Is Your Pelvis still birthing?

October 8, 2015 in Childbirth, Pelvic Floor, Pelvis, Post Partum, Women's Sex Issues

Is Your Pelvis Still trying to Birth Your Baby?

Labor can be such an arduous task. Whether it’s really quick or lasts for days, the impact on the body is huge, especially for the pelvis. It doesn’t matter how long it takes to get the baby out, the pelvis can still be left in its open birthing position. It can remain this way for months to many years.

 

I first identified this issue in my aunt who had a very traumatic birth with her first son who was 47 years old at the time I found this. Her pelvis was still open from birthing. When I realized what was going on I started looking for it other women who came to see me and was surprised how often I found it.

 

How do I know if a pelvis is still birthing?

 

I’m able to feel what the energy of the bones and tissues want to do. I listen to the body and see what wants to happen. No matter what part of the body, an ankle sprain, I can tell you how you twisted your ankle, an injury to your shoulder, leg or pelvis, your body holds onto the energy of the injury. It’s in the tissues and remains there and your body has to work around it. It’s usually not a big deal except most of the time we keep reinjuring it, in the same way. That could because the energy of the injury remains in the tissues until we release it. It could also be why some injuries just never seem to fully heal.

 

Birthing Pattern in the Pelvis

Birthing Pelvis

Pelvic Motions during pushing phase of birth

It’s the same thing with birth and the pelvis. When the pelvis births a baby, the sacrum pivots and in the pushing phase the tailbone moves backwards and the sit bones, or ischiums splay out to the side to get wider.   Usually this is the position that most women get stuck in because they tend to have a trauma response in their body from the intensity of the labor.   Pushing too long or the baby coming through too quickly can create a shock effect in the tissues and they get stuck in this open birthing position.

 

I’ve been asking these women whose pelvis’ are still birthing what they are experiencing and the effects have been from severe to subtle.   The most common complaint was a sense of feeling ungrounded.   Some complained of not being able to sit comfortably or evenly on their buttock.   Others had more subtle complaints of feeling spacey, just not the same, or feeling weird when walking. One of the bigger issues women can have from this is painful intercourse and an inability to contract their pelvic floor muscles.

 

Since all of the pelvic floor muscles attach to the bones of the pelvis, having the bones widened puts a stretch on these muscles. A stretched out muscle doesn’t have the same contraction ability and will appear weak.   These lengthened muscles also don’t have the give or flexibility they need in order to allow penetration to happen with intercourse.   My aunt I mentioned earlier has very little to almost no contraction of her pelvic floor muscles. Another client I saw was still in a birthing pattern and she was having pain with penetration. After one session of bringing her ischiums back together, her pelvic floor muscles relaxed and she had no more pain!

 So what do I do?

It’s a shame that the main treatment for weakened pelvic floor muscles is to see a   women’s health physical therapists, yet most of them don’t know how to assess or treat a pelvis stuck in the birthing position. No amount of kegels or biofeedback is going to help you get a strained, traumatized muscle stronger until it gets some help. It’s amazing how instantaneously a muscle can respond and contract when it’s not being lengthened or in a state of shock from the birth.

 

Most chiropractors don’t know about this stuck birthing pelvis and your doctor will most likely look at you weird if you bring this to their attention.   They all are just dealing with the physical tissues that when you look at the tissues everything appears just fine.   They aren’t aware of and don’t know how to address the energetics, emotions or trauma that get so tied up into the tissues keeping them held in this birthing pattern. You have to address them all in order for the tissues to release and the pelvis to return to it’s normal pre-birth state.

 

I have found in working with women that we need to address ALL of the trauma or issues that occurred during the birth so the pelvis can return to it’s birthing position after a treatment.   The sooner after the birth one comes in the better.   It’s easier to release the birth pattern because it hasn’t been stuck in the body for a length of time for it to think it’s the new normal position to stay in. However no matter how long it’s been you can still release the bones and tissues so they can find their natural place. It’s just takes a bit longer.

 

 

 

 

 

Breathing Difficulties After Baby?

August 29, 2013 in Abdominals, Post Partum

Diaphragm and Organ Restrictions after Childbirth Leads to Breathing Difficulties

Ever wonder what happens to all your abdominal organs when the baby grows so big in your belly?   Did you have problems taking a deep breath during your pregnancy?  What about afterwards?

It’s very common for woman to experience mid back pains after delivery or have difficulty taking a deep breath.   As your baby takes up space in your belly, your stomach, liver and small intestines all get jammed upwards and laterally. See photo below.  It also compresses your diaphragm upward into your chest and your ribcage widens out to the sides.  Sometimes things have a hard time getting back to their original places after birth.  This is really true if your baby found it fun to use your stomach or liver as its punching bag!pregnant belly w_ organs

Working with so many post partum woman I’ve seen time and time again where one organ, more commonly the liver, gets jammed upwards and remains this way for months to even years after birth.  I also find the thoracic spine and diaphragm to be restricted in mobility after having a baby.

If you find it difficult to take a deep breath after delivery or you have pain in the bra line area you may have some restricted organs or diaphragm in your midsection.

Jane came to see me after delivering twins two years ago.  She complained of not being able to take a deep breath since delivery.  One of the babies laid sideways across her upper belly near her ribs during her pregnancy.  I found her liver and stomach to be jammed up into her chest and her diaphragm and mid thoracic spine restricted in the middle.  With just one session her organs and her diaphragm released and were back in their normal place, and the mobility of her thoracic spine was freed.   She told me she was surprised she wasn’t hyperventilating because she had been taking so many deep breaths since our session together.

Getting your organs back in their proper place and getting the thoracic spine moving again is helpful to regain that sense of having your body back after pregnancy.  Doing some abdominal contractions, pulling your belly button back to the spine til it can’t go anymore, while also focusing on bringing your lower ribcage together in front can help with the flaring ribs and to mobilize your diaphragm.   Initially, some woman report having mid back pains when doing these contractions but over time that pain goes away as things gain more mobility and find their way back to their normal position.  If your organs are really stuck upwards you may need some help from a practitioner who does visceral manipulation and or a chiropractor to help make an adjustment in your thoracic spine.

THERE IS HELP OUT THERE FOR YOU!

Just know that whatever ailment you may be experiencing in your body after birth, there is help for you.  Keep searching til you find the right practitioner who knows how to help you.  Many healthcare professionals don’t have experience working with the post partum body.  Keep searching til you find one who does.

It saddens me how many women are left to feel crazy, “it all must be up in your head” after childbirth when their body doesn’t feel the same anymore.  There is help and it can feel the same again.  Don’t give up!

 

 

Helping Women Heal Their Body After Birth

July 10, 2013 in Pelvic Floor, Pelvis, Post Partum

Being a Women’s Health Physical Therapist has given me the privilege of working with a lot of post partum women.  I have a profound respect for the body’s ability to birth a baby.   It is a natural event that the body is designed to perform.

While birth is a natural function of the body, it is not designed to handle the effects of prolonged pushing or a baby that comes out in a less than ideal way.   These conditions place excessive strain on the pelvis and vaginal tissues and create issues.  Issues that a woman doesn’t have to just deal with for the rest of her life, but can get help with and fully recover.  That is, when she gets help.   Often times women are left to just deal with theses issues on their own and learn to just live with them.   Many are convinced or made to believe it’s just a natural side effect of childbirth.   But it doesn’t have to be this way!

A large majority of issues such as painful intercourse, incontinence, a pressure or falling out feeling in the vaginal area from organ prolapse, or just your body not feeling the same anymore, can all be helped by working with a women’s health physical therapist.

Helping Women Get the Help they Need!

Birthing professionals need to understand the effects a birth can have on a woman’s body and help them get the support they need to help their pelvis come back to it’s normal alignment and get their vaginal tissues released.    This idea that birth is a natural function and we just spring right back to our pre-pregnancy state doesn’t always happen for all birthing women.   The birthing professional needs to listen to the post partum woman and help them to understand that what they are experiencing in their body is an effect of birth and there is help.

Also understanding that when a birthing woman gets to a point in her labor where she feels like she doesn’t want to go on, it’s too much, or “just get this baby out of me now!” are all signs where the body can register the event as traumatic.  When trauma occurs the tissues get stuck in the position she is in during the traumatic moment.  The woman may not vocally say these words, it may just be a fleeting thought but those tissues respond accordingly.    After the birth is over when you are reviewing the birth with the new mama, asking her if she got to that point of wanting things to stop or be done could give you an idea if any trauma effects may have occurred.

Releasing Trauma in the Bodymassage

When we experience any traumatic event our body has three different options to protect itself.  We can either choose to fight the event, try and flight from it or we just freeze.  During labor, fighting and running away are not an option.  The body’s only choice is to freeze, so the tissues get stuck in whatever position they are in at the time.

Usually this occurs during the pushing phase.   When women are pushing their ischiums, or sit bones, are splayed out to the side, their sacrum is nutated, where the tailbone is farther away from the pubic bone, and their tissues are bearing down.   A traumatic response can keep these tissues in this position well after the birth is over.

By listening to the tissues on an energetic level, one can feel what they still want to do.   Helping a new mom tune into the effected area and realize that the birth is over can bring the tissues into a more neutral state.

When I assess post partum women’s tissues on an energetic level, many of them present with their bladder and uterine tissues still bearing down as if they are continuing to push a baby out.    By just placing my index finger on the urethra and bladder and just listening to what that tissue wants to do, most of the time my finger gets pushed out of the vagina.

The great thing is, it’s easy to fix this problem.  By having the woman bring her attention to the tissues I’m touching  she can help them to realize the birth is over, that the tissues can stay up and inside.  The tissues retract back up and in like a turtle pulling its head back into its shell.

Bringing the ischiums back into midline also helps to relax the pelvic floor tissues.  Since the pelvic floor muscles attach to the sides of the ischiums, when they are splayed out and stuck there, the pelvic floor muscles can have too much stretch on them not allowing them to relax and contract fully.  Sometimes one ischium gets more pressure than the other, creating an imbalance in the pelvis, especially when sitting.  To learn more about pelvic trauma in birth, read this blog.

The vaginal tissues may need help releasing the effects of the baby turning it’s head to come out.  Many times I can still feel the twisting effect on the pelvic floor tissues from this part of the birth.  Soft tissue mobilization of the vaginal tissues can help restore normal function and contraction ability of the pelvic floor muscles.  Read more here.  Without this type of work regaining strength in the pelvic floor muscles can be like beating your head against a wall.  The muscles need to be released in order to work properly.   But in order to free up these tissues, any trauma that may be present in the tissues needs to be released first.

I had one mom I worked with who had seen another women’s health physical therapist for 12 sessions and she reported that after every internal session of massage with this PT, her pelvic floor area would ache and hurt afterwards.  This is a sign that there is trauma in the tissues.  When a tissue with tension in it doesn’t want to let go or release, there is trauma that needs to be addressed first.  Also when a tissue reacts by hurting worse after a session, the body is trying to tell you it does not like that approach, something else needs to happen first.  By listening to the tissues and sensing them you can tell when they are willing or unwilling to release.  There is a different quality to the tissues when trauma is present.

Working with trauma in the tissues can be challenging, depending on the amount of trauma one has experienced.  A lot of times with birth, just the act of bringing a woman’s awareness to the tissues, helping her breathe down into the affected area can help them to release.  Also helping her go back to remembering herself before the moment of trauma and reconnecting to herself then can help release the tension and trauma in the tissues.  This work needs to be extremely gentle and respectful.  Forcing any tissues in the vaginal area is very counterproductive.

Helping new moms recover from the effects of birth needs to be a bigger priority in our country.   In France, women get 8 physical therapy visits after giving birth.  Getting moms the support and help they need to heal from the effects of trauma from birth and get their body and tissues back into their proper place should be available for every woman who has had a baby.    I wish I could see every post partum woman just once to get her on the path to reclaiming her body and healing after birth.

 

 

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 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.

4 Reasons New Moms Need Physical Therapy

April 23, 2013 in Bladder issues, Pelvic Floor, Post Partum, Prolapse, Women's Health Issues

4 Reasons New Moms Need Physical Therapy: This week’s featured guest blogger is Ginger Garner, PT, MPT, ATC, PYT.  Visit Ginger at  www.gingergarner.com and www.professionalyogatherapy.org

 

Pregnancy and childbirth exact an enormous toll on a woman’s body. It is transforming and beautiful, but when a mother does not get the physical and emotional support she needs, the effects can be devastating.

I am a new mother, three times over. Each time after I have given birth, I have benefited enormously from physical therapy afterwards. I could not stand strong, fit, and wholly healed without it.  massage

I am also a physical therapist, myself, and feel that every woman should know her rights to receive physical therapy as a new mother. One of the many fields of specialization in physical therapy is women’s health. I bet you didn’t know that. That’s okay. Most doctors don’t either.

A physical therapist (PT) in women’s health is dedicated to helping women get their bodies back after birth. They can treat a myriad of issues, including pelvic and back pain, incontinence, and other ailments. The American Physical Therapy Association’s 2010-11 report titled Today’s Physical Therapist: A Comprehensive Review of a 21st-Century Health Care Profession, states “physical therapists are committed to facilitating each individual’s achievement of goals for function, health, and wellness.” The core values of a physical therapist are “altruism, accountability, integrity, clinical excellence, social responsibility, and compassion.”

The sad fact, though, is that most new mothers will never get the therapy they desperately need after giving birth.

But I am passionate about turning the tide. All too often, women in general, not just new mothers, do not receive the health care they need. Read my article which reviews the shocking statistics about the crisis in women’s health care today in the US.

A Prime Example of Falling Through the (Medical) Cracks

I have had patients and friends who have suffered from pelvic pain, sexual dysfunction, painful scarring, chronic incontinence, and lower back pain for so long that it has severely altered their quality and enjoyment of life.

A friend recently came to me asking for advice for another girlfriend. Let’s say her name is Teresa. Teresa had just undergone major abdominal surgery (think C-section) and was having awful abdominal pains and even headaches.

Knowing that the two are related, based on her surgery type and plan of care, I immediately asked if the surgeon had referred her to physical therapy. Of course the answer was no. Her plan of care did not include any post-operative physical therapy. In fact, when I asked Teresa directly, she said her doctor (a woman, mind you) had never even mentioned needing physical therapy.

I was upset by what I felt was an oversight by the physician to refer Teresa to therapy, but mostly I felt a surge of urgency to help her. This woman needed therapy immediately, yesterday, even. She was floundering, depressed, in pain, and alone at home six weeks after major surgery on her reproductive organs due to a cancer scare. She had no idea how to get better (she had been a marathoner) now that she had this huge scar (larger than that of a C-section) across her abdomen. Even coughing caused pain, and the related headaches and back pain were terrifying.

But, it was not the doctor’s fault. Not really.

Doctors are educated very little, if at all, about PT services in medical school. A good friend with an MD sister said this when asked if she had learned about PT in medical school: “sure, we had education about what PT’s do in medical school. It was a single lecture, on one day, it was optional, and it covered all allied health care services.”

Physical therapists spend a similar amount of time in earning their degree in physical therapy (7-8 years) as doctors do in medical training. There really is no way a single optional lecture in medical school can prepare physicians to know what PT’s do and how to refer for physical therapy.

The Take Home Message

Be your own advocate in health care. Before going into surgery or giving birth, educate yourself about what to expect and what you will need for your body to heal fully.

The biggest mistake a mother can make in seeking maternity care is assuming her doctor knows best. The doctor may not even know PT’s treat women’s health issues, much less how to refer to PT for prenatal or postpartum rehabilitation.

There is good news though. Here are the tools you need to get physical therapy after giving birth:

First, BEFORE you give birth, ask your doctor is he/she refers to physical therapy after giving birth. If you already have low back or pelvic pain during pregnancy, then you should get a referral for physical therapy now. Do not wait until after giving birth.

When asked why you need it (physical therapy), you can give them these four reasons:   click here to read more

 

 

 


GingerGarnerpicGinger Garner PT, MPT, ATC, PYT

Ms. Garner is an educator, integrative physical therapist, and founder of Professional Yoga Therapy Studies, an organization that creates inter-disciplinary curricula and educational competencies for using yoga in medicine and rehabilitation.  Ms. Garner received her Master of Physical Therapy from the University of North Carolina at Chapel Hill, where she completed studies in the School of Medicine and School of Public Health.  Ms. Garner began working in the field of integrative therapies in 1995, after becoming licensed in sports medicine.  Her clinical specialties include public health education, orthopaedics, and pain management, with a focus on maternal health.

Ms. Garner has been writing, teaching, and lecturing for hospitals and medical practices throughout the US since 2000, and in 2012 she joined the Caring Economics Coalition and the work of Dr. Riane Eisler, who she credits as one of her greatest mentors.  Ms. Garner now consults pro bono with medical schools at several domestic and international universities in order to develop integrative medicine curriculum in medical therapeutic yoga.  She is currently an instructor with Medbridge Education and consultant at the University of Mississippi Medical Center, Misericordia University’s Doctoral Physical Therapy program, and the University of Saskatchawan School of Medicine.  These evidence-based programs are a first of their kind in North America.

Ms. Garner considers her most important work to be in maternal health care advocacy and health care policy,  where through her multi-media platforms she works to increase awareness of, and eliminate barriers to, receiving holistic and integrative health care.   Ginger is a mother of three children, and lives with her husband and rowdy sons on a small island off the east coast of the US.  Ginger can be contacted at www.gingergarner.com and www.professionalyogatherapy.org.

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