How Physiotherapy Can Save Your Pregnancy?

 

Pregnancy is not an illness, but some complication can change this happy event in a very challenging time… As well as giving birth can be the best day of your life or one of the worst.
A lot of these issues can be prevented with an adequate preparation. It’s also a great way to be in control of your pregnancy (reducing your stress!) and to give birth the way you wish by understanding exactly what your body and your baby are going through.

In fact, in France, primipara (women having their first baby) have 10 birth preparation sessions with a women’s health physiotherapist or a midwife. Unfortunately, no equivalent exists in the UK even with NCT classes. For these reasons, we offer one to one birth preparation session with one of our highly train women’s health physiotherapist, to palliate this lack and to give you the opportunity to have the best pregnancy possible!

Let’s review the common problems you may suffer from, during pregnancy/delivery and how birth preparation can help you to prevent/diminish these issues:

What are the common problems during pregnancy?

 

Click on the + to learn more about each problem:

Pregnancy Pain

Pain are very common during pregnancy and can be a major issue as you may end up unable to walk (or only with crutches) and bed bound for the end of your pregnancy. It can start as soon as the first trimester when hormonal changes already kicked in but pains are stronger in the third trimester, especially when the baby gets bigger!

The pains can appear in various location  (wrist, ankle, pelvis, back,….), but the most common ones are:

  • Lower back pain are most of the time due to sacro-iliac joint (pelvis joint) inflammation with or without irradiation in your legs as a sciatica
  • Pubic symphysis pain (maybe you had a SPD during pregnancy so you already know this pain!): You can feel a burning pain in between your legs, especially when closing or shearing your legs (walking or rolling over)

Unfortunately, with pregnancy limitation, you can’t take any drugs. Therefore, birth preparation is great tool to prevent/limit these inconveniences to occur by providing you adequate exercises for example. Then, manual therapy provided by women’s health physiotherapist or our osteopath can help to attenuate or suppress these pains if there are already there.

Have a look below on how Birth Preparation can prevent these symptoms and for more information about osteopathy during pregnancy have a look at:
http://myfrenchphysio.london/osteopathy/

Effort Incontinence

30% to 50% of women suffer from this condition… Effort urinary incontinence is characterized by urine leakage (not preceded by urgency) occurring when sneezing, laughing, coughing, and lifting or during physical activities (running, jumping…). In extreme cases, even walking can trigger it.
This type of incontinence is due to a brutal abdominal pressure increase causing leaking through either hyper-mobility of the urethral canal (urinary canal) or sphincter failure (weakness of muscles blocking the urethra).

To learn more about this condition have look at this article: http://myfrenchphysio.london/womenhealth-obstetric/obstetric-post-natal-pelvic-floor/what-type-of-incontinence-do-you-have/

Constipation

It is well known pregnant women and new mums are constipated.

There are several causes:

  • Pregnancy hormonal changes slow down bowel activity creating constipation within the intestine.
  • After giving birth, C-section scar, tear and episiotomy make it extremely painful to have a bowel movement. In this case, we speak about terminal constipation.
  • Furthermore, pressure creating during labour lead to haemorrhoid and consequently painful bowel movement and again a terminal constipation.
  • Finally, growing uterus push rectum backward creating an angle with the anus compromising stool expulsion.

To learn how your women’s health physio can help you to manage constipation have look at the section below on how birth preparation work (with a video of a massage against constipation) or look at our video on the topic: https://www.youtube.com/watch?v=nAFFe1e_8Yo&t

Stretch Mark

Stretch marks are the consequence of fast weight gain or growth leading to rapid skin stretch. This stretch will break the superficial part of the skin, revealing its deepest layer creating stretch mark.
Pregnancy stretch mark appears commonly in the last trimester. They are due to hormonal change creating ligament laxity but also making your skin weaker.
Also, as you may have noticed pregnancy is often related with fast tummy and breast growth stretching violently your skin…

After childbirth, stretch marks usually fade and are less noticeable, but rarely disappear completely. The only efficient curative treatment is laser surgery.
But better prevent than to cure. So let’s talk about prevention. It is usually advice to moisturise your skin, which is always nice to do but there is actually no proof it prevents stretch mark…

The only two good ways to prevent them are avoiding to gain too much weight (12kg is a normal gain weight) and to keep a correct skin mobility. For both, during your birth preparation session, your women’s health physiotherapist would give you specific advise on how to maintain adequate weight gain and exercises to mobilise your skin like abdo MG.

For more details about these treatments and exercises videos, have a look below on the part about how birth preparation work or have a look at our video on the topic: https://www.youtube.com/watc

h?v=OKb4MyY7Jfg&t

Unable to Exercise

As mentioned on the part about pregnancy pain (on the left), exercising is a great way to prevent pain but also to reduce many pregnancy complications.
However, in the first trimester you may feel so unwell that’s sport is really not an option. Then later you may feel walking is already challenging so you don’t see how you could exercise especially if you were not used to before.

In all of these cases, Birth Preparation will help you to understand what sport are good or not for you and how to start/continue them throughout your pregnancy!
For more details have look at:
http://myfrenchphysio.london/womenhealth-obstetric/sport-and-pregnancy/

Urgency

Urinary incontinence by urgency is an involuntary urine leakage preceded by compelling urge to urinate, leading sometimes to complete urination. This type of incontinence is caused by an involuntary contraction of the bladder and it is not link to physical activity. It is named unstable bladder or hyperactive bladder. It can appear in certain situation associated with reflex micturition such as uncontrollable laugh, fear, orgasm…

To learn more about urinary incontinence mechanism, cause and treatment, you can read this article: http://myfrenchphysio.london/womenhealth-obstetric/obstetric-post-natal-pelvic-floor/what-type-of-incontinence-do-you-have/
For urgency management and treatment: http://myfrenchphysio.london/womenhealth-obstetric/how-to-manage-urgency/
Finally, a Video of a technique to manage urgency: https://www.youtube.com/watch?v=nZiL7tEjUBA&t

 

Heavy legs/Poor blood circulation

Thanks (not really) to your hormones, diameter of you veins increase. Furthermore, a new venous system develops for your baby and the weight of your growing baby press on the biggest vein of your body the vena cava.

The combination of these 3 elements prevents the blood to come back normally from your lower limbs to your legs, creating sensation of heavy legs, swelling or even varices.

During birth preparation session, your women’s health physio will give you advices and exercises to improve your blood return and reduce all the above inconveniences!
For more details about treatment, have a look below in the part about how birth preparation work.

Stress

Pregnancy can be very stressful (especially the first one). Your whole body is changing, hormone kick in, your posture change, you can’t control your mood… It’s like puberty happening in just 9 months!

It may be difficult for you to understand what is going on and you may feel powerless. Therefore, a big part of the birth preparation provided by our women’s health physio is to explain you all these changes to empower you and give your back control over your pregnancy!

If you want to learn more about pregnancy change have read below on the part about how birth preparation help you to manage pregnancy stress or have a look at this article or video:
http://myfrenchphysio.london/womenhealth-obstetric/how-pregnancy-change-your-body/

 

What are the common problems caused by the delivery?

 

Click on the + to learn more about each problem:

Episiotomy & Tear

During delivery, your pelvic floor withstand an important stretch. If this stretch is too important (big baby) or your pelvic floor is not elastic enough, it may tear. This tear are always problematic as they will require time to heal properly and can be the cause of important pains. Another risk, when a tear occur, is if it goes through the sphincter canal. It’s even more problematic as it will lead to anal incontinence.

To avoid the risk of tearing your anal sphincter, an episiotomy may be performed. It’s a cut of the pelvic floor of few centimetres in a specific direction to avoid anal sphincter tearing.

Even though, tear and episiotomy can be manage with post natal physiotherapy (see our blog on the topic), always better to prevent than to cure!
It’s why during birth preparation sessions our women’s health physio will teach you techniques (pelvic floor massage & Epino) to prepare your pelvic floor and increase it’s elasticity as well as techniques to breath and push adequately during the delivery to avoid the risk of tear and episiotomy.

To learn more about these techniques see below the part about how birth preparation help to reduce the risk of tear and episiotomy or have look at our previous blog and video:
http://myfrenchphysio.london/womenhealth-obstetric/3-tips-to-prepare-your-pelvic-floor-for-a-good-delivery/

Diastasis

Throughout the pregnancy, your belly and abdominal muscles are weaker and stretch to create space for your baby. When these abdominal muscles are too strong before the pregnancy or the belly developed too quickly, the linea alba between rectus abdominis (6 packs muscle) tears leaving a gap above and below your belly button. It is named Diastasis.

To know if you have a diastasis, after giving birth, you have to lie down on your back with knees bend and feet on the floor. Put 3 fingers underneath your belly button and press gently. Raise your head, if your fingers are blocked, there is no diastasis. If your fingers go deeper, there is a diastasis. Warning: do it only once as the repetition of this test can increase the diastasis.

Continue below to read on how birth preparation help to prevent diastasis or to learn how to treat diastasis please have look at: http://myfrenchphysio.london/abdominal-rehab/

C-section

A c-section is a surgical act. The surgeon will work in the Operation Room usually the patient is under local anesthesia but general anesthesia may be necessary. Baby will be born by an incision in the mother’s abdomen and uterus.

C-section has important on your body afterwards:

  • Your transit will be slower
  • Your blood circulation is weaker
  • Your scar is painful and fragile

To learn how birth preparation will teach you how to manage these issues continue below and for more information about C-section have look at our previous blog:
http://myfrenchphysio.london/womenhealth-obstetric/obstetric-post-natal-pelvic-floor/what-is-a-c-section/

Anal Incontinence

Anal incontinence is characterized by difficulty or incapacity to keep gas or stools. Throughout the pregnancy, baby is supported by a hammock composed of the pelvic floor muscles, which also surround urethra, vagina and anus. Consequently, pregnancy imposed important pressure on these pelvic floor muscles, stretching them and leading to their weakening.

During the labour, baby delivery as well as episiotomy or tear will stretch or cut the perineum from the vaginal part to the anal part. In some case, the tear can rip apart the external anal sphincter.

Continue below to read about how birth preparation reduce of such issue to occur or to learn more about anal incontinence mechanism, cause and treatment, you can read this article: http://myfrenchphysio.london/womenhealth-obstetric/obstetric-post-natal-pelvic-floor/what-type-of-incontinence-do-you-have/

Sexual Issues

Pain may be present due to scare adhesion of episiotomy, tear or C-section.  Hypotonic perineum (pelvis floor muscle weakness) is also a common issue which may lead to loss of sensation. Main dysfunction are classified as followed:

  • Genital pain caused by sexual intercourse are called Dyspareunies 
  • Involuntary contraction of perineal muscle preventing penetration is named Vaginisme 
  • Sometimes there is also an incapacity to have an orgasm which is called Anorgasmie

To learn how birth preparation prevent this issue continue below or  learn more on this topic, have a look at: http://myfrenchphysio.london/womenhealth-obstetric/obstetric-post-natal-pelvic-floor/your-sex-life-after-a-baby/

What are the common problems after giving birth?

 

Please have a look at our previous article about Pelvic Floor rehabilitation, giving all the details on what happen after birth and how to manage this beautiful but challenging moment:
http://myfrenchphysio.london/womenhealth-obstetric/why-a-pelvic-floor-rehabilitation-is-essential-after-every-pregnancy/

How birth preparation works and prevents/diminishes pregnancy issues?

 

Click on the + to learn more about each problem:

Prepare your pelvic floor

Thanks to specific exercises and techniques such as pelvic floor massage and Epino (explain in the next part), birth preparation will help you to prepare your pelvic floor for the delivery but also to recover quicker/better after it!

Our women’s health physio will also teach you breathing and pushing technique during delivery to reduce risks of episiotomy and tear.

To learn more:
http://myfrenchphysio.london/womenhealth-obstetric/3-tips-to-prepare-your-pelvic-floor-for-a-good-delivery/

Prevent pregnancy pain

Pregnancy pain are mostly due to an accumulation of tension in your muscles (gluteus maximus, piriformis…) or a lack of movement of your joints (SIJ, pubis symphisis). Consequently a lot of pregnancy pain can be easily avoid by using adapted exercises (stretch, gentle mobilisation, etc.) which you can learn in birth preparation sessions.

Here are some example of exercises:

http://myfrenchphysio.london/womenhealth-obstetric/top-8-safe-pelvis-exercises-you-can-do-during-pregnancy/

 

Adopt a good posture for you and your baby

With hormonal changes, the gain weight and mechanical changes your posture is going to be drastically change. If you already see a pregnant women at 8 months, you know what I mean with this very particular penguin walk!

Birth preparation will help you to keep a good posture throughout the pregnancy thanks to postural exercise. They are here to help your body to adapt smoothly to pregnancy changes and prevent inconvenience such as back pain, SPD, PGP… Your women’s physiotherapist or osteopath will also give you advices to adopt a good posture at work.

Have a look at our play list of postural exercises:
https://www.youtube.com/watch?v=W9R6e7HVb9o&list=PLRX6atq71tTqvp75_BEl7wMrlo-srAWlG

Prevent heavy leg

Thanks (not really) to your hormones, diameter of you veins increase. Furthermore, a new venous system develops for your baby and the weight of your growing baby press on the biggest vein of your body the vena cava.

The combination of these 3 elements prevents the blood to come back normally from your lower limbs to your legs, creating sensation of heavy legs, swelling or even varices.

Our women’s health physio can help to improve your blood return and fight heavy legs with drainage techniques and also by teaching you specific exercises such as:

Give you control over your pregnancy

Birth preparation aims to empower you through a better understanding of what your body is getting through with anatomy and physiology notions.

Pregnancy is a changing time. It is a complete revolution for your body. Sometimes it’s comfy, some other you will wish you could give birth right away… It can be a great source of stress, especially if it’s your first baby and your discovering it all and if it’s your second or more, you also have stress/challenge to take care of the olders!
Therefore, within the birth preparation sessions our women’s health physio will explain you all these changes with advices on how to manage them to give you the possibility to have the pregnancy you dreamed of and to relax!

For more information about these changes:
http://myfrenchphysio.london/womenhealth-obstetric/how-pregnancy-change-your-body/

Our women’s health physio on top of explaining everything will also be able to answer your question and your concern, perfect to reduce your stress and putting you in control of your pregnancy!

Prepare your abdominal muscle

Throughout the pregnancy, your belly and abdominal muscles are weaker and stretch to create space for your baby. When these abdominal muscles are too strong before the pregnancy or the belly developed too quickly, the linea alba between rectus abdominis (6 packs muscle) tears leaving a gap above and below your belly button. It is named Diastasis. To know if you have a diastasis, after giving birth, you have to lie down on your back with knees bend and feet on the floor. Put 3 fingers underneath your belly button and press gently. Raise your head, if your fingers are blocked, there is no diastasis. If your fingers go deeper, there is a diastasis. Warning: do it only once as the repetition of this test can increase the diastasis. To learn how to treat diastasis please have look at: http://myfrenchphysio.london/abdominal-rehab/

Manage pregnancy pain

Unfortunately, all pain are not preventable during pregnancy and especially at the end of the third trimester, you may experience pelvic girdle pain and pubis symphysis pain. The most common ones are:

  • Lower back pain are most of the time due to sacro-iliac joint (pelvis joint) inflamation with or without irradiation in your legs as a sciatica
  • Pubic symphysis pain (maybe you had a SPD during pregnancy so you already know this pain!): You can feel a burning pain in between your legs, especially when closing or shearing your legs (walking or rolling over)

Unfortunately, with pregnancy you can’t take any drugs. Consequently, manual therapy provided by women’s health physiotherapist or our osteopath can help to attenuate or suppress these pains and help to prevent their recurrence with specific exercises.

We give some example here: http://myfrenchphysio.london/womenhealth-obstetric/top-6-exercises-to-avoid-pelvic-girdle-pain-during-pregnancy/)

Advices and treatment against constipation

We saw above what cause constipation. Now let’s see how birth preparation can help you to manage this issue.

Our women’s health physio will give you advice on your diet, how to go to the loo correctly and how to have good bowel movement. She will also teach you specific techniques to manage constipation like these ones:

Reduce risk of stretch mark

We saw above the cause of stretch mark and that moisturing wasn’t really efficient to prevent stretch mark…

The only two good ways to prevent them are avoiding to gain too much weight (12kg is a normal gain weight) and to keep a correct skin mobility. For both, during your birth preparation session, your women’s health physiotherapist would give you specific advise on how to maintain adequate weight gain and exercises to mobilise your skin like abdo MG.

 

Practice sport safely

First, anyone can benefit from exercises; it keeps you fit, happy and prevents disease.
Secondly, through your pregnancy, you will be less and less able to move around due to weight gain or increase fatigability.

Thanks to sport you will limit these problems and avoid the common vicious circle which is as you do less you are less able to do, so you do even less… Pregnancy overloads your muscles and joints creating back, neck, abdominal, SPD and pelvic girdle pain. Sport is the key to prevent these issues. It also helps you to limit weight gain; (normal weight gain is 12kg), which is not only useful to go back faster in your bikini but more importantly prevents diabetes.
Risks of hypertension, preeclampsia and post-partum depression are also reduced by exercises.
Even less consequential inconvenient like constipation, swollen legs and varicose are limited by sport.

However, not all sport are good or you can’t practice your activity the same way when your pregnant and when you aren’t. Birth preparation and our women’s health physio will help you to understand which sport to do and how to do them safely.
You can already find some information in this video:

How birth preparation helps you to have a better delivery and diminish risk of tear/episiotomy?

 

Click on the + to learn more about each problem:

Understand Labour & Delivery mechanism

Understand the different stages of the delivery it will reduce your stress and prepare you to react adequately to the different situation which may happen. After following birth preparation, you will know the different labour stages, material which can be use and the reasons (forceps, ventouse), and for each how to react adequately to have the closest delivery you to the one you wished for. It will also help you to prevent tear/episotomy by knowing how to react during the delivery!

You can already find information here:
http://myfrenchphysio.london/womenhealth-obstetric/obstetric-post-natal-pelvic-floor/what-to-expect-for-your-delivery/

Pelvic floor massage to reduce risk of tear/episiotomy

Our Women’s health physio will teach you how to massage your pelvic floor to massage your pelvic floor.

This techniques associated to others will increase the elasticity of your pelvic floor and reduce the risk of episiotomy and tear. We give information about pelvic floor massage here:

Prepare you to a potential C-section and learn how to manage it afterward

A c-section is a surgical act. The surgeon will work in the Operation Room usually the patient is under local anesthesia but general anesthesia may be necessary. Baby will be born by an incision in the mother’s abdomen and uterus.

Our women’s health physio will teach you how to manage the consequence of the C-section.

What Happens following the C-section?

You could have a urinary catheter during 24h and a midwife will put you on an analgesic drip.
Obviously, don’t lift/carry heavy objects (heavier than your baby weight) for 40 days after the C-section. It means: NO buggy, carrycot,…

Don’t take a bath or go to the swimming pool during these 3 weeks to avoid any infection risk!

Your transit will be slower (you will have your first gas after 12 or 24 hours) and it will cause constipation which you can manage by using simple techniques.

Your blood circulation is weaker and it will be important to facilitate blood return (cf vascular gymnastic):
– Avoid sitting position during the first days to help the healings of the c-section scare
– Keep your leg raised and stand up very often.

Your scar is fragile:
Every time you cough, sneeze, laugh…, it will pull on the scar tissues and produce pain. To protect it, hold the scar with both hands to lift it.
For the first 3 weeks, put Mepiform on your scar. It is a silicone plaster and it will help the healing process and avoid ugly scar.
You also could put mother tincture of calendula or any scar reduction cream.

Start to massage your scar as soon as the edges of the wound are closed (21 days): Feel free to ask to your women’s health physio how to do it:
– At the beginning, convergent and slide movements
– Later, divergent and circular movements
– Much later, “palper rouler” and ventouse

Do not forget, even with a c section, you need to retrain your pelvic floor afterwards. And, obviously, take care of your abdominal muscles!

For more information:
http://myfrenchphysio.london/womenhealth-obstetric/obstetric-post-natal-pelvic-floor/what-is-a-c-section/

Learn labour techniques to manage pain better

In birth preparation sessions, you will:

  • Learn positions to help your baby to present himself correctly.
  • Find your position to give birth
  • Learn breathing technique to reduce contraction pain
  • Learn breathing technique to help your baby to go out protecting as much as possible your abdominal and perineal muscles

You can already find some of these information here:
http://myfrenchphysio.london/womenhealth-obstetric/obstetric-post-natal-pelvic-floor/what-to-expect-for-your-delivery/

Epi-No to reduce risk of tear/episiotomy

If you are not keen on doing massage, you can use this balloon , which will stretch your perineum.
Even if you do your massage, it is a good item to prepare the perineum with gentle stretching exercises after Week 36.

  • How to use it?
    • Slowly inflate the EPI-NO balloon to the point of stretching and comfort.
    • Each day you will inflate and stretch a bit more.
    • After the stretching phase (around 5 minutes), relax your pelvic floor muscles and allow the inflated EPI·NO balloon to gently expel itself from the vagina. This will familiarise you with the sensation of delivering the baby’s head.
    • Do 4 cycles per session (20 min training)
  • Optimum training is achieved when the balloon size has reached a diameter of 8.5 -10 cm (3-4 inches) and can be pushed out while inflated (usually after 3 weeks of training)
  • There is no risk for your baby.

During birth preparation sessions, our women’s health physiotherapist will teach you how to use it!

Advice to prepare the post-natal period

Pregnancy is only the first stage of a beautiful but challenging process. Knowing what will happen afterwards and how to react is a great asset. Therefore, part of the birth preparation is to teach you what will happen once you gave birth!

You can find all the information in our previous blog:
http://myfrenchphysio.london/womenhealth-obstetric/why-a-pelvic-floor-rehabilitation-is-essential-after-every-pregnancy/

This blog doesn’t intend to frighten you. Pregnancy is one of the most amazing moment of life and our aim is to help pregnant women to enjoy it as much as possible.

We want to acknowledge all the potential pregnancy problems to empower women by increasing their understanding of their body and providing specific solution for each issue.

Too often our patients waited too long to contact us only because they were not aware treatment existed for their problem.  So we can only guess how many women out there are suffering alone due to lack of information…

Additionally, for women who are not based in London and don’t have access to our services don’t hesitate to have look at the rest of our blog and YouTube Channel!

 

As usual, don’t hesitate to share to spread the good words and help other women to understand their own body!

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