Pregnancy and Postpartum: Where the modern medical model falls short.
BY ANDY PARK DC,
DYNAMIC NEUROMUSCULAR STABILIZATION (DNS) SPECIALIST.
Pregnancy and Postpartum: Where the modern medical model falls short.
It was about 6 years ago now that all at once it seemed like many of my wife’s friends were starting to have kids. There was nothing unusual about that though as we lived in central Illinois at the time and were in our late 20’s. For this region of the country that was pretty par for the course. The one thing that I did find unusual however was how many questions I would get from them all asking about what movements, exercises, or activities were appropriate during pregnancy as well as in various stages of postpartum.
I was happy to give my professional recommendations but what I was surprised about and found unusual was how these women were not receiving information regarding these things they were asking me about from the care providers that they already had. Clearly there was and is a gap in the modern medical model when it comes to movement, exercise recommendations and pregnancy/postpartum. So, lets touch on a couple of common myths and recommendations or lack thereof that may cause some confusion during pregnancy and postpartum.
Laying on your back during sleep, exercise or any other time.
This is something that I get questions about often from many of my pregnant patients. Many OBGYNs will still say that as you get into your 2nd trimester of pregnancy you should definitely avoid exercising and sleeping on your back. One would think that there is a lot of research on the topic. It turns out however there is very little if any relevant research on the topic and is frankly something that doctors have been telling women for decades now and is based on a flawed understanding of human anatomy. The thought is that if you lay on your back as the baby and uterus increase in size, that it may start putting pressure on your primary abdominal blood vessels which may lead to cutting off blood supply to the baby. This simply is not the case. If this was something that was truly happening, you would see many people passing out from laying on their backs before any harm was caused to the fetus as the arteries and veins in the abdomen are so major that the bigger concern would be that blood was not getting to your brain resulting in you losing consciousness. Things to note however is that if you do happen to be on your back whether it be in bed, or during exercise and you do start to feel a little lightheaded, simply roll to your side and that should help to alleviate that symptom. We also do want to be aware of any abdominal coning if you are exercising on your back (coning is when you engage your core muscles and what looks like a long skinny bubble starts to push out from the centerline of your “six pack” muscles). All this to say if you find yourself laying on your back when you wake up from sleep there is no need to panic. Simply move on with your life and find a comfortable position for you.
How much exercise is too much or too little?
I get this question along with how heavy should I be lifting, or even CAN I lift during pregnancy. Is it ok to start doing a new workout? These are all great questions but let’s start with addressing intensity or HOW heavy we should be lifting.
Generally lifting about as much as you have been doing previously or continuing whatever program you have been doing consistently is not an issue and should be fine to keep going with. As pregnancy progresses however a consideration to keep in mind is while you may physically be able to deadlift “x amount, is your pelvic floor up for it? Can it handle the load with the added stress of a baby that is continuously getting bigger and heavier? With that since it would be very difficult to assess exactly how much is too much for the pelvic floor as pregnancy progresses., as a precaution I generally recommend going down to about 80% of the load you were using pre pregnancy at around the 2nd trimester.
All that to say I would absolutely recommend lifting weights or doing some sort of moderately challenging physical activity through your pregnancy. We want to make sure we have good level of physical preparedness and capacity as giving birth can be physically demanding.
What are things I can do for myself if I am experiencing physical pain during pregnancy?
While it is not considered “normative” to have pain during pregnancy it is certainly fairly common. Your body is being asked to do a lot of things that it probably has never done before if it is your first pregnancy especially. It also bears mentioning that most people have at least a few compensation patters when it comes to movement that maybe are fairly dormant during regular life but once someone becomes pregnant the changes in your body can absolutely wake up those dormant dysfunctions. Dysfunctions that may start dipping their toes into injury territory which may lead to pain.
So what can we do to address pain during pregnancy? Try to prevent it before it starts! Something you can do that may help to keep pain at bay is get into a consistent workout regiment before pregnancy and maintain it throughout! The better control you have over your body the less likely you are to be put in a compromising situation where your body may “freak out” a bit resulting in a potential injury moment.
Certainly, if you have pain seeing your primary healthcare provider may also be your gut reaction but I would recommend reaching out to a rehab based chiropractor or physical therapist over your OB or Midwife as physical medicine is generally not the scope of those types of providers.
How can I support the recovery of my body post partum?
While certain exercises may not be appropriate before you have been cleared for exercise again (typically 6-8 weeks post) there are definitely things you can do to help support your recovery immediately post partum. Focusing on diaphragmatic breathing and appropriate bracing while doing activity or even just having that be your main focus is something you can start working on day 1 post partum. Thinking about your breathing while feeding your new baby is a great time to get some practice in. On the flip side once you are “cleared for exercise” that does not mean you are good to run an ultramarathon. Our bodies typically function on a spectrum of health vs go or no go and in fact many birth professionals I have spoken to will attest to a womans body taking upwards of a year to fully recover post birth. With this in mind, having the mentality of ramping back up into more strenuous exercise is advised. If you don’t know what that looks like I would recommend reaching out to a chiropractor, physical therapist, or a trainer with experience rehabbing women in the early postpartum phase.
What should my pregnancy support team look like?
As I have already alluded to, a chiropractor, physical therapist, and maybe a massage therapist versed in prenatal care would definitely be on my short list. In regard to birth specific healthcare providers, I generally recommend having a midwife over an OB (at least in the state of Illinois as midwives are just above the level of nurse practitioner) for non-complicated lower risk pregnancies. Midwives are experts in pregnancies and OBs are experts in when pregnancies go wrong. Meaning OBs may be slightly more inclined to jump to a medical intervention even when it may not be absolutely necessary. In my personal experience Midwives tend to have a much more balanced view of what kind of care you need and are typically a bit more considerate of you and where you are at in your life. I would also recommend adding a doula if you have the means to do so. They essentially act as a guide during birth and leading up to it and especially for first time moms is I feel an indispensable resource.
If you’re an mom to be or going through your second + pregnancy who is also experiencing an injury, want to prepare the best you can for labor and delivery, or want to improve how you are moving and feeling, then don’t wait any longer. Give us a call (773-296-2766) or text us at (773-692-0670) to book your FREE Discovery call or Movement Assessment today!
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