I like to think that I was in shape leading up to, and during pregnancy. I was running consistently before, and until 18 weeks pregnant (stopped due to pubic symphysis dysfunction), and lifted weights 2-3 times a week, I never stopped walking or moving my body. So why did I end up with an injured spasmy back on several occasions? Why did my prolapse persist long after my doctors predicted? I’m learning that it may have had more to do with my posture and alignment, than with my fitness or strength.
Let’s start with pregnancy posture’s effect on the back. During pregnancy, a woman is forced to carry a significant load of weight in the front of her body. The weight of the belly and breasts might round her shoulders and upper back forward. Her back arches in attempt to balance the weight in front of her. While this load increases, her abdominal muscles stretch and become less effective. Her back muscles tighten in order to hold her upright and work overtime without the help of her abs for stability. She may shift her hips forward and clench her glutes to compensate (a permanently clenched muscle is a weak muscle.) Each woman is different, but the one thing that is the same is that there is a major muscle imbalance between front and the back after that baby load is gone. What does this imbalance mean? It means that every time a postpartum woman bends over, picks up her baby, lugs her baby in it’s carseat (the worst!), or reaches for something in front of her, her overworked back muscles are put at risk. It might take time to retrain and strengthen the abs after their extended rest, but there are changes that can be made to protect the back in the mean time.
Other common injuries postpartum women suffer from are diastasis recti (DR) and pelvic organ prolapse (POP). Both of these are in part caused by weak/stretched/damaged connective tissues and mismanaged intra-abdominal pressure. DR is a separation of abdominal muscles due to weak connective tissue that then may bulge out under pressure, and POP being the decent of pelvic organs due to weak supporting ligaments and tissue that may bulge down under pressure. We can’t always fix the damage, but we can make postural and breathing changes to better regulate internal pressure that often increases the severity of both conditions and prevents healing.
OK. So how do we protect ourselves. Fix our posture and breath. Easy? Some changes are, some changes aren’t. Here are the easy ones:
- Make sure you’re practicing 360 breathing as often as possible. If we practice something only once or twice a day for a a few seconds, it’s easy to fall back into our normal shallow breathing patterns. You should feel your ribs expand in every direction (including your back), and you should feel your breath go all the way down to your pelvic floor. If your pelvic floor expands on your inhale – it will automatically contract on exhale – therefore strengthening it. A good 360 breath also evenly distributes pressure! If you pull your belly in on an inhale – the pressure that would have gone to your belly may redirect as excessive pressure down on your pelvic floor. Alternatively, breathing only into your belly (and not ribs) puts pressure against the abdominal wall every single breath preventing a DR from healing.
- Cue proper posture. Slouching, slumping, over arching backs, tucking bums, etc. don’t just cause aches and pains. Poor posture can limit 360 breathing and alter intra-abdominal pressure, it also can contribute to muscle imbalances and therefore puts people at risk for injury. Correcting posture can take a lot of work and specialized exercises, especially if poor posture has been present long term. Luckily, there are a few cues to help you get in better posture now.
- ‘Imagine a string pulling up from your pubic bone through the crown of your head’
- ‘Pretend you are ease dropping on a conversation taking place behind you’
- ‘Stack your ribs over your pelvis’ (You want your ribs to aim for your hip bones, opposed to flaring out as seen when women thrust their chests forward)
3. Focus on both breathing and posture in ALL of your movements. Below are some of the most common movements that new moms do repeatedly – that we can focus on.
Lifting the baby.
The tendency is to let the back round when we bend and not take breathing into consideration at all. The problem is that this posture puts strain on isolated back muscles and prevents a deep breath that would engage the pelvic floor and abdominal muscles. This lack of engagement puts both at risk of extra pressure.
What we should do is keep our backs nice and straight (squat or bend the knees if needed) take a deep inhale in preparation, and begin our exhale just before we exert ourselves. The exhale engages our pelvic floor and abs so that we don’t end up putting extra pressure on them.
Other controllable things to consider:
Raise the height of your changing table so that you’re not bending, or change where you change the baby so the the muscles worked are different each time.
Bring the baby close to your body before standing up. This alters the center of gravity and decreases the load on your back. (This was huge for me when Maura was placed in her cast. She could no longer be changed on our changing table and gained 5 pounds overnight, literally… This was also the second time I strained my back. If I knelt next to her on the floor, pulled her onto my lap, then stood up from a squat – my back was spared.)
Baby Carrying (with and without carriers)
The tendency here is to let posture go out the window.
With a newborn lacking head control women often lean back and let their hips go forward – this is a great angle for the baby but not for your abs/back/pelvic floor.
With a bigger baby and toddler it’s common to stick one hip out to support the weight, and even worse many women favor one side which leads the major muscle imbalances (and eventually rotational scoliosis in my case… oops!)
Often with a baby carrier, we feel like it’s easier on our bodies – but if the straps are too lose women can end up tensing the shoulders and back. If the waist/hip band is too low or loose she may end up with the same lean back, hips forward position to support the new baby. If the carrier is too tight, it may limit moms ability to breath deeply.
The best thing to do here is be aware of your posture and how carrying your child alters it. Do your best to remain up tall with the same cues as above. Change the position you have your child in frequently and rely on your arms (instead of your core) as often as possible. – Best to start that with your tiny newborn than attempt the change with your 30 lb toddler… holy arm burn!
Pushing a stroller
Keep yourself up tall, ribs over pelvis. Pushing the stroller with arms extended may shift posture by encouraging you to stick your bum out or bend at the waist. Keeping your elbows nice and close to your sides and again relying on your arms will protect you.
Lugging a baby in a car seat
I have no advice. I think I may try to avoid the click in baby seat if we have another round. I can’t think of any way to lift and lug this combo that is safe. If you must do it, remember the exhale on effort to protect yourself. Try to limit the distance the car seat is carried. Use a stroller even when it’s less convenient. I definitely am guilty of lugging the car seat only in and out of doctor appointments, and even through parking lots into stores etc. Thinking back, I easily could have cut down on that! Live and Learn.
The postpartum period is not easy on a women’s body. Hopefully some of this information can make your postpartum experience free of injury!
Coming soon will be a post on ‘Why I requested my Birth Records’ and I also noticed I have a half of a post written on the end of our Maple Syruping adventures that I never finished….. It’ll be long past season when I get around to it, but I’ll get there!