So being on the other side of birth as a Women's Health Physio...what are my thoughts; Firstly that I survived, yes! Has it changed my perspective on things? Will I Support ladies differently when treating them? Did I do my pelvic floors as I preach to others? Find out here in my reflections and thoughts on my preparation for labour and the process from start to finish ....
So our little baby girl arrived 12 days early, this took me, my husband, family and pilates class that I was due to run that day entirely by suprise! I woke that morning happy and relaxed with a lazy morning in bed, enjoying materntiy leave, I reached for my phone and sent a facebook post to my dad wishing him a happy birthday, thanking him for all his love and support and stated 'bets on to see if you have a granddaughter with the same birthday!'....now on reflection I am sure through some physiologically hormonal in tune way I knew it was going to happen....I was also due to run my final pilates class that afternoon and I had made sure to send information to my colleague who was due to cover from the following week just in case anything was to happen....Who knows, maybe it was coincidence.
So that morning I went for a sunny walk with my family and dog to the local park and made a comment that I had started to waddle in the past few days and suddenly felt a bit lethargic with wanting to do things which is not like me...I had the idea of maternity leave being a chance to do DIY and get things done, pah! I also had a little pelvic pain around my hips and lower back more so that day a little like period pains.......this turned out to be it all kicking into action! We then went for lunch at a restuarant with 7 members of my family, and I could have eaten a horse I was so hungry. I had myself a yummy spinach and ricotta cannelloni and wanted to drink loads, I made a comment to my mum that my period type aches had started to get a little wave like and stronger. Minutes later I felt this almighty swelling and pressure in my lower tummy and a sudden sensation of release and I was soaking wet! .....an immediate feeling of excitement grew within me, and I turned to my mum to say I think my waters have just broken, to which she could see immediately what I was referring to. The chair and my lap were soaked! So there I was in the middle of a restaurant with potential panic and embarassment to set in, but I truely account for the sense of calm that washed over me to the hypnobirthing course and its preparation both me and my husband had done over the previous 6 weeks.
'Own your Birth' Hypnobirthing course led by Hypnobirthing trained midwife Emma Dufficy Rope, was money well spent. We went to four evening sessions with her, along with two other couples. Emma highlighted at the beginning that having your birthing partner there was as important as you going through hypnobirthing as they are your 'toolkit' provider. Both of us invested in it whole heartedly and I would 100% like to highlight that it isn't going to work for you if you just turn up to the sessions and then go away and not talk about it or spend time practising.....come on practising relaxing is hardly the biggest chore! So we made no excuses.
The sessions consisted of learning about the physiology of labour which is truely fundamental to getting into the hypnobirthing mindset. Emma explained the physiological origin of perceived labour pains and the purpose of them. She removed the idea of pain from our vocabulary with the use of 'surges' rather than 'contractions' and 'labour', and helped us to adjust our mindset and outlook on 'surges' as a positive not a negative experience, by emphasising that they would bring us closer to meeting our little ones. She also allowed us the time to discuss and verbalise to one another what our most wanted and most dreaded labour experience would be, this helped me and Ady to communicate and be prepared for how to deal with such situations if they arose......and to be realistic that they might occur rather than wearing a pair of rose tinted glasses and deny all acceptance of complications arising. It was so important to work as a 'team' rather than having our own experiences seperately, and i owe Ady everything for really getting on board with it for me. Emma taught us many different forms of relaxation which were great, this mostly taught us the power of distraction and focus. Breath control was also a huge part of this, this formed one of my main distraction strategies in labour. All of the above strategies have the aim of tapping into our own natural analgesic, the 'love hormone' oxytocin which is produced in high levels in pregnancy but off the chart levels in labour.
With all this in our 'toolkit', it made me the calmest and most collected member of my family in that restaurant..they were all hysterical wanting to call me an ambulance! In a timely and calm way I managed to call the hospital, call Suzie who kindly covered my pilates class that day, and call my husband whilst also getting a change of clothes and organising my family and who was going to drive me home. My mum drove me home, and in all the confusion we had left my house keys with my dad.....panic neaaaaarly struck but instead, I took some deep breaths and used my surroundings as a form of focus; taking in the country air, feeling the beautiful warm sun on my back and having a walk around the garden whilst we waited for Ady and the keys so we could get the all important hospital bag and head to hospital!
Ady arrived, excited as well (whether he was secretly pooping himself we shall never know!), he did a great job of keeping me calm and happy, packing the car up. Hugging my mum and dad (who had also arrived by then) goodbye was such a ground breaking moment to know that when we saw them next we would have given them a grandchild :)
I waddled into the car with contractions that were timing pretty regular at 3-4 minutes apart for 30-45 seconds (things were appearing to progress quickly!) and set up my TENS (transcutaneous electrical nerve stimulation) machine and oh waow was it good. I turned it up as I could feel a contraction building and it really helped to dampened it down and help me focus on deep breathing with a long expiration, blowing out all the tension. Our journey went smoothly, a lovely sunny drive with no traffic thankfully. As we walked across the hospital carpark it was apparent things were progressing as I was finding it hard to walk during a contraction.
As we arrived at the hospital, we were immediately transferred to the central delivery suite rather than the midwife led birthing unit. It was explained to us that due to our little lady having a poo inside me which was obvious when my waters broke that they recommended she needed constant CTG monitoring with a strap around my tummy and ideally this needed to be done on my back....at this point Emma and her mindfulness skills came in very useful. Nearly all mums want a water birth and to hear those words that it had been denied from you could easily send you in a state of whole body mental and physical stress with a total plummet of all the oxytocin levels we had been working so hard to keep high. So i had to make a decision about how to address this. I had one of the last coherent conversations prior to her being born then with the midwife, and reasoned with her that i would really like to be able to move around if i can't be in the water, as this was one of my biggest fears that we had practised and rehearsed in the sessions. She then agreed to check her heart rate and if she didn't seem in any distress i could be up on the bed rather than lying down. This helped to give me some element of feeling of control and empowerment in the situation rather than be completely useless, and as everything was fine i managed to stay in a high kneeling position for the next 6 hours!!! In that time i had the Julie Flood hypnobirthing CD on repeat (god only knows how many times the poor midwife Anna and Ady heard that!), which kept me focused the whole while on my deep breathing and visualisation exercises. I didn't hear the CD as much as Ady or Anna as i was in a fluctuating state of consciousness and subconsciousness, it is now so hard to describe the feeling but I was 'away with the fairies', at one point I was dreaming and nearly started to talk to Ady as if my dream was real! To the point that Anna could only work out if i was having a contractiuon by the CTG machine readings....I blocked out every beep of the machine, every conversation of staff walking in and out and managed to focus and tell myself none of that mattered, I was in control.
I then got to a point of feeling the need to go for a poo (lovely I know!) and Anna said right its time to push, for an hour and a half I was then stood or leaning over the bed making good progress but due to the protocol of not pushing over a certain length of time when the baby has had a poo already the decision was jointly made that the doctor come in to assist with a kiwi delivery (suction cap to help hoover her out!). With prior knowledge about instrumental deliveries, episiotomies and tearing and all the statistics running through my head I managed to keep calm and tell myself in that moment it was in her best interest. After two attempts of suction with an episiotomy (cut) out popped our little girl. What a feeling of overwhelming happiness in that moment, having your baby who has gone everywhere with you but you have never met, to be suddenly on your chest. Waow. Undeniable devotion to her from that moment on.
After a little while we managed to latch and feed for the first time which could be such as anxiety ridden moment but all the while Ady was calmly reminding me you can do this, no need to worry and so the oxytocin remained high. In fact for the next 24 hours I was like I was on morphine, as high as a kite! This love drug stuff is great I told myself! and so I made it through with only TENS pain relief to show for it, and to this moment it astounds me just how powerful a state of mind can be. It has got me thinking of Professor Lorimer Moseleys work into the role of thr brain and pain and his stories of those with snake bites or nails in the shoe (https://www.youtube.com/watch?v=gwd-wLdIHjs), which highlights how beautifully our body and all that we feel and perceive is controlled by our brain....and a lot can influence its output; our preparation, hormones, environment, previous experiences and many others. This is another reason I have wanted to share my positive birthing story to help the next lady who is about to go through hers. As first times mums a lot of what we have to go on is what those nearest and dearest say to you, and we have a habit of retaining and remembering the bad horror stories not the good......how does this influence our oxytocin levels do you think?! Interestingly my dog has recently been spayed or the equivalant of a hysterectomy, and she has no idea it has happened and would have been running around as normal from the minute the anaesthetic wore off if she could. Our neighbours 1 year old son just had a heart valve replacement and his mum said he is as happy as can be and no different. Our culture has a quite medical and painful outlook on childbirth and it has me wondering about the powerful implications on a ladies birthing experience and how the culture could creates a vicious cycle of events...
This is just my one experience of birth mixed with a physios scientific mind, I have no idea what my next birthing experience will hold but I certainly know I will be visiting Emma again for our next course of hypnobirthing. I am 100% aware that not everyone has positive birthing stories and this blog has never been written with the aim to cause upset, it is purely to help promote the awareness of strategies to prepare for one of the most life changing experiences. Preparation is key. Visit Emma's website for more info: www.ownyourbirth.co.uk
so, I hope I can influence just one ladies delivery, or outlook on pain in general.
Well hello.....Remember me?! I hang my head in shame that it has been two months since the last blog, but I do have an excuse! There has been a slight development in our lives with the addition of our little baby girl, she decided to suprise us and arrive 12 days early. There was none of this 'first baby always are overdue', don't believe it ladies. She announced her arrival in true movie style via my waters breaking when out to dinner at a busy restaurant with my entire family (details will be in a follow up blog of my experience of labour and hypnobirthing!), and she has been keeping us very busy and wrapped around her little finger ever since.
Only one week earlier at 37 weeks pregnant I had put together a few videos for you of some of the key exercises I incorporated into my pregnancy workout, which helped me to remain active and pelvic pain free in pregnancy, and enjoy an active labour. As highlighted in previous blogs, exercise in pregnancy is encouraged in national guidelines and current research but for the ladies questioning it in early pregnancy, the information and support available to them can still be inconclusive, 'wooly' and thin on the ground. This is where your Women's Health Physio comes into play, a voila! So I have been my own guinea pig and taken one for the team in my own pregnancy, (although there is no secret I am an exercise addict) with good results and no glitches I will be pleased to add!
The videos include; exercises for key pelvic and core muscle groups that need maintaining and strengthening, including; 1) gluts, which are essential in order to cope with the centre of gravity and pelvic tilt adjustments that occur with a growing bump, and 2) the deep abdominal muscles that have to accomodate and support a growing bump, whilst they lengthen and have altered mechanical alignment with the changing contour of the abdomen. They also highlight day to day things to be aware of such as the way you stand, sit to stand and move around with a growing bump, showing you that you can be exercising your core muscles at any time not just in your gym gear.
The aim of the videos are to highlight what level of physical activity is possible to maintain if you lead a healthy and active pregnancy, with a well structured programme and good form. In them I talk about the importance of developing your own body awareness (proprioception), and that the need to understand a good technique with each exercise is paramount. This is above overloading with weight which can lead to poor form, not to mention too much strain through a core and pelvis which is already under strain and under a high intrabdominal pressure system. Your body is going through daily changes and therefore being aware of your form and posture is key in order to avoid injury. Therefore, if you are not familiar with these exercises and haven't been active or doing similar exercises, don't reach for the kettlebell and 'give it a go'. Completing a tailored and structured programme is paramount, A) to avoid injury, B) to save your energy at this time of high demand, and so make it as efficient a programme as possible to achieve the maximum gains.
As mentioned in my previous blog 'Folic Squats', there is a need to targert prenatal exercise uptake and fitness awareness, so that ladies like myself can enter pregnancy fit and able to sustain a programme such as this. This routine is not something I had picked up the week before, but a modified programme I had been doing throughout the year prior to my pregnancy, therefore my body was robust enough to tolerate and thrive.
If you would like to know more of what's possible for you in your pregnancy, I would highly recommend having a one to one with a women's health physiotherapist, or personal trainer who specialises in antenatal exercise. This is not a time to stop, it's a time to listen and become in tune with your body, and care for it. By that I mean don't expect it to have to cope with extra weight gain whilst becoming sedentary, unfit and inactive without repercussions. i.e pain, weakness, and reduced physical tolerance. Don't get me wrong, IT IS important to have those days / evenings on the sofa when you just feel drained from growing your baby and cannot face doing anything at all (I had plenty of those!), but equally keeping with a scheduled regular exercise routine will boost your energy and tolerance in pregnancy....and ultimately help you perform in the grand finally of childbirth and keep you going in those early sleepless baby days! Not to mention reducing your risk of complications in pregnancy such as gestational diabetes and heart related conditions.....a win win really!
Have a look, like and share of my youtube channel 'The Powder Room Physio' where you can view me sporting a nearly ready to pop bump whilst giving demonstrations, advice and education on my pregnancy exercise programme............enjoy! Apologies if you catch an eyeful of my bump making an escape out of my tshirt, it fitted me the week before! And apologies if the sound quality is lacking at times.
Squatting is a very natural position for us to move into, we do varying degrees of it when we sit down, get in and out of a car, on and off the toilet and reach for something on the floor. Over time, we as a race have gotten progressively worse at it as we have developed furniture to assist us with squatting for tasks such as toileting, or preparing food which we would have traditionally done in a deep squat position. It is so important for maintaining range of motion of the back, hips, knees and ankles, it is also excellent at maintaining the length and strength of the buttocks (gluts) and the pelvic floor. It is also excellent to help prepare the body for the childbirth and ensure complete and relaxed pooing!
If you are not used to squatting, it is important to be aware of the ideal posture as it could feel unnatural. The heels should remain heavy on the floor with your body weight over them. Your pelvis should be in an untucked position with the tip of your tailbone pointing up behind you, not tucked under you like a dog with its tail between your legs. Therefore the whole of your spine is extended, and your chest and eyes lifted. You can also start by sitting back on to a higher stool, then a normal height chair, then a foot stool. Good form is paramount so maybe use a mirror or partner to be able to feedback to you.
Deadlifting can be an excellent exercise for working the muscles in your posterior chain (in normal language...the muscles running down the back of you!), in particular your hamstrings (back of thighs), gluts (buttocks) and deep back stabilisers. These muscles are so important for helping you counteract your growing bump shifting your centre of gravity forward and the increasing feeling that you are going to tip over forwards!
If you have never deadlifted before, seek advice from a professional who knows how, such as a women's health physio. Key things you are looking for include;
If all else fails, you cannot go wrong with the step up. This is such a functional exercise, we step up when going up curbs, the stairs, and even in and out of the bath. Applying the principles i describe here of activating your buttocks, thighs and deep abdominals when stepping up and extending can really help to support your pelvis and growing bump.
Pelvic girdle pain can often be felt when stepping up the stairs, practising step ups in a controlled way with focus on muscle activation can help stabilise and support a weak hypermobile pelvis experiencing pelvic girdle pain. If you are suffering with PGP, as pointed out in the video, make sure to make every step count when going on the stairs or even walking along; focus on pushing down through the heel which can aid squeeze of the buttocks and give you more strength, thus reducing the feeling of your leg going to give way.
Last but not least. This is a more complex exercise challenging many body systems including your proprioception, whilst working your glut muscles intensely! It is therefore important to only do this if you are comfortable with understanding the task at hand and can be aware of good form. I would recommend seeking advice from a women's health physio or personal trainer confident in antenatal exercise prescription.
Make sure to explore my youtube channel 'The Powder Room Physio' containing other videos with advice on pregnancy posture, exercise, pilates and pelvic floor function.
Next time I will be sharing with you some of the pilates moves we focus on in the antenatal Bump to Baby and Beyond Pilates class. As mentioned in previous blogs, pilates can be an excellent form of exercise for all in pregnancy to maintain and develop an engaged and supportive core muscular system, so stayed tuned for those!
As mentioned previously, I will also be sharing my own personal experiences of labour and hypnobirthing, ekkkk!!! My role as a women's health physio can involve listening to and supporting ladies with their experiences so I feel it is only fair to share mine. Including all the undesirable bits no one talks about but everyone wants to know...