Consider:
- When you are faced with an unplanned pregnancy, the first and the best thing you should do is to communicate with professionals whom you can talk to; they’ll answer all your questions and discuss the matter and your circumstances with you for better understanding. You can also seek the advice of other people and hear their perspective on your situation so you can have another person’s POV.
- Try your best to avoid isolating yourself from others (in hopes of keeping the matter as a secret and to face it alone). It will be hard, but you should be open to your family and friends and accept their support, as isolation might lead to depression.
- As much as possible, avoid pressure. Don’t listen to what other people would say. Your choice is all that matters — you are the one who would be living with that choice, anyway.
- Talk to others, especially those who are or have been in the same situation as you. You would have a chance to find out what it was like in their situation and you might be enlightened.
Common Exercises to avoid depression
You can do a lot to ease and avoid depression. It might be a trip to the gym, aerobic exercises, doing anything you enjoy, or just chilling out and relaxing. When you can lessen your stress and anxiety, you will also be able to function well, mentally and emotionally.
Side effects associated with unwanted pregnancy may lead to an increase in maternal and infant deaths, even illnesses and marriage problems. It may also lead to difficult decisions like abortion. It will be a hard time for the mother, so it is important that she is being supported by her loved ones to help her get through it and come up with her choice of what to do with the situation.
Alison is the chief blogger at BabyJoggerStroller.co, a one stop shop for Best Jogger Strollers. Alison is on a mission to give parents the best advice on jogging strollers, fitness tips, and actionable health tips to stay fit & get back in shape.
Pregnancy can be an incredibly exciting time for both new mums and dads alike, that is, when the mum to be isn't battling unpleasant pregnancy symptoms! All to often what should be an enjoyable and happy time in a mothers life, turns out to be just plain uncomfortable.
Here are the top 5 most common Pregnancy Symptoms and how to eradicate them!
- Lower Back Pain: Lower back pain is the number one negative pregnancy symptom for women in Sydney. It's cause can be multi-faceted, but it is generally attributed to the increased ligament laxity that occurs during the second and third trimester. Now, the good news is this ligament laxity is what allows the pelvis to survive the birthing process, the not so comfortable news is that while the ligaments and increasing in laxity, the rest of your body can feel a little sluggish and floppy. Often the place this shows up the most is in the lower back and pelvis, as the baby grows, there is more and more pressure put on this area and the surrounding joints and soft tissue structures... not much fun!
The good news is that while the ligaments may be increasing in laxity, if your muscle system is strong you should have no trouble holding it all together, so to speak. This is where prevention is definitely better than cure. Rather than waiting until the third trimester (when the painful pregnancy symptoms kick in) starting early with a core and pelvic floor strengthening routine such as Pilates, will help to ensure that but the tae your ligaments begin to stretch, your muscle system is ready to take over and protect your boney alignment.
- Depression: The good news is there are many ways to combat pre and post natal depression. Exercise, mindfulness, social groups are all great ways to ensure you have the support and positivity around you to get through this sometimes stressful time! The food you eat also plays a huge factor, as much as your craving random combinations of peanut butter and pear, try to ensure you are still drinking enough water, decreasing and where possible eliminating caffeine and ensuring you eat plenty of greens and healthy fats!
- Urinary Urgency: As your bub grows, there are many changes your body goes through to accomodate this little bundle of joy. The increased load and pressure your unborn puts on your pelvis can start to have a negative impact on your pelvic floor. You might find urination becomes more frequent and occasionally urgent. This is because not only do the muscle of your pelvic floor have to support your growing baby, but they also have to do their normal job of supporting your bladder! Sometimes the increased work load is just too much.
Again, prevention is better than cure here. Getting involved in pre-natal exercises such as yoga and pilates helps to increase the strength and endurance of your pelvic floor muscles (very important even after the pregnancy!) Not sure if your doing your pelvic floor connection correctly, never fear, we have some great tools to teacher you how here!
- Middle Back Pain: Unbeknownst to many people, it is not only lower back pain the falls into the negative Pregnancy Symptoms category! Middle back, also known as thoracic, pain is a common symptom in later stage pregnancy. As your baby grows, your changing body has less and less space left to accomodate them! Often you will feel little feet or hands getting lodged in between ribs and chest cavities. At this stage, as much as we love them, there can moments where you seriously wonder will this ever end!
In this case, the best way to get relief is to see a Physiotherapist. This takes a special and trained therapist to help adjust your alignment to ensure rib and thorax pain are kept to a minimal.
- Foot and Ankle Pain: The word 'Cankles' comes to mind. You pull out your favourite scrappy candles (as there is no way your wearing heels right now!) but to your dismay that starts won't fit around your now ballooning ankles. Increased swelling is most common Pregnancy Symptoms and although not necessarily serious, it can definitely be uncomfortable and at the very least unsightly!
The best way to keep the candles to a minimum is through movement and elevation of the feet. in the Pilates studio we do many exercises with the feet over head to help return the excessive fluid to the heart. It also helps to keep the feet moving, especially while sitting at a desk. If all else fails, compression stockings (yes the attractive kind you wear on an aeroplane) will keep candles at bay!
So there you have it, while we are not denying there are many unpleasant Pregnancy Symptoms that plague the pregnant women, there are also many easy fixes and ways to prevent the discomfort if your just a little bit prepare!
The words bonding with baby and attachment together, describe the beautiful and innate relationship that naturally exists between a parent and their child. It includes the deep non-verbal emotional communication between them. The creation of a secure attachment for the child is extremely important for his/her mental, physical, emotional, intellectual and social development.
The initial bonding between the baby and his/her mother and father takes shape in different ways, however both are fundamental to help the baby feel a sense of security and form positive self-esteem.
Bonding with mum.
The bonding with baby process between a new born and their mother starts directly in the womb, but the labour plays a crucial role for it. In fact when the baby travels through the birth canal, the mother releases a great amount of oxytocin, the hormone related to bonding. The bonding process continues also when the baby is placed on the mother’s breast after birth. Different studies demonstrated the importance of an early skin-to-skin contact between baby and mum to enhance the bonding and attachment. After birth mothers have several different ways to improve the relationship with their baby, first of all through breastfeeding, but also through simple things like soothing touches, nursing, bathing, changing the baby, rocking him/her, singing, reading or making special eye contact.
Bonding with dad.
On the other side, many dads struggle to find their role as a new parent, since usually mums perform most of the caregiving duties, particularly when it comes to feeding. However the way fathers interact with their babies can have a significant impact on their brain development. Studies showed the importance for the dads to start talking to their baby while he/she is in utero, whether it’s reading a story, singing a song or simply talking to them. This helps the baby recognize his voice a few hours after birth. Once the baby is born, the father should try to dedicate time to his baby, separate from the mother’s time with the baby. This includes skin-to-skin contact, eye contact, bathing, changing and bottle feeding.
Which factors can disrupt the bonding process?
Different factors could disrupt the bonding and attachment. Firstly, if the primary caregiver (often the mother) or the baby has a health issue, this can affect the non-verbal communication between the two and therefore create obstacles for a secure bond. For example, if the parent is often depressed, angry or anxious, he/she won’t be able to calm and soothe the baby, thus hindering the bonding process. Other factors could be related to the pregnancy, for example if the baby experiences difficulties in the womb, or to the delivery process, during a caesarean birth for example. Adopted babies or those who spend time in hospital neonatal units away from their parents may find hard to feel safe, secure and relaxed. As the child grows, other obstacles for a secure bonding and attachment could be being moved from one parent to the other, as a result of adoption, foster care or loss of a parent, being mistreated or abused.
The First Touch Program we offer at BPS gives you the perfect change to enhance the bonding with your baby through massage techniques, empathic listening and touch relaxation. Come along in September to our studio in Caringbah for a 5 weeks course that will help you to understand your baby through the unique body language, cues and signals he/she uses to communicate with you.
When it comes to Pregnancy and Exercise, it's not unusual to be a little confused about what you should be doing? Let our women's health Physiotherapists and Pilates instructors help clarify for you!
If there are two words which cause much tension between women and physicians alike it's pregnancy exercise. Should you exercise while pregnant? And if so, how much is too much and exactly what type of exercise is advisable?
1) Should you Exercise while Pregnant?
While no two women are alike, the consensus is that exercising while pregnant is definitely a win! Not only does it help to support your body throughout pregnancy and help prepare your body for the physical process of labour, it also does a lot for the psychological and social/spiritual aspects of child birth and the journey into motherhood. Movement releases endorphins 'feel good' hormones into our blood stream, and with all the crazy pregnancy hormones travelling around your system during pregnancy a little feel good pick me up is a pleasant change!
2) What kind of Exercise is best while pregnant?
The more important questions is not whether or not to exercise during pregnancy but what kind of exercise is the most appropriate during pregnancy? Given each female body is very different and the changes a womens body goes through during the three trimesters of pregnancy are equally as different, there is no blanket exercise which works best for all. The benefits of a tailored program can not be overstated here and this is where Pilates comes into it's own. With the use of a variety of equipment and props, Pilates allows for appropriate positioning to ensure comfort and safety for mum and bub, and as bub grows these positions can be changed accordingly to ensure the maximal benefit is received with the minimum risk.
3) What do you ned to consider when exercises while Pregnant that you didn't need to think about before?
Pregnancy brings with it a variety of changes for the mothers body, from increased amounts of relaxin (one of the main hormones responsible for increasing join flexibility to allow for birth), to the need for greater water intake due to a larger blood volume, sensitivities to heat, increased swelling, increased load placed on the mothers cardiovascular system and the list goes on. For these reasons there are a few considerations when it comes to choosing the right expertise for you. It's important you take extra care to drink plenty of water before, during and after your workouts, try to avoid working out in the heat of the day or choosing classes which may promote 'hot' environments (various types of hot yoga). As you progress it's also important to consider how long you can lye on your back for, as the increased load on your abdomen often means blood flow to your heart is compromised and uncomfortable. An experienced womens health movement expert will be able to help you through these movement decisions and is one of the reasons specific prenatal classes are preferable over a generic exercise class when you are pregnant.
4) Pilates or Yoga for Pregnancy Exercise?
This is a question which has been answered time and time again and it's a hard one because no two Pilates instructor or yoga teachers are the same. When it comes down to it, the decision comes back to what is it that you are trying to achieve! Pilates in the studio uses equipment and because of this can be incredibly helpful for women in the later terms of their pregnancy where lying flat on their back on the floor is not comfortable (or advisable). The use of the Pilates brings means instructors can ensure you have the optimal positioning and tension for your workout, making the session both more effective and a much more enjoyable experience for you and bub. The use of the Pilates equipment means that exercises and stretches can be made more or less challenging depending on the capabilities and need of the individual.
Yoga on the other hand incorporates many spiritual aspects and because of this plays a great role in preparing the mother emotionally for the journey she is embarking on. Yoga flows can help to take the body through gentle ranges increasing the flexibility of certain joints, however it should be mentioned that this focus on 'flexibility and stretching' can be dangerous as the mothers relaxin levels increase and joints become neutrally more flexible. It is therefore important you understand the needs and abilities of your own body when deciding if Pilates or Yoga pregnancy exercises is right for you. It's always a good idea to get a professional opinion, your Physiotherapist is a great resources for helping guide you through the decision making process.
5) How does Pilates Equipment assist Pregnancy Exercise?
The Pilates equipment supports the changes a womens body goes through during pregnancy. By being able to adjust resistance, height, set up, support and movement direction, any exercise can be modified or made more challenging to suit the body it's assisting. It also allows for a variety of movement positions (which is incredibly helpful in later pregnancy) every exercise can be done in every plane of movement, so if you need to avoid lying on your back or standing for long periods of time this can be easily achievable.
Want to start your Pilates Journey? Our Physiotherapists, Pilates Instructors and Yoga teachers are here to help.
There is certainly a lot of accessible information out there about pregnancy, birthing and parenthood.
Being a first time mum myself, I know how many hours can go by whilst you search the Internet looking for answers. Plus everyone we come across loves to share their thoughts and advice and of course there are the horror stories…we have all heard about the friend of a friend who’s birth was completely traumatic or the comments about how our bodies will never be the same again. Yep, we just don’t want to hear it!! But out of all of the information we have around us, what should we actually listen to and take on board?
As a physiotherapist I like to think I have some aspects covered such as the pelvic floor, looking after aches and pains and appropriate exercise prescription but there are many other areas that I’m not sure on and need to look to others for support. We as health practitioners who treat pre and postnatal women are often looked to for advice and I think each of us make up one piece of the puzzle. So here are my thoughts on how to help our clients through pregnancy, childbirth and beyond:
- Recognising the individual: We are all different and deal with situations in our own special way, particularly in pregnancy (hello hormones!). It is not possible to apply one-size fits all. I believe it is vital to recognise the individual and what they consider important in order to help with their specific situation.
- Help establish a support network: Once we have gotten to know our clients we can help them establish their support network. Do they need nutritional or dietary help following an awful bout of morning sickness, or help dealing with birthing anxieties? Does the client need assistance with time management strategies, aches and pains or just reliable resources to help with their own self-directed learning? Recognising our own expertise and referring onto other health practitioners where necessary will help develop a support network for the client so they know where to turn if and when they need assistance.
A few things I can suggest….
- Positioning: Being pregnant can often mean discomfort, particularly as we enter into the 3rd Tips to try and assist clients to find comfort would include:
- Use pillows – whether sitting or lying they can be used for support. Try to ensure that the client is sitting or lying straight – so no twisting or leaning to one side. It can often feel ok at the time but when they get up or if they repeatedly sit like this, it can make them sore and cause longer term dysfunction.
- Lying on the back – I believe past 20 weeks it is not advised to lie flat on the back. This is just a general guideline and dependent on individuals. I am 30 weeks now and feel quite comfortable lying on my back but that would not be the case for all. Lying flat on the back can cause compression of the vena cava (the main vessel returning deoxygenated blood to the heart) that can result in dizziness and nausea. Clients are likely to feel this quite clearly so there is no need to worry if they aren’t sure. However to err on the side of caution, it is best to lie on the left in a well-supported position.
- Overstretching: During pregnancy the body releases the hormone relaxin to prepare for childbirth. Relaxin increases the laxity of the ligaments through the pelvis that for some can cause pain and discomfort from instability, but for others it means they can finally achieve those difficult yoga poses. Although it can be great to feel a little more elastic, it is very important to not overstretch as this can cause injury. Always tell clients to be controlled and move within their usual range of movement. Move slowly and purposefully into positions and it is a good idea to not hold any stretch for a prolonged period of time – perhaps up to 30 seconds.
- Aches and pains: They can crop up anywhere in the body and can change everyday but they definitely should not be ignored. If clients report continued discomfort, a Physiotherapist should complete an assessment to ensure things don’t worsen. The Physio will also be able to prescribe tailored exercises so clients can move safely. A fabulous exercise approach for pregnancy is Pilates. It is individualised and specific including gentle release, stretching and strengthening within a safe and controlled environment. Pilates is excellent for keeping active but not overexerting ourselves as exercise that is too strenuous can increase blood pressure and cause overheating which can put unnecessary stress on the baby. It is a good idea for clients to check in with their midwife or doctor to ensure they are cleared for exercise as it can be contraindicated if there are complications.
Pregnancy, childbirth and transitioning into parenthood does not mean we have to stop everything and completely change our usual routines but it does mean we may have to alter a few things. Seeking advice from health professionals will allow our clients to understand their own bodies and gain a deep understanding of their needs. Remember we are all different and we should listen to our own bodies.
Once you have delivered your little one into the world, it doesn't stop here! Movement, exercise and life goes on. Alison from BabyJoggerStroller has some great ideas for this next chapter in your life here!
As a physiotherapist and 20 weeks pregnant with my first bub, I am very aware and interested about the topic of the pelvic floor. After speaking with doctors and midwives, reading endless hospital brochures, online resources and books, I get the message that it is vital to look after my pelvic floor during pregnancy and beyond but what exactly should we be doing?
What is my pelvic floor and why is it important?
The pelvic floor is a group of muscles that act like a sling or trampoline that support the bladder, uterus and anus. They also need to be adaptable to our everyday movements – being able to contract and relax for optimal bowel and bladder function. The pelvic floor works as part of a team including the core muscles and the diaphragm. This trio work together to create ultimate function and stability and if one, two or even all three become compromised, it can lead to dysfunction, such as incontinence, reduced spinal stability and inefficient breathing patterns.
How does pregnancy change things?
Of course achieving optimal pelvic floor function becomes more and more challenging the further we move through our pregnancy. As the baby grows, so do our bellies meaning our core muscles are stretched/distorted and struggle to function in the stabilising manner they did pre-bub. Our internal organs start to become squashed eventually impeding on our diaphragm and reducing how much it can descend when we inhale. The bubs weight also pushes down onto the bladder and pelvic floor, with the most noticeable symptom being the increased need to urinate.
The pelvic floor deserves a special mention as not only does it have to put up with 9 months of pressure from the ever growing bub but it is very significant in the natural birthing process, hence it definitely needs attention, time and TLC. Of course prevention is better than cure, therefore by connecting to your pelvic floor early on and discovering its capabilities, you can teach the pelvic floor to be adaptable, avoid any bowel or bladder continence issues during pregnancy and beyond, be supportive to our ever changing environments and of course assist us in the natural birthing process.
So....what should we be doing?
In order to answer this question, there are a few factors to take into consideration:
- We are all different.
- Each woman has been on her own journey and we all lead different lifestyles, therefore it is very challenging to specify a one size fits all protocol of pelvic floor exercises.
- Exercise prescription must be based on the individual.
- This will enable you to determine the purpose of the pelvic floor exercises, i.e. to connect to a weakened pelvic floor or to relax or let go of an overactive pelvic floor.
Ideally, each of us would undergo a thorough assessment with a physiotherapist to determine our individual exercise needs. However here are a few exercises that are very relevant during pregnancy: (Please note that lying on your back during pregnancy can make you light-headed or dizzy due to the uterus pressure on the vena cava. If you experience this, please choose a different position to connect to your pelvic floor.)
- Connecting to our pelvic floor.
- Lie flat on your back with knees bent and feet flat. Breathe. As you inhale feel the diaphragm descend as oxygen flows into our lungs. The increase in intra-abdominal pressure causes the pelvic floor to descend simultaneously. Both the diaphragm and pelvic floor ascend as we exhale.
- Once you feel this subtle movement – try in different orientations i.e. sitting, 4 point kneeling, lying on your tummy and standing.
- Gentle pelvic floor toning – to counteract the general softening, pressure and weakening that could occur during birth.
- Start lying on your back as above. As you breath naturally, gently feel your pelvic floor lift, similar to the feeling of stopping the flow of urine.
- Practice a slow controlled lift, holding that position and then add fast squeezes, perhaps once per day, starting with 5 repetitions. Change orientation as above to challenge yourself in more functional positions.
- Ensure you are lifting the front and back part of your pelvic floor – you should feel the vagina lift too, not just the anus.
- Learn to let go.
- Important for women with an overactive pelvic floor and during childbirth.
- Particularly focus on this during the final weeks of pregnancy.
- As above, gently feel the lift of your pelvic floor but focus your attention to letting go.
- Feel the space between your sacrum and pubic bone – feel the expansion and breathe deep into your pelvis.
- Try in different orientations and eventually letting go without tensing up first.
Giving birth pushes our pelvic floor to the absolute limits and regardless of how your bub makes it into the world, we need to start pelvic floor exercises from day 1! This will allow us to reconnect and regain tone. Try to do at least one set (as above – gentle pelvic floor toning) per day.
Several studies demonstrate that exercise participation is likely to benefit persons with general depressive symptomatology. In particular exercise can have important antidepressant effects during the post-natal period. In September BPS will start offering quality mums & bubs Pilates classes to give our new mums the chance to enjoy the benefits of Pilates with their baby and thus reinforce the bond between them.
When to start postnatal exercise
“The gestational and postnatal period are characterized by a global morphological and structural transformation of the female body. In particular the abdominal musculature has to dilate in a few months to allow the growth of the fetus and the pelvic floor is subjected to an overload from the increased visceral weight" says gynecologist Rossana Sarli. "Therefore it’s very important in the immediate postpartum period to help the 'pelvic – abdominal system' to regain its functionality".
Six weeks after giving birth, most of the changes that happen to your body during pregnancy will have returned to normal. If you had a caesarian birth, a difficult birth or complications during pregnancy or delivery, it may take a little longer, so if you are not sure, ask your doctor when is a good time to restart exercising.
Types of postnatal exercises
General exercise, such as walking, can be started as soon as you feel comfortable after giving birth. Keep in mind that your lower back and abdominal muscles are weaker than they used to be. Your ligaments and joints are more lax and easier to injury if you stretch or twist too much. Therefore avoid any high-impact exercises or sports that require rapid changing of directions. Instead choose low-impact forms of exercise, such as swimming, aqua aerobics and Water Pilates, Pilates, Yoga or Cycling.
Pilates can provide an ideal postpartum workout! A safe whole body form of exercise, the Pilates method strengthens the deep core and pelvic floor muscles, thereby creating a firm muscular support for your spine and organs as well. At our mums& bubs classes you will learn sequences of movements to strengthen and lengthen your back muscles, thus reducing any lower back pain you may have. By focusing on spinal articulation in different planes of movement, postural control and breath, you will quickly re-find your pre-pregnancy body awareness. Pilates can also stimulate circulation, which brings a reduction of excess water weight retained after delivery. Last but not least, Pilates can be a great way to keep mind and body under control while hormonal changes might produce overwhelming emotions.
What about your baby?
Unlike exercises classes where your baby stays passively in the classroom, during our mums & bubs Pilates classes your baby is an integral part of the session. During some exercises your baby acts as a weight and as he/she gets bigger, you get stronger! It’s the most natural form of progressive resistance training. At BPS mums & bubs classes your baby will have the chance to interact with you firstly and then with other babies, thus stimulating his/her physiological development, getting ready for crawling and standing, improving balance and reducing stress levels, which helps him/her to sleep better.
For further details about our mums & bubs classes visit us in person or call 8544 1757. But if you want to come try our classes straight away, make sure you reserve your spot by booking in advance! You can easily do it online here.