Pregnancy brings about significant changes in a woman's body.
We develop this guide to inform you, so you know what to expect, and learn how to work with what happens in your body, and make the journey one of joy and expectations, not fear or concern.
We will explore the physiological changes that occur during pregnancy and offer practical advice and tips on how women can optimise their physical and mental wellbeing, especially in regard to the abdomen and pelvic floor.
Pregnancy-related changes
1. Musculoskeletal Changes:
During pregnancy, a woman's body undergoes several musculoskeletal changes to accommodate the growing foetus:
a. Postural shift – As the baby grows, the woman's centre of gravity shifts forward, leading to an increased lumbar lordosis (curve in the lower back) and a protruding abdomen. This can result in increased stretch on the abdominal wall (a severe type is called diatasis recti), pressure on the bladder, and potentially contributing to lower back pain.
b. Pelvic girdle laxity – Hormonal changes, such as the release of relaxin, can lead to increased joint laxity, particularly in the pelvis. This can result in pelvic girdle pain, which affects mobility and comfort.
c. Abdominal muscle separation (diastasis recti) – This is the separation of the rectus abdominis muscles along the linea alba (the midline of the abdomen). This separation occurs naturally during pregnancy to accommodate the growing uterus and the extent vary significantly among individuals. After pregnancy there is typically a gradual convergence of the separated muscles.
2. Hormonal changes:
Hormones like relaxin and progesterone play a crucial role in preparing the body for childbirth. However, they can also affect the stability of joints and connective tissues, increasing the risk of musculoskeletal issues.
3. Increased intra-abdominal pressure:
The growing foetus and uterus can lead to increased intra-abdominal pressure, which, if not managed properly, can contribute to conditions like diastasis recti, pelvic floor dysfunction, prolapse, or incontinence.
Minimising back pain, diastasis recti and pelvic floor dysfunction
1. Exercise and physical activity:
Practicing certain specific and targeted exercises can help mitigate the risk of diastasis recti and incontinence. We may also recommend certain support garments and braces to make the pelvis feel more stable.
a. Pelvic floor exercises – Kegel exercises, under the guidance of an experienced healthcare professional, can help improve tone of the pelvic floor muscles, reducing the risk of prolapse and incontinence. We recommend this be done as part of whole body exercises such as Pilates or yoga to make it more contextual for everyday activities.
b. Core stability – Focus on exercises that promote core stability and avoid movements that excessively stress the abdominal muscles, such as sit-ups. Pilates and yoga can be excellent choices when adapted to pregnancy. We prefer the term "stability" over "strengthening" as "strengthening" tends to promote over-activity of muscles that increases intra-abdominal pressure in inexperienced people.
2. Proper body mechanics:
Maintaining good posture, using proper body mechanics, and avoiding movements that place excessive strain on the back or abdominal muscles.
a. Lifting techniques – Pay attention when you lift, and use more of your legs than your back to disperse load and minimise stress on the back and abdominal muscles.
b. Rolling over – When you get bigger, roll over in bed by bending your knees, keeping feet on the mattress to reduce strain on the abdomen.
3. Pelvic support:
Certain braces and garments like belly bands or maternity belts can provide additional support to the abdominal muscles and the pelvis, reducing discomfort and potential risk of diastasis recti.
4. Nutrition and hydration:
A well-balanced diet and proper hydration are essential during pregnancy. Adequate nutrition supports tissue repair and overall health, while hydration can prevent urinary tract infections and promote bladder health. If this is a concern, including those with gestational diabetes, we can recommend experienced dieticians for prospective mothers.
5. Weight management:
Along the same vein as above, maintaining a healthy weight during pregnancy can help minimise the strain on the abdominal muscles and reduce the risk of incontinence. Your obstetrician and midwife are the best people to speak about what is expected and ideal for you.
6. Mind-body practices:
Practices like mindfulness, meditation, and deep breathing can help women manage stress, which can contribute to better pelvic health.
Postnatal rehabilitation
We are here to help. If you experience symptoms including morning sickness, diastasis recti during and following pregnancy, we can treat your symptoms with manual therapy or acupuncture, advise on what exercises you can do, and support you can wear, during and especially immediately following birth, to minimise and mitigate symptoms.
Changes are expected. Don’t treat them like a disease – work to optimise recovery
There are appropriate types of exercises to do (and also some to avoid, such as sit-ups or crunches) at different stages to aid abdominal muscle wall recovery and pelvic floor function, and reduce the likelihood of incontinence and/or prolapse.
For example, we incorporate diagnostic ultrasound imaging and Pilates reformer to facilitate visualising and perceiving ideal patterns of abdominal muscle recruitment and involve the spine and core to help you develop the coordination.
Breathe your way back in shape
After pregnancy, many restorative exercises can be better done by engaging your diaphragm, core and pelvic floor muscles. If you breathe better, you recover better and faster.
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