Pregnancy
What happens to the body in pregnancy and motherhood?
Pregnancy, delivery and motherhood bring about major changes to a woman’s body. Many women fear the changes that motherhood brings, whether this is weight gain, deconditioning, loss of tone, pelvic floor problems, posture deterioration, pain etc. Many of these problems can’t be prevented; it’s just a part of human mortality. However, some of these problems can be prevented or minimised or their impact reduced. It is always easier to prevent the problem rather than attempt to cure them. Common problems in the physiotherapist’s domain are:
- LBP and pelvic pain
- Pelvic instability
- Headaches
- Postural deterioration
- Abdominal muscle deterioration
- Pelvic floor deterioration and incontinence
- Carpal tunnel syndrome and De Quervain’s syndrome
What physiotherapy is needed pre-pregnancy?
Pregnancy will bring about many changes including weight gain and re-distribution and posture change, abdominal muscle stretching, pelvic floor stress, pelvic ligament laxity to prepare for delivery etc It is much easier and more effective to educate and equip a woman with ‘pregnancy-skills’ before the event, when there is time, motivation and ability to address the issues without distraction of the pregnancy. This pre-pregnancy programme should ensure the woman is familiar with ideal posture and how to achieve it, lumbopelvic stability including control of deep abdominal and pelvic floor muscles (and probably back and hip muscles as well), and ensure her pelvis is optimally aligned and supported to deal with the stresses and strains of pregnancy. Postural muscle retraining involves use of diagnostic ultrasound (the same technology that your midwife or obstetrician will image your baby’s development). Diagnostic ultrasound allows real-time imaging of the action of your deep stabilising muscles of your spine and pelvis and pelvic floor, to teach the correct quality, low tone contraction that can be utilised before, during and after pregnancy. These measures do not prevent pregnancy-related pain, but increase your chances of reducing it. This is also an opportune time to discuss the woman’s exercise preferences as some may or may not be suitable for pregnancy.
What physiotherapy is needed during pregnancy?
During pregnancy, there appears to be a misconception that you can’t continue to work on pelvic floor and abdominal muscle exercises. Wrong! The contraction of these muscles is a low tone, sustained contraction and it will not harm your baby’s development. I am not talking about sit-ups or more aggressive exercises – these need case-by-case interpretation. Maintenance treatment of pelvic alignment and stability is necessary to prevent pelvic and low back pain. Treatment is provided that is respectful of your growing baby and specific to findings on examination. Pelvic instability is common in pregnancy and can be debilitating, particularly when there is a burst of ‘relaxin’ hormone release around 20 weeks and again toward the end of gestation as your body prepares for parturition. Pelvic symmetry (alignment), pelvic stability (tummy, hip and pelvic floor muscles) and sensible patterns of use (work, sport etc) must be monitored. Headaches are not uncommon in pregnancy, and can be treated if deemed to be cervicogenic (arising from your neck; often posture related) Ongoing negotiations regarding exercise programmes may be necessary. Carpal tunnel syndrome (median nerve entrapment at wrist producing P&Ns in the hand) is common, and thought to be related to fluid retention. Delivering the baby seems to be the best cure for carpal tunnel syndrome, but splints and other simple measures may help control symptoms. Past history of neck problems or postural issues may be worth exploring to reduce the risk. De Quervain’s tenosynovitis (wrist tendon problem) is late in pregnancy and after baby is delivered. Splints and exercises can be effective, along with more invasive treatment if needed. Various other weight-increase problems may become evident in pregnancy, and relate to awakening of previously dormant problems due to the stresses of pregnancy.
What physiotherapy is needed after pregnancy?
Pregnancy and motherhood is a gift and a privilege, but the last thing a mother needs is physical aches and pains while she’s trying to care for baby and family. The post-partum period is a difficult time of adjustment for the new mother. There are major and sudden body form and posture adjustments, hormone changes, husband/partner issues and expectations, let alone the physical needs of the new baby. The body is desperately trying to reestablish itself in the face of new challenges. The physical issues include carrying and nursing baby, lifting baby capsules and baby bags in/out cars, bending over to change nappies, bathing, falling asleep in bed while nursing etc. This is on top of a de-conditioned body that needs to reestablish itself after pregnancy – a very vulnerable time. There is sleep depravation to deal with, let alone the emotional upheavals that can dictate mood and motivation. The entire motherhood years (and particularly the nurturing years) are a time of self-sacrifice for the mother. It is often not until the children are semi-independent that the mother seeks help for her numerous aches and pains, at which stage the problem is well established.
It is never too late, but sooner is better, and prevention is even better again. Where possible, it is preferable to deal with the predictable issues in the pre-pregnancy period. If postural issues, pelvic floor and abdominal muscle exercises are familiar from practice pre-pregnancy, then there is not the mental and physical burden in difficult post-partum time. Also, knowledge is power, and awareness of these potential issues can allay symptoms and facilitate more effective treatment if the problem arises. One of the core issues to address post-partum is abdominal and pelvic floor muscle tone. Don’t think that because you had a caesarian that you are exempt from pelvic floor problems. Diagnostic ultrasound is used to examine and teach exercises for these areas.
