Postpartum Chiropractic Care

This blog was originally published on trianglecrc.com. I am sharing it here because chiropractic is one of the BIRTHFIT four pillars and is crucial in healing postpartum! 

The American College of Obstetricians and Gynecologists (ACOG) released new guidelines last month regarding postpartum care.  As it turns out, we would serve women better by giving them more than one six week check-up after birth.  ACOG referenced an ongoing process of care instead of a single visit.

I couldn’t agree more, and this is a huge step in the right direction in terms of creating a better environment for mothers and families.  But there is still a lot of room for improvement.  Bringing a baby into the world is serious business: it’s both serious and a business.  And as someone in the business of helping families, I can tell you that there are two crucial things that I do for women as a chiropractor in the postpartum period (and we’re not even going to touch on chiropractic care for babies in this post).

 BIRTHFIT Baby Michael

BIRTHFIT Baby Michael

PHYSICAL ADAPTATIONS POSTPARTUM

The first thing is that I help a woman’s body adapt from a physical standpoint.  It is my hope that we’re raising enough awareness through BIRTHFIT and other wonderful organizations to point out that SLOW IS FAST and a woman doesn’t need to be working out right after having a baby.  But she does need to be able to move from her bed to the bathroom, and doing so requires some amount of structural competency.  The biomechanical changes that happen during pregnancy are vast, and they occur over the length of a pregnancy.  But they don’t revert immediately after the placenta is birthed.  Instead, a woman’s body has to rediscover its center of gravity and stability after having lost a significant amount of weight and balance in a (relatively) short period of time.  As such, part of the continuity of care that’s required postpartum needs to be from a movement/biomechanical standpoint.

EMOTIONAL SUPPORT POSTPARTUM

The second thing I do is hold space, which is something a postpartum woman needs.  In our office, follow up visits are all 15 minutes long.  But the first postpartum visit with one of our existing patients is double that in length.  This is for several reasons: we don’t want them to worry about being late if it’s one of their first outings with a new baby; they’ll likely need to nurse or change while in the office (and we want to check baby’s latch anyway!); and we need to allow ample time to just sit and talk with mom.  One of the exercises we do in the BIRTHFIT Postpartum Series is encourage women to share their birth story with someone who deserves to hear it.  Being fully clothed (though likely with excess bodily fluids about your person) in a place where people care about you and you are welcome to breastfeed or bottle feed without concern is a great place to share your story: the ins and outs, ups and downs, highs and lows.

In a postpartum chiropractic visit, we’ll re-establish a foundation of breath, determine when/how to introduce functional movement, and enhance the body’s biomechanics in order to better support a postpartum healing journey.  But we’ll also just listen.  Because caring for women postpartum is not just about checking boxes and showing up to appointments; it’s about caring for the soul that just guided a new being into our world.

xox

Dr. Mumma

Stress in the Motherhood Transition

Six years ago (with a mountain of student loan debt in tow, while starting my first business from scratch in an area where the number of people I knew could be counted on one hand), I would have told you that I wasn't stressed.  I didn't feel stressed out.  But realistically, I was in a constant state of stress.  The important part here is that the stressor was present, not how much stress I was (or in this case wasn't) feeling.  

I am currently the owner of two businesses and COO of another, a wife, and the mother of two boys, and still have a pretty big pile of student loans; I now recognize that I'm no stranger to stress.  While my blissful ignorance regarding stress a few years ago felt "fine", it likely was a contributing factor to my autoimmunity after my second child was born.  Our bodies cannot thrive under constant stress, and eventually something will give. 

But stressors flood the Motherhood Transition.  Pregnancy is a stressor.  Birth is a stressor.  Breastfeeding is a stressor.  Healing your body during the postpartum period is a stressor.  Add those stressors together with sources of chronic stress like finances, work, family, traffic, diet, environmental toxins, etc., and it's easy to see how a lot of women end up with some dysfunction of their physical body.  One of the most common dysfunctions of the physical body in our world today is autoimmunity. 

(SIDE NOTE: If you have been diagnosed with (or suspect that you have) an autoimmune condition (like Hashimoto's thyroiditis, lupus, diabetes, RA, MS, etc.) there is a docu-series that's going on this week that I recommend you watch regarding autoimmune diseases called Autoimmune Secrets.)

That doesn't mean you're doomed to autoimmunity (although statistics are certainly rising at an alarming rate!).  What it means is that you need to take an evaluative look at how your physical body is doing - whether you're planning a pregnancy, pregnant, nursing, or had kids 20 years ago. 

A simple exercise to complete is to jot down your stressors. 

  • What are your sources of stress? 
  • What of these can be eliminated? 
  • How many stressors do you have that are projections or completely fictitious? 

Grab a pen and start writing.  

Take a look at your list and be honest with yourself.  Yes, we can eliminate a lot of our stress simply by cutting out any excess, changing our diet to one that is anti-inflammatory in nature, and increasing our sleep/rest; but a lot of stressors are still going to be around.  So rather than stress about it (heh heh), give yourself tools to deal with stress. 

Not sure how?

Grab another piece of paper and aswer the following questions:

  • When do you feel amazing?  (Do that more.)
  • What foods don't settle well with your body?  (Eat those less.) 
  • When do you get time to clear your head?  (Repeat that daily.)

Great ideas for stress relief include meditation, yoga (kundalini is my favorite!), journaling, grounding (spending time outside barefoot), or gardening.  These practices all have additional benefits as well! 

Stress isn't going to go away, so you might as well find ways to deal with it effectively. 

xox

Lindsay Mumma, DC

Training Smart Through Pregnancy

This article originally appeared on https://thebarbellphysio.com/training-smart-pregnancy/ on March 13, 2017. 

As a BIRTHFIT Regional Director, chiropractor, and mom, I am all for women exercising during pregnancy. I have reaped the benefits of exercise through two pregnancies and have seen plenty of patients experience the same benefits. A few of these benefits include decreased musculoskeletal complaints throughout pregnancy, improved body mechanics and posture, prevention of gestational diabetes and preeclampsia, and stress reduction (1, 2, 3). In general, society seems to be catching on that pregnant women can and should be exercising during this time. Now it’s time to start exercising smarter.

The point of exercise during pregnancy is twofold: benefit mother and baby in the same way that non-pregnant humans benefit from exercise; and to prepare for labor, birth, and the postpartum period.

That second part is probably more important than the first, but it’s the one that’s being overlooked. Yes, there are a ton of benefits to exercising during pregnancy, but I’d like to encourage women to train FOR something rather than just train.

Below are some examples of changes that happen during pregnancy and how to train to accommodate for these changes.

 

POSTURAL CHANGES

What happens in the body: The postural changes that occur during pregnancy mean that more of the mother’s weight is shifted anteriorly; strengthening the posterior chain helps to offset these changes.


What Mom experiences: Common complaints associated with this include low back pain, knee pain, and a very obvious “pregnancy waddle”.

How to help: Strengthening exercises for the posterior chain include squatsgood mornings, and lunges. These exercises should be part of a woman’s regular routine. (Regular chiropractic care and physical therapy can also help women navigate the postural changes occurring in the body.)

 

ABDOMINAL EXPANSION

What happens in the body: The entire abdomen expands in order to accommodate for a growing fetus. This leads to stretching of the connective tissue between the abdominal musculature, typically resulting in a separation of the rectus abdominis muscle bellies (known as a diastasis rectus abdominis or diastasis recti).

What Mom experiences: Common complaints associated with this include low back pain and also a general feeling of weakness in the core. Weakness here can also impact the pelvic floor, as the core functions as a unit rather than in individual pieces.

How to help: Working on diaphragmatic breathing is one of the best things to do for the health of the abdomen. This includes breathing deep into the abdomen (all the way into the pelvic cavity) as well as expanding breath into the sides and back. Breathing effectively will allow a woman to create more appropriate intra-abdominal pressure according to the principles of Dynamic Neuromuscular Stabilization (4). Using this breath as the base point of stability for all exercise is crucial throughout pregnancy and into the postpartum period. Avoiding movements that could aggravate a diastasis and decrease the overall function of the core such as sit-ups, toes-to-bar, v-ups, or L-sits should begin at the onset of pregnancy. Instead of hammering away at her abs during a workout, a pregnant woman can work on the Functional Progression (part 123, and 4, put together by Dr. Erica Boland based on DNS principles) that mimic a child’s first year of development (during which babies heal their own diastasis!).

 

MINDSET CHANGES

What happens in the body: As a woman prepares for labor, birth, postpartum, and the weight of bringing a child into the world, her mindset becomes an essential tool in preparation. Horror stories from well-meaning friends and family (and even strangers) about how scary birth can be plague women from the minute they announce their exciting news. As a woman becomes a mother, there is a ton of information to sift through and a lot of mental preparation to do. The stressors of pregnancy can add up quickly.

What Mom experiences: Increased stress during pregnancy negatively impacts the mother, but can also negatively impact the fetus for years to come (5). Knowing that doesn’t help a woman decrease her stress! Women frequently report feeling overwhelmed during pregnancy, while others report anxiety or depression.

How to help: Preparing the mind for pregnancy, labor, birth, and the postpartum period (including motherhood in general) is as important as physically training the body. Incorporating a daily mindfulness practice is essential in helping women alleviate stress during pregnancy (6). But it is also a necessary component in helping to prepare for the unknown of labor and birth. ACOG has updated its guidelines to state that active labor does not begin until a woman has reached 5-6cms of cervical dilation (7). This means that even moms who are preparing for an epidural or other coping mechanisms during labor are going to need to be prepared to get most of the work of laboring done outside of the hospital setting. Honing in on mindful practices can help a woman prepare to be in tune with her body throughout pregnancy and into the postpartum period. An easy way to do this is by starting or ending each day with 10 minutes of meditation. A woman can take that time to work on diaphragmatic breathing as an added bonus, and allow her mind to clear as she connects with her baby.

 

TRAINING THE POSTERIOR CHAIN, THE FUNCTIONAL CORE, AND THE MIND ARE THREE WAYS THAT WOMEN CAN TRAIN SMARTER DURING PREGNANCY RATHER THAN JUST WORKING OUT WITH A BABY ON BOARD.

 

ABOUT THE AUTHOR

Dr. Lindsay Mumma is a chiropractor and the Regional Director for BIRTHFIT NC. She is a BIRTHFIT Senior Leadership Team member and authored the BIRTHFIT Trimester Series books. She owns Triangle Chiropractic and Rehabilitation Center in Raleigh, NC, where she works primarily with pregnant and postpartum women as well as athletes. She and her husband have two active boys.

 

References

  1. Clapp, James F., III, and Catherine Cram. Exercising Through Your Pregnancy. 2nd ed. Omaha: Addicus , Inc., 2012. Print.
  2. Hammer, R et al. Exercise During the Childbearing Year. J Perinat Educ. 2000 Winter; 9(1): 1–14. 28 Feb 17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595006/
  3. Wang, C. et al. "A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women." Am J Obstet Gynecol. S0002-9378(17)30172-2.10. 1016/j.ajog.2017.01.037 (2017): n. pag. gov. 1 Feb. 2017. Web. 9 Feb. 2017. <https://www.ncbi.nlm.nih.gov/pubmed/28161306>.
  4. Kolar P, Sulc J, Kyncl M, Sanda J, Neuwirth J, Bokarius AV, Kriz J, Kobesova A.
    “Stabilizing function of the diaphragm: dynamic MRI and synchronized spirometric assessment”, J Appl Physiol. 2012;42(4):352-622
  5. Buss, C. et al. Maternal pregnancy-specific anxiety is associated with child executive function at 6–9 years age. Stress. 2011 Nov; 14(6): 665–676. 28 Feb 17. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222921/>.
  6. Guardino, C. et al. Randomized Controlled Pilot Trial of Mindfulness Training for Stress Reduction during Pregnancy. Psychol Health. 2014; 29(3): 334–349. Published online 2013 Nov 1. 28 Feb 17. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160533/>.
  7. The American College of Obstetricians and Gynecologists. Committee on Obstetric Practice. Approaches to Limit Intervention During Labor and Birth. Number 687, February 2017. 28 Feb 17. <http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Approaches-to-Limit-Intervention-During-Labor-and-Birth>.

When Should I Start?

I often get asked if it is too soon or too late to be BIRTHFIT.  My answer is always the same: "Of course not!"

BIRTHFIT comprises four pillars: fitness, nutrition, chiropractic, and mindset.  Practice within each of those pillars makes for a pretty healthy lifestyle.  What better time to adopt a practice in these areas than before you decide to get pregnant?  And what mom doesn't need a little more mindfulness and self care in her life postpartum?  It's never too soon or too late to join the movement! 

Diastasis Rectus Abdominis

In an effort to produce some information regarding why those two recent NPR articles (A and B) are the exact opposite of what we’re attempting to convey to our audience and the women we work with, Dr. Mathews asked if I would help construct a response.  I started writing, but then realized I’d basically already completed this task.  Below you will find the Appendix from my first book, The First Trimester, which I dedicated to discussing diastasis.

Breath & Flow

The BIRTHFIT Postpartum Series Breath & Flow class is a brand new course that highlights the importance of (you guessed it) breathing and flowing through functional movements.  

So What's Different?

This class is similar to the traditional BIRTHFIT Postpartum Series, and can stand on its own as a postpartum rehabilitation course.  It does, however, set the tone for the BIRTHFIT Postpartum Series and as such can serve as an introduction prior to taking the BIRTHFIT Postpartum Series. 

The Breath & Flow course is appropriate for women who have had a baby in the last 4-12 weeks. (While appropriate for anyone beyond that point, the healing occurring during that time coincides with the content of the course.) 

There are no weights used.  While some external equipment is used, we do not focus on strength building during this course. 

Non-mobile babies are welcome.  This class is not a "mommy and me" class and isn't designed for children, but those babies who are not yet mobile are welcome to accompany their moms.  

Rather than the twice weekly for four weeks (like the traditional BIRTHFIT Postpartum Series), the Breath & Flow course meets weekly for 75-90 minutes.

If you'd like to join the next Breath & Flow course, register here!  

Big Feelings

Big Feelings

I posted on my Facebook account a few days ago that I couldn’t look worse than when yawning whilst ugly crying.  I posted it because I’d laughed at myself while doing so and thought it was a relatable thing since we all have big feelings sometimes and the yawning was very indicative of my current status as both an entrepreneur and a mom.

 

What surprised me was how many people reached out to me concerned about my crying.  My close friends called or texted to check in, which seemed normal, but I also had people I rarely speak to reach out.  I appreciated their genuine thoughtfulness and concern for my wellbeing.  But I hadn’t considered that sharing that I have feelings would be cause for alarm.

 

NEWSFLASH: we all feel things.  And if we allow ourselves to, we feel LOTS of things.