Pregnancy & Body Mechanics
Protect Yourself from Injury
Jenna was 29-years-old when she had her first child, a wonderful and healthy baby boy. She had what the medical community calls an “uncomplicated pregnancy” and what her friends liked to call “unfair”. She had ‘that glow throughout, had only 2 weeks of morning sickness, and never seemed to have any aches and pains that slowed her down. She continued to exercise, work, and do yard work with her husband. What she didn’t know was that from the beginning of pregnancy her body had increased levels of the hormone relaxin, sufficient to loosen the ligaments throughout her body, not just in the pelvis and not just as needed in the late stages of pregnancy and childbirth. She didn’t know that some of the techniques she used for lifting, carrying, gardening, and moving in bed, were causing more strain than necessary on her already hard-working body, and that there were smarter, more protective ways to move and function.
There is a surplus of information available for pregnant women on the physiology of how their bodies are changing (frequent urination, limb swelling, breast tenderness, etc), what may happen to their emotions, and general guidelines regarding the importance of regular exercise. What many women lack, however, is knowledge of the physical changes they are undergoing and how this affects them in daily function during the pregnancy and can affect their recovery postpartum. They also lack clear directives on how to apply knowledge of these physical changes in a way that improves function during and after pregnancy, including decreased risk of back or pelvic pain, pelvic organ prolapse, and urinary or fecal incontinence. Further, medical literature indicates that the majority of women surveyed postpartum were dissatisfied with the level of counseling they received prenatally regarding potential physical changes after delivery. Clinical experience would support these findings, as most women presenting to physical therapy months – even years –postpartum for musculoskeletal and/or pelvic floor complaints, lament that no one ever told them how to better care for themselves during pregnancy.
Both research and clinical experience have provided valuable insights regarding the predictable physical changes of pregnancy, such as altered breathing habits and over-stretched abdominal muscles. Specific education, exercises, and changes in body mechanics are crucial in assuring that women learn the best way to live in their pregnant bodies with the goal of maintaining optimal function until delivery.
Protect your pelvic floor!
The muscles of your pelvic floor (Kegel muscles) must stay healthy to help prevent future organ prolepses and/or incontinence. These muscles are challenged daily in regular life, but are under strain throughout pregnancy from the increasing weight of the uterus and changes in pelvic stability.
- Learn how to do a proper pelvic floor contraction. General guidelines are to squeeze the muscles in your pelvis as if you are trying to hold back urine or gas. You should be able to do this without holding your breath, with minimal squeezing of the buttock or thigh muscles, and you should see the perineum move up and in if you watch yourself with a hand mirror. It is recommended that these are performed 30-50x/day.
- Always relax your pelvic floor muscles fully after performing each individual contraction. The ability to relax fully after contracting the pelvic floor is at least as important as being able to contract the pelvic floor in the first place.
- Avoid bearing down and lifting. The act of bearing down, also known as Valsalva technique, is frequently used when having a bowel movement, lifting, and during position changes (lying down to sitting up, kneeling to standing, etc). Regular use of valsalva technique should be absolutely avoided because of the excessive strain it creates for the pelvic floor. In place of it, try exhaling gently while making a “shhhh” sound and engaging your abdominal muscles as if you are drawing together the bony points on the front of your pelvis.
- When in doubt… Despite the best of instructions and intentions, research has shown that 50% of women still do not perform a proper pelvic floor contraction. If you wonder, you may ask your physician or midwife to check for you during an appointment. Many physicians, including Christiane Northrup, MD, women’s health expert and author of the acclaimed Women’s Bodies, Women’s Wisdom, advocate consulting with a physical therapist who specializes in women’s health in order to evaluate pelvic floor contraction and prescribe an appropriate exercise plan.
Protect your abdominals!
From a mechanical perspective, the abdominals are among the most altered during pregnancy. In order to prevent these alterations from creating permanent structural compromise it is important to move in a way that protects them where they are the most weak.
- Don’t sit straight up in bed. During pregnancy you will get in and out of bed at least 280 times…and that’s only if you don’t ever take a nap, get up to go to the bathroom, or need to check on other children in the middle of the night! When not pregnant, it is often fastest to sit straight up from a lying down position (though still not great for our bodies even then!), and many women continue to get up this way without giving it any thought. It may feel more challenging than it was pre-pregnancy, but it is easy to dismiss because after all, what doesn’t feel harder than pre-pregnancy?
- So what should you do? For all position changes, and for getting in and out of bed especially, break the movement down into smaller parts. If you are lying on your back or on your side facing the middle of the bed, roll over to your side facing the edge of the bed. If this requires a lot of effort or creates discomfort, try exhaling gently while making a “shhhh” sound and engaging your abdominal muscles (as if you are drawing together the bony points on the front of your pelvis) while you are changing positions. When you are on your side, use your arms to press up into a sitting position while simultaneously dropping your legs off of the side of the bed. Just reverse the process when getting into bed.
A real understanding of the physical changes of pregnancy is possible and application of this knowledge can demystify the process for women and give them more ownership in their function during and after pregnancy. Don’t let yourself be one of the thousands of moms who say, “I wish I had only known ____ when I was pregnant! I could have prevented ___!”