Back to Basics for Moms-to-Be
A Sore Subject
By Andrea Braslavsky
Aug. 20, 2001 -- When I was pregnant with my daughter almost two years ago, I was told about the overwhelming rush of love I would feel toward her -- but nobody warned me about the overwhelming upper back pain that would come along with caring for a newborn 24-7.
Like most infants, Josie wanted to be held all the time, but complying with her not-so-subtle preverbal demands strained my shoulders, my arms, even my wrists. The near constant hunching and leaning over during her feedings, baths, and floor playtime didn't help the situation, either.
What was going to happen to my back and arms, I wondered with alarm, as she grew from 7 to 20 pounds?
To top it all off, I was still experiencing some of the lower backaches that began during my pregnancy. I had been hoping those aches would finally clear up after childbirth -- instead, they lingered for months.
Statistically, I am in good company: Studies estimate that between 40% and 50% of expectant mothers will experience lower backaches at some point during pregnancy, and many new mothers will develop back pain after the baby's born.
An informal poll of my friends revealed we all share the same dirty little secret: Pregnancy and backaches seem to go hand in hand -- but few of us mention it to our doctors, and fewer still do anything about it.
"In terms of people who complain of back pain, some studies out there quote the number at 40%; that's almost every other person," says Julie Colliton, MD, a rehabilitation medicine specialist at the Steadman-Hawkins Sports Medicine Clinic in Vail, Col. "What we see is a tendency for people who have had back pain prior to their pregnancy to be more likely to have back pain during their pregnancy. So that's one risk factor. And back pain during a prior pregnancy is also a risk factor."
"It's not that every single person will have back pain throughout her entire pregnancy: Some might have pain in the first trimester and then it gets better, and some might not develop it until their second or third trimester," she adds.
The potential causes are varied, Colliton says, but three mechanisms are behind most pregnancy backaches, and they can strike independently or in combination.
The Three Scourges
The first is lumbar pain -- that is, lower back pain.
Lumbar pain is often attributed to the increased pressure on a woman's vertebral discs caused by the increase in her overall mass -- "the increased weight your back has to support -- as well as the change in your center of gravity," says Colliton.
The second is sacroiliac pain, or pain in the pelvis.
"Your body releases a chemical hormone throughout pregnancy called relaxin which helps prepare ... your pelvis to allow ... the birth of your child," she says. "As that continues to progress throughout the pregnancy you can have some pain emanating from those joints and those structures, and some secondary minor instability in those areas."
And the third is nighttime pain.
"This is thought to be due to vascular engorgement: You increase your blood volume during your pregnancy and a lot of that gets pooled in your legs, which is why you get swollen legs by the end of the day," explains Colliton. "And then you go to bed and all that blood pools in your pelvis and stretches those structures, causing that type of pain."
So What's a Growing Gal to Do?
When it comes to treating pregnancy back pain, one size does not fit all, says Colliton.
"If you have a prior diagnosis of back pain, or if you had back pain in a prior pregnancy, hopefully you will have an ob/gyn who is [aware of this] and gets you into a good physical therapy program that focuses on aggressive strengthening and stabilization" before you try to get pregnant, she says.
"While you are pregnant there are a variety of ways you can do stretching and strengthening and stabilization exercises in an altered posture, [because] after the first trimester we don't like to have people doing exercises flat on their backs," she says.
Good posture is also important. Colliton says physicians should teach women the neutral spine posture -- which neutralizes the swayback posture many women develop. If a woman has to stand or sit for long periods of time, stepping or resting one foot on a low stool relaxes pelvic muscles and helps decrease the strain on the spine.
Other posture tips:
"Sleeping posture is also very important. What I have found is that subconsciously you are going to move into the position that is most comfortable for you anyway, but a lot of times a total body pillow that you can roll around on and hug is very effective in keeping you in a good posture throughout sleep," says Colliton.
The best sleep positions depend on the type of pain a woman is having. A good general rule of thumb is not to sleep flat on your back, as it may reduce blood flow to the baby. To avoid that position, Colliton recommends putting a pillow beneath one hip or raising the head of the bed a couple of inches.
All Sorts of Support: Friends and Hosiery
"We always encourage women to start using abdominal support when they start having back pain," says certified nurse-midwife Patricia A. Powell, CNM, MPH. "Certain undergarments, like elastic stockings that have reinforced spandex, help with the lower abdomen support. When you support the lower abdomen, that gives less pull to the back and back muscles."
"There can also be a psychological component to back pain," says Powell. "Women with less support tend to elicit more complaints about things. If you are alone, you tend to focus on [your pain] because there is no one there to share it or help you work through it. Anything can be exaggerated by isolation."
Women without a partner can look for support within her family and her community.
A partner or a support person can also help with household tasks that might aggravate back pain; this is especially true for women who already work at physically demanding jobs.
"Pregnancy itself is a challenge to the ... body; women can handle that, but if they have to work at lifting, stretching, reaching, and pulling, that can certainly add to some of the normal aches and pains of pregnancy," says Powell. "Even that can be tolerated if a woman has support, [so] I encourage support persons, fathers, anyone, to can help even with small tasks."
Relief can also come in the form of heat massages, regular massages, warm baths, warm water bottles, and/or acetaminophen, says Powell.
Both Powell and Colliton highly recommend gentle exercises that strengthen and stretch. One type of exercise that worked wonders for me was prenatal yoga class.
"If you get off you feet, if you lie down, if you stretch out, you are going to feel better," says yoga instructor Barbara Nardi, who teaches yoga at the Pierce Program in Atlanta. "Yoga works on keeping the abdominals and the back strong without stressing them. But probably the most important thing that yoga does is it just makes a woman take time to take care of herself."
Another alternative is chiropractic care.
"It's not contraindicated during pregnancy -- as long as it is in the right hands with someone who is aware of the ligament, hormonal, and biomechanical changes that occur during pregnancy," says Colliton. "The right person knows that there are some adjustments you don't want to make during pregnancy, and knows you well prior to your pregnancy."
Pain, Pain Go Away
If you expect your back pain to disappear after childbirth, you may have an unwelcome surprise in store. For many, the old pain doesn't clear up right away, and for some, new pain may develop in entirely different and unexpected places.
"This [area] hasn't been well studied," says Colliton. "Some studies say that the relaxin levels decrease to prepartum levels early on, and other studies say that they stay high, especially if you breastfeed. We do know that a lot of that ligament [overstretching] can stick around for up to eight months postpartum. So someone who had lumbar or sacroiliac pain could have it for up to eight months."
"It is really important for those women to get into a physical therapy program where they learn good biomechanics: how to lift and carry their baby, how to put their baby in the crib and take the baby out, and what exercises they can do while holding the baby," she adds.
Relaxin or no relaxin, it is important for all new moms to learn proper posture.
"Pain can also develop because you are not carrying the child right, or picking him up right, or only carrying the car seat with your left arm -- that's where working with a therapist is helpful," says Colliton. "They can watch you and say, 'This is a better way to do it.' "
Many of the pregnancy good-posture tips still apply, but there are also new tricks.
"You cannot pack everything and the kitchen sink in those baby bags, put it on one shoulder, then grab the baby and the toddler," says Powell. "You can't carry it all, so try to anticipate where you have to go what you need to take. It's also better to have something to push ... so you don't have to carry it."
Even new moms who have perfected the art of holding, nursing, bathing, and burping a baby while maintaining correct posture can also run into problems. Colliton says women should work to strengthen the neck muscles and those in between the shoulders.
"Strengthening and stabilizing those muscles is important, because those are the core of what we use for our upper extremities," she says.
Once again, yoga came to my rescue.
"Postpartum yoga is even more important, because your body has been through something incredible and you really need to get things back, and you have to start slowly," says Nardi. "You would start with the same types of poses that you did during pregnancy. The big difference is that you don't have a baby so you can do stronger abdominal poses and poses on your stomach."
Nardi says she sees many new moms with pain in the upper back. "It is very common -- especially if you are nursing, because your breasts are bigger and heavier and you are hunched over the baby all the time," she says. "Lying on the floor and doing arm movements is great [for] opening up and relaxing, instead of fighting gravity and having everything push down."
"The most wonderful thing about doing yoga, particularly postpartum yoga, is that it helps you keep your sanity. ... It helps you take care of yourself and gives you some peace, and connects you to others," she says.
Sanity, a moment of peace, and a connection to others -- those are things any new mom can use.
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