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.

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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.

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  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.

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  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

 

 

Pregnancy Massage – Is It Safe?

The popularity and education of prenatal massage has increased significantly over the past few decades.

In tribal cultures, prenatal and labour support massage was common.  Anthropologist George Engelmann documented these techniques in the mid 1880’s; however the first documentation of labour massage was in 15th century England.  It was common practice for midwives to use massage while the mother was in labour to make her more comfortable and to relieve pain.

tribal women

The elder women of the Nama Hottentot tribe of South Africa give massage treatments to the pregnant women of the tribe several times a week to prepare for the upcoming childbirth.  In Uganda, pregnant mothers receive massage daily in an effort to make their muscles and joints supple for an easier labour and delivery.

Women in tribal societies resume their normal everyday activities almost immediately after giving birth.  Among the natural methods used to restore strength and decrease post-partum depression in the new mum, the most important and widely accepted tradition is massage.

tribal massage

In our medically advanced society, massage can often be over-looked as an important part of pregnancy health care.  However, this tried and tested tradition is one of the oldest forms of the healing arts and has been used for thousands of years in almost every culture.

Every pregnant woman deserves some pampering and massage is a wonderful way to reduce stress and promote general wellbeing.  Massage can be received during all three trimesters of your pregnancy for both normal and high risk pregnancies.

With the exciting news that you are pregnant, your body is about to undergo stress-producing changes.  Some of the consequences of these changes can leave a woman feeling sore, tired and uncomfortable.  Massage is therefore a great way to relieve this discomfort through the positive effects of soft tissue manipulation.

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Pregnancy Massage therapy helps the body adjust to accommodate the life growing within.  It can assist in reducing stress, encourage relaxation and prepare muscles and joints for childbirth.  Not only can this be a treat for you, but a much needed therapy to ease some of the aches and pains experienced during pregnancy.

It has been claimed that during the first trimester, pregnant women should not have massage as it may cause miscarriage, however if the pregnant woman is healthy and proper guidelines for working with pregnant women are followed, then there is absolutely no medical evidence to support that a massage could harm the pregnancy or cause miscarriage.  Most times this myth is circulated by the very ones who should not be doing pregnancy massage as they are not qualified to do so.

Just recently the Australian Association of Massage Therapists (AAMT) has announced after completing their own research that pregnancy massage during the first trimester is considered safe “if undertaken by a trained pregnancy massage specialist.”

Here is a recent article about this breakthrough in pregnancy massage during the first trimester:

http://pregnancymassageaustralia.com.au/break-understanding-first-trimester-massage/

Probably the main reason for not getting massage in the first three months is more about comfort as it may trigger dizziness or increase your morning sickness – on the other hand it may eliminate these symptoms.  You won’t know until you try it and then you can let your therapist know if you start to feel uncomfortable and adjustments can be made or you can just stop the treatment.

Remember, there is no danger, just the potential to be uncomfortable.

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The most important thing to consider with pregnancy massage is using a qualified Remedial Massage Therapist who has had specialised training in pregnancy massage and knows the anatomy and physiology of a pregnant woman.  Just being a massage therapist doesn’t mean that they are qualified to give massage to pregnant and postpartum women.  Be cautious that just because a brochure offers pregnancy massage, it doesn’t always mean that they are qualified to do so.

It is essential to ask any questions or raise any concerns you may have to your therapist at any time during the treatment.  A professional pregnancy massage will always start with a minimum fifteen minute consultation prior to actually having a massage each and every time you attend.  You should be asked specific questions about the progress of your pregnancy, your current condition, your antenatal appointments and specific areas of discomfort and range of motion checks.

A trained pregnancy massage therapist will safely and effectively answer any questions you may have about having a massage during any stage of your pregnancy.  We also do not recommend the tables with the hole where the belly hangs down, as this puts so much more pressure on the sacrum, lower back and can strain the ligaments around the uterus and pelvis, not to mention your growing breasts which may be tender or uncomfortable.  Just imagine all that weight of your baby in your womb, just hanging down with the force of gravity – while your therapist is also then creating more pressure during the massage with the massage techniques (or not effectively working through this area so they don’t put more pressure there), so then your glute (bum) muscles are tensing trying to overcompensate for the pressure created in your back.  The best position during pregnancy massage is in a side-lying position, with your top leg at a 90 degree angle supported by a bolster under your leg and knees stabilising the hip joint, along with your top foot also being supported, not just hanging down at the edge of the bolster. Support cushions will also be used to stabilise your body to prevent you from rocking or rolling from side to side.

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Vicki Hobbs of Phoenix Therapies Pregnancy Centre is a qualified Remedial Massage Therapist specialising in pregnancy, induction, labour and postnatal massage.

Vicki is a highly trained pregnancy massage specialist having completed the Diploma in Pregnancy Massage course in 2013 with Pregnancy Massage Australia.  This training is an advanced level of training for pregnancy massage, but also specialising in working with high risk pregnancy clients such as those with pre-eclampsia and other conditions such as pubis symphysis separation, pelvic girdle pain, lower back and hip pain, injuries and other pregnancy related dysfunctions.

She also holds a Diploma in Pregnancy Massage & Maternity Care after training in 2008 with Suzanne Yates, who is a well-known author, shiatsu practitioner, midwife and the Director of the Well Mother Centre in the UK. www.wellmother.org

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Vicki has expert knowledge and training of the anatomy and physiology of the pregnant body, stretching during pregnancy, labour position techniques and massage instruction for your partner.  She is also a Certified Birthing Assistant (Doula) and Childbirth Educator and conducts regular “Essential Birthing Journey” workshops for pregnant women.  Vicki is passionate about sharing her knowledge as a Hypnobirthing Australia Practitioner having been trained in this method earlier this year and also in the Mongan Method (originally in November 2009 and then completed a refresher in November 2012).

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In addition to this, my insurance company specifically covers me for pregnancy massage, not just remedial massage, which further ensures that all strict training criteria and guidelines have been met for your own peace of mind.

As with most therapies, there are always precautions involved with receiving treatment during pregnancy, however pregnancy massage (when performed by a trained and experienced therapist) is a safe procedure with benefits far outweighing the risks.

For your own peace of mind, you can even discuss with your medical practitioner or obstetrician of your intention to have a pregnancy massage, and they will advise you if they feel that you should not do so for whatever reason.

BENEFITS OF PREGNANCY MASSAGE

The benefits of massage in general are numerous, however more specifically for pregnancy they include:

  • Relief from muscle cramps, tension, spasms;
  • Relief from pain especially in the lower back, neck, hips and legs;
  • Reduction of stress on weight bearing joints;
  • Improvement of muscle tone;
  • Dilate the blood vessels, therefore improving blood circulation including the placenta, which brings greater nutrition to the tissues of the body and enhances waste removal;
  • The lymphatic system circulates faster and more efficiently which results in more energy and less fatigue and helps to reduce swelling;
  • May help with the reduction of varicose veins;
  • Stimulates glandular secretions which will stabilise your hormonal levels and reduce their side effects;
  • Enhancement of elasticity and pliability of skin and connective tissue (ligaments and tendons);
  • Helping with sleeplessness or insomnia;
  • Increased range of flexibility and movement and become less prone to injury;
  • Helps to calm the nerves and reduce anxiety, which is also transferred to your baby to help them feel more relaxed and soothed;
  • Prepares the muscles and tissues used during labour and birth.

Many of the problems that arise during pregnancy are due to muscle strain, weakness and poor posture.  Proper exercise and appropriate stretching will increase your energy, strengthen the muscles most strained during pregnancy and labour, stimulate circulation and increase flexibility in the joints.

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Here is a great testimonial from one of our regular pregnancy massage clients:

“I would recommend Phoenix Therapies Pregnancy Centre to anybody.  I first heard about them in an advertisement in the local magazine Offspring.  I was 24 weeks pregnant, working 25-35 hours a week in a busy café and was starting to feel a little tense in my lower back.  I decided to treat myself to a massage but I was a little nervous about having a massage while pregnant so I did some reading on the internet and Facebook which helped me to make a decision.

Vicki and Sarah are very professional and welcoming and I felt comfortable in their abilities almost instantly.  The bodyCushion that they use is so comfortable and supportive.  Pregnancy massage was such a great way for me to relax (body and mind) before the arrival of my baby. I continued to work right up to 36 weeks (3 weeks before baby was born) having a massage every 2 weeks or so definitely helped me stay very active during my pregnancy especially towards the end. I look forward to going back for a massage without my big belly!

Thank you Phoenix Therapies Pregnancy Centre”
Laura

MORE INFORMATION

For more information or to book a pregnancy massage contact Vicki Hobbs of Phoenix Therapies Pregnancy Centre, which is now located from my lovely home in Landsdale (the northern suburbs of Perth).

My details are (08) 9303 9111 or check the website www.phoenixtherapies.com.au

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