Peri & Postpartum Health

As any woman going through a pregnancy knows all too well - there are changes that happen in your body as it grows. Some of these changes are normal and comfortable, but others can bring pain, problems with continence, pressure and problems with ligament and muscle function.

The hormonal changes in pregnancy contribute to loosening of the ligaments in the body so that the pelvic girdle can allow for growth and delivery of the baby. This is normal during pregnancy, but in some people, the normal changes can make the joints susceptible to injury and pain. The pain is not normal or inevitable.

As your baby grows, the muscles and fascia in the abdomen and back stretch. If the fascia is stretched too quickly, or beyond its ability to accommodate, tears can occur and the muscles on the front of your belly (the rectus abdominus) can separate. This is called a diastasis rectus abdominus (DRA). If you have a diastasis your ability to stabilize your spine and transfer load effectively may be negatively impacted. DRA has been linked with breathing disorders, back pain, and stress urinary incontinence.

Another important change that happens during pregnancy is an increase in intra-abdominal pressure. This can change your breathing pattern and put increased pressure on your pelvic floor and bladder. Often women have problems in the joints of their rib cage during and after pregnancy due to the accommodation required in these areas, and the multiple muscles that interconnect the pelvis and the thorax.

During vaginal delivery, there is always some stretching of the pelvic floor muscles and supporting structures. Some women also experience tearing of these structures, which often result in stitches. Sometimes the baby puts pressure on the nerves that control the pelvic floor during the pregnancy or delivery which can alter the function of the nerves and by extension the contraction of the muscles in the pelvic floor. If you have to have an episiotomy or stitching you will have some scarring in your pelvic floor muscles once they have healed. It is possible to also have some separation of the pelvic bones at the pubic symphysis.

C-section deliveries require an incision across the fascia at the front of your body that can cause changes in muscle function and scarring in some women, though these scars are generally much smaller and less invasive than those that were created historically.

These changes, when taken as a whole, can eventually lead to incontinence, pelvic organ prolapse, thoracic spine and shoulder girdle pain, low back pain, and even neck pain or pain in the feet (plantar fasciitis) in some women. Though some women have no issues during or after pregnancy, many women lose the stabilizing function of their deep core muscles (in the back, abdomen and pelvis). This loss of normal function can lead to many other compensatory problems if it is not recognized and addressed.

All new mothers would agree that the postpartum period is very busy. We would like to encourage you to remember that your health is very important, and it is important to find the time to take care of your body after pregnancy. After all, it won't be long before you have to be able to run after a toddler and take part in family activities that require normal muscle function. If you take care of your body now, it should improve any problems that you are currently experiencing, and should also help you to prevent issues that can arise in the future. If you don't correct abnormal muscle function now, it may eventually lead to compensation strategies that can cause other issues.

Our therapists have all have advanced training about the unique problems that can develop in women both during and after pregnancy. We see women in all stages of pregnancy and postpartum if they have developed any issues. We also offer a postpartum screen to women who have experienced a healthy pregnancy to determine if there are any areas that they should focus on before returning to vigorous activity. Cara has taken advanced courses in pelvic girdle and thoracic spine dysfunction during and after pregnancy, real time ultrasound imaging to assist with retraining post childbirth, internal pelvic floor assessment (if needed for urinary incontinence, scar management, pelvic pain or pelvic organ prolapse) and advanced techniques for pain management and motor control assessment and retraining. We find working with new mothers very rewarding and motivating.