Valuing Your Body and Instincts During Birth

January 10, 2014 in Childbirth, Pelvis, Pregnancy

 

Pregnancy can be an overwhelming time for you and your body.  So many changes occur to your body as it swells to unrecognizable shape and proportion.  Then comes the uncertainty of birth.  How is this baby supposed to get out?  Really?  You can read all the books, watch all the videos and attend all the childbirth classes you want to prepare yourself for the anticipated day of your babies arrival.  Yet nothing can really prepare you for what you are going to experience.  Because no one really knows what YOUR experience is going to be of how YOUR baby chooses to come out.

 

This may sound kind of gloomy but let me reassure you of one thing.  That baby will find it’s way out one way or another.  The more prepared you are for your birth of what you CAN expect will help you relax into the process of what needs to occur. Read all the books, watch all the videos and take all those classes.  Know what needs to happen in your body for birth and what you truly desire to happen for you and your baby.  Then let it all go!

 

Letting Go In Labor

 

That’s right, let it go.  Because birth is really about letting go.  Allowing the process to happen.  Your body is designed to get your baby out.  When we can really connect into that sacred space deep within us you will know exactly what you need to do to help get your baby out.  Many women would benefit from really finding this space of knowingness within so they can listen to it during labor.  Yet most modern day hospitals and OB’s aren’t designed/trained to help women find this inner wisdom.

 

 

Giving Up your Power During Birth

 

We give our power over to our doctor and disconnect from our inner knowingness.  So many women in my practice have shared how they had a cervical check and were only 6-7 cm dilated and shortly after needed to push but was told not to push because they couldn’t be at 10 already.  When we listen to the people around us and not to our body’s signal, because we don’t know any better, more of that disconnect occurs.  When you try to stop from pushing when your uterus is pushing your baby out it creates all kinds of energetic blocks in your pelvis.  Your baby gets the confusing message, come out, no don’t come out.  There is a holding energy that anchors in your pelvis.  You lose that trust of your body that you once had or maybe never really had.

 

It’s challenging for a first time mom to understand what is going on in her body during labor to really trust herself to know.  Yet the more you can connect into your inner knowingness the more you can question other peoples judgements of your situation.  Your body knows how to do this so if you feel like pushing listen to your body.  Value the wisdom that your body knows how to get this baby out.

 

I saw one mom you came in for a post partum session and I kept feeling the energetic pattern of the babies head going into her right hip while there was a twisting of her upper body to the left.  When I asked about this she reported her husband was holding her right hand up by her shoulder while she was pushing.  Instinctually she let go of his hand and reached over to the left side bedrail and pushed.  Then her baby shifted into the center of her pelvis to come out.  Yet there was fear when this happened and this pattern was stuck in her body.  Identify and releasing the fear allowed the pattern in her body to let go.  Twisting her upper body to the left put some torque into her pelvis to shift the baby over into the outlet to get the baby out.  When I explained to her why she did what she did, she was able to value her body’s instinctual knowingness better.  YOUR BODY KNOWS!

 

So how do you connect to your inner knowingness?

 

It starts with a practice of quieting yourself and really connecting into your body.  Connect into your pelvis.  Feel the baby down in your pelvis.  Feel any sensations you feel in your body.  Become still and quiet and just feel what you feel inside of you.  Where do you get drawn?  Bring your breathe down to your pelvis or wherever you get drawn in your body.  The more you can practice this now the easier you will do so during your birth. During labor clear all the distractions around you and connect inside of your body.  See and sense what your body wants to do and get into that position.

 

A colleague of mine was in labor with her second child and she was feeling like she was losing her hold on the contractions and not getting anywhere as her labor wasn’t progressing.  She kicked everyone out of her room and quieted herself and went down and connected into her pelvis.  She got up and knelt on her knees with her butt up in the air and head down and stayed there till she felt something change inside.  Then she was able to continue on with her labor and push her baby out.  She did not know of inversion before this but this is a great technique to rotate a baby whose head is coming into your pelvis in a more challenging way, (OP or occiput posterior).  She got this information from her body and knew what to do.

 

So whenever you are feeling stuck with anything in life, whether it be birth or anything else, connecting into your pelvis and womb space can offer you a creative answer or direction.  If you need any support in feeling this connection I’d love to help you out.  I am amazed at the significant changes in my life since I’ve really embraced and reconnected to my pelvis.  It’s a powerful area and worthy of our attention.

 

 

 

 

Pelvic Trauma in Childbirth

July 30, 2013 in Childbirth, Pelvis, Post Partum

Realizing how the body goes about getting a baby out of the body is an extremely amazing feat.   Seems downright impossible if you look at the size of a newborn baby and the size of the pelvis, especially the vaginal opening.   What does make it possible is the way both the baby’s head and the mom’s pelvis are able to shift their sizes to accommodate.  The fetus’ cranial bones overlap to make it smaller and the pelvic inlet and outlet are made larger by the movement of the pelvic bones as the baby passes through.

Most of the time in an uncomplicated birth this process goes about smoothly.  However if the pelvic bones aren’t able to move normally like they should then dysfunctions occur in the pelvis and the baby’s head gets greater than normal pressures on it as well.

The biggest issue I encounter in working with post partum women is the lasting effects of abnormal tensions in the ischial bones.   These bones are not commonly addressed in standard post partum care.   The lasting effects on women with ischial dysfunctions could be low back and hip pain, pelvic floor muscle weakness, prolapsing of pelvic organs and painful intercourse.

Let’s take a closer look at the anatomy of the pelvis to see what is happening.  pelvis

Our pelvis looks like one continuous ring of bone yet different parts of the pelvis have different names.  The pelvis is comprised of two big ilial bones that are the broad, elephant ears shaped bones that connect on either side of the sacrum in the back.  This area of connection, where you see little dimples in the low back area on some people is called the sacroiliac joint.  If you were to put your hands on your hips at your waist you have contact with the top portion of these ilial bones.  When you slide your hands down the outside edge of these bones towards the midline of your body, where your buttocks connect into your upper thigh this is the area that your ischiums are located.  When you sit down on a chair the pelvic bones in contact with the chair are your ischial bones.   In a picture of the pelvis the ischial bones are that part of the pelvis that have a hole in the middle.  The lower part of the ring of ischial bone goes forward to connect to your pubic bone that sits low in the front of your body, in the middle of your two groin areas.  The bone leading from the ischiums to your pubic bone is called your pubic rami.

Mechanics of childbirth

During the first stages of labor the upper part of the pelvis needs to widen to allow the baby’s head to enter into the pelvis.  To do this the top portion of the sacrum needs to move backwards while the lower part of the sacrum, the tailbone area moves forward.  This is called sacral counternutation.  In the later stages of labor the opposite sacral motion, nutation, needs to occur where the tailbone moves backwards.   While at the same time the ischial bones widen out to the side.  It is during the last part of labor as the baby is coming out that pressure may be exerted more on one side of the ischium than the other.

As a physical therapist I understand the mechanics of the joints and muscles and what needs to happen for childbirth.  Adding to that knowledge is a skill I have developed to be able to sense or feel what the tissues and bones have gone through during a birth or an injury.

As I have worked on postpartum women I have been able to sense how the baby has come out of the pelvis.  I have felt many pelvic floors where the tissues are still twisting a bit from the baby’s head rotating to come out.  The pelvis may be a bit twisted or rotated as well.  Many times the baby’s head has contacted more of one ischium than the other.   That side ischium is harder and most of the time is still splaying out to the side more than the other.  Sometimes both ischiums are still in that splaying out position and need help coming back into midline again.

I had one client that came to me for painful intercourse who had this very issue.  When assessing her pelvic floor muscles they were like a tightrope straight across her vaginal opening.  When palpating the muscle there was very little give.  Normal muscle is like a trampoline, bouncy with pressure.  This muscle was like a board, with little give.   With the ischiums splayed outward the pelvic floor muscles are stretched to the brink.  Just encouraging the ischiums to come back together relaxed the muscles to where there was a bounce again in the tissues.    She reported having no more problems with intercourse after one session.

Many other clients come to me complaining of one sided hip and/or low back pain.  I find that it is usually the side where the ischium has not come back to its normal midline position.  After correcting the boney alignment and working to relax the pelvic floor muscles internally the hip/back problem goes away.   In one day I saw three different post partum women all presenting with the same pelvic twisting to the left and right side ischium splayed out to the side.    Through my sense of touch I could feel the baby coming out more into that right ischium.   It had more of a traumatized feel and stayed in that opened, birthing position.

Some women with ischial dysfunction complain of significant core weakness.  They complain of not being able to fully contract their pelvic floor muscles.  Their strength just never seems to improve no matter how long they have been doing kegel’s.   They also feel very weak in their core and have little strength around the pelvic region.

With the pelvis being out of alignment the muscles have tensions placed on them that is not normal.  This increased tension or tone in the muscles diminishes its contractile ability sometimes to the point of not being able to contract at all.

No matter how many kegels they do they just don’t seem to gain any strength.

The ischiums coming back into their normal midline position helps to bring the pelvic floor muscles back to their normal resting place so they can activate more fully during a contraction.  They no longer have abnormal tensions on them so they can contract through their full range of motion.  After a session of realigning a woman’s pelvis she immediately notices an improved strength in her kegel ability.

It is my theory that when the ischiums remain in the splayed out position the pelvis is sensing that birthing is still in process.  I’ve also tuned into urethra’s, bladder’s and uterus’ that are still bearing down like they are pushing out a baby.  Once the ischiums come back together in their midline position then the organs can easily realize that pushing out is no longer needed.  After I get the ischiums in their normal position I check internally with the organs and if they are still energetically pushing out I have the woman tune into those organs and with intention tell them to stay on up and inside.  As soon as I start saying these instructions I can feel the organs energetically retracting back on up and in, like a turtles head going back into its shell.  This helps the organs to stay in their proper place easier.   Mobilizing the ischiums is only one of many other areas and issues that need to be addressed to help with organ prolapse.  Yet I feel it’s a very important part of it.

WHY DOES ALL THIS HAPPEN?

If the baby’s head fits through the opening in the middle of the pelvis how does the head come out putting more pressure on one ischium than the other?  If you were to look down on the pelvis you would think a baby could only come out in midline. However, once the baby’s head is through the pelvic inlet it’s up to the pelvic floor muscles, ischial bones and the tailbone to continue to guide the head through the pelvis.  If those three bones are in their normal positions and the muscles and tissues attached to them in a normal state as well, the baby does come on out midline.

If you look at the pelvis from the underneath side you can see how the tailbone and the ischial bones are the three boney landmarks the baby’s head needs to pass through.  What if the pelvic floor muscles on one side had more tone in them and are tighter than the other?  The pelvic floor muscles attach on either side of the tailbone and lower part of the sacrum.  If one side has more tone than the other side then the sacrum is not going to be able to move backwards symmetrically.  If the sacrum is anchored on one side this may guide the baby’s head more into the opposite side ischium.

The women that I worked with that had right-sided trauma in their ischiums also had increased tone in the right side pelvic floor muscles.  Since I didn’t see them prior to childbirth I can’t say that this increased muscle tone caused the imbalance in the ischiums.  Plus this increased pelvic floor muscle tone noted after childbirth could be a side effect of the trauma and not the cause.   I am just not sure how one sided increased muscle tone influences the baby’s head out of the pelvis, whether it causes more tension on the same or opposite side ischium, but I’ve felt enough pelvis’ to know that it does.

How does the effect of increased tone in the pelvic floor muscles potentially influence or guide the baby’s head out of the pelvis?   Increased tone on one side of the pelvic floor muscles may cause the baby’s head to be pushing or guided more into the opposite side ischium.  Or is it the muscle tightness prevents opening of the ischium and nutation of the sacrum on that side causing the baby’s head to shift towards the tight side?  Either way whether tension in one side pelvic floor causes trauma on the same side as the tightness or the opposite side, the ischiums are still getting uneven tensions placed upon them leading to increased trauma and dysfunction in the bones and pelvic floor tissues.

Another player in this mechanic could be the sacroiliac joint.  If the sacrum is unable to nutate on one side because the sacrum is not sitting in the joint properly this can prevent it from opening up and possibly cause a shifting of the baby’s head toward one ischium more than the other.

I highly recommend any pregnant woman get their pelvis and sacroiliac joints assessed for normal mobility prior to going into labor.    A Webster trained chiropractor or a Women’s Health physical therapist can help you determine if your sacrum has the ability to move as it should prior to going into labor.   It could help you have a faster delivery.

One of my clients who had right sided ischial trauma presented with a cervix that was pulled off to the right side.  Instead of the cervix being in midline, it was positioned more to the right and pointing right into the right ischium.  Is that the reason her baby came out more into her right ischium than her left?

These are just a few theories I have come up with to help explain the imbalance I am finding in pressures and trauma on one ischium more than the other during childbirth.

WHAT CAN WE DO TO PREVENT THIS?

It’s hard to say if we can prevent this uneven pressure on the ischiums.  My guess is if women had their sacroiliac joints assessed for mobility and their pelvic floor muscles assessed for relaxation ability prior to childbirth then maybe we could help the baby find a more midline approach out of the pelvis.   While it is easy to assess sacroiliac joint mobility, it is not common practice for any women’s health physical therapist to do any internal work during pregnancy.    I have worked internally for pain and mobility issues in some pregnant moms but it is not common practice to do so.  I’m wondering if routine checking of woman’s pelvic floor muscle tension in the third trimester, and treating increased tone issues, might be helpful for mom’s and baby’s to have an easier birth experience.

The other key factor to address is baby’s positioning in the moms belly prior to the start of labor.  The more midline the baby’s head is down in the pelvis the better chance the baby has of making its way evenly into the pelvis.  Any restrictions in the abdominal fascia or uterosacral ligaments can restrict uterine mobility and prevent baby’s head and body from getting into the optimal position to come out.  Gentle release work of this fascial restriction can free up the mobility in that area and help the baby get into a better position.

For health care practitioners understanding the mechanics of the pelvis and pelvic floor muscles is imperative in helping moms have as easy of a birth as possible.  For pregnant moms any dysfunctions or problems in your low back or pelvis need to be addressed prior to going into labor.   Then your baby can have a smoother, hopefully easier transition through your pelvis.  I am a huge proponent of making sure the pelvis and pelvic floor muscles are in good working order prior to labor beginning.  If we can help make the passageway work more smoothly then both mother and baby will experience fewer traumas.  And don’t we all want that!

 

Exercise after Childbirth-Proceed with Caution! Part 3

May 31, 2013 in Abdominals, Childbirth, Diastasis Recti, Exercise, Post Partum, Pregnancy

Exercise After Childbirth-Part 3

So we’ve discussed the issues of low back pain and pelvic organ prolapse in two previous posts.  There is one other issue you need to be aware of that doing the wrong kinds of exercises can keep from healing and that is diastasis recti.

Diastasis Recti

A diastasis recti is a separation of the rectus abdominus muscle, otherwise known as the six-pack muscle. The rectus abdmonius muscle runs from the sternum down to the pubic bone and has two muscle fibers separated by a connective tissue called the linea alba. During pregnancy, as the uterus expands the two muscle bellies separate and the linea alba gets stretched thin. It is very important to allow this connective tissue to heal so the muscle bellies can come back together. Any activity that causes the abdomen to move forward forcefully causes this connective tissue to stretch out thus preventing it from healing.

Also any twisting motion causes the rectus muscle bellies to separate making the diastasis larger. You need to avoid all twisting motions and any forward forceful movements so you can let your rectus muscle to come back together and heal. Sit ups or crunches, especially with twisting are the worst thing you could be doing right after having a baby as the transverse muscle is so weak it can’t keep the lower abdomen from jutting out.  Many moms are doing sit up wondering why they aren’t getting their bellies smaller.  Sit-ups are working the wrong muscle and doing more damage than good in the post partum period.  It’s the transverse muscle that needs to be strengthened.

I’ve written a another post on how to prevent diastasis recti in pregnancy and I also teach a class and offer a video on healing Diastasis Recti you can check out here.

What is the best way to strengthen the abdominal muscles?

Pulling your belly button all the way back toward your spine and holding it there, WITHOUT HOLDING YOUR BREATH, and then trying to do little pulses to take it back even farther.   When the muscle is weak you will notice movement with your pulses at end range of your abdominal contraction.   You want to get the muscle stronger to when you go to pulse there is actually no movement that occurs.   That will help shorten your lengthened abdominal muscles.  Start off just doing 10 pulses and work you way up to doing as many as you can at one time with 100 being your goal.  Doing this several times throughout the day will help you lose the pooch that so many women have after pregnancy.

 

Exercise after Childbirth-Proceed with Caution! Part 2

May 30, 2013 in Childbirth, Exercise, Pelvis, Post Partum, Prolapse, Women's Health Issues

Exercise After Childbirth-Part 2

So many women are jumping right back into doing the same exact exercise program they did before getting pregnant and their body is just not ready for it.  There are 3 main issues you may experience if you aren’t careful in the post partum period.  We’ve already talked about low back pain and why you can develop this problem in a previous post.  Click here to review.

Prolapsing of Pelvic Organs

Another issue you can experience if you are not careful is prolapsing of your pelvis organs.  Prolapse is when your pelvic organs, your bladder, uterus or rectum, are falling down or out of your vagina.  It can feel like pressure in your vaginal area or like a tampon is falling half way out.

I had one client come to see me who was only 7 weeks post partum.  She had a stage 3 bladder prolapse.  That is where the bladder was sitting at the opening of the vagina.  I asked about her delivery and she said it went smoothly, she didn’t push more than an ½ hour and everything felt fine afterwards.

When I asked about what exercises she was doing she reported she was running and doing pilates 100’s.  Those are the two worse exercises you can do that early on in the post partum period.  She developed her bladder prolapse from the exercises she was doing after having her baby.

What happened to her bladder?

The pelvic floor muscles have been stretched and are weak from childbirth. They run from the pubic bone in front and attach to the tailbone in back.  One of the main roles of the pelvic floor muscles is to offer a hammock like support to our pelvic organs, which are also held in place by ligaments. So if your pelvic floor muscles aren’t strong enough to help support your organs, the ligaments have to take on extra work to keep them in place.  If excessive strain keeps getting placed on the organs the ligamentous suport can fail, causing prolapse.   Whenever we cough, sneeze, laugh or exercise and our abdomen goes forward forcefully, downward pressure gets applied to the bladder and uterus and pushes them down, thus stretching out those supportive ligaments. Any jumping, running, high impact exercises, and/or crunches or pilates 100’s, can create the same downward forces.

When we do these activities without first strengthening our pelvic floor muscles and our abdominal muscles we are at risk of prolapsing our pelvic organs.  To learn more about restrengthening your pelvic floor  and your abdominal muscles read these articles.

Once your organs fall down it takes a LOT of effort to correct the situation.  Most doctors will only recommend surgery; but there are other options.  You can work on strengthening your structural support around the organs and see if that can help with the prolapse.  This can cover another 5-6 blogposts, but I just want you to know that it is possible to manage this prolapse without surgery.

Stay tuned for the third issue you can develop if you are not careful with exercising after childbirth and then how you can strengthen your body safely!

Exercise after Childbirth-Proceed with Caution! Part 1

May 29, 2013 in Abdominals, Childbirth, Diastasis Recti, Exercise, Post Partum, Pregnancy

Exercise After Childbirth- Part 1

Most new moms are ready to shed those extra pounds and jump right back into their pre-pregnancy workouts right after giving birth. With all the changes that have happened to your body over the last 9 months doing what you did before getting pregnant might not be the smartest and safest thing for your body. Certain exercises can cause long-term problems for your body. Knowing what exercises are safe to do and which are harmful is very important after having your baby.

3 Issues you want to Avoid when Resuming Exercise After Delivery

There are 3 major issues you might encounter if you are not careful with exercising immediately after giving birth. You are at risk for low back strain, prolapsing of your pelvic organs (falling out of your vagina) and diastasis recti- a separation of your rectus abdominus muscle, known as the six-pack muscle.

Each issue is so important that we’ll talk about them in a separate post so you have clear understanding on how to avoid developing these problems that are no fun to experience.

Low Back Strain/Pain

Our core muscles in our body are made up of 3 muscles, the transverse abdominus, the pelvic floor and the multifidus muscles in the back. Two of these muscles have been completely stretched to the max from childbirth and pregnancy and are very weak, the tranverse abdominus muscle and your pelvic floor muscles. The transverse abdominus muscle runs from your spine in the back around to the front and attaches into the rectus abdominus or the six-pack muscle. It acts like a corset supporting your spine. Remember how stretched out this muscle was with your pregnant belly? If you don’t do any strengthening of this muscle and just let it be it will shrink back but may not be as short as it was prior to pregnancy, thus giving you a little pooch in your belly.

So your pregnancy loosened the corset around your back and pelvis and you don’t have the support you had prior to pregnancy.

Jumping right back into doing the same exercises as you did before pregnancy can cause a strain on your back as your abdominal  and pelvic floor muscles don’t have the strength to stabilize the spine like it did before.

So your first order of exercise should be to re-strengthen your transverse abdominus muscle and your pelvic floor muscles.  Performing a kegel, or pelvic floor contraction is important in the post partum period.  Normal strength of the pelvic floor muscles is the ability of the muscles to maintain a good contraction for 10 seconds.  Click here to learn more about restrengthening your pelvic floor after childbirth.

While this is a great idea and may be a little easier for a mom who had a c-section than a vaginal birth, trauma to the pelvic floor tissues can prevent any strengthening from happening.  Helping to heal the vaginal tissues that got so strained during the birth process can help improve your muscles ability to contract.   Click here to read more on how to do that.

Working on restrengthening your abdominal muscles is also a must after childbirth.  The abdominal muscles act as a corset to support our spine.  Without this support our spine is at increased risk for injury.   The abdominal muscles get extremely lengthened during pregnancy and sometimes can separate creating a diastasis recti.  If you have any separation, this alone can cause low back pain as the muscles are ineffective in supporting the spine.   You need to heal this first and part of healing a diastasis is restrengthening your abdominal muscles correctly.   Doing crunches will only make things worse!

In my class and video, How to Lose the Pooch for Good, I present a 4 step healing process to bring your abdominal muscles back together and also how to restrengthen your abdominal muscles safely to get rid of your “pooch” for good!

Also your pelvis has just gone through an amazing transformation getting your baby out and may have some challenges getting back to it’s normal position.  This can create low back pain as well.  Opening up to allow your baby out creates an instability that takes time to solidify again.  This usually takes around 3-4 months.  I recommend you wait until then to resume any high impact aerobic activities.  Focus in on just doing your abdominal restrengthening and your kegels and walking for the first 3 months.  Then once your core is stronger then you can introduce more high impact type of activities.

But with everything you do, you must listen to your body.  If it doesn’t feel right, don’t do it!  You only have one body, so you need to learn to take care of it, honor it and do what feels right.

Following your Intuition during Pregnancy

April 9, 2013 in Childbirth, Pregnancy

A friend of mine wrote this amazing article that I just had to share with you all, a must read if you are pregnant or in the birth field.  It’s all about dealing with fears, learning to ground yourself and access your intuition to manage your pregnancy.  So many tests are done that create fear and this article helps you navigate the best course of your pregnancy care, by following your own instincts.

Loved it, hope you do too!

 

Bear Wisdom Pathways Spring 2013

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