Melinda and Samuel
By Melinda Fontaine, DPT
Having a baby is like running a marathon with your pelvic floor and pelvic girdle muscles. Did you know that:
- 65% of women who had low back or pelvic girdle pain during pregnancy reported persitent symptoms 14 months after delivery1
- 20 -70 % of new moms experience stress urinary incontinence 2
- 24% of women still experience pain with sex 18 months postpartum3
- Diastastis Recti exists in 39% of postpartum women 6 months after delivery 4
Leaking urine, low back and pelvic girdle pain, pain with sex, and compromised abdominal wall integrity are common issues that many mom’s encounter after childbirth. The good news is that these complications don’t have to be permanent! Pelvic Floor Physical Therapy, home exercises, and lifestyle modifications can help tremendously. In this week’s blog, pelvic floor physical therapist, and new mom, Melinda Fontaine breaks down how new mom’s can care for their newborns while still conserving their health.
Recently, I had the opportunity to be a guest speaker for the MuirMommies group at John Muir Health in Walnut Creek. As an alumnus of the group I was elated to be back, and to meet with the attentive parents who gathered to discuss a myriad of questions. Most were interested in learning how to better care for their children. However, on that day I wanted to turn the tables, and talk about how parents can take care of themselves. Predominately, I wanted to equip parents with tools to prevent common injuries that are often associated with the daily activities of caring for a baby.
It is estimated that 67% of women experience back pain postpartum, and the most associated factor with back pain is heavy work. It’s important to note that “heavy work” can also include repetitive tasks such as lifting a baby, breastfeeding, or bottle feeding as well as heavy lifting. When a newborn comes home, he or she spends the majority of their day eating, sleeping, and dirtying diapers. So let’s focus on how to take care of Baby’s needs without compromising your own well being. Whether breastfeeding or bottle feeding, caregivers should always be aware of their posture,bringing Baby close to their body and finding a position that allows them to sit (or stand or lie) with a straight spine and relaxed arms. Be wary of really plush seats that mold you into a forward bent position. I highly recommend propping Baby on a pillow for feeding. Additionally, some pillows have belts to keep them close to you, and I find this very helpful to keep Baby from sinking into a gap between you and the pillow. If using a bottle, try to keep your wrist as straight as possible to avoid carpal tunnel syndrome. It is natural to look down at your baby during feeding and marvel at the wonder that is this tiny little human in your arms. My suggestion for when you do so is to avoid sticking your head way out in front of you. Keep your head towards the back of your chair. Yes, this means you will have a double chin, but Baby won’t mind, and it will help prevent your neck from getting sore (All these same rules apply if you are pumping).
Gertie
Foundations
It is also beneficial to be cognizant of how you lean over a crib to pick up your newborn. Unfortunately, most cribs have a railing that prevents you from being close enough to the mattress to use proper body mechanics when lifting your baby. Because of this, it is extremely important to do all that you can to help save your back. There are a few cribs on the market that have sides which open like doors (ie. Gertie) or fold down a little at the top (ie. Foundations). When lifting Baby into or out of the crib, be sure to get yourself as close to the crib as possible. Hold Baby as close to your body as possible and bend at your hips while keeping your back straight. Activating your abdominal muscles can also help support your back. To protect your thumbs, keep them glued to the rest of your hand. I prefer to lift baby with one hand under the head and neck and one under the buttocks. You can also lift Baby by grasping around the torso (once your baby has decent head control). Furthermore, as long as it is safe for Baby, and he or she can’t climb out of the crib, keep the crib mattress high. A higher mattress means less bending and leaning! The same principle applies to changing diapers and using a higher changing surface will be better for your back.
Orbit Baby
OK, Baby is now fed, rested, changed, and you’re ready to hit the town! I know there is probably a crying fit, some baby vomit, and another diaper change first, but bear with me here. When getting Baby into the car seat, it’s important to be sure to do so without bending or twisting your spine too much. As always, brace with your abdominal muscles and keep Baby close; avoid holding Baby at an arm’s length away from you. Get as close to the car seat as possible when putting Baby into the car seat. If your car seat is in a middle seat, sit in the car facing the door with Baby on your lap, turn your whole body to face forward, and then put Baby in the seat next to you. (Orbit Baby even makes a car seat the swivels.) After securing Baby’s racing harness, hop in the driver’s seat and take off. Your seat will try to make you slouch, but you can fight this by sitting up straight, sticking your butt and lower back as far towards the seat as you can get it, adding a lumbar pillow if needed, and pulling your head back all the way to the headrest. When you have reached your destination, reverse the directions above to get Baby out of the car. At this point, it becomes a choose-your own-adventure endeavor. Option A means you’ve opted to use expert body mechanics to load Baby into a stroller by keeping Baby close to your body, bracing with your abdominal muscles, and getting low and close to the stroller. You’ll then push Baby around to your heart’s content while holding your head up high and your wrists straight to avoid carpal tunnel syndrome. Option B is strapping Baby to yourself using a carrier. I recommend carriers that go over both shoulders and around the waist to evenly distribute the weight. Many people are concerned about the carriers that hold Baby facing you with their legs spread wide. Fear not, This is actually a good position for Baby’s legs. Babies’ hip joints are still developing and this frog-legged position provides the most congruency between the bones, which is actually good for developing hips. You may notice that neither of these options included balancing Baby on one of your hips as we often find ourselves doing. This balancing act should not be an option because it stresses your body unevenly and can lead to hip, back, neck, shoulder and other pains.
After a successful outing, you make it safely back home with Baby and a huge sense of accomplishment. Now you are just one bath (and a few feedings and at least one change of clothes) away from bedtime! The best place to bathe Baby is the kitchen sink. I like the kitchen sink because the kitchen faucet is typically the highest faucet in your home, so you don’t have to bend over to wash Baby. Don’t worry about the kitchen sink being uncomfortable for baby, there are a number of bathtubs or padded contraptions that you can use in your sink to make it nicer if you desire. If your sink is not amenable to bathing, or when Baby gets too big, you will have to move to the adult tub. To avoid having to bend over the side of the tub to scrub behind your little one’s ears, go ahead and get in the tub if possible. This allows you to get really close to have good body mechanics, plus you’ll have a good time to bond while splashing in the water. If you cannot get into the bathtub, then get as close as you can to the tub and kneel on a padded mat or sit on a stool.
After bathtime, proceed with your bedtime routine. Maybe you give Baby a little massage with some lotion or sing “Head, shoulders, knees and toes” or recite Goodnight Moon for the upteenth time today, and then get Baby down to sleep. Before you collapse into bed, for a few hours of much needed rest, I have one more set of instructions. Gently, put yourself to bed. You deserve it! Brush your teeth and put on your pajamas. Sit on the side of your bed. As you lift your legs up onto the bed, use your arms to guide your upper body to the bed so that you are lying on your side. Roll onto your back or your other side keeping your body as straight as a log. Remember logs don’t twist, so your hips and shoulders should be in alignment at all times. Try placing a pillow under your knees if you are a back sleeper or between your knees if you are a side sleeper to keep your spine in alignment through the night. When it is time to get out of bed in the morning, or in the middle of the night, reverse these instructions. This way of getting in and out of bed, known as the log roll, protects your hard working back so that you can wake up feeling refreshed and ready to start again.
I hope you are able to try some of these tips to keep yourself in good health while raising healthy children!
Readers we want to hear from you! What parenting, baby, or childbirth questions do you have? And if you haven’t already, SUBSCRIBE to this blog (up top, to the right, under Stephanie’s photo!), so you can get weekly updates in your inbox, and follow us on Facebook and Twitter where the conversation on pelvic health is ongoing!
Regards,
Melinda Fontaine, DPT
Melinda is a native of Concord, California and is part of our Berkeley team. Melinda earned her bachelor’s degree in exercise biology from UC Davis and her doctorate in physical therapy from Simmons College in Boston. When she’s not at PHRC, you’ll find her either dashing around in her running shoes or cooking up delectable meals in her kitchen. She’s famous for her killer baked chimichangas and her inability to stick to a recipe.
1 Bergström C, Persson M, Mogren I. Pregnancy-related low back pain and pelvic girdle pain approximately 14 months after pregnancy – pain status, self-rated health and family situation.Umeå, Sweden: BMC Pregnancy Childbirth.; 2014.
2 Sangsawang B, Sangsawang N.Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment. Bangkok: Srinakharinwirot University; 2013.
3 McDonald EA, Gartland D, Small R, Brown SJ. Dyspareunia and childbirth: a prospective cohort study.Melbourne: Murdoch Childrens Research Institute; 2015.
4 Fernandes da Mota PG, et al. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Lisboa: Univ Lisboa, Fac Motricidade Humana;2015.
5 Irion JM, Irion GL. Women’s Health in Physical Therapy. Philadelphia: Lippincott Williams & Wilkins; 2010.
FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.