Many women would agree that carrying and delivering a baby is one of the most joyous experiences in their lives… but it is also very challenging on their body. Many women assume that once they lose their pregnancy weight, they have done all they can do to be healthy and fit. After all, having a baby is a natural thing, and everything should fall back into place in time. But problems can arise years after having a baby that will never be linked to the pregnancy or delivery, but could have been avoided with awareness and exercises in the post-partum period.
1-Breathing and neck pain: During the third trimester, the baby pushes into the diaphragm, making it hard or impossible for the expectant mother to take deep abdominal breaths. She then uses a lot of neck muscles to assist her with breathing. If she doesn’t learn to breathe with her diaphragm once she is no longer pregnant, it can lead to neck pain over time, due to overused neck muscles.
2-Low back pain and pelvic pain; There are 4 muscles that are responsible for stabilizing our lumbar spine and sacro-iliac joint (D. Lee 2004). As research continues, more muscles will likely be added to this list. But let’s look at these 4 muscles that prevent our spine from shearing and enduring excessive strain.
3 out of 4 of these muscles are seriously compromised during pregnancy and delivery. The Transversus abdominus (TA) gets stretched significantly during pregnancy not to mention if a woman has a cesarean. An incision must be made right through it, compromising its strength. The diaphragm gets pushed on by the baby making it contract less efficiently. The pelvic floor can be torn by an episiotomy or tearing during a vaginal delivery. Depending on how easy or difficult a woman’s pregnancy and delivery is, the toll on these muscles will vary and so will the predisposition for low back and pelvic pain.
3-Urinary incontinence: As mentioned earlier the strain put on the pelvic floor muscles during vaginal delivery can cause low back pain. These muscles are also the reason so many women have urinary incontinence after delivery. A study conducted by Allen et al (1990) investigated 96 women both prenatally and postpartum to determine if childbirth caused damage to the pelvic floor muscles and/or its nerve supply. They showed that a vaginal delivery impairs the strength of the pelvic floor and notice that recovery had NOT occurred at 2 months postpartum. They also demonstrated via needle EMG, that vaginal delivery caused partial nerve damage to the nerves supplying the pelvic floor muscles in 80% of these women. This is significant and a weak pelvic floor has been linked to organ prolapse, which requires extensive surgery. (Ashton, Miller et al, 2001). Doing Keigel exercises is an effective way to rebuild strength in pelvic floor muscles, but it may not be enough.
I feel the women who are especially at risk of developing low back pain are those who have experienced both a vaginal and cesarean delivery. The women who only had cesareans will have virtually no issues with their pelvic floor. And the women who only had vaginal deliveries have no scar tissue hindering the efficiency of the contractions of their TA muscle.
Physiotherapists can help by assessing the impact that the childbearing experience has had on these muscles. Just like retraining is necessary after an injury or a surgery, it’s also necessary after having a baby. With the proper exercises a woman’s body can be as good as new… at least until the next baby comes along.