Episode 03: How to choose your doula?
How to choose your doula? In today’s episode, I had the pleasure of interviewing Ann Fulcher, doula and head of the Hearts and Hands UCSD
If you have been suffering from your lower back on a daily basis since you gave birth, this video is for you!
I’ll show you 10 exercises specifically designed for addressing postpartum back pain, and specifically lower back pain.
Watch the video for a full follow along sweet session.
Here is an overview of what I’m going to cover in this blog post:
First and foremost, know that low postpartum back pain is the most common cause of sick leave after delivery and that nearly 50% of women will suffer from lower back pain postpartum and during their pregnancy, according to a study on Pregnancy-related low back pain
Bottom line: you are not alone! But it doesn’t mean that it has to be like that and that there is nothing to do to make it better.
In my osteopathic practice, postpartum back pain, and especially lower back pain, was one of the top 3 reasons why women were coming to see me.
But why are you experiencing this? It’s never one thing or the other. Like in any situation, postpartum back pain is the result of a combination of factors. Let’s take a look at some of them.
First, diastasis recti, core dysfunction and weakness is one major cause. Diastasis recti (DR) is the separation happening between your “6 pack muscles”, the rectus abdominis. Usually, you can feel it when practicing a self-test (link) or if your OB-GYN tested for it. Most women have a separation of 2 fingers width and it is considered problematic when it is greater than 2 fingers. Most of all, the tissue quality is of high importance when assessing your DR, meaning the depth and as I said, how do the tissues feel underneath your fingers when testing. You can check our post on How to know if I have diastasis recti? For more details click on the link.
DR is often associated with a dysfunctional core engagement, but also with pelvic floor dysfunctions most of the time. This can lead to this:
DR => dysfunctional core engagement => pelvic floor dysfunction => dysfunctional lower back and hip support => lower back pain and hip pain
One of the main functions of your deep abdominal muscles is to support your trunk, organs and protect your spine. When there are weaknesses like the ones we just talk about, these muscles can’t fully play their protective role. You can now understand why it could result in this ripple effect leading to lower back pain.
I also introduced the notion of hip pain. This is something that I will discuss in a future post.
Low postpartum back pain is the most common cause of sick leave after delivery and that nearly 50% of women will suffer from lower back pain postpartum and during their pregnancy.
How you gave birth is also playing its role in the onset of postpartum back pain:
All of these will definitely have an impact and could potentially participate in causing postpartum back pain. In my practice, especially in the first weeks postpartum, working on the area around the epidural was bringing a lot of relief to my postpartum clients complaining about lower back pain. The epidural is definitely a great add-on but it can increase the risk of suffering from postpartum back pain. Indeed, lots of women are left in sub optimal postures for several hours during labor, creating in turn lots of stress on all the different muscles and ligaments in their pelvic area.
Pitocin, the artificial version of oxytocin, triggers really strong contractions and can also slow down labor in some cases. Your uterus is “linked” to your lower back and specifically your sacrum (the V shaped bone just above your tailbone) by several ligaments. So whatever happens in this area has a direct effect on your lower back and sacrum joints and soft tissues. This results in a higher risk of suffering from postpartum low back pain in the following days and weeks. Something I saw over and over in my practice too.
C-section is also related to a higher incidence of postpartum back pain, especially when performed along an epidural anesthesia. You can read this study on the matter.
Bad breastfeeding posture, especially in the first days and weeks, can definitely participate in the onset of postpartum back pain. We see lots of new moms not really at ease and uncomfortable when nursing their baby. And it’s perfectly normal. Breastfeeding is not always an easy or straightforward task. But using a nursing pillow, trying not to hold baby with your arms too much or avoiding being turned to one side, or seated on one side of your butt and looking down too much can definitely make things smoother and less painful.
Other factors are also to be taken in consideration when trying to understand why you’re suffering from postpartum back pain. Like weight gain, hormonal changes, etc. See this blog post on upper back pain in pregnancy and postpartum.
Overall bad posture will definitely put you at a higher risk too. During your pregnancy, as your baby and uterus were growing, your whole weight and center of gravity have been shifted forward. This results in more stress on your lower back muscles and soft tissues. However, this is something preventable with the appropriate posture work and exercise routine.
Your uterus is not “isolated” in your body. As I just explained, it is surrounded by and connected with other structures like ligaments and joints.
After giving birth, despite the void created in your uterus, your center of gravity doesn’t “come back” right away. It takes some awareness and conscious postural work. The exercises I’m showing you can help you and your body realize that. Just look at yourself in the mirror from the side, march in place for 3 seconds and notice what you see. Chances are your lower and neck curves are exaggerated, your shoulders are rounded forward, your chin is up, your middle back is rounded and your hips are opened with your feet pointing externally. Classic postpartum posture.
This creates an on-going, chronic stress on the muscles in your back, resulting in low back pain.
New mom chores, like holding baby on one side, changing baby bent forward, bathing baby while on your knees and bent forward, picking up things from the floor, among others, can create even more stress and pain in the lower back area. Especially when you don’t have full control of your abdominal and pelvic floor muscles yet. The diastasis recti we talked about earlier will add to this and cause even more low back distress.
Do I have to add that sleep deprivation adds to all of this? Several studies have also linked postpartum depression to postpartum back pain and sleep deprivation.
Thankfully, all of this is not a fatality. There are ways to help you navigate the postpartum era with more ease and less discomforts and pains. All it takes is the right information and routine:
Here is a step-by-step detailed guide of the exercises shown in the video:
The most common mistake here is that we usually perform this with our hands directly below our shoulders. To have the most natural breathing and avoid placing too much pressure against your pelvic floor, you should slide your hands slightly forward. This way you’ll place the focus more on your upper back (which intends to have the most mobility in the flexion/extension movement we’re taking it through) rather than on your lower back.
Start on a quadruped position. Slide your hands forward. Round your back all the way up in the angry cat position, vertebra per vertebra. Then, drop the back down, arching the back and pulling the tailbone up.
Repeat.
This is a great exercise to help increase mobility in your upper back and help decrease tensions and pain in your lower back.
Start in a quadruped position, with your hands directly below your shoulders. Bring your right hand on the back of your neck. Bring your right elbow all the way up to the ceiling and then move it to your opposite wrist. Repeat 5 times.
Repeat on the other side.
A classic one, but a good one when one is feeling her back. To make it more focused on the upper back, bring the knees to each side of the mat.
Start on your quadruped position. Bring the soles of your feet together and leave your knees on each side of the mat. Push your butt to your heels and reach forward with your hands. If you feel comfortable, you can place your forehead on the mat.
Stay there and breathe.
True or reactive sciatica, is a common thing when one is suffering from her lower back. This stretch and exercise will help you alleviate the pain when done consistently.
Start on a quadruped position. Bring your right knee on the back of your left knee. Bring your hips back and sit back with your legs crossed. If you need, you can add a pillow underneath your butt to make it more comfortable, especially if you don’t have enough flexibility to sit comfortably. Stay there and breathe until you feel relaxed and that any pain or discomfort fades away.
Repeat on the other side.
One of the best! It equals a self-massage.
Start with your back and head against the ball, chin down to respect a neutral alignment in your back. Roll back, and find what feels good for you, arms our or on your hips. Stay there and breathe. To come back, roll forward, hand on the floor, bring your head back up slowly while keeping your chin down.
This exercise is a life saver! One of my favorites and one my clients’ too!
Start in a crossed leg position. Place your arms on your ball or seat of a chair. Bring yourself forward, keeping your back neutral and your chin down. Stay there and breathe. You can also rock side to side thanks to the ball.
In this exercise, you will strengthen your core while stretching your back. The perfect combo!
Lie on your side, next to a wall, with a pillow underneath your head and between your knees. Bring your knees up, to form a 90 degrees angle at your hip joints. Bring your arms up and place your hands on the wall.
On an exhale, lift your pelvic floor up, bring your belly in, and push against the wall with your hands. Make sure to keep a neutral back and keep your chin down throughout the exercise.
Repeat 5 times.
Switch sides and repeat.
Combining the best of both worlds: strengthening your core and glutes and relaxing your back!
Lie on your back. Feet up on the seat of a chair. Roll your pelvic bones back to the mat, and bring your tailbone up to the ceiling. Place your hands, with your finger interlaced, on the top of your head.
On an exhale, gently lift your pelvic floor muscles and bring your hips up, by squeezing the glutes. Push your hands up and relax your back.
Repeat 10 times.
A classic one to fire your glutes and alleviate low back pain discomfort.
Place your resistance band just above your ankles. Bring your hips back and place your hand palms against each other.
On each exhale, push against the band and walk to the side. Place your attention on your glutes here and keep your deep core engaged.
Repeat 10 times on each side.
This one is a variation of the previous exercise.
Place your resistance band just above your ankles. Bring your hips back and place a small ball, block or pillow between your hands.
On each exhale, push against the band and tap with your foot to the side. At the same time, push against the ball or pillow to trigger even more core engagement. Keep your attention and focus on your glutes and core here. Keep in mind that if your left leg is doing the movement, you will feel your right glutes.
Repeat 10 times on each side.
Again, if you need more help and assistance to start your pregnancy support journey or your postpartum recovery, you can always reach out to me to schedule a free online consultation. Always a pleasure to help and support Mamas during their journey!
Disclaimer: Bonjour Baby strongly recommends that you consult with your physician before beginning and enrolling in any exercise program, even if you are in good physical condition, not suffering from any complications, and able to participate in the exercise.
Bonjour Baby is not a licensed medical care provider and represents that it has no expertise in diagnosing, examining, or treating medical conditions of any kind or in determining the effect of any specific exercise on a medical condition.
How to choose your doula? In today’s episode, I had the pleasure of interviewing Ann Fulcher, doula and head of the Hearts and Hands UCSD
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Sex after Baby and Orgasmic Birth Debra is a world-renowned inspirational author, speaker, filmmaker, DONA International doula trainer, Lamaze International childbirth educator, author and graduate
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