» Introduction : Areas of Pain after Childbirth

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Introduction

Areas of Pain after Childbirth

Back

During pregnancy, the weight of the growing baby changes a woman's posture which can result in strain to the back, pelvis, neck and shoulders. The alterations in pelvic alignment also can lead to muscle spasm and difficulty with walking. In fact, according to a 2010 study, approximately 50% of women experience strained and irritated ligaments in their lower backs due to alterations in the alignment of their pelvis with childbirth [1].

 

Pelvic bones which open at pubic arch during childbirth

As the fetus grows, the increasing stretch of the abdominal muscles causes them to weaken.  The central abdominal muscles are called the rectus abdominis, which attach from the sternum (breast bone) to the pubic bone.  These long strap-like muscles may separate down the middle, resulting in a condition called “diastasis recti’. Muscles that are stretched are weak, which leaves the spine less supported and more vulnerable to strain and other injury.  After the childbirth, the physical work to care for the baby is quite challenging. Lifting car seats, lugging around strollers and carrying and feeding your baby all require strength and good posture to perform safely. Combine the weakened muscles with the hormones that soften the ligaments before and after delivery, and it's no wonder that so many new moms have backaches, muscle soreness and joint problems.

 
Normal versus separated abdominal muscles [diastasis recti] due to pregnancy

Trying to get back in shape and lose the baby weight can cause problems as well.  Sit ups, leg lowering and other abdominal exercises can result in more strain on the spine, other joints, and the weak abdominals, as well as potentially worsening a diastasis recti.

Hips

Depending on the duration and positions during labor, a woman can spend many hours with her feet up in stirrups or with her legs being stressed in extreme ranges of motion. Because of the ligament softening hormones released during pregnancy, the pelvic joints are mobile, allowing widening of the joints as the baby passes through the pelvis and birth canal.  Both of these factors can contribute to hip and back pain.

The Perineum

Women who have had a vaginal delivery experience significant strain on the perineum commonly resulting in swelling and discomfort after childbirth. Perineum is the term describing area of the women’s genitals between the anus and the pubic bone.   90% of women who have just given birth report pain in their perineum, with 37% listing the pain as severe [2]. Pain is usually due to the trauma that has occurred during the birthing process. Pain is commonly felt while walking or sitting, and can interfere with taking care of your baby. In Balance Physiotherapy can help you recover from the delivery, reduce your pain and help you focus on healing and enjoying time with your new baby.  

Numbness in hands and wrists

Due to the physical strain a growing baby puts on a mother, many pregnant women develop carpal tunnel syndrome before or after delivery. Carpal tunnel syndrome can develop when the median nerve is compressed in the wrist due to swelling or because of carrying the baby or car seat [3]. 62% of pregnant women will experience symptoms related to the compression of this nerve [4]. Pregnant women and new mothers may also experience "double crush" syndrome in which the median nerve is not only pinched in the wrist but also further upstream, usually near the neck.  This frequently occurs as a result of the increased forward head posture that develops as pregnancy progresses or after birth as the new mom looks down at her baby.

The symptoms of both syndromes include numbness in wrists and hands that is frequently more pronounced at night. It is estimated that all pregnant women experience compression of the median nerve during the last three months of pregnancy, however, many do not have any symptoms [4]. It is less common for the symptoms to extend after pregnancy, but the numbness can extend for up to three years after the baby is born.  



Nerve, ligament and tendons involved in carpel tunnel syndrome

Other causes of wrist and hand numbness include the tremendous amount of lifting performed by new moms. Car seats, strollers and diaper bags all have to be transported frequently and poor lifting techniques can exacerbate pain and weakness in the upper extremities. Any swelling in the shoulders, arms and hands can pinch nerves causing numbness.

Leg Cramps

Muscle cramps can be very painful and uncomfortable, disrupting sleep and the ability to sit comfortably as well as return to exercise. Cramps can be caused by a potassium deficiency. While breast feeding, a mother can lose electrolytes and if they are not replaced, an imbalance will occur which can lead to leg cramps. Leg muscles may also be recovering from the birthing process as well as the pregnancy. Lumbar spine restrictions may also cause leg cramps due to entrapment of peripheral nerves.

Headaches

There are many different reasons for experiencing headache pain after childbirth [5]. Changing hormone levels during and after pregnancy can lead to headaches, the severity of which can range from a mild annoyance to severe migraine type pain. Post partum headaches can also be attributed to stress and tension due to prolonged head and neck positions during nursing, shrugging the shoulders while holding the baby, as well as carrying car seats and heavy diaper bags.  As wonderful as it is to have a new baby, it is a significant change in lifestyle, commonly causing sleep disruption and stress. A rare yet serious cause of post partum headaches can be attributed to complications after an epidural injection during labor. After an epidural, there is a very slight possibility of spinal fluid leaking from the injection site which may cause headaches. The pain lessens when the sufferer is lying on her belly and increases upon sitting or standing. Although very rare, this is a serious condition that should be treated by a doctor right away.

Depression

Postpartum depression is a very serious condition that occurs in approximately 25% of new mothers. The symptoms include sadness, sleeplessness, feelings of guilt and inadequacy, exhaustion and low energy. Postpartum depression has been attributed to vitamin deficiencies [6] and also the changing hormone levels that women experience [7]. Risk factors include formula feeding, smoking, low self esteem, anxiety, history of depression, health problems of the baby and lack of a support system [8]. It has been reported that of these risk factors, smoking, formula feeding and a history of depression most significantly increase the risk for postpartum depression [8].

Pregnancy, delivery, and motherhood are amazing life experiences.  All new moms require emotional support as well as others to take care of her needs as well as that of the baby.

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