I’m pregnant – why does it hurt so much?

Preparing for birth is like preparing for a marathon.

You need to condition both your mind and your body.

You need to release fear, which creates tension, producing more pain, creating more fear, which starts a whole vicious cycle in the mind and body as described by Obstetrician and leading advocate of natural birth, Dr Grantly Dick-Read in his book ‘Childbirth Without Fear’.

However, let’s look at an area of the physical side of pregnancy.  One of the important physical aspects of the body during pregnancy is the pelvis.  Your pelvis is not one fixed bone, it is made up of the sacrum, coccyx and the two sacroiliac joints, one on the left and one on the right, which are joined at the front by the pubis symphysis, a fibrous cartilage.

Surrounding the pelvis are really important muscles which help to stabilise the pelvis, but let’s really just focus on the psoas muscles (pronounced so-as), which also works to send messages back to the central nervous system.

The psoas major muscles are quite large muscles and are the only muscles that connect your spine to your leg on either side of the spine.  The psoas connects from the last four vertebrae of the spine between the pelvis and the ribs and then wrap around to the front of the pelvis and drop down to attach at the lower end to the top of the thigh bone.

psoas muscle

The iliopsoas is a hip flexor and externally rotates the hip and the psoas (major) part of the muscle assists in lumbar extension and moves the ribs forward into a thrust, lifting the chest.  When these muscles contract they will shorten, when the muscles relax they will lengthen and release tension.  The psoas is shortened more so during pregnancy due to the anterior pelvic tilt, as your uterus expands, baby grows and you are carrying more weight.

During pregnancy, the psoas contributes to pain through the lower back, groin, adductors and can even cause weakness due to the extra pressure from the weight of the uterus.  Being in a sitting position for long periods of time can shorten the psoas muscle causing pain and tension in the pelvic floor, the hips and the spine.

It can also affect the space in the abdomen, affect the alignment of the skeletal system and limit the range of motion in the spine, pelvis and legs, which in turn will limit the functionality of birthing positions such as squatting.

The psoas plays a significant role in Optimal Foetal Positioning (OFP) and can be a reason a baby stays in the breech position, as it can prevent the hips from extending and restrict the opening of the pelvis.  It can cause the disks in the spinal cord to compress and also shorten the hamstrings and calf muscles.  Pregnant women should learn to relax, release and lengthen the psoas muscles on a daily basis so that baby will find an easy transition into the birth canal.

Optimal Foetal Position

Medical Illustration – Nucleus Medical Media

 

Childbirth Educator and Physical Therapist Penny Simkin writes:  “It is less important to know the foetal position than it is important to respond to the needs of the birth.  The muscles, ligaments and bones may need accommodation regardless of foetal position.  In other words, tension in the psoas pair of muscles or pelvic floor can delay an anterior baby and a posterior baby.  Extension of the anterior foetus’ head can prevent engagement in some pelvises.  The main point is that we can, when needed, promote progress regardless of foetal position.”

It is also important to be aware that the hormone ‘relaxin’ does not reduce muscle tension.  It softens the abdominal muscles to cope with the growing size of your belly and relaxes the pelvic floor muscles.  Relaxin promotes the rupture of the membranes, the opening and softening of the cervix and vagina, relaxes the pelvic ligaments and joints, the intrauterine ligaments and the pubis symphysis to help with the smooth transition of baby from womb to world, however pregnant women need to do more of their own work to stretch out and release stress and tension in the muscles (particularly the psoas) as the hormones will not do this for you.

Liz Koch from Core Awareness is an advisor for the well-known Spinning Babies organisation and recommends this simple gravity technique to help release the psoas muscles during pregnancy and to also encourage Optimal Foetal Positioning while relieving stress and anxiety.

Liz Koch - Core Awareness

  1. Lie on your back and use pillows to create a diagonal support from your sit bones to your head (if you’re not pregnant, you can just lie on your back).
  2. Bend your knees, with your heels about 12 – 16 inches away from the buttocks.
  3. Keep your feet about a hip width apart and parallel with each other.
  4. Place your hands on your belly or at the sides of your body and simply rest in this position for 10 – 20 minutes.

Well known Physical Therapist Susan McLaughlin demonstrates how to release the psoas and relax the pelvic floor muscles, which can also be incorporated during pregnancy.

Susan McLaughlin - psoas release

  1. Place the bolster near the bottom of the shoulder blades.
  2. Make sure that the ribs remain relaxed and flush with your abdominal wall.
  3. Extend the legs.
  4. Make sure that the back of your thighs fully touch the floor.
  5. If they don’t you need to bolster up higher.
  6. Relax like this for 5-10 minutes.
  7. Allow your legs and torso to relax.
  8. Practice breathing.
  9. Focus on allowing the pelvic floor muscles to relax on the inhale.
  10. Tension in the pelvic floor can pull on the sacrum, limiting sacral mobility that is necessary to widen the pelvic outlet.

Regular massage will certainly release tension and stress in the pregnant body encouraging the feel good hormones endorphins, aid in increasing circulation and reducing oedema.  A qualified pregnancy massage specialist will be able release the psoas muscles as well as teach a pregnant woman how to stretch and relax the psoas on a daily basis to ensure her body is ready for labour and birth, and assist in Optimal Foetal Positioning.

I am a Pregnancy Massage Specialist with a Diploma in Pregnancy Massage and Maternity Care from both Well Mother and Pregnancy Massage Australia.  My business is Phoenix Therapies Pregnancy Wellness  located in the northern suburbs of Perth and I have been operating since 2004.  I work with women during pre-conception, pregnancy and the postnatal period as well as after caesarean section to promote rapid healing both physically and mentally.

I am also a certified Doula, Hypnotherapist and Heal Your Life Facilitator while running another business as a Hypnobirthing Practitioner at the Hypnobirthing Centre WA and a Member of Hypnobirthing Australia.

To book your pregnancy or postnatal massage or just to get more information please call me on (08) 9303 9111 or email vicki@phoenixtherapies.com.au

 

 

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