Musings From A Once Pregnant PT: Gearing Up For Delivery

Posted on Posted in All Posts, Women's Health
 

pregnant woman physical therapy

Hello all,

This is Elizabeth Shah, staffer at Thrive, reporting from my home. I am on maternity leave after having recently welcomed our second child, and find myself reflecting on what I’ve learned through this pregnancy and delivery process. If you’re expecting a post on how to parent, stop reading. I don’t know what I’m doing and am, in fact, accepting suggestions. This is post about how my physical therapy background informed my pregnancy. I’m talking about the physical experience: what helped me to feel well during the process, and how might I apply these ideas to my patients.

I have been lucky during both pregnancies to be able to work until nearly delivery, to feel relatively well outside standard nausea and fatigue, and to be healthy as per the metrics relevant to my OBGYN (blood pressure, heart rate, etc.). I am extremely grateful for this good health, and think it linked directly to the body awareness and information available to me as a PT. What about being part of this profession contributed to my wellness, and that of the baby’s, during pregnancy? Here are some of the anecdotal things I believe to have helped:

• I WAS ABLE TO MOVE THROUGHOUT MY ENTIRE PREGNANCY

• I UNDERSTAND, THROUGH MY EDUCATION, THE BENEFIT OF CORE STRENGTHENING AND PELVIC FLOOR ACTIVATION

•  I KNOW WHAT TYPE OF PAIN AND DISCOMFORT IS “TOO MUCH,”   AND AVOIDED ACTIVITIES THAT MAY HAVE PUT ME AT RISK

Physical therapy is a movement-oriented job, and there is minimal time spent in the chair. While at times this is difficult, I believe ultimately this to be a benefit. My body is conditioned to tolerate standing, squatting, and load bearing activities due to my occupation, and the constant movement helped maintain a healthy cardio-vascular system and relative endurance. I think, anecdotally, that being upright during the day prevented some of the stiffness and postural pain that many pregnant women are well acquainted with. Now, does that mean that people with desk jobs are doomed to feel unwell during pregnancy? Certainly not! However, it is true that if your job requires you to sit in a chair, you will have to find the opportunity to stand and walk as often as possible outside of work. Additionally, as your center of gravity changes during pregnancy, one might find it difficult to maintain a healthy posture in sitting. A pregnant person might want to have some back support attached to the chair, in addition to having some gentle stretches to do both during the workday and after.

I continued to exercise during my pregnancies, although moderately. Gentle strength training and core/pelvic floor activation work is essential during pregnancy in preparation for childbirth and everything after. Additionally, it will help prevent back pain and difficulty with daily lifting tasks. THE BODY PREPARES FOR CHILDBIRTH IMMEDIATELY AFTER BECOMING PREGNANT, as hormonal changes allow for widening of the pelvis. Some are surprised to find that relaxin, the hormone that creates ligamentous stretching, is produced in large amounts as early as the first trimester. You might be thinking, “So what?” Well, with increased ligamentous stretch comes an increased risk for strains and sprains. In the interest of full disclosure, ligament and muscle changes can also lead to continence issues. Yikes. When connective tissue is no longer as taught and able to prevent injury, the muscular control system needs to be correctly engaged to prevent excessive movement. The diaphragm, abdominals, back, and pelvic floor musculature all contribute to stability and capability when it comes to movement and control. So do the muscles of the buttock and hip. Therefore, gentle muscle activation exercises are essential during pregnancy.

pregnant yoga physical therapyThe key to exercise during pregnancy is “portion control.” As mentioned earlier, the body begins to stretch so you can pass a baby through the birth canal. So, some stretching to relax the muscles of the pelvis to allow for this to happen is good. However, too much, as mentioned earlier, will lead to overstretch and injury. That’s why I think activity modification is important to some extent. “No pain, no gain” has no place during pregnancy. Personally, I practiced Iyengar yoga during my first pregnancy and Pilates during my second. I thought both met my needs with regards to postural strengthening and stretching. I should mention that, while I took group classes, I met with the instructors immediately upon finding out I was pregnant and received ongoing coaching throughout the experience to make sure I wasn’t putting myself at risk.

Targeted and specific activity is GOOD during pregnancy, and not to be feared. However, education is important. If you are exercising in group classes, make sure you seek out knowledgeable instruction. I  found success with Pilates and Iyengar yoga classes, but there are many options out there that fit all interests. Whatever you choose, be discerning and look for someone who’s an expert on working with pregnant women. ADDITIONALLY, YOU MAY SEEK OUT THE CARE OF A PHYSICAL THERAPIST. We can help if you’re curious about safe exercises, about how to help avoid continence issues or address ones that are developing, or if you are in pain. At Thrive, we work with pregnant patients all the time. However, if you’re reading this and unable to receive care from Thrive, seek out a PT in your area. Make sure, before attending, that you ask if the care is one-on-one, that the focus is on neuromuscular control, and that the therapist works regularly with pregnant patients.

Ultimately, after reading my post, it is my hope that you come away with one important concept: EXERCISE AND MOVEMENT ARE GOOD DURING PREGNANCY, and should be modified and tailored to the pregnant person. As always, ask a professional if you are unsure about how to proceed, need stretching or strengthening advice, or are already in pain. We look forward at Thrive to working with our pregnant clients, and growing our Thrive family (pun intended).

Cheers,
Elizabeth Shah, PT, DPT, OCS

Image(s) above courtesy of nenetus at FreeDigitalPhotos.net


Elizabeth D'Annunzio Shah Physical Therapist New York CityElizabeth D’Annunzio Shah, PT, DPT, OCS works with patients of all ages and abilities including recreational athletes, professional dancers and performing artists. She has a special interest in vestibular and balance disorders, movement theory and creative solutions for both neurologically and musculoskeletally impaired persons. Elizabeth is passionate about exercise as a means to maintain health, manage stress and enjoy life! She practices yoga in the Iyengar tradition, is an avid surfer, and participates in distance running events whenever possible. (read more)