HELP! My Baby Wants to Snuggle and Hates Being Put Down

While pregnant you probably read every article on the internet on all the gadgets and goodies you need once the baby arrives to make sure you have a baby registry that sets you up for success. The best crib, bassinet or co-sleeper? Check. The best carseat? Check. Information on the best butt paste and breast pumps were readily available. Information on what to expect in those first few weeks? Yeah…not so much. Now that you just had the baby you may find yourself in a whirlwind of emotions asking yourself, “is this normal” and thinking, “nobody told me this was a thing”.

Picture this scene - you are wrapped in a nice and cozy, warm blanket constantly being rocked to sleep with music always playing. That seems pretty freakin’ fantastic, right? Well, not so long ago that is where your baby was at while in the womb. Being rocked back and forth in a pool of amniotic fluid, wrapped in the warmth of your body listening to the sweet sound of your heartbeat. Now that they made their great escape, everything is different. It’s cold, they are no longer wrapped and rocked to sleep and they have this newfound freedom to move while noises and lights are different and really really loud and bright. The only thing that isn’t new is the comfort of you. Of course they want to snuggle up and be next to their protector; you’re the only thing they recognize in this new world! It is not only common but it is normal in those early days for babies to want and need to be held. They are not trying to be spoiled or manipulate you, they are simply seeking the same comforts they had while on the inside—a steady heartbeat, warmth and the gentle sound of your breath.

Just because it’s normal for babies to need to be snuggled, it doesn’t mean it is always easy. I remember those sleepless nights, questioning if I was doing anything right and calling friends before the crack of dawn for support and guidance. The best thing I did was focus on my personal needs (and wants). I focused on breathing, gentle movement, snuggles, and filling my cup emotionally and with quality nutrition.

Lying-in during the co-regulation period can be a huge stress reliever in those early days as it takes away the unrealistic expectations that you “should” be out and about showing off the baby. The baby won’t know if she met Great Aunt Susie Q at 2 days or 2 months, but she will recognize and sense your stress levels if you’re anxious about going out. If you aren’t ready to leave the house, don’t! Lying-in gives you an amazing opportunity to support your needs and desires while also working to build a relationship with the newest member of your family. Skin-to-skin helps keep the baby warmer, stabilizes blood sugar levels and even helps regulate breathing. This can lead to better bonding, less crying, decrease in postpartum depression and maybe even better sleep for both of you (no promises)! With skin-to-skin you may be thinking, but what about visitors? That’s the glorious part about being a new mom, you can say no. For me personally, if you want to visit but don’t want to see me wearing nothing but a tank top or nursing bra, you may want to wait a month or so.

Once in the recovery period, it’s great to continue skin-to-skin and also get up and start moving around more. One way to ease back into your new reality is to take the babe with you. Go out and walk with your baby. She still wants and needs all the snuggles so baby wearing is a great option to allow you to get up and get back to moving.

Last, but certainly not least, it takes a village to raise a child. There is great strength in asking for help. As Doula-Extraordinaire, Jenny Anderson in Bend, Oregon said, “Postpartum is a tricky, cloudy, and confusing time. Connecting with your community, and asking for help from lactation experts, doulas, therapists, doctors, family, and friends is a sign to the world that you recognize your own boundaries and that you are not expected to do all of it alone. You are mama. Not a mama AND a lactation expert AND a doula AND a therapist AND a doctor AND a maid AND a gourmet chef AND … AND … AND ….You are perfect as a mama, with a powerful support system.” I can tell you that raising my daughter through the early days wasn’t easy but it was definitely easier with the help of friends and late-night texts, early morning calls, food delivery, laundry and housecleaning support from my mom and an amazing lactation consultant who came to my house along with my own chiropractor and acupuncturist. The support is around you, it’s just important to ask for what you need.

And mama, you’ve got this! If you are in the area, I’d love to set up a free 15 minute Healthy Mama strategy session call to discuss how we can help you create the postpartum you want.

XOXO- Dr. Lauren

Pubis Pain aka “Lightning Crotch” or Pelvic Pain During Pregnancy: Part 2

Part 2 - Managing pubic symphysis dysfunction through exercise

Not sure what pubic symphysis dysfunction is or the causes? Check out Part 1 for more information!

The most important thing to know is that each mama is unique in her needs. For that reason, it is important to see a chiropractor or physical therapist with additional training in pregnancy and postpartum to find out what your specific needs are. With that being said, there are some general guidelines. Y’all know by now that I love mamas to stay active during pregnancy but there are some exercises that are best modified or temporarily taken out when you have SPD.

The ‘Don’ts’ of exercising with pubic symphysis pain (exercises to avoid with lightning crotch):

• Don’t over-stretch

  • Yes, it is possible to over-stretch, especially during pregnancy when relaxin and progesterone are helping muscles and ligaments relax in order to prepare for birth. If you are doing yoga or pilates, it’s a great idea to not push mobility at the end of any pose as this can increase your risk fo stretching too much and destabilizing the pelvis

• Limit single leg movements for a few weeks (2-3 weeks) and slowly add them back in your routine to see if you can manage the load. If not, that’s OK…you can take them back out. If they do not increase or cause pain, it’s a great idea to add them back!

  • This includes taking out lunges, bulgarian split squats, pistol squats, warrior pose, assault bike, and step ups as all of these exercises are one-leg dominant and can increase shearing on the pelvis.

  • Here’s the catch…some mamas actually benefit from single leg movements with a little modification. If you notice that deep lunges cause pain, you can modify it! First, try to change the position of your feet by bringing them closer together. You may notice that by bringing your feet closer together decreases your pain but still lets you use those muscles. This is great! You can strengthen this area and then try to increase the distance between your feet as you get more comfortable. The next thing you can change is the depth or how far down you go into the lunge. If a full lunge causes pain, try to lunge at half depth or a quarter of the depth. If you are able to do these without pain, that’s great - you should continue to do them! Our goal is never to exclude the movements you love but to work with them to see what can work with your body at this time.

• Use caution with traditional “core” exercises 

• Traditional core exercises like sit-ups and crunches focus on activating one or two muscles independently of the core system (diaphragm, pelvic floor and all abdominal and back musculature). Working these muscles can actually pull on the pubic rami and increase pain. Core exercises like the plank are advanced and require full pelvic/core stability and joint centration (the pelvic floor and diaphragm should be aligned). It is common for mamas to compensate during this movement as their natural gravity shifts and this compensation can lead to increased pelvic and low back instability.

• Watch deep squats or sumo squats

  • I love deep squats because the bottom of a squat is when the pelvic floor is most relaxed (hello benefits in labor) BUT that stretch can be too much with pelvic pain. If you notice pain with deep squats OR after deep squats, it’s okay to take them out.

• Adductor stretch or adductor machines 

  • The adductors are connected to both the inner thigh and the pelvis and can definitely play a role in pelvic pain. Like most everything, it is best to figure out if the adductors need relaxed or strengthened. If you are constantly stretching and they don’t feel better, they may actually need strengthened! Vice versa, if you’ve been working hard to strengthen the adductors but they continue to be sore, you may need to calm the signal from the brain to down regulate this pain. The best way to know this is to see a professional who can guide you in what your body currently needs.

• Fast/explosive movements 

  • We want to continue moving during pregnancy but fast and explosive movements require the musculature around the pelvis to respond quickly and when there is pain this reaction is often slower. It is easier to compensate and not utilize the appropriate muscles to create the force to stabilize.

Exercises that may improve pubic symphysis pain

• Focus on posture and pelvic alignment

  • As you stand and walk your diaphragm should be aligned with your pelvic floor — this is a neutral spine. If you drop into too much anterior or posterior pelvic tilt this can increase pain/pressure on the pubic region. So one easy exercise to stand in front of a mirror and focus on finding that neutral spine.

• BREATHE

  • As we inhale, our pelvic floor gently descends and relaxes and as we exhale it gently lifts and contracts. This is a normal progression with diaphragmatic breathing that naturally helps to activate the deep abdominal muscles and stabilize the pelvic region with the breath

• Balance strength and mobility

  • All movements should be slow and intentional to start to focus on maintaining task-specific pressure (that’s the amount of support/brace/natural tension you need to create to stabilize the body). This intention trickles down to balancing strength and mobility so we aren’t over-stretching or strengthening a muscle that does not have its full range of motion.

• Work the glutes and adductors in synergy through movement

  • Banded monster walks

  • Glute bridges with band around knees and yoga ball or block in-between knees

  • High Bear or low bear: with bands around knees and yoga ball or block in-between knees —> if you are able to do this and looking to advance the movement without doing a bear crawl, you can simply lift and hold one arm or one leg at a time

  • Hip Hinge or banded good mornings

  • 90/90 or Shin box flow: this is a movement where slow and intentional movements are best

• Work all of the core together

  • Box squats: i mentioned earlier that deep squats may not be beneficial but shortening the range of motion to the point before there is pain can be extremely helpful in pelvic pain and keeping pelvic mobility with core stability

  • Side bridge

  • Bird dog with pelvic floor focus and focus on breathing and elongating spine

  • Dead bug with focus on crossover

Part 3: Labor and Delivery considerations for pubic pain

Mama, if you are struggling with pubic symphysis pain or any pelvic pain, I understand the frustration, anger and fear that comes along with it. I believe that no woman should have to suffer through pregnancy or postpartum in pain. Call 331-307-7110 to schedule an appointment today or book online. Not ready yet? That’s OK, schedule a free 15-Minute Healthy Mama strategy session today to discuss your options.

Symphysis Pubis Pain aka “Lightning Crotch” or Pelvic Pain During Pregnancy: Part 1

Part 1 - What is pubic symphysis dysfunction and what causes it?

Symphysis pubis pain is unaffectionately known as lightning crotch. It's that feeling that 20% of pregnant women know all too well—the sharp and sudden pain deep in their pelvis. The feeling of their pelvis shearing, pain that can stop a mama mid-step or leave her gasping for air trying to roll over in bed. Affecting 1/5 of all pregnancies, it's important to know what it is and what to do if you are one of the mamas affected.

What is the pubic symphysis?

The pubic symphysis is a cartilagenous joint that connects the left and right pubic rami. The pubic symphysis helps transfer weight during normal activities like walking but also helps to stabilize the pelvis.

During Pregnancy, the pubic symphysis opens and expands in order to make more space for the baby to descend. With the help of hormones, the average pubic symphysis widens 3mm (30-40% of normal) during pregnancy and up to 20mm during labor. This widening is extremely beneficial to allow the baby to rotate, the pelvis to open and the baby to descend. 

What are the signs and symptoms of symphysis pubis dysfunction (SPD)?

SPD can present in many ways from a mild twinge of pain to a debilitating pain. Here are a list of ways pubic symphysis pain can show up:

• Sharp or shooting pain at front of pelvis, vagina, rectum or pelvis (hello, one of the causes of lightning crotch)

• Pelvic/pubic radiating to upper thigh/groin

• Throbbing or deep achy pain around hips, low back, lower abdomen or perineum (between vagina and anus)

• Pain with transferring weight from one leg to another - pain with walking, standing on one leg, climbing stairs, getting in/ out of the car or bed and rolling over in your sleep

• Clicking or popping sound of pelvis accompanied with pain or discomfort

• “Pregnancy waddle” to avoid pain
  

What causes pelvic pain during pregnancy?

Like most of women’s health care especially around pregnancy and postpartum, we do not know the cause of SPD. Realistically, there is not one cause but instead SPD is related to a variety of factors and it’s important to find the root cause for yourself. However, here are some theories as to the links/causes of pelvic pain during pregnancy and postpartum:

1. Prior pelvic trauma 

2. Hypermobility

Whether you have a connective tissue disorder like Ehlers-Danlos Syndrome or are just generally bendy, excessive mobility in the pelvis can lead to increased instability.

3. Pelvic joints not moving properly (unequal muscle pull), bony misalignment 

As we naturally progress throughout pregnancy we alter our general posture including the angle of our pelvis. Changes in biomechanics along with added weight and gravity can lead to increased pressure in the pubic region

4. Baby positioning 

Those kiddos can be an adventure before they even make it Earth-side. If a baby is posterior, asynclitic or transverse, it may lead to increased pressure or pain on the pubic bone. For ideas to help baby positioning, check out the free download “Optimizing the Pelvis Through Pregnancy” or check out Spinning Babies or Miles Circuit.

5. Repetitive motion

If your occupation, hobbies or past fitness routines were one-sided, this may be shown in muscular imbalances that can lead to uneven force transfer and mobility/stability. 

6. Hormones

During the 1st trimester there is an increase relaxin and progesterone. This helps increase joint laxity to allow for the opening of the pelvis. The studies are inconclusive but this increase in relaxin may be related to SPD.

Stay tuned for Part 2- Managing pelvic pain through exercise and mindset

Part 3 - Labor and Delivery Considerations with pelvic pain

7 Tips from a Chiropractor and Mom to Help You Have a Great Pregnancy

Pregnancy Tips to Help You Prepare for Birth

Pregnancy is an amazing time when our bodies are going through a wild ride of transitions from bloating and constipation to swollen feet and possibly even fear of the unknown. It’s also a time that we are creating a beautiful life that we will soon welcome. Even with the hiccups in life, that doesn’t mean we need to succumb to the negatives! In fact, I believe that pregnancy should be (mostly) enjoyable. Here are my top 7 pregnancy tips:

1. Focus on Core Strength & BREATHING

   To improve core strength means you are also improving pelvic girdle strength and helping cultivate a strong pelvic floor that is able to dynamically move through labor and delivery. The core is naturally activated through proper diaphragmatic breathing and moves in connection with the diaphragm and pelvic floor to help RELAX the pelvic floor. Being able to appropriately activate and relax the pelvic floor is important during labor because it may decrease 3rd and 4th degree tears and the need for an episiotomy! Another added bonus is that working on core strength during pregnancy can speed up the recovery of diastasis postpartum.

2. Avoid Constipation during Pregnancy

   I know this is about postpartum constipation, but the 5 of the 6 suggestions (+ the bonus) all may help relieve constipation during pregnancy. So go ahead, eat more veggies, stay hydrated and don’t hesitate to buy one of the best inventions ever, the Squatty Potty. Avoiding constipation can relieve pressure on the pelvic floor that can lead to dysfunction later on. Plus, who doesn’t love a daily BM?

3. See Pelvic Floor Specialist AND a Chiropractor during Pregnancy

   For some reason think this is an OR situation but what better way to move through pregnancy than optimizing your body through functional movements and adjustments? I love when mamas see both me and pelvic floor therapist to get the best outcome for their pregnancy. In my opinion, this is one of the best ways for a mama to prepare for birth because it helps her mobilize and stabilize her body in order to support the structural changes that come with pregnancy, delivery and postpartum.

4. Continue or Start Working out / Train for birth

   Training for birth isn’t about reaching new PRs or hitting every gym day at full intensity. It’s about nourishing the body through movement and listening to your body’s needs. It’s about mobilizing the body so it can move optimally while also being strong. Working out during pregnancy can even include learning different positions that can be used during labor and delivery that can help ease pain and keep you moving.

5. Take a Childbirth Education Class

   Did you know the first stage of labor could take Taking a class can help you prepare for the unknown and plan for it. That way when the time comes you aren’t surprised about the changes coming your way. Planning ahead can help you prepare for the birth you desire and just as important, create a backup plan for if things don’t go as planned. Having your ideal plan and working through decisions before you are in pain and possibly scared can be really empowering so you feel you get to make an educated decision!

6. Hire a Doula 

   Full disclosure, I am biased towards a doula. I love doulas because they are able to offer emotional support and knowledge in labor to help a mama move through the delivery process. Even with a supportive partner, a labor doula can help a mama know what to except and calm any nerves that may arise during labor.

7. Listen to and Respect Your Body

   Learn from my mistakes, please! When I was pregnant with my first I had this attitude that I was strong enough to do anything and slowing down was a sign of weakness. I literally worked an eight hour shift with zero breaks and I ate a handful of nuts while in the restroom one day. My idea back then was that strength was determined by how much I physically accomplished. If I was tired, I pushed through. If I was hungry, I held off eating until my next break. I wasn’t going to be weak and take the breaks my body was craving. Sure, I was accomplishing a lot of tasks but I was left physically and emotionally drained. This time around one of my main goals is to listen to my body and respect what it needs. Some days this means eating more food, some days it is resting more and other days I feel comfortable and confident enough to do everything. I know it’s still early in pregnancy but I already feel physically and mentally better because my soul isn’t constantly exhausted trying to check off all of the boxes. So, do what you need to do to fuel your body- that can be rest, less or more activity, less or more food, maybe it’s doing the Expectful app daily and maybe it’s doing more yoga. Each person is different and each mama’s needs can change day-by-day so tune in and check your own needs daily.

Bearing Down / Pooping vs IAP

Key Differences between IAP regulation, Valsalva and Straining

One thing active pregnant mamas constantly hear is to be careful not to increase intra-abdominal pressure (IAP) because it will cause a diastasis or pelvic floor disorders. This is most common in the mamas who still lift and exercise during pregnancy. While the people who say this are all well-meaning and trying to be helpful, they often don’t realize the only way to not increase IAP is to stop breathing and that’s not beneficial to anyone! But before you decide to stop breathing to prevent an increase in IAP, let’s discuss the differences between straining (what people think of when they hear IAP), Valsalva and true IAP

Straining / Bearing Down during Pregnancy

Think of a time that you were really constipated and just wanted to go to the bathroom. That forceful pushing and straining or “bearing down" you did in order to achieve a bowel movement is abdominal straining. During straining the pelvic floor eccentrically contracts and relaxes to help improve voiding. (1) While bearing down can be beneficial in the case of constipation (but still not advised, if you have chronic constipation please reach out to a local functional medicine doctor to help you get better bowel movements), it is not ideal as we move through our daily life. Constantly bearing down/forcefully pushing or bulging the pelvic floor musculature can actually lead to pelvic organ prolapse.

Valsalva during Pregnancy

The Valsalva Maneuver is also when one bears down but in this case the pelvic floor muscle response is to contract and lift the pelvic floor to stop the flow of urine. A few studies have shown that the Valsalva can help with pelvic organ prolapse by reducing the amount the pelvic floor drops but this should only be completed with a trained women’s health physical therapist because if done incorrectly, may lead to a bearing down movement instead. (2,3) 

Intra-abdominal Pressure and Pregnancy

IAP is the pressure within the abdominal cavity and changes can be felt every time you breath. This is accomplished through proper diaphragmatic breathing which naturally utilizes the diaphragm, lower rib expansion and even the pelvic floor! As you breathe in your diaphragm expands downward and slightly outward while the pelvic floor GENTLY relaxes down to mimic the movement of the diaphragm. This movement naturally draws air into the diaphragm and increases IAP to help stabilize the low back and pelvic floor. As you breath out, the diaphragm moves upward and the pelvic floor gently lifts and tightens to support the pelvic floor and surrounding muscles. We want to breathe, stabilize and move all at same time to ensure we are not accidentally bearing down by holding our breath. This is one reason we never recommend someone hold their breath during movements as that more closely mimics bearing down.

IAP Regulation and Pregnancy

IAP regulation should be automatic, relaxed or natural and should focus on generating optimal IAP. IAP regulation includes the gentle expansion of the lower ribs, activation of abdominal and back musculature as well as the pelvic floor without bearing down. This is easier said than done though because it can take some time (and practice!) to retrain our breathing depending on the causes of altered breathing. And yes it might take a little patience to get your breathing out of your chest into your entire abdominal cavity! Once we are able to regulate IAP without thinking about it, this becomes one of the best ways to activate the deep core muscles for better control and stability.

Benefits of Intra-abdominal Pressure and Pregnancy

Dynamic Neuromuscular Stabilization is one of the leading researchers in understanding the benefits of IAP and how to properly regulate the natural changes that occur with breathing. Their research shows that IAP regulation can lead to the following benefits:

• An increase in IAP stabilizes the spine (goodbye low back pain)

• IAP “can unload the spine during static and dynamic lifting tasks” (hello better support while lifting or living)

• Provided anterior lumbopelvic postural stability (goodbye hip and pelvic pain)

• Creates balanced co-activation of diaphragm and pelvic floor (hello pelvic floor health)

• Activates the deep core muscles to allow for optimal coordination of improve joint stability

So the next time you second guess lifting or exercising for fear of IAP, remember that IAP is actually supportive! But you might want to double check to make sure you aren’t bearing down while doing that lift…nobody wants to clean that mess. 

References:

1. https://www.researchgate.net/publication/51038641_Misconception_of_the_Valsalva_maneuver 

2. https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/uog.4082

3. https://www.ncbi.nlm.nih.gov/pubmed/22771226 

4. http://www.rehabps.cz/data/DNS_IJSPT_paper.pdf 

5. Nachemson AL, Andersson GBJ, Schultz AB Valsalva maneuver biomechanics Effects on lumbar trunk loads of elevated intraabdominal pressures. Spine. 1986;11:476–479

6. Hodges PW, Gandevia SC. Changes in intra- abdominal pressure during postural and respiratory activation of the human diaphragm. J Appl Physiol2000;89(3):967–976

7. Hodges PW, Eriksson AE, Shirley D, et al. Intra- abdominal pressure increases stiffness of the lumbar spine. J Biomech. 2005;38(9):1873-80

8. Gardner-Morse MG, Stokes IAF. The effects of abdominal muscle co-activation on lumbar spinestability. Spine. 1998;23(1):86–92

9. Gandevia SC, Butler JE, Hodges PW, et al. Balancing acts: respiratory sensations, motor control and human posture. Clin Exp Pharmacol Physiol.2002;29(1-2):118-21

10. McGill SM, Grenier S, Kavcic N, Cholewicki J. Coordination of muscle activity to assure stability of the lumbar spine. J Electromyogr Kinesiol.2003;13(4):353-359