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Pain after Childbirth

Introduction

Physical Therapy in Chicago for Womens' Health Issues

Welcome to Body Gears Physical Therapy’s resource on pain after childbirth.

While many health issues affect both men and women, there are a number of conditions that only affect women. Women's health is a distinct specialty within the healthcare field. This guide was designed to help you understand the causes and treatment options available for painful conditions which can develop after childbirth. There is no reason to suffer alone – get educated on your condition, speak to your healthcare practitioner about it, and get help.

A woman's body goes through many physical changes before, during and after childbirth, with many of these changes being accompanied by pain. With all the other emotions and physical changes during this time (lack of sleep, excitement over the new baby, spending time with visitors, learning how to be a new parent, etc.), having to deal with pain is the last thing a new mother wants to add to the mix.  Pain can be felt in various parts of the body. This article describes the causes and best treatments for the most common types of pain experienced by new mothers.

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. Body Gears Physical Therapy 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.

Methods of Treating Musculoskeletal Pain

Heat or Ice

Depending on the type of pain, applying heat or ice can offer relief. Aching muscles can benefit from warm compresses or heating pads to increase blood circulation and promote muscle relaxation.  In order to prevent burns, take care to ensure that there is a towel between the skin and the heating pad.  Heating pads are only safe on skin that has normal sensation. The use of heating pads, rice bags, hot tubs or even warm baths and showers can relax muscles and reduce pain. Headaches or perineum pain can often be relieved with the application of an ice pack or cool compress.

Massage

Massage can be very helpful in relieving stress and reducing associated muscle aches and pains.  Post-partum massage is not a luxury, it is a genuine treatment intervention that can reduce pain and facilitate relaxation plus a more balanced muscle length.

Relaxation Techniques

Yoga, deep breathing, and meditation are all good techniques for new mothers suffering from pain. Relaxation techniques can also help mothers deal with other stresses related to having a new baby in the house. During the baby’s nap, resist the temptation to take care of housekeeping tasks. Instead, close your eyes, breathe slowly and deeply, keep your neck and shoulders relaxed and supported, and focus your mind on the present, noting the thoughts that pop into your mind without making judgments or dwelling on them. This type of "mindful meditation" has been shown increase relaxation, as well as improve your mood and pain tolerance [9].

Medications

If you are experiencing pain that can not be relieved by other means, you can speak with your doctor about the possibility of over-the-counter or prescription medications that can help. Many medications can end up in the breast milk as well, so make sure you speak with your health care provider before taking any medications or natural supplements to ensure that they are safe for both you as well as your baby.

References

  1. Sipko T, Grygier D, Barczyk K, Eliasz G. The occurrence of strain symptoms in the lumbosacral region and pelvis during pregnancy and after childbirth. J Manipulative Physiol Ther. 2010;33(5):370-7.
  2. East CE, Sherburn M, Nagle C, Said J, Forster D. Perineal pain following childbirth: prevalence, effects on postnatal recovery and analgesia usage. Midwifery. 2011;In press.
  3. Walker JA. Management of patients with carpal tunnel syndrome. Nursing Standard. 2010;24 (19):44-8.
  4. Ablove RH, Ablove TS. Prevalence of carpal tunnel syndrome in pregnant women. WMJ. 2009;108(4):194-6.
  5. Goldszmidt E, Kern R, Chaput A, MacArthur A. The incidence and etiology of postpartum headaches: a prospective cohort study. Can J Anesth. 2005;52:971-7.
  6. Beard JL, Hendricks MK, Perez EM, e al. Maternal iron deficiency anemia affects postpartum emotions and cognition. J Nutr. 2005;135:267-72.
  7. Soares CN, Zitek B. Reproductive hormone sensitivity and risk for depression across the female life cycle: a continuum of vulnerability? J Psychiatry Neurosci. 2008;33(4):331-43.
  8. McCoy SJ, Beal JM, Shipman SB, Payton ME, Watson GH. Risk factors for postpartum depression: a retrospective investigation at 4-weeks postnatal and a review of the literature. J Am Osteopath Assoc. 2006;106(4):193-8.
  9. Kingston J, Chadwick P, Meron D, Skinner TC. A pilot randomized control trial investigating the effect of mindfulness practice on pain tolerance, psychological well-being, and physiological activity. J Psychosom Res. 2007;62(3):297-300.
  10. Norman E, Sherburn M, Osborne RH, Galea MP. An exercise and education program improves well-being of new mothers: a randomized controlled trial. Phys Therap. 2010;90(3):348-55.