Having heard so much information and misinformation and lack of information for women during and about their pregnancies, I think there could be an entire class dedicated to the Mythology of Pregnancy and Childbirth. Part of the confusion is that while many of the physical changes that women encounter are rather predictable, their effect on each individual woman is not (read Pregnancy: What is Normal & What is NOT When it Comes to Body Changes for more info). Further, what people are willing to accept as ‘normal’ for pregnancy, and what they are willing to do about it, varies widely. Take the following exchange for example, which happened at this year’s American Congress of Obstetricians and Gynecologists Annual Scientific Meeting, when an Ob/Gyn was asked if he ever refers to physical therapy (or other providers or services):
Ob/Gyn: We have a great pelvic floor PT team and refer to them for pelvic pain.
Me: That’s great! And how about for your obstetric population? For example, a pregnant woman with back pain?
Ob/Gyn: No. I typically tell her (a pregnant woman with back pain) that her pain is only going to get worse as the pregnancy progresses over the next few months, so to just take it easy and hang in there, and it is likely to improve after she has the baby.
Me: Well, it may very well get worse, but only because nothing is being done. If you were a patient – regardless of pregnancy – and had significant back pain, would you want to let it get worse over the coming months as it ran its course without trying to do something to hasten the process? Exercise, massage, changes in body mechanics, use of support belts, etc…something!
To be clear, this was not an adversarial exchange. It was rather a moment of recognition by him that it just hadn’t crossed his mind, and that working with physical therapy (or other providers) would have a role in restoring or maintaining a woman’s optimal function and minimal pain or discomfort levels during pregnancy.
Another story of ‘lack of awareness’ deals with how many women don’t know that such ‘aches and pains’ can occur, Vicky Yeisley, DPT will spin this yarn, but I’m going to steal some of her thunder, only to make plain the take home of her piece:
“The point of this is to inform you that yes, your body goes through some drastic changes during pregnancy that have the capability to result in pain. Listen to your body. If you are having pain, seek help.”
Own your pregnancy,
Pregnancy Pain? Are you sure that’s not normal…
So there I was two weeks ago at a baby shower. My friend Nicole was sitting in a big comfy chair, surrounded by beautifully wrapped presents, and getting ready to open the generous gifts before her. Just as she was about to begin, one of the other guests asks her, “So overall, how has the pregnancy been going?” Nicole shrugged and said “Good, except for the sciatica.”
At that point I realized that I was the only one in the room nodding my head, giving her the look like “Girl, I hear ya” whereas the rest of the women looked at her like she had a third eye! I was shocked at the questions that came next, like they had 1) never heard of a pregnant woman being in pain, and 2) had never heard about sciatic pain. Nicole explained the shooting pain down her back, into her butt and back of her thigh and that doing little tasks like going from sit to stand or moving in bed were terrible. She explained that her baby was in a position that was hurting her sciatic nerve and that the pressure on the nerve was causing all of her pain.
Again, the blank stares in response to her comments were still blowing my mind.
It was then that I realized that I was the odd man out, and that in reality, most women who have never been pregnant or aren’t around pregnant women very often, don’t understand the changes that happen to your body. They hear about nausea, breasts getting bigger and feet swelling up, but none of them had heard about how the pelvis was affected by the pregnancy and that yes, (gasp!) there is often low back, buttock, hip, groin, pubic bone or tailbone pain involved.
My friend, being the savvy woman that she is, consulted Dr. Google, who suggested a “belly band” that helped take the pressure off of her pelvis, which helped, and her pain was less, but not completely gone. Problem solved…right?
To me, there is a bigger problem at hand. First being that most women going into their pregnancy are completely unaware of the changes that happen to their bodies, specifically within their pelvis, that often result in pain. When this pain does arise, they either neglect to say anything to their OBGYN, or even worse, if they do say something, they are told by their doctor, “Well, you’re pregnant…”
Well, let’s put it this way. You gain at least 20 lbs, and your weight starts shifting forward, so that now, the weight that should have been distributed through your heels is now going through your toes. This means your base of support and center of mass is forward and totally off whack. The lowest part of your spine starts curving inwards more, so that your pelvis tilts forward, and now, you have a really nice Donald Duck butt going on. Then, the middle part of your spine starts curving outwards more, because your breasts are getting bigger, causing your shoulders to become more rounded and your head to lurch forward.
Oh, not to mention, your hormones are going crazy and as more relaxin is being produced, the more your ligaments, that help to hold your bones together, are getting very loose. Since your ligaments can no longer stabilize you, your muscles have to work overtime for extra support. Not to mention, if the ligaments are weak, the bones tend to shift and one’s alignment can become compromised. To me, this whole scenario is a recipe for disaster and pain, but to many “it’s just part of being pregnant.”
The sciatic nerve is a huge nerve that comes out of the sacrum (base of the spine, in the middle of the pelvis) and travels down through the buttock and down the back of the leg into the foot. This nerve can get inflamed by poor alignment of the pelvis or sacrum, instability of the pelvis or sacrum and often by increased myofascial restrictions within muscles like the piriformis, hamstrings or gluts. We tend to sit more and more throughout the day, which compresses the piriformis muscles especially, and can put more pressure on the sciatic nerve, causing more pain. Many women experience sciatic nerve symptoms during their pregnancy, and often learn how to tolerate the pain, instead of fixing it.
If a non-pregnant woman complains of low back or buttock pain, she is sent to physical therapy or given some sort of medical intervention to assist in decreasing her pain. However, when a pregnant woman (who typically goes through weight gain, has weak connective tissue and poor postural alignment) complains of low back or buttock pain, she is often told that “it’s just all part of the adventure.” This kills me, because I get to see these women 5-10 years after having children, who have chronic pelvic pain, and when you ask them when this all started, they can often trace it back to their pregnancy.
The point of this is to inform you that yes, your body goes through some drastic changes during pregnancy that have the capability to result in pain. Listen to your body. If you are having pain, seek help. We often have to advocate for our own well-being and health, and make sure that our concerns aren’t overlooked.
Pregnancy is a gift and an amazing opportunity to bring life into this world. It is not easy…but it doesn’t have to be painful either.”