Pregnancy and postpartum care

I’m going to start this article by dedicating it to all my friends and patients who are pregnant at the moment, have had a baby or are thinking about getting pregnant in the future.

If you know me personally, you are probably a bit fed up of hearing me say it all the time… I’m sorry (no, I’m not!) but I can’t help it! 🙂  So here I go one more time; specialized physiotherapy is super, super important! Even if you don’t have any symptoms, there is enough evidence to prove that:

1. It helps to treat and prevent a lot of problems that may arise with pregnancy and childbirth – pelvic girdle pain (pain in the pelvic joints), urinary incontinence, pelvic organ prolapse, back pain and other aches and pains.

2. It helps to prevent the same problems that might not manifest during pregnancy or immediately after childbirth but may arise later in life with ageing and menopause.

Consequently, specialized physiotherapy helps women enjoy a healthier and happier pregnancy, childbirth and postpartum.

And that is why in my opinion, it should be common practice to have a consultation with a women’s health physiotherapist routinely as part of the care given to pregnant patients and after birth, to promote a good postpartum recovery.

In some countries like France, it’s common practice. So why is it so important?

Let’s start from the beginning. During pregnancy even before the bump starts showing, the body goes through major changes. The posture and the way the body moves changes, the weight on the joints increases and the muscles, ligaments and soft tissues get more flexible and elastic to allow the pelvis to stretch to accommodate the baby. All of these changes happen due to hormonal changes (hormones! – a sensitive topic wherever it’s mentioned!), but they are very important. They need to occur in order for the body to be prepared to create a beautiful human being and to allow the baby to grow in the tummy during roughly the nine months that follow.

Some women feel really well during pregnancy with almost no symptoms. However, approximately 20% of pregnant women suffer from pelvic girdle pain and lower back pain during pregnancy, and approximately 7% of women continue to struggle with pain even after giving birth. It is also known that 30 to 50% of women will experience urinary incontinence during pregnancy. Here is when I say what I always say…even though these symptoms seem common, they are NOT normal and they can be treated and prevented! If they are left untreated they can become worse over time.

So why do some women experience pelvic girdle pain, low back pain and urinary incontinence during pregnancy?

As I mentioned before, not every woman will experience these symptoms during pregnancy so if you are pregnant or thinking about getting pregnant don’t panic!

What we know is that there are risk factors that can make women more predisposed to these problems. Women that have a previous history of lower back pain, pelvic girdle pain or pelvic floor dysfunction and have a high workload are more predisposed to struggle with pelvic girdle pain and lower back pain during pregnancy and post-partum. For urinary incontinence, being overweight, the pregnancy itself and childbirth (vaginal delivery or c-section) seem to be the risk factors to develop urinary incontinence. The risks of developing pelvic organ prolapse in women are related to increasing age and number of deliveries, a family history of prolapse, pelvic floor muscle weakness, obesity, repetitive heavy lifting, and repetitive constipation and straining.

If you think you may be at risk and you’re pregnant or thinking about getting pregnant, you’ll be relieved to hear that seeing a women’s health physiotherapist for treatment and guidance will help you prevent and treat all these problems.

We also know that the hormonal changes that are responsible for increasing the capacity of the muscles (pelvic floor muscles, abdominal muscles and all the soft tissues surrounding the pelvis) to lengthen and stretch during pregnancy can make your joints more hypermobile (which is not necessarily bad – but we do need to have healthy muscles to cope with that). If on top of that you add the extra weight (the baby, the amniotic fluid, the breasts and so on) and then you add possible previous pain/dysfunction or weak muscles – you have a perfect recipe for developing pelvic girdle, lower back pain and urinary incontinence. The muscles that were already tight, weak and trying to cope with previous problems simply cannot cope with having to stabilize a pelvis that is now more hypermobile and on top of that hold everything in place while the intra-abdominal pressure (the pressure inside the tummy caused by the baby growing and everyday actions such as coughing, laughing and lifting weights) keeps increasing during the nine months.

What can women do to prevent it?

Think about pregnancy and post-partum as a marathon or a sports competition of some sort, where you are a competing athlete. As any other athlete, you would ideally prepare yourself before the competition to make sure you are able to give the best performance and you don’t get injured or are slowed down because of any injury.

Women’s health Physiotherapy – specialized physiotherapy for pregnancy and The Mummy MOT for postpartum recovery

Seeing a women’s health physiotherapist specialized in pregnancy and postpartum for the right treatment and guidance to prevent all of these issues is key. Specialized physiotherapy before and during pregnancy and the mummy MOT are pre and postnatal detailed physiotherapy assessments of the back, abdominal and pelvic area. Under these programmes I will check your posture, breathing, tummy gap (for postpartum) and pelvic floor function. An individualised treatment plan, advice and exercise programme will then be created for you. You can find out more about how to book an appointment with me here. Alternatively, if you don’t live in London and you want to find chartered women’s health physiotherapists all over the UK click here, or Mummy MOT physios click here.

Having good lifestyle habits is also fundamental. This sounds a bit clichéd but in most of the cases this alone will be enough to prevent a lot of problems.

Exercise and Fitness

Exercise is fundamental and according to the American College of Obstetricians and Gynecologists exercise is safe during pregnancy unless you are advised otherwise by your doctor, midwife, women’s health physiotherapist or other healthcare practitioner that you seeing.

Having healthy muscles, being strong and flexible and having good levels of fitness is fundamental. You know already that your muscles will generally have to work more, so if they are healthy they will be able to do it a lot easier. As I said before, unless you have any contra-indication to exercise during pregnancy it is safe to exercise following the guidance of healthcare practitioners and specialized fitness professionals. It is also safe to initiate gentle and guided exercises postpartum as soon as you feel you are ready. Activities such as pelvic floor exercises, Yoga, Pilates or exercises prescribed by women’s health physiotherapists or fitness professionals are great ways to keep your muscles healthy without the risk of injuring yourself. Make sure you always seek advice from a qualified professional that understands pregnancy and postpartum.

From a general fitness and stamina point of view, the guidelines recommend thirty minutes of moderate exercise five times a week. Most guidelines advocate a maximal heart rate of 60–70% (going for brisk walks for instance) for women who were sedentary prior to pregnancy and the upper range of 60–90% of maximal heart rate for women wishing to maintain fitness during pregnancy. Keep in mind that if you are struggling with urinary incontinence during pregnancy continuing with high impact exercises may make it worse. In this case it is very important that you see a women’s health physiotherapist for guidance. Pregnant women who have relative contra-indications to exercise, meaning that it’s okay to exercise but with some restrictions, should always have individualized exercise prescription.

Diet

Nutrition is also fundamental. Having a healthy and varied diet (respecting your own restrictions), avoiding processed foods, eating organic foods and avoiding large quantities of sugar is essential. You need to make sure that the “fuel” you are giving to your body to function every day is good. Otherwise, it won’t give you the energy you need for everyday life activities and healing. You also need to make sure you are drinking enough fluids and eating fibre because you want your bowels and bladder to work well. Constipation and bloating also increase the intra-abdominal pressure leading to more pressure on the pelvic floor muscles (which are already under pressure) and straining (which can cause more pelvic floor dysfunction and hemorrhoids). A healthy diet is really important. You need to make sure that the bowels and bladder are working well, you have plenty of energy and that the levels of inflammation in the body are low. The best way to make the right choices when it comes to diet is to seek professional advice!

Sleep, rest and stress management

Sleep, rest and stress management are another thing to consider. If your brain feels under a threat all the time, wired and tired, your muscles will act as if they have to be ready for fight or flight. Consequently, muscle tightness, soreness and pain are possible outcomes. Sleep and rest are also important to break the vicious cycle of tightness, stress and pain. So during pregnancy and postpartum (and really throughout your life) finding strategies and support to relieve stress are essential for a better quality of life.

All of these strategies along with the incredible ability that the body has to recover after birth will help women cope better with pregnancy, childbirth and postpartum. I see it every day in my practice. I guess that’s why I never tire of telling this to everyone that I know who might benefit from this advice.

On a funny note take a look at this video:

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