A Healthy and Pain Free Pregnancy
Over the past 8 years working as a women's and pelvic health musculoskeletal physiotherapist, as well as going through my own pregnancy, delivery and recovery postpartum, I have learned a lot about pregnancy, birth and living life with baby outside the womb.
I always encourage women to get in to see their local women's and pelvic health physiotherapist earlier in pregnancy even if they are feeling good so that we can establish an understanding of where things are at pre-birth, provide some easy preventative exercises, and help to modify anything in their day to day that might assist them in their pregnancy, birth and postpartum goals; as well as just providing a basic level of awareness and education on what is "normal" and what can be treated. That way, we can keep you mobile, help with alignment and resilience of your system to enhance birth outcomes (like limiting tearing... yes, please;)), see if there are any differences we need to adjust for postpartum, and most importantly empower you in your health. If however, you are unable to get in to see someone prenatally, we can always work with you postpartum - whether 2 months or 20 years, first or third!
But for those of you are in it here and now, here are a few ways you can help yourself stay active and reduce the common aches and pains that come with the amazing and huge changes to our bodies, mind and soul with creating, growing, nourishing, loving and eventually delivering a whole human being! Many issues around pregnancy and postpartum are common, but NOT normal - they can be treated and you don't have to push throughout it or suffer in silence.
Movement & Exercise:
Research has shown the amazing benefits to both Mom & baby on continuing to move and be active during pregnancy. This is a time to do what feels good for your body and mind. Please do not start any new high intensity or high impact activities though, and you may feel you need to change to lower intensity activities as belly and baby get bigger. The best "exercise" is the one that you want to and will do, so just keep moving how you like, get out in nature and find joy in some form of movement. Listen to your body and check with your local women’s/pelvic health physio if you have any questions on modifications, core or breath exercises.
Breath work & Mindfulness:
Ensuring our ribcage and diaphragm are moving well is the keystone to our reflexive core and pelvic floor stability, function and health. Focusing on a three-dimensional breath (not just belly or chest), allowing our back/side lower ribs to come up and out, like a bucket handle, optimizes the movement of our diaphragm and pelvic floor. Exhale, encourage the breath up and out gently from the bottom up further balances the pressure dynamics so we get the best recoil action of the pelvic floor and transversus - providing strength and control. Take your time with your breath and play with it in various positions.
Breath work also helps to balance and calm the nervous system (when done in a slow and focused manner). You can also try to really slow down your exhale (almost twice as long as your in breath) - this will really help to activate the parasympathetic (rest and digest) nervous system, calming mind and relaxing body. Yum!
There are so many other amazing breathing exercises to help calm, restore and focus the mind if you are experiencing any stress, anxiety or other mental health concerns around your pregnancy or other aspects of life including alternate nostril breathing (nadi shodhana), cooling breath (sheetali pranayama). Some great meditation tools I like to use (even outside of pregnancy) include the Calm, HeadSpace, and Insight Timer.
Hydration & Proper Elimination:
Limiting undue pressure on the pelvis/ pelvic floor via the digestive system (one of the pelvic floor’s main functions) will be helpful to maintain the reflexive activation of the core/ pelvic floor, reduce congestion in the pelvic bowl, and keep you feeling healthy overall. Water over fibre will be helpful to stay hydrated (both for baby and bowels). Proper potty posture (knees higher than hips by using a step stool) will be helpful and trying to limit bearing down with elimination is key - instead give yourself a bit more time on the toilet and take a few nice deep breaths to allow pelvic floor to relax and open to allow easier elimination.
Support/ Compression Belts:
While these braces can be helpful for some, knowing which on to get and how often to wear it, etc. can be time consuming, expensive and frustrating if it doesn't work as expected. As such, they should be assessed and prescribed by a women’s health/ pelvic floor physiotherapist to make sure you are making a good investment that will actually do the job it is meant to do, get you out of pain and/or provide support.
Movement Restrictions (Diastasis Recti Abdominis):
Research shows that at least 66% of women by the third trimester have some form of DRA. Don't worry! It is natural and functional for these muscles to stretch to make room for baby, however, we want to limit any pressure bulging out of the midline as much as possible. Thus, restricting movements that create this pressure bulging (typically sit ups, crunches, sitting straight up from lying down, as well as lying straight back from sitting) will be important throughout pregnancy and for at least 6 weeks postpartum (or longer depending on if you continue to bulge). When getting into/out of bed, please move from your side and push/ lower yourself. There are also some basic core and breathing integrative exercises that can help to maintain the communication between all core muscles, helping to manage the pressures in the abdomen and limit that bulging.
Pelvic Floor Connection & Relaxation:
There is a lot of information out there talking about starting Kegels during pregnancy to stop any potential for leaking urine postpartum. Unfortunately, it's not that simple. For example, there is only a 3% difference in support related pelvic floor dysfunction (like urinary incontience and pelvic organ prolapse) between vaginal and C-section births. Further, a lot of women are not connecting to their pelvic floor correctly, or are doing this too much and creating more tension in the pelvic floor (which like a stretched muscle, is weak and non-functional, meaning you can still leak if you are too tight; and you may cause pain). Further, we want the pelvic floor to open and expand with delivery to allow baby out with as little tearing as possible.
As such, I recommend just connecting (in your mind while sitting, during child's pose in yoga, with your breath, etc.) to see if you can activate AND relax it. Working with your breath and in a reclined or side lying position will make it easier: inhale and imagine your sits bones gentle spreading sideways or imagine space between front-back (make sure not to push or bare down); exhale gently blowing out of your mouth like flickering a flame and at the same time gently connect to pelvic floor thinking about stopping gas (a little toot) or like tucking tail (without moving your pelvic or hips). For more information on Kegels, see my colleagues', Lisa Flanders, PT, video on Kegels: http://lisaflanders.ca/not-tmi-episode-2-kegels/.
Perineal massage, stretching and using other tools like Yoga Tune Up balls or the Epi-No can also help to stretch, relax and allow for more adaptability of the pelvic floor in preparation for birth. Please consult a women's or pelvic health physiotherapist to help you safely apply these more direct releases, especially if you have any vulvar swelling or varicosities.
Prevention & Getting Treatment:
When you are unsure or need some guidance, please consult a women’s or pelvic health physiotherapist (or other experienced antenatal healthcare provider). We are here to help and it is better to seek advice and care earlier, even if it is just to ease your mind:)
Wishing you a happy and healthy pregnancy!
Disclaimer - Everything shared is for informative purposes only. It is not intended for assessment, diagnosis or treatment purposes. If you feel there needs to be further investigation, please seek out a qualified health care professional for a proper assessment.