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POSTNATAL HEALTH
JOHN PETROZZI: Hi and welcome to Living is Easy! I’m John Petrozzi, and thanks for joining us today.
Well, today, I thought we’d talk about how women can regain their strength and their posture after giving birth because the birth process is such a traumatic episode for both the baby and also the mother. There are so many changes that happen to the mother’s spine. The mother starts off with a really healthy spine (hopefully to start with).
The Spine
In a healthy spine, there’s actually three curves. There’s a curve in the neck which goes forward, a curve in the mid-back area which goes backwards and a curve in the lower back, which also goes forward, similar to the neck curve. These curves are perfectly aligned and they should all make an angle of about 64°, in a really healthy spine. Hopefully, throughout the whole pregnancy process and also after pregnancy, we can try and regain these curves. It is possible and really, really important for maintaining good spinal health, so that you don’t start to get spinal problems later on down the track.
So I thought we’d first start off with what the spine should look like before birth. The spine is really made up of bones and discs and ligaments. It’s surrounded by a structure of muscles that hold it together. And the muscles produce movement and they also provide for stability and support and also shock absorption.
So you can just imagine after you’ve conceived and the baby’s starting to grow inside the uterus, the baby starts to put on some weight and your tummy area – your abdomen – starts to come bigger. And by doing that, basically, the belly button area starts to bulge forward and while it does that, it starts to drag the lower back forward with it so you start to get a quite a sway back. And you’ve probably seen that before in dances. Dances get a sway back when they do a lot of back bends and so do people who do acrobatics and gymnastics.
So throughout the pregnancy process, you start to develop increased curve in the lower back, but then also what happens is you start to increase the curve through the mid-back, basically around the shoulders and through the mid-back area. That could start to produce some problems later on down the track in your neck and shoulders. It can start to tighten those areas. And that can lead to problems later on like headaches and shoulder pain and those sorts of things.
So, really, we want to try and make sure you got a strong back throughout the pregnancy process. Make sure you’re lifting correctly, bending correctly, and also going to the toilet correctly.
The Uterus
Well, the uterus itself is an amazing structure. It’s actually a sac of muscle and it expands from a small size, I suppose, which is about as big as your fist, and expands right out to the size of the baby when it comes out, which is between 50 and, I suppose, 56 centimeters, depending on the size of the parents.
So the actual uterus has got three layers in it. It’s got an outer layer, which has got muscle fibers that track from vertically, basically, the top of the uterus right down to the bottom part of the cervix. So there are lots of fibers like a big air balloon, I suppose. Then on the middle section of the uterus, muscle fibers are scattered and they’re sort of arranged in a haphazard sort of position where they’re sort of like jigsaw puzzles all joined together. Then, the inner layer is a really interesting layer. It’s got a ring of muscle, basically like, you know, the outside part of a ball and you’re just twining spring all around the inside part of the uterus.
Through different parts and different stages of labor, these muscles are actually contracting at different times. So, for instance, when labor starts to happen and the woman starts to feel some contractions of birth, that’s actually a portion of the uterus that’s contracting which is the longitudinal fibers. That actually happens is that the dome or top part of the uterus starts to become tighter and all the fibers start to bunch up on the top part of the uterus, and effectively what happens there is the roof of the uterus becomes thicker and thicker as those muscles start to bunch up at the top. And basically by doing that it makes the whole uterus smaller and it’s kind of like squeezing the baby closer down towards the pelvic rim so that birth can happen. And during that whole time the baby is actually, normally, positioned downwards.
Actually, in our little daughter’s birth, her head was positioned up and her bum was down so she was actually in a breached position. But, you know, normal vaginal delivery, the head of the baby is positioned downwards. That’s because the biggest part of the baby is the head, and if the woman’s pelvic floor can expand to allow the head through, the rest of the birth, in nature, tends to happen along quite smoothly.
But in a breech delivery, where the bum or the feet are pointing down, anything but the head, then it becomes quite complicated, and if the baby doesn’t turn, then often a caesarean section is needed where the uterus is cut and the baby is lifted out from the uterus. That has its own complications associated with it as well.
The Abdominal Muscles
But essentially, what’s happening through both caesarean births and vaginal deliveries is that the woman’s body is changing immensely. You’ve got weakening of muscles in the abdominal area, which is the front part in your belly, and you’ve got weakening of muscles in the back area. So if you don’t rehabilitate the muscles correctly after birth, then you might be heading down towards the road of having back pain later on down the track.
So, really, what happens throughout the birth process is that the abdominal muscle wall actually becomes weaker. I don’t know if you’ve seen it on yourselves or other women who have had gone through birth, but you can sometimes see a separation of the abdominal muscles at the front part of the abdomen. So if you look around the belly button area, just above the belly button, sometimes you can sort of poke in there with your fingers and you can feel a bit of a separation between the two sides of your abdomen. So that is really an area that needs to be strengthened, because if it’s not, later on it can start to give you some pain.
Other things that tend to happen is you can get compression or some irritations through the joints and ligaments and nerves down through the lower back. Again, because of the birth process and because of carrying a baby around in the uterus, what tends to happen is the lower becomes quite, I suppose, compressed and squashed, and the lower back starts to bow inwards. And just like anyone who is carrying weight or is overweight, they tend to compress the discs in the lower back. So you need to strengthen and stretch those muscles out after pregnancy as well.
And later on in the show, we’ll talk about that and go through some examples and some scenarios that you can use to help strengthen the muscles in the lower back, so you’re preventing things from happening later on down the track. Also, research has found that strengthening these muscles after pregnancy makes the second and third or pregnancies afterwards much easier, because the muscles are already conditioned and they’re strong to allow the birth process to happen naturally.
Hormones
Another thing that happens during pregnancy is a chemical change. The body is an amazing thing; it’s full of chemicals that allow for things to happen naturally without having any sort of intervention. So there’s a hormone called “relaxin”, which starts to be excreted by the mother’s body closer towards the end part of pregnancy. And what that hormone (relaxin) does is allow for the actual relaxation of muscles and ligaments in the pelvic area to occur, so that when the baby’s head starts to come down the birth canal, these structures down to the pelvis are actually also relaxing and they’re expanding to allow for that birth process to happen a little more easily.
You can also take advantage of that hormone, because that hormone hangs around the body for about six to eight weeks afterwards, after the birth process. And often, if you see a chiropractor or another health practitioner who’s helping you align the spine, that process of alignment is actually happening a lot easier, because that hormone is around and it’s actually keeping things nice and supple and soft.
So let’s go to a break and when we come back from the break, we’ll talk about some exercises you can do to help strengthen your pelvic floor and abdominal muscles. So stay with us.
[Break]
JOHN PETROZZI: Hi and welcome back to Living is Easy. Today, we’re talking all about how we can get our new mothers, who have just had babies, back to strength, and how we can make sure that their posture is strong so they’re preventing problems from happening later on down the track.
Posture
So let’s just say we’ve gotten our baby just home and a lot of things are going to happen in that period of time, potentially to our back, because mom is going to be sitting down and breastfeeding. Dad will be around as well, and they’ll be holding the baby and also caring for the baby, so posture is a really important thing to hone down on after having a baby.
So, like I said at the beginning of the show, there’s three curves on the spine. There’s a lower back curve, mid-back and neck curve. And essentially, they should all be supported during whatever you’re doing. So if that’s sitting down in a chair or on the couch feeding the baby, that means that you really need to be sitting down with a back support, like a pillow behind your lower back. If you’re sitting down without a pillow, what tends to happen is your back starts to slump and you start to lose that beautiful curve in the lower back. And if you look at your baby, they actually don’t have a lower back curve. They don’t even have a neck curve. All they’ve got is that big C-shaped curve.
So let’s imagine you sitting down, you wanna try and put a pillow in the lower part of the back and bring the baby up close to your breast, so you need to also put a pillow or a feeding pillow underneath the baby so that you’re not carrying the weight of the baby. And imagine yourself sitting down there like you’re working at a computer, you want to be looking out forward at the screen. So to do that, you need to make sure the pillow that the baby is lying on is high enough and your shoulders are actually sitting up nice and relaxed. Because what tends to happen is you’ll be sort of slumping forward and your head sort of drags forward, your chin pokes forward, and that will also start to give you some shoulder pain and also neck pain. They’ll set you out for problems later on like having headaches, neck pain and shoulder pain. So make sure there’s enough pillows behind your back and under the baby to keep you upright.
And also for dads, when you’re picking and moving the baby or burping the baby, make sure you’re not slouching forward and losing those curves. Make sure you stay up nice and straight. I suppose the next problem is lifting and carrying the baby around, onto change tables and on the feeding chairs or into the sort of bath where the baby’s having a bath. So things you should look put for is make sure your workstations are high enough. Don’t get working on a dining room table where you are slouched forward. Have your change table up nice and high and also have your bathing table up nice and high, so that way, you are not actually bending forward and losing that curve in your lower back.
The same goes when you’re lifting the baby. Make sure that you’re tightening the tummy a little bit using your legs instead of your back and just lifting the weight of the baby straight up vertically. No twisting and no sort of swaying of the body when you’re lifting. Make sure that you stay up nice and straight.
Exercises
Okay, well let’s get down to some of those pelvic floor exercises. Again they’re really easy, it’s not rocket science. They’re really basic actually and even if you haven’t had a baby you can do these pelvic floor exercises. They’re good for everybody – both male and females.
So to start off with, just sit up in a straight back chair or on a chair. Breathe in, and then start to tighten in the bottom part of your pelvis, sort of like as if you’re holding in a wee. Then hold it for as long as you can. Often that’s something about sort of one or two seconds. Then breathe back out again and relax the pelvic floor. So again, all we need to do is breathe in, tighten and scoop in the lower part of your pelvic floor like your holding in a wee, then relax and do it all over again.
To start with just after having a baby, whether it’s sort of a vaginal delivery or caesarean birth, do it for about five to ten times until you start to become tired, then give yourself a bit of rest and do them again later on down the track.
They say the best time to do these exercises is when you’ve got some time so why not do them when you’re breastfeeding? Start to tighten the pelvic floor and they’ll start to give you a lot more strength through the lower part of your pelvis. Also, these muscles link in to your back muscles, so having a strong pelvic floor is also good to strengthen your back.
Here’s a couple other things you can do while you’re holding your baby and you’re breastfeeding. Start off just with sitting down on a chair or standing up, tuck your chin into your neck or into your throat and bend your neck forward and that will start to give you a nice gentle stretch through the top part of your shoulders.
Another one you can do is putting your hands on your shoulder, so left hand on left shoulder and right hand on right shoulder. And basically draw big circles with your elbows and that will keep your shoulder joints nice and loose.
Another one is one for the side part of your neck and you’ve probably seen people and athletes do this before, really before a swim race. What you wanna do there is tilt your ear to your shoulder and then place a hand on top of the head and then pull down to the side.
Again, don’t be forceful with these exercises. You need to do them nice and gently. If you’re looking after your neck, you should be able to start to feel some changes after a couple of times of doing the stretches.
Another good stretch is just connecting the hands out in front of you, and like a cat would do, just arch the back backwards and stretch your hands forward. This is a really good exercise for helping to strengthen and actually stretch out the muscles in the back part of your spine. Because whenever you’re sitting down in your chair and breastfeeding, these are the muscles here that tend to get really tired.
Another more advanced exercise and, again, please be careful if you have had a caesarean birth, because having a caesarean birth means that your abdominal muscles have been cut and they take a good sort of two to six weeks to heal. So this next exercise is a good one to do on all fours on the floor. Just pop down to the floor and place your hands on the floor and your knees on the floor, like you’re in a cat position. Then what you wanna try and do is arch your back backwards and open up like a harbor bridge. Hold up for a good sort of five seconds or so, breathing in naturally and normally. And then start to arch your back downwards like a reverse harbor bridge. And do a series of these, say, about six to eight. Again don’t tire yourself out. Just do them to the point where you’re starting to feel some benefit and starting to feel some loosening.
Posture really is an important part of having a healthy spine but also having a healthy body, because your brain sends messages—drilling some messages—every second of the day throughout the whole body. And all those nerve impulses have to travel through the spine then out from the spine to get to everything. To get to your cells in the skin, in muscles, in organs – every single cell supplied by a nerve – either directly or indirectly. Almost all of them come out from the spine except from a couple up the top of the neck and through the cranial bones. But apart from that, everything comes out from the spine. So, the healthier your posture is and the stronger your back is throughout your life is essentially, you have a healthy life.
Emotions
So let’s get down to some of those emotions that start to change throughout childbirth. I found this one really, really interesting because on day one, after you’ve given birth, most feelings that new mothers feel is elation and excitement because the baby’s just come out. But also, they may feel like they can’t sleep. They become hyper-vigilant trying to listen to the baby breathing and, you know, the baby’s more than likely sleeping by their bedside.
Most of the time, through a caesarean section, or all the time through a caesarean birth, the mother’s given a lot of medication – either an epidural or a spinal block—and through these medication is delivered morphine and other pain medications. So often, drowsiness is really a common part of day one.
With the cesarean delivery, basically from the belly button down is put to sleep, and generally, within three or four hours after the birth process, the legs start to come back and you start to feel some feeling back there again.
Day two is an interesting one because you tend to feel sore and tired. You feel a bit awkward because the baby is learning how to feed on the breast, so often women feel still quite drowsy from medications and quite tentative and anxious, because they’re starting to learn how to breastfeed.
Milk doesn’t come through for a good sort of half a week, to a few weeks sometimes, and there’s the early milk which comes through and that early milk is choc-a-bloc full of antibodies and healthy nutrients for the baby. The baby, essentially before that, was connected to the mother through the umbilical cord, and all the nutrients was delivered through the umbilical cord. And now, all that nutrients has to be delivered through milk, so there’s a lot of nutrients that gets delivered through the mother’s milk, and that really is an important part of growth for the baby.
Day three is a really interesting one and I found that with, personally with the birth of our baby, the mother tends to go through “baby blues” in the third day. What’s happening now is that mother’s milk is starting to come through, but also there’s a lot changes happening to the chemistry within the mother’s body and mother’s brain. So, you know, teary and being emotional is a very common part of day three after birth.
Generally after the third or fourth day, if there’s been a vaginal delivery, mums and bums are sent home. If there’s a cesarean section, then they generally stay in the hospital for a good five days, because that allows the mother to get some rest and so that they can go home and start to do some gentle exercises when they go home. Of course, lifting and carrying the baby is a really important part of bonding time so the added rest and benefit in staying and sleeping after birth is very, very important.
Sleep
So a couple of other things that I want to touch base with before we end the program is that sleep and relaxation is an important part of mothering, and also fathering because the father’s there for support. So sleeping is an important part where the body starts to rest and recuperate and regain the strength for the next feed. And often the baby will feed every four hours or so. They say the baby feeds six to eight times a day and might increase in times of growth spurts and might decrease in times when they are not growing. But generally it’s about six to eight feeds a day and that comes down to every four hours. So if you’re sleeping throughout the day, you’re having a little catnaps, you’re allowing your body to have some time to rest and recuperate, because at nighttime, you’d be waking up two (sometimes three) times a night to feed the baby.
Feeding also takes a while; that takes an hour and a half or so. You’d be feeding the baby, burping the baby, getting them relaxed and put them to sleep. So really, you’re staying up about an hour and a half to three hours a night, feeding and being with the baby. So it’s important to get some sleep.
Best position to sleep in is either on your side or on your back. If you had a caesarean birth, it’s probably a good idea to put some pillows under your knees to bend the knees so that you’re taking and keeping pressure off the stitching. Side-lying is a good position to sleep in and you can just hug a pillow, sleep on the side with a supportive pillow underneath your head.
Always try and avoid sleeping on the stomach, and that goes for everybody. Sleeping on the stomach is not so good for you because it twists and puts the neck joints out of position and that puts a lot of pressure onto the joints and nerves and muscles in the neck. So you might be more prone to having neck problems, shoulder problems, and also headaches and migraines. So look after the way that you sleep at nighttime.
Nutrition
Another important part of the early stages of birth for the mum and the baby is making sure the mother gets enough nutrients and water. There’s quite a few reflexes that happen innately in the mother, and if you had a baby, you’d probably notice that whenever you put the baby to your breast to breastfeed, you have an instant desire to drink water. And that’s a reflex that your brain has kept and it allows your body to stay hydrated so you can produce enough milk. It makes sense, doesn’t it? So it’s important to keep enough water going throughout your nutrition.
Emotional Support
Another important part of the process after birth is staying positive and having a good community support around you. So, well that means having a good, supportive partner and/or family support around you. There’s some really great support networks out there, and if you had a delivery in a hospital, often there’s some “after care” that the hospital provides. There’s also a Tresillian Care, which is a great 24-hour service on the phone and they also come to your house if you need to. They basically go through things that you should do at home to provide the best environment for yourself and the baby. There’s also a community support through early childhood centers. It’s really an important part to get involved in. There are generally mothers’ groups that you can go to and you just set yourself up there and make some friends with the mothers’ group.
So get into a community network, mother’s group, have family support if you can, and it’s important to stay positive even in those times when your hormones are racing around through your body making you feel anxious and nervous, like things are starting to go a bit haywire.
It’s also important that if you are feeling anxious and nervous, to the point where you need support, go and talk to your family care, your GP, and they’ll certainly give you some aid throughout those first few weeks and months of having a baby at home.
So that’s all what we had time for, unfortunately, today. We talked a lot about posture, a lot about looking after your baby, but it’s really important to look after yourself and your posture. So posture is an important part of having a healthy spine, and it’s important for both males and females, regardless of if you’ve got a baby or not.
So go to the website, there’s a couple more tips on how to look after your baby during those first couple of months. And thanks for joining us today on Living is Easy. To listen to this and other podcasts, go to www.livingiseasy.com.au.
I’m John Petrozzi. Until next time, stay well and stay happy!
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