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Pregnancy

 

Reflux and Heartburn

Reflux occurs when stomach acid travels back up the oesophagus.  This can cause heartburn, a symptom of reflux.  Heartburn is a burning sensation in the chest and can be common during pregnancy.  Both hormonal and physical changes during pregnancy can contribute to the onset of heartburn.

 

During pregnancy the placenta produces a hormone called progesterone which will relax the smooth muscles of the uterus .  Progesterone relaxes the gastroesophageal valve which is the valve between the stomach and oesophagus.  Normally this valve works to stop stomach contents, including stomach acid travel backwards up the oesophagus.  When this valve becomes too relaxed, naturally it will not work as effectively in preventing the up flow of stomach acid into the oesophagus, causing heartburn.  Progesterone can also slow down digestion by making peristalsis (wavelike contractions) sluggish in the oesophagus, stomach, and intestines.

 

When the growing uterus and baby starts to push into the stomach and diaphragm in later stages of pregnancy, this puts extra pressure on the gastroesophageal valve challenging its ability to keep the stomach contents contained. 

 

Osteopathy can help by creating more space for the baby within the abdomen, allowing some of the pressure to be taken off the stomach.  Tension/imbalances within the diaphragm can also be addressed to further alleviate pressure on the gastroesophageal valve.

 

What you can do at home:

  • Avoid acidic (e.g. citrus fruits and tomatoes) spicy, and fried foods.

  • Avoid carbonated drinks.

  • Eat smaller meals more regularly.

  • Do not eat too close to going to bed (e.g. 2.5 – 3 hours).

  • On average it takes 2.5 – 3 hours for 50% of your stomach contents to be emptied into the small intestines.  4 – 5 hours for the stomach to be completely emptied.  Note: these times do differ between men and women and depending on what and how much you’ve eaten.

  • Try staying upright, opposed to lying down, especially after eating.  If trying to sleep, you may try propping yourself up slightly with a pillow.  In early stages of pregnancy if you find it too difficult to sleep propped up, you may try lying on your left side as this helps with digestion.  It is not recommended to sleep on your back in later stages of pregnancy.

Restricted Breathing

 As the uterus and baby grows there becomes less space through the abdomen.  This can impede the diaphragms movement making breathing restricted.  Other postural changes such as the growing belly drags on the lower rib cage, also affecting the diaphragms ability to move freely. 

 

Osteopathy can help by creating more space for the uterus and baby to move, reducing some of the pressure on the diaphragm.  Releasing restrictions and tension through the whole rib cage and the diaphragm itself also allows breathing to be less restricted.

 

 
 

Nausea and Vomiting

Vomiting can cause physical strains through the abdomen, upper back, and neck that osteopathy can release.  Improving circulation to and from the liver can also assist in reducing nausea.

 

Headaches and Migraines

Headaches and migraines can be a mixed bag during pregnancy.  Some women may experience more headaches and migraines during pregnancy and others will not have as many headaches or migraines if they have previously had them.  Often if migraines had been triggered around your menstrual cycle, you may notice an improvement when pregnant.  It’s unknown exactly what causes headaches and migraines during pregnancy, but it’s likely related to an influx of hormones and new chemistry while pregnant, in addition to increased blood volume, which may be why these complaints are more common in the first trimester of pregnancy and often resolve during the second and third trimester. 

 

Osteopathy can help by working through structural factors that may be causing your headaches and migraines.  We can help by improving joint mobility and muscular tension; improving blood supply and circulation; reducing nerve irritation; improving posture; giving advice on correct posture, exercises and stretches, stress and tension relief, breathing, and ergonomic setup.

 

Red Flags:  Headaches in the second and third trimester can be a sign of preeclampsia.  Preeclampsia is a condition in which the placenta is not functioning properly and the kidneys and liver may also be involved.  In the early stages of pregnancy blood vessels develop to supply the placenta with sufficient blood flow.  It is believed that in preeclampsia these blood vessels do not develop correctly, being more narrow and reacting to hormonal signalling differently, limiting the amount of blood flow.  The condition is characterised by high blood pressure (when blood pressure has previously been normal), increased protein levels in your urine (proteinuria), and often swelling in the face, legs, feet, and hands.  Other symptoms may include, rapid weight gain as a result of fluid retention, abdominal pain (usually the upper right abdominal area, under the ribs), severe headaches, changes in reflexes, decreased levels of platelets in your blood (thrombocytopenia), reduced or no urine output, dizziness, vomiting and nausea, shortness of breath, and visual changes.  Preeclampsia would normally develop after approximately 20 weeks gestation, but it can develop earlier in some women.  If preeclampsia is not detected early, it can lead to eclampsia, a much more serious condition for you and your baby.  The only cure for preeclampsia is delivering the baby, at which the condition normally resolves.  In rare cases postpartum preeclampsia may develop after delivery of the baby.

 

While headaches and migraines can be normal during pregnancy, it is still recommended you seek advice from a trained professional if you are concerned, as sometimes they can be a sign of something more serious. 

 

You should seek further medical attention if:

  • You develop a headache for the first time in your second or third trimester.

  • You have a sudden violent headache.

  • You have a headache with fever and neck stiffness.

  • Nothing will relieve your headache and you have other symptoms such as visual changes, slurred speech, drowsiness, numbness, or a change in normal sensation.

 
 

Low Back/Lumbar and Nerve Pain

One of the most common complaints during pregnancy is low back pain.  This is most likely due to your growing uterus and baby, and hormonal changes.  As your uterus grows it shifts your centre of gravity causing structural changes such as an increased lumbar lordosis/curve and anterior pelvic tilt, and your abdominal muscles are stretched and weakened.  This increased weight through the front and other structural changes affect your posture and put strain on your low back causing pain. 

 

In addition, nerves may end up being compressed causing nerve pain.  Nerve pain may be felt locally in the low back or can radiate to your legs.  Sitting or standing for long periods or lifting can make it worse.  When lower back pain radiates into the buttocks and thighs, it's often confused with sciatica, a relatively uncommon condition.  True sciatica during pregnancy affects only a small percentage of pregnant women.  If you have sciatica, your leg pain will usually be more severe than your back pain.  You're likely to feel it below the knee as well, and it may even radiate to your foot and toes.  And you'll probably feel a tingling, pins-and-needles sensation in your legs or possibly some numbness.  Seek further medical attention immediately if you feel weakness in one or both legs, or lose sensation in your legs, groin, bladder, or anus (this may make it hard to pee or have a bowel movement, or alternatively, cause incontinence).

 

Not only does low back pain cause a difficult and uncomfortable pregnancy, but if it is not resolved before labour, it may cause additional discomfort that could be avoided if addressed earlier. 

 

Osteopathy can assist in reducing some of the pressure on certain areas of the back be balancing the load and releasing tight achy muscles and nerves that may be entrapped.  We can also offer advice and recommendations on posture and exercise that may help.

 

What you can do at home:

  • Be mindful of your posture.  Avoid locking the knees and letting the pelvis tilt forward, creating excessive extension (curve) through the lower back.  Try and tilt the pelvis back slightly and move towards a more neutral curve in the low back.

  • Strengthening exercises for your core and back.  Please consult a health professional before starting these.

  • Swimming and walking are good low impact forms of activity you can do while pregnant to help keep strong and mobile during your pregnancy.

  • Pelvic tilts and cat cow can help relieve low back tension.

 

Ligament Pain (Round Ligament)

There are two round ligaments, one on either side of the uterus.  They attach to the upper sides of the uterus and run through the inguinal canals (located in the groin region) and connect with the mons pubis (the tissue that sits over the top of the pubic bone).  These ligaments are about 10 – 12 centimetres long and they increase in diameter and length as the uterus grows during pregnancy.  Their role is to help maintain the anteversion position of the uterus as it grows.  

 

Due to the increased tension on the ligaments they can spasm or contract causing a short, sharp, jabbing, cramping pain in the lower abdomen and groin regions.  Although painful, it is considered a “normal” and safe pain during pregnancy.  It’s normally experienced during the second trimester, and more commonly felt on the right side, although you can experience it on either side or both sides.

 

You may feel round ligament pain as a short, sharp or stabbing pain if you suddenly change position, such as when you're getting out of bed or a chair.  You may feel it when you cough, roll over in bed, or get out of the bathtub.  You may also feel it as a dull ache after a particularly active day, like when you've been walking a lot or doing some other physical activity.  Usually, the pain of the round ligaments is temporary and resolve spontaneously by resting or changing position.  However, if pain persists, immediate follow up with a doctor is recommended to rule out other more serious causes of pain during pregnancy.

 

Osteopathy can help by releasing some of the tension on the round ligaments and assist you in maintaining good posture during your pregnancy, which will also help reduce some of the tension on the ligaments.

 

What you can do at home:

  • Rest.

  • Change positions.

  • Avoid sudden movements.

  • Avoid prolonged sitting or standing.

  • Avoid heavy lifting.

  • Bend forwards slightly when coughing or sneezing if these trigger pain.  This will relieve some of the tension on the ligaments.

  • A heat pack to the area or a warm bath may relieve pain.   But not too hot, as too warmer temperature is not recommended during pregnancy.

  • Daily stretching exercise may be helpful.  Try cat cow and savasana yoga poses.

  • Place a pillow between the knees and under the belly when lying on your side.

  • Be mindful of your posture.  Avoid locking the knees and letting the pelvis tilt forward, creating excessive extension (curve) through the lower back.  This posture will put more stretch on the ligaments.  Try and tilt the pelvis back slightly and move towards a more neutral curve in the low back.

  • You may find a maternity belt helps.

 

Varicose Veins and Haemorrhoids

During pregnancy, your blood volume increases, while the rate at which blood flows from your legs to your pelvis decreases.  This puts pressure on the veins, which cause varicose veins.  Varicose veins are enlarged veins that commonly occur in the legs, although during pregnancy they can also appear on the buttocks and vaginal area.  Hormonal changes can also lead to varicose veins as increased progestin levels can dilate the veins.  In addition, during pregnancy the uterus puts pressure on the inferior vena cava (the vein that carries blood from the legs and feet to the heart), further contributing to varicose veins.  Varicose veins are generally harmless, although they may become itchy and uncomfortable.  Haemorrhoids are another form of varicose veins.

Haemorrhoids are swollen veins in and around the anus and lower rectum.  They can cause itching, burning, pain, or bleeding and they are common in pregnancy, particularly the third trimester due to extra pressure through your pelvis and on the vena cava.  Being constipated can also cause haemorrhoids as straining to have a bowel movement can put added pressure on your veins.

 

Osteopathy can help with venous return by releasing tension and pressure through the pelvis and diaphragm.  Soft tissue massage can also help with circulation through the legs.

 

What you can do at home:

Varicose Veins

  • Avoid sitting and standing in the same position for too long.

  • Avoid wearing high heels.  Walking in flat shoes helps with circulation by using your calf muscle as a pump.

  • Keep moving with regular exercise.

  • You may find compression socks helpful.

  • Avoid crossing your legs when sitting.

  • Elevate your legs at times to help with circulation.

  • Sleeping on your left side will help relieve some of the pressure off the vena cava.

  • Reduce sodium intake to limit swelling.

  • Avoid becoming constipated.

 

Haemorrhoids

  • Soak in a warm bath, but not too hot.

  • Avoid sitting for long periods.  Sitting for too long puts pressure on the veins in the anus and rectum.  You may like to try sitting on a ring cushion.

  • Avoid becoming constipated.

 

Carpal Tunnel

Carpal Tunnel is a common complaint during pregnancy.  It is often a result of fluid retention which occurs when pregnant.  This fluid retention causes increased pressure in the carpal tunnel, which is a space in your wrist formed by wrist bones on three sides and a ligament that runs across the top.  The median nerve and tendons that move the fingers run through this space.  The median nerve is responsible for sensation to the thumb, index, middle, and half of the ring finger and is also responsible for some movement of the thumb. 

 

When the median nerve is compressed the symptoms of carpal tunnel may be felt including numbness, tingling, and pain or an ache in the wrist, hand, and fingers, hand stiffness, and a weakened grip.  Normally, carpal tunnel will not be experienced until the second trimester as this is when more fluid is retained, however, some women can experience it earlier.  The symptoms can come and go and are often worse at night.  Sometimes, pain may extend further up the arm also.

 

Osteopathy can help be moving some of the built up fluid in the arms and creating more space through the carpal tunnel.

 

What you can do at home:

  • Try and avoid activities that make it worse.

  • Avoid sleeping on your hands.

  • You may find wearing wrist braces at night help.

  • Self-massage through the forearms.

  • Ensure you are correctly setup at your work desk and computer.

  • Take short breaks at work to move and stretch your arms, wrists, and hands.

  • Find a pregnancy yoga class.

 

Pelvic Instability

Hormonal changes in pregnancy loosen your joints by relaxing the ligaments in your pelvis and low back.  This can make you feel less stable and cause pain when you walk, stand, sit for long periods, roll over in bed, bend over, lift things, or get out of a low chair, car, or the bath.

 

Osteopathy can help by correcting any structural imbalances that may be putting extra load on certain joints and ligaments.  When appropriate we can prescribe gentle strengthening exercises to help provide a little more stability during your pregnancy.

 

Costochondritis (Rib Pain)

Costochondritis is inflammation of the cartilage that attaches the ribs to the sternum, causing localised chest pain and tenderness when touched.  In later stages of pregnancy the lower rib cage expands as a result of being stretched by the growing uterus and baby.  This stretching can cause inflammation at the costosternal and the costochondral joints which are the joints between the costal cartilage and sternum and the costal cartilage and ribs respectively.  Normally costochondritis occurs in the upper ribs, but during pregnancy it may be experienced through the lower ribs also, as a result of the stretching and expanding happening here.

 

Osteopathy can help by stretching the soft tissue/muscles that attach to the ribs, including the diaphragm, to release some of the tension on the ribs and cartilage.  We can also help by creating more space for the baby, reducing some of the pressure through the lower rib cage.

What you can do at home:

  • At home you could try using an ice pack on the painful area to reduce the inflammation.  Apply it for 20 minutes at a time, directly on the ribs that are affected.

  • You may also find some relief from stretching the chest.

 

 

Swelling and Fluid Retention

Swelling (oedema) is a normal part of pregnancy as a result of increased fluid and blood.  This swelling actually helps soften the body  to accommodate your growing baby and prepare the pelvic joints and tissues for labour.  Other factors that may increase swelling include hot days, standing for long periods, long days of activity, low potassium consumption, high caffeine consumption, and high sodium consumption.  If swelling occurs suddenly please seek medical advice immediately as this may be a sign or preeclampsia.

 

Osteopathy can help by working on the lymphatic system and circulation.  Reducing pressure through the pelvis and abdomen, assists venous return.  In addition, soft tissue massage to the hands, arms, feet, and legs can also help move fluid, reducing unwanted swelling.

 

Cramping, Achy, and Restless Legs

During the second and third trimesters you may start to experience leg cramping, aching, and restless legs.  You may experience these symptoms during the day, but most commonly they crop up during the night and disrupt your sleep.  A combination of things may lead to these symptoms such as; poor circulation as a result of the growing uterus restricting blood flow; swelling, also caused by poor circulation; the extra weight your legs are now having to carry; dehydration; and some vitamin and mineral deficiencies have been linked to cramping such as magnesium, potassium, and some B vitamins.

 

Osteopathy can help by improving circulation and moving fluid build up in your legs.  Releasing tight and tired muscles may also provide some relief.

 

What you can do at home:

  • Stretching your hips and legs regularly will help with circulation and tight muscles.

  • Avoid sitting cross legged.  Avoid sitting in general for too long.  Avoid standing for too long.  Changing your position regularly is best.

  • Get up and walk around for a few minutes if you have woken with pain or cramping.

  • Magnesium is a safe and often effective supplement to use.  Please always consult a health professional prior to starting any supplementation when pregnant.

  • Rub magnesium cream into the areas of your legs that are cramping and achy.  Please ensure you only use a cream that is safe during pregnancy, some have added nasties you want to avoid.

  • A foot and leg massage from someone at home.

  • Drink lots of water to stay hydrated.

 

Pelvic Pain (Sacroiliac Joint Pain/SIJ, Symphysis Pubis Dysfunction)

Posterior pelvic pain is felt in the back of the pelvis through the sacroiliac joint/s.  This is the most common type of low back pain during pregnancy.  It may be felt as a deep, sharp pain on either one or both sides of your buttock region.  The pain is not normally constant, but felt when walking, climbing stairs, standing on one leg, getting in and out of a car or the bath, getting up from sitting, rolling over in bed, twisting, lifting, bending, or leaning forward when sitting.  Women with posterior pelvic pain, can often have pain over their pubic bone too, this is called symphysis pubis dysfunction.

 

Osteopathy can help relieve the symptoms of SIJ pain and symphysis pubis dysfunction by gently improving the mechanics of the lower back and pelvis.  This also helps prevent additional unnecessary pain during labour.

Birth Preparation

Osteopathy not only assists with aches and pains during pregnancy, but it can also help prepare you physically for labour.  Removing or reducing any pregnancy related pain is the first step to avoid any added discomfort during your birthing process.  It's also important to correct any low back and pelvic dysfunctions to promote an easy passage for the baby to birth through.  For example, you have two deep large muscles called psoas muscles that run down either side of your abdomen and they act like guide ropes for the baby during labour.  If there is an imbalance between these muscles they can affect the direction the baby will move down into the pelvis.  In addition, if pelvic alignment is not optimal it can also impact the direction the baby travels through the pelvis, possibly creating difficulties and more pain.  Addressing structural imbalances and dysfunctions sets you up for the best chance at having less complications during labour.  Osteopathy uses gentle and safe techniques suited specifically for pregnancy.  In addition, we can teach you breathing exercises and provide you with exercises for birth preparation including pelvic floor stretches.