Post-Pregnancy Problems Part II, or, Bouncing Back From Pregnancy [while being more tired than ever before in your life]

Dr. Edmund Bruce-Gardner

In this instalment, we will consider some of the common issues that can arise while your body bounces back from the rigours of pregnancy, all the while dealing with the changes that motherhood brings.

Thoracic (mid- and upper back) pain

There are (surprise surprise!) big changes taking place here.

As the body adjusts to no longer having this large object compressing all the internal organs, changing the centre of gravity, and altering spinal and rib mechanics, the curves in the mid- and low back start to return to pre-pregnancy proportions.

However, this is complicated by a few factors. ​

Change in bust size and weight increase the forwards pull from the breasts, leading to increased strain on the thorax, particularly the upper part. 

This generally leads to a flattening of the thoracic kyphosis (outwards curve), increasing stress on the joints in the spine, forcing the muscles that hold you upright to work harder, and generally reducing mobility through the area. 

And all of this assumes you are not holding an increasingly heavy baby the whole time!

​Shoulder Problems

The above-mentioned reduction in movement in the thorax quite naturally makes the areas around it work harder. 
​This can be particularly noticeable in the shoulder, because it relies on so many things working well to do its job properly (for more information on this bemusingly fragile joint complex, see the relevant series of posts).

Briefly, because the shoulder has very little support from its bony structure, it relies heavily on the musculature surrounding it to maintain stability.  There are a lot of small muscles with big jobs in here, and they can (and do!) complain if they feel overworked and underappreciated. ​

You can help keep them happy with gentle mobilisations like shoulder rolls, and exercises designed to improve the range of motion in the chest and mid-back.  Ask your osteopath for post-pregnancy-suitable exercises today!

Another factor that can have a huge impact to shoulder problems after giving birth is if you choose to breastfeed your baby either partially or fully.

You will no doubt have received oodles of advice about breastfeeding, which position is best, how to get a good latch, etc, etc. 

The only two things I would like to touch on here are the importance of bringing the baby to the breast, rather than leaning the breast into the baby (this is regardless of position, generally), and the fact that it will probably hurt quite a lot, at least initially. 

With regards to the first point, this is not something which will have failed to have been mentioned.  However, it is really easy to do without realising. ​​

Often, I will observe the mother taking great care to face the body towards her, support baby's head in a suitable position, and do that little swiping thing with the nipple to elicit a latching response... ...and then sort of fold the shoulder down and over to create better contact. ​

Other common problems include elevating the shoulders to try and lift the baby up to the breast, and/or gazing lovingly down at your little bundle of (mostly) joy. 

I know this does not sound like a problem (and I am certainly not advocating you avoid it!), indeed, one of my wife's biggest joys of breastfeeding was the sense of connection with this little being you are nourishing; but holding your head in such a flexed (and normally sidebent/rotated) position puts a huge mechanical strain on the shoulder, thorax and neck

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Again, problems in the shoulder area cannot really be divorced from factors in the neck, thorax, ribs, and further down in the arms, so your osteopath will do a full assessment of all these areas.

The second point is not really one with which osteopathy can help, but it is worth mentioning as far too many sources bang on about the joy of breastfeeding and how it's a wonder (which may well be true), but fail to mention that until you and - more importantly - baby learn what you are doing, it can be really quite painful as well.

​Wrist and Hand Pain

Moving down the arm, we may find that the stresses of breastfeeding, as well as carrying a baby constantly, can quickly take their toll.

Most parents will hold their child in their non-dominant hand, as this frees up the dominant hand for more complex tasks like writing (or possibly more likely these days, tapping on a phone!) or opening doors.

This has the advantage of leaving your dominant hand free.  It also means you are doing a lot of unaccustomed work with what is probably your weaker side. This may result in elbow, forearm, wrist or hand issues.

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This lovely image was created by Dr. Soraya Burrows

Carpal Tunnel Syndrome is when a nerve gets compressed in the wrist.  It is very common during pregnancy due to all the extra fluid sloshing around, which takes up valuable real estate, particularly in small bony tunnels (like the eponymous carpal tunnel).  Although this should improve after giving birth, these symptoms may continue for a while, particularly if you were getting them on the side on which you now hold your child.

​Neck Pain and Stiffness

This is very closely related to the factors discussed above involving upper limb, shoulder and thorax.  In particular, the reduced range of movement in the thorax and ribs means that all head movements get 'focused' into, well, the neck itself, rather than the load being shared down through the rest of the thorax.
Add to this the Baby Adoring Gaze Syndrome, and we have the potential for a very stiff and sore neck.

​Headaches

Again, the factors above (particularly in the neck) can massively predispose towards headaches.  

Headaches due to the exuberant swings in various hormone levels are common just after pregnancy, but musculoskeletal factors can contribute and complicate the picture a little bit

Note:  If you have blinding, excruciating headaches in the day(s) following giving birth and you received an epidural, please tell your GP or obstetrician straight away. It may indicate 'post dural puncture' headache, which is when the membrane or 'bag' around your brain and spinal cord is pierced by the injection.  The chances of it happening, according the knowledgeable chaps at the NHS, are around 1 in 200.  It has often described as 'the worst hangover in the world', and may also be associated with neck pain, nausea and photophobia (dislike of bright lights)

​Low Back Pain ​and Pelvic and/or Pubic Pain are a huge topic, and will be dealt with in a later post.