Wednesday, November 19, 2014

Pelvic Floor and Babywearing

Before my second child was born I had a vague awareness that some women suffer from pelvic floor
dysfunction after childbirth, but I didn't think it would happen to me. After all, I had a strong core and my first child was born via cesarean section, so I assumed I wouldn't need to worry about this apparently very common part of womanhood.
After my second baby was born, I found myself suffering from a prolonged postpartum recovery, very heavy bottom, and what I now know as typical pelvic floor dysfunction symptoms. (Why hadn't anyone told me about this?!) My midwife referred me to a physical therapist specializing in pelvic floor rehab. She also advised that I not lift weights, run, or do anything else to put downward pressure on my pelvis and abdominals until I recovered. What about babywearing? I regularly wear my 35-lb toddler in addition to my newborn, and as a Volunteer Babywearing Educator (VBE) I also teach babywearing on a regular basis. How would babywearing affect my pelvic floor recovery?

Luckily, Babywearing International’s network of volunteers led me to Jennifer Stone, PT, DPT, OCS. In addition to being a babywearing educator with BWI of Central Missouri, Jennifer is a board-certified physical therapist who specializes in pelvic floor function and women’s health. She is a Doctor of Physical Therapy (DPT) and an Orthopedic Certified Specialist (OCS). Jennifer has 2 children, aged 26 months and 7 months, and has been wearing since her elder child was born. Jennifer became interested in the pelvic floor after a traumatic precipitous birth (45 minutes from 1st contraction to baby on the outside) left her with what she jokingly calls a “shredded pelvic floor” and the need for both a repair surgery and physical therapy. Sadly, there were no therapists within a 100 mile radius of her who could help, so she decided to go get training. She feels her pelvic floor practitioner certification meshes extremely well with her orthopedic specialty and manual therapy focused residency program, and is passionate about helping women live healthy and full lives – free of pelvic floor issues! Jennifer agreed to be interviewed on the often silent topic of pelvic floor dysfunction (PFD), as well as how PFD interacts with babywearing.

Shannon: Hi Jennifer. Thanks for agreeing to share your knowledge on this subject. Could you briefly explain what pelvic floor dysfunction is, and how prevalent it is?
Jennifer: The pelvic floor is a group of muscles that line the internal base of your pelvis and surround
your vagina and anus. It functions similarly to a “sling” which works with your core to hold up and support your internal organs as well as the bony structure of your pelvis and lower back, providing a strong supportive base for movement. Pelvic floor dysfunction is extremely common in women-estimates in medical studies range from 25-40%, but we believe it is likely underreported due to the sensitivity of the subject and our culture’s attitude toward the area in question. Pelvic floor dysfunction refers to anything that causes those muscles to not work correctly. Symptoms can vary from pain to prolapse to incontinence, and many women have more than one of these symptoms throughout their lifespan. It can be related to childbirth, but in many cases it is not.
Shannon: What causes PFD?
Jennifer: In general, PFD can be caused by a variety of circumstances. Risk factors include: precipitous birth; very fast or very slow pushing stage in labor; genetics; lifestyle factors (e.g. heavy lifting, poor core strength); age; gender (female); hormone levels; and a variety of other things. Sometimes we can't narrow it down to one specific cause. For example, I have worked with women with vulvodynia or vaginismus (pelvic pain and pain with female exams or intercourse) who have never had children. I have also seen children and women who haven't ever had intercourse who have PFD issues. This is an area where a lot of research is still ongoing; we know a lot more about how to treat it than we do about what causes it (in some cases).
Shannon: Once diagnosed with (mild) PFD, I was advised not to lift or squat lest I aggravate the
symptoms. Was this sound advice? Will babywearing slow my recovery?
Jennifer: The concern that most practitioners have with lifting and squatting is that when your core and pelvic floor are not activating correctly to provide that stable base for movement, you end up putting a lot of downward pressure through your pelvic floor, which could exacerbate prolapse (i.e. organs protruding through the vagina-can be uterine, bladder/cystocele, or rectum/rectocele). Theoretically, the ideal solution would be “never lift anything until we get your pelvic floor back to normal.” However, most of us moms live in the real world where we can’t do that! So I usually suggest that women try to limit themselves to lifting 12 pounds or less as much as possible. Also, it is easier on your pelvic floor if you pick your child up close to your body (to your chest if possible) in a seated position, and then stand versus leaning over to pick him/her up. Babywearing a newborn should not slow your recovery-I would try to avoid prolonged wearing of a toddler or older baby if possible, and especially try not to do things such as stairs and hills while wearing the toddler. Again, this is advice for prolapse. If you are having pain (tight or spastic pelvic floor) the advice is different, and it is also different if you are post-surgical for any reason.
Shannon: Are there some carries/carriers that worsen symptoms more than other carries/carriers?
Jennifer: High and tight is more ideal. Basically, you are trying not to drop your natural center of gravity (which normally sits a little above your bellybutton). This is similar to advice that you would hear for low back pain-“try to carry books or heavy items close and tight in to your chest, not at waist level with arms extended.” Also, having the weight of the baby as central as possible and evenly distributed over your body is better-generally a 2 shoulder carrier is going to do that a little better than a ring sling. I am often asked about back vs front carries-I do not think back carries are going to be significantly better than front carries, and in fact a low/sloppy back carry will drop your center of gravity WAY more than a front carry (plus you have to factor in bending over to get the baby into a back carry).
Shannon: Is holding a baby in arms worse or better than babywearing for the pelvic floor? Why?
Jennifer: Generally babywearing is better! You will usually not be able to keep your baby as snugly in to your body if you are holding him/her in arms, nor will his/her weight be as evenly distributed. If you are lifting something, in general it is best to have that thing attached to your body and not moving around-just as in the example above where I said it’s better to pick your baby up in sitting and then stand vs bending over or squatting to lift him/her-it’s even better to get baby snugly tied on, because then your pelvic floor treats his/her weight as if it were part of your body (the difference between you gaining 8 lbs vs lifting an 8 lb object).
Shannon: Are there particular activities to avoid while recovering from PFD?
Jennifer: Always defer to the advice of your pelvic floor therapist if you have one! Keep in mind that
everything I have said here is a very general tip, but that the practitioner who has evaluated you and had their hands on you is going to be MUCH more knowledgeable about what will help you specifically – all bodies are different, and all pelvic floors are VERY different. I would also welcome people messaging me for more specific advice if they like. (email: In general, activities to avoid for prolapse or a weak pelvic floor are: lifting, squatting, carrying heavy weights up steps, anything where you feel you have strain (take stool softeners if you need to-it is important that bowel movements do not cause straining!), and Kegels. Yes, I did say avoid Kegels. Studies show that 80% of NONSYMPTOMATIC women do not do Kegels correctly when they are asked to-and in fact, they usually do a motion that would cause worsening of prolapse! So until your therapist has literally taught you how to activate your pelvic floor from scratch, doing Kegels is probably counterproductive. Products or advertisements that suggest that you can fix this issue by just doing Kegels in a certain position are likely incorrect as well. Typically, people need someone to actually teach them with a hands on approach and verbal and tactile cuing.
Shannon: Are there any other tips you would like to mention?
Jennifer: In general, I am a huge believer in listening to your body. If something feels like it isn’t right, it probably isn’t! You are probably going to have to be your own advocate in this area until you find the right practitioner (aka: you may have to convince your doctor to write you a prescription for pelvic floor physical therapy as many doctors aren’t fully aware of what we do or how we can help-or sometimes they think we only work with incontinence, or only with pain and aren’t aware of the full spectrum). Don’t assume that it will just go away, especially if you want to have more children-I know how busy we all are as moms and how we can end up being the last in an impossibly long list of priorities. However, taking care of your health is the best way you can take care of your baby in the long and short term!
Shannon: Thanks again for agreeing to share your knowledge and insights.

Jennifer’s suggested links:

Interview by: Shannon L. of Jennifer Stone, PT, DPT, OCS

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