Pregnancy

Many people believe that maternal health begins when the patient discovers they are pregnant. However, pregnancy support ideally begins months prior to conception by taking into consideration aspects such as ideal nutritional support (e.g. pregnancy vitamins) and optimal blood flow to the uterus. This not only helps to increase the chances of conception, but also supports the health of the growing foetus once conception has occurred. Osteopathic treatment prior to pregnancy can also ensure there are no pre-existing complaints present which may cause problems further into pregnancy. 

 

Pregnancy should be a wonderful and exciting experience, but for many expectant mothers it may be accompanied by morning sickness and many other aches and pains. During pregnancy, the body undergoes enormous change in a relatively small timeframe to accommodate the growing baby. Osteopaths aim to assist the body in continually adapting and aligning as the pregnancy progresses.

It is important the you are supported during this time as your body undergoes rapid change. 

 

Changes During Pregnancy 

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Fatigue

Fatigue is common, especially in the first 12 weeks and again in late pregnancy. The expectant mother may need to get more rest than usual.

 

Altered Hormones 

The levels of estrogen and progesterone, hormones in the female body, undergo changes during pregnancy, and relaxin, a hormone produced by the ovaries and placenta, begins to be released.  These changes in hormones loosens and softens the joints, ligaments and muscles to allow the body to stretch and expand for the growing foetus and also to allow for softening and widening of the pelvis during birth.  This increased ligament laxity and joint instability results in overuse of the surrounding muscles in order for the expectant mother to maintain steadiness throughout the course of the pregnancy. 

 

Weight Gain and Fluid Retention 

Weight gain in pregnancy is approximately 10-15 kg which is made up of uterus, foetus, increased blood volume, breast tissue and extracellular fluid. 

Approximately 6.5 litres of fluid is retained during pregnancy and this fact, along with the enlarging uterus effecting the return of blood from the legs to the heart, commonly leads to swelling of the legs and possible subsequent varicose veins.  Patients may also experience swelling of the hands and carpal tunnel syndrome. 

Some measures that not only ease the discomfort but may also reduce leg swelling and make varicose veins recede after delivery, include wearing compressive/elastic support leggings and resting frequently with the legs elevated.

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Respiratory changes 

As the uterus gets bigger in size and grows upwards, the diaphragm (a thin muscle that separates the chest from the abdomen, and is vital in respiration) is also displaced upwards, reducing the size of the chest cavity.   In order to compensate to this now decreased lung capacity, the rib cages is forced to expand outwards (approximately 10-15 cm).  This rib expansion can lead to local pain.  

Typically, in the third trimester as the uterus expands to be right under the rib cage and the baby increases in size, pain may also be felt from feet/head/buttocks pushing up under the ribs. 

 

Cardiovascular Changes 

Cardiac output (the amount of blood pumped by the heart per minute) is increase during pregnancy due to increased blood volume and the requirement of more blood flow to the uterus.  There is an approximate 30-50% increase starting during the first trimester and reaching a peak between 16 to 28 weeks. 

From the 16 week mark, due to the growing baby, cardiac output is affected by the position of the mother.  Lying on your back may compress the inferior vena cava (a major blood vessel returning blood to the heart) and may lead to the blood pressure of the mother dropping, and possibly resulting in dizziness or light-headedness.   Ideally when lying down, the mother should be lying on her side.  So what about during the night when you are asleep? The going-to-sleep position is the one held longest during the night so women should not be concerned if they wake up on their back, but should simply roll back onto their side. Preference is given to lying on the left, however, either side appears to reduce risk. 

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Urinary Changes 

The role of the kidneys in the human body is to filter the blood.  As the blood volume has increased during pregnancy, the kidneys must work harder.  

When any individual lies down, the activity of the kidney is increased in comparison to when they area standing.  During pregnancy this phenomenon is amplified - quite of the reason why an expectant mother needs to urinate more frequently during the night when trying to sleep.

As the pregnancy progressed the uterus presses on the bladder, reducing its size so that it fills with urine more quickly than usual. This pressure also makes a pregnant woman need to urinate more often and more urgently. 

 

Biomechanical changes

During pregnancy the body transitions through rapid musculoskeletal changes.  Due to weight changes as the foetus grows, the uterus expands and the breast size increases there is a change in distribution of the body’s mass and additional pressure is place on the joints and muscles.  All of these postural changes are aimed at absorbing extra forces and maintaining balance and stability. 

These changes mainly affects the pelvis, spine and lower limb:

 

Pelvic

Due to the increased mass at the front of the body (ie the growing uterus and breast tissue) the pelvis rotates anteriorly (forward) and the centre of gravity shifts forward.  These changes along with the hormonal changes that cause ligaments to soften and stretch in the pelvis, results in the pubis (joint at the front of the pelvis where the two halves of the pelvis come together) and sacroiliac (joint at the  back linking the pelvis and lower spine) joints widening.  

The pubic and sacroiliac joints are typically stable, however this widening results in increased motion leading to compromised joint stability and subsequent reliance of local muscles contraction for control.

 

Spinal 

As the pregnancy progresses this forward tilting of the pelvis leads to a compensatory increase in the curvatures of the spine. The lower back (lumbar spine) increases the arch (lordosis) in order to return the centre of gravity back to a neutral position to restore postural balance and prevent the expectant mother from falling forward.   The growing uterus also leads to stretching of the abdominal muscles and the small muscles in the back shorten in order to maintain an upright position. 

In the upper back (thoracic spine) there is an increase in the forward curve (kyphosis) due to the increase breast size. The shoulders begin to rotate in and are dragged forward.  Due to this increase in kyphosis, the neck (cervical spine) compensates by increasing it’s lordosis. 

 

Lower limb

Due to the changes at the pelvis and shifts in the centre of gravity compensatory changes also occur in the lower limb to further enhance postural stability.  As the pelvis tilts forward, the hips must rotate out to redistribute weight leading to the “waddling” gait we see as the pregnancy advances.  The knees hyperextend which may lead to patella tracking issues, the lower leg rotates inwards and in order to avoid falling over, the expectant mother “grasps” the ground with their toes leading to tightening of the calf muscle (gastrocnemius) and the muscle in the arch of the foot (plantar fascia).  The feet roll inwards (pronate) and arches drop leading to widening and flattening of the feet.