Welcome to the Best of Birthful. Creator and host Adriana Lozada curated and edited each selection in this playlist of the show’s most popular episodes. It’s a tailored introduction to the expansive catalog she amassed over the first five years of Birthful’s 300+ shows.
Massage and craniosacral therapist Molly Deutschbein discusses the structural changes the body goes through before and after giving birth. Explore how the pelvis can affect the uterus and how to keep the body in alignment during the different stages of pregnancy.
- French mothers don’t suffer from bladder incontinence. And nor should you, The Guardian
- Nutritious Movement with Katy Bowman
- 8 Breastfeeding Positions to Make Nursing Easier, The Bump
- The Lymphatic (Lymph) System, Live Science
- Real Food for Pregnancy, by Lily Nichols
Related Birthful episodes:
- Restoring Your Vitality After Birth, with Kimberly Johnson
- Can Exercise During Pregnancy Make Labor Harder? with Deb Flashenberg
- Baby’s Position and Labor Flow, with Gail Tully
- Vaginal Rehab, with Susi Hately
- You Pelvic Floor, with Lisa Gillispie
- Diastasis and Tummy Fitness, with Bethany Learn
- Updates in What You Should Eat during Pregnancy, with Lily Nichols
[Best of Birthful] How Your Body Changes with Birth
Hey, mighty one. With nearly 300 Birthful episodes in over five years, it may be hard to know where to begin listening to the show. To make it easier, we’ve put together the Best of Birthful series, which showcases some of our favorite or most relevant episodes. This is one of those. If you enjoy what you hear, make sure you subscribe. It’s free, and that way you won’t miss a thing. Enjoy.
Hello, mighty parents and parents to be. As always, thank you so very much for all the love you give the show. If what you hear is helpful, make sure you subscribe so you don’t miss a thing. So, today I am renewing an episode with my dear friend Molly Deutschbein, who is an expert in all things related to the soft tissues of the body, alignment, and the nervous system. And I’m super excited for all of you to listen to this, so welcome Molly. Can you tell us a little bit about yourself?
Well, I am a body worker and doula in Rochester, New York. I went to massage school so that I could be a craniosacral therapist, so that’s my primary modality, but before that I was a childbirth educator and a La Leche League Leader, and a lot of my practice has always been with pregnant moms, moms with fertility challenge, babies who are having trouble settling, or with breastfeeding, and now I’ve gone back into actually attending births, which is very exciting. So, I just have a private practice here where I focus on my doula work, and my body work, and I incorporate a lot from Spinning Babies, and the Arvigo Abdominal Massage, and craniosacral therapy. They all come together for a really nice, well-rounded approach to keeping people healthy through the childbearing season.
Lozada: And I love that you’re always learning and adding more things. You’re certainly… You’re like me. Really curious of like, “Ooh, what about this part and how does this connect with that?” Yeah. All the things integrate, which is why I thought you were the perfect person to come and talk about these structural changes, because you have this very holistic approach. What… Let’s focus on pregnancy a little bit. What are those structural changes, major things that happen and that we need to know about?
Deutschbein: I think there is… We could get so super nerdy with this. Let’s be really clear. Your body is an amazing thing in that we go through this incredible metamorphosis when we’re pregnant, and if… I like to go back to when ourselves, as the pregnant person, when we’re born. We actually go through this fantastic circulatory change, you know, going from the baby in the womb to actually being outside the body. And when we go through puberty, we have these amazing things that happen again, where the body restructures. And then when we go into pregnancy, this happens again, that we have to change how blood moves through our body, how the connective tissue is working in our body, so that we can support the pregnancy. It’s I think from a very natural point of view, it’s very tempting to say, “Oh, a normal woman just becomes a woman with a baby in her uterus, and that’s what it means to have a normal, healthy pregnancy.”
But that’s not really true. Her body has to go through these significant changes in focus in order to have an environment that will hold a baby safely through pregnancy and then deliver that baby into the world. And one of the biggest changes, and that’s the lens I want to look at for our talk, is in blood flow. In order to support the growing uterus and the growing baby, we need to increase our blood supply by 50%. So, that means if I have two cups of blood, by the end of the pregnancy, I’m gonna have three cups of blood. That’s a huge increase in volume, so a lot of things have to happen in order to support that.
Lozada: And why do we need to increase? What is its function?
Deutschbein: Well, so the blood volume is going to help us move around the things that need to be moved around. We’ve got a lot of hormones and fluids that have to be moving through pregnancy. It’s also going to help us build that uterus. But the uterus grows to like 10 times its original size. You know, it has to become this very large container. We’re also building a placenta, and the pool of blood that the placenta is sitting in, so those are things that we need a lot of blood for. Plus, towards the end of pregnancy, we naturally have some extra blood so that as we are delivering the baby, if there’s some blood loss, we’ve got some extra. You know?
The body has a little extra to give there so that we don’t bleed out really quickly. So, one of the things that’s required in order to accommodate this increased blood volume is that our blood vessels actually have to become more relaxed. Pregnant women have a drop in blood pressure and that is because of the hormone relaxin, and that’s where I’m really going with this conversation, is relaxin, because relaxin affects so many things in the body, and one of the really important roles of relaxin is that it helps our blood vessels have less tone, so that we can allow more blood to flow.
The other thing that it does is it affects the tone of the uterus right from the beginning. So, a lot of pregnant women, they get a little confused. Their joints feel loose in the beginning of pregnancy. Well, that’s because the relaxin is active then, so both in the ovary and in the uterus, this relaxin is being created right from the beginning of pregnancy. So, what happens when our blood vessels have lower tone in them? Well, one of the first things that you might see is swelling in the legs and feet. So, it’s really important from the beginning of pregnancy for pregnant people to get their feet up, get their feet over, lay down on your couch with your feet up high enough so that they’re higher than your heart, and pump your feet back and forth and help those blood vessels to get the lymph and the venous return back to the heart.
The same thing is true for your arms and hands, because a lot of the day our hands, our wrists, they’re below the level of our heart, and what can happen is pregnant women can end up with carpal tunnel syndrome because of that fluid accumulation in the hands. So, if you’re finding that you’re getting a lot of fluid accumulation in your arms and hands, assist the system with some gravity and lift those hands and arms up over your head. Even better, hang from a pull-up bar.
Lozada: I love it, and I… When you read books about pregnancy, you hear some symptoms. You could get carpal tunnel syndrome and all of that. But knowing where it comes from and what you can do to alleviate it.
Deutschbein: Yeah. And the other thing to take into consideration if someone’s really struggling with this puffiness problem is the body needs more protein. Not so much the protein itself, but those amino acids that it uses to build all the different proteins that it needs. You know, we take the protein in, we digest it, and then we can reassemble all those amino acids in different ways that we need. And there are times when we’re not getting enough protein in our food.
Lozada: So, we’ve got the blood flow and how that changes in terms of edema. What all other changes are needed?
Deutschbein: Well, so as we start to carry the baby around, like initially, in the first three months of pregnancy, the uterus is in its usual position for whatever that is for that woman, so the baby’s inside the uterus, and the uterus is attached to the pelvis with 13 ligaments. And the position of that uterus and how it’s interacting with the pelvis is going to have a huge effect on how comfortable this person is carrying this baby around. And because baby is in the uterus, we want baby to be able to move within the uterus and within the pelvis, within the mother’s abdomen, in such a way that it can get out in the most efficient way possible.
Lozada: Yeah. And I know that a lot of people really focus on and we’ve started to focus more on like what’s baby’s position, and I really appreciate the idea that it’s not so much that baby got into a weird position, but that it got into the position that it could, like the position that was available from this uterine shape.
Deutschbein: Exactly! And that uterine shape is very dependent upon posture, and what’s going on with mama’s body, so as the uterus gets bigger, as we move into the fourth, fifth trimester of pregnancy, it’s normal to get some anterior pelvic tilt. We don’t want too much, because it’s gonna strain the back, especially with the ligaments being softer, so we can have the uterus start to move too far forward if there’s too much of an anterior pelvic tilt, but in our world that we live in today, we’re more likely to see the opposite, which is where, and I’m gonna pick on my yoga friends a little bit.
We’re often told in yoga to tuck our tails in. This idea of tucking your tail puts the pelvis in something called posterior pelvic tilt, which means that our tailbone is going under. This is really not something that is great for pregnant people, because it puts a lot of stress on the ligaments on the back of the sacrum. It also encourages the baby to stay in the pelvic bowl as much as possible. The pelvic bowl is actually more like a cornucopia than a bowl, so it’s not that the pelvis is holding the uterus. It’s that it’s actually like a cornucopia. The uterus is sitting in the front of it and the uterus is not supposed to be wedging down into that bowl all the time.
So, when we tilt the uterus so that it’s more like a bowl, the uterus will sit, or when we tilt the pelvis so it’s like a bowl, the uterus will sit in it and then when baby’s found a position, it’s going to stay in that position, whatever that position is, whereas if the uterus is more like it’s sitting in that cornucopia, baby can twirl around. Baby can move in lots of different directions. Baby can have a lot more options for what is the best way to negotiate with this body in this pelvis.
Lozada: So, what’s the easiest way to make sure you’re not doing that posterior pelvic tilt and sort of going with your anterior pelvic tilt or putting the pelvis in a nice, proper position that will allow the uterus to be a cornucopia and not just sitting in a bowl?
Deutschbein: I’ll tell you, in our culture, this is really hard. Because it’s everything is set up for us to be sitting in a posterior pelvic tilt, in an overstuffed chair, or an office chair that tilts you back. In your cars, those bucket seats. So, the things that you can do. One is, I know this may sound hard, is to try your best to always sit on a firm chair and on the edge of the chair. But the third part if you’re sitting in a more appropriate position is the front of your pelvis, where the two halves of the pubic ramus come together to form your pubic bone, and your pubic synthesis is this very special cartilaginous joint in women, in females, that allows that pelvic bowl to open up a little bit more in pregnancy when that softens. We don’t really ever get told that we’re supposed to sit on that, but in actuality we are. That’s the third part of our triangle.
So, we’ve got our sit bones underneath our butts, and then we’ve got our pubic bone, and if you sit so that you’re on those sit bones and leaning into your pubic bone, that gives you the perfect tripod for posture and your pelvis will automatically be in the right position when you’re doing that.
Lozada: And I think it’s interesting to have this retraining of the body when it’s all… when it’s shifting so much. So, you were talking about the uterine positioning and what if you do have a generally forward, like I’ve heard the term pendulous uterus.
Deutschbein: Ah, yes.
Lozada: Yeah. And I don’t know what the incidence of that is or… But if it’s high enough that we should talk about, what can you do? Or what are some of the things to pay attention to?
Deutschbein: Gail Tully has a great tool for this. She… What she tells you to do is put a flashlight at your naval, and if the flashlight is pointing straight forward, you’re fine. If it’s pointing straight up, that’s interesting. But the real one to pay attention to is if it’s pointing down, because that means that the uterus may be too far over the pubic bone and baby’s head might actually just kind of hang out on there instead of being able to move into the bowl. So, we want to encourage the uterus to move back a little bit.
And Indigenous people have had solutions for this forever. All sorts of different ways of wearing what in Central America is called a faja, wrapping something like a rebozo around the belly, and that’s to help support the uterus, so that it’s not moving forward so much, and stretching all of those ligaments in ways that can be quite painful. And one of the ways is wearing… And get some professional guidance with this, because we don’t want you to do anything that’s gonna hurt yourself, but wearing something that you wrap around to help give your uterus some support and your belly some support.
Lozada: And to give you that support without tucking the tailbone, right? Because that’s the original thing, you want to… In my mind, positioning, if I want to bring the belly in, I tuck.
Deutschbein: Right. Oh, Adriana, that is such a good point. Yes. Because it’s what we need is to bring the belly back and give the back a little support so it doesn’t feel like it needs to tuck under like that.
Lozada: In terms of the structural changes during pregnancy, was there anything else you wanted to make sure we talked about?
Deutschbein: No, I think we can move on. Well, okay, so here’s a nice segue. Let’s talk about breasts. So, all of us, we go through puberty and I don’t know about anybody else, but all of a sudden there was this thing in my line of vision, like all these… There were these things on my chest, like it was distracting to me. And then when I got pregnant, probably the very first thing I noticed were breast changes. You know, the areolas changed color and all of a sudden the breasts just feel like they start getting bigger, bigger, bigger, bigger, bigger. And women who didn’t have them before have got more tissue, and women who did have them before, they just get bigger, and you’re wondering how many bra sizes am I gonna go up?
It’s important to have a very loose bra, so that as the ribcage is opening, there’s no resistance to that. Again, giving the uterus and the baby as much range of motion as possible, so that they can expand in the way they need to. But also allowing that breast tissue to expand, because we’ve got… The breasts are in the front, but also they go into the underarm region of our bodies. We need to be really mindful of our posture with our shoulders, because as the breasts get heavier, we start to lean forward.
So, finding a good balance between a bra that gives you the support that you feel you need, so you can go to work and do the things that you need to do every day, but also gives you enough movement so that the rib cage can expand, and then remembering to keep those shoulders moving backward.
Lozada: And I find, like in my daily life also, like it’s a trick to do that, to rotate back, not just pull the shoulders, but rotate and make that scapula move closer together and down to create a different opening, while not sticking out the ribs.
Deutschbein: Yes. That rib thrust is a big problem, especially again for those of us who’ve trained as dancers, or we’ve done a lot of yoga. You know, we’re trying to move the sternum up, so we think, “Oh, I’m gonna have a nice, wide chest with the sternum going forward.” So, up comes that ribcage. So, a helpful tip for that is if you feel the bottom of your ribcage just underneath where your nipple line is, and you find the top of your hips, what we call the anterior superior whatever it is. It’s the ASIS. If you put your hands in both those places so that they’re in line with each other in a flat plane, like if you put your board across your hips and your ribs, that that would be flat, that’s that neutral position.
And all of us who drive, and read books, and watch TV, and sit in overstuffed couches, when we put ourselves in that neutral position, we’ll find that our shoulders are forward. Then we roll them back, the scapula’s down along the ribs, and then we’re like, “Oh my gosh, now my head is really far out there.” So, that gives you a truer indication of where your posture is at, and the stress that your body is under trying to maintain that posture, than just thrusting your ribs up.
Lozada: So, what… Yeah, what else do you want to talk about?
Deutschbein: Well, so you know, so the structural stuff of pregnancy, we come back to my friend relaxin. Relaxin may take up to a year to clear. So, why would that be? Well, because we still need to move a lot of blood around. Our blood volume is going to come down, but as long as we’re feeding that baby, we still need to have a lot of resources moving through the body. So, as we’re holding the baby, we want to be very conscious of what kind of support do we need? Again, in our culture we have this Madonna pose of mother nursing the baby, holding the baby horizontally across her body, and she appears to be absolutely effortless holding her baby this way.
But all of us who have nursed, we understand that if you try to be posturally correct and hold your baby like that, you’re just… Your back’s gonna hurt all the time and your arms aren’t strong enough. So, it’s important to support your changing structure by having something underneath the baby. Or experiment with other positions that allow baby to be like with reclined nursing, where baby’s just kind of laying along mama, or even a football hold, where baby can be alongside. Whatever we’re doing, we want to make sure that we’re not pulling the breast down, the baby’s not pulling the breast down, and our shoulders aren’t going, kind of following that movement and getting all hunched over as that relaxin is leaving and leaving us in whatever position we’ve been in for that year after the baby’s been born.
Lozada: And I really appreciate also the mantra of bring baby to breast, not breast to baby.
Deutschbein: Yes. Because it’s not just about the baby. This has to work for you. How can we position your body now so that you are able to maintain your own structural health while you’re taking exquisitely good care of your baby? Those things are both equally important.
Lozada: Yes. Absolutely. No, love it. So, what else? I’m at your mercy right now, Molly. You tell me where we’re going. Because there’s so many options and I don’t know-
Deutschbein: There are.
Lozada: … what you consider. I will trust you to consider what is most important for people to know about.
Deutschbein: Well, let’s talk about the pelvic floor.
Deutschbein: So, you know, that is… I have got to give our… I think this is an internet thing, honestly. I really do. I think that the mothers who are giving birth today are really smart and like you said, they are getting access to a greater variety of information, and when they found out that in other countries all pregnant women get postpartum pelvic therapy, physical therapy for the pelvic floor, they have started storming the gates. Because having a baby, of course it’s a normal, natural thing, but it’s also really important during this year after the pregnancy to do what your body needs you to do to get that pelvic floor in appropriate tone again.
If your doctor tells you that hemorrhoids are normal, that pain during intercourse is normal, that leaking when you sneeze, or you cough, or you laugh is normal. “Oh, you’ve had a baby. That’s normal.” Let me tell you, that is not normal. That is not how we’re supposed to function. That means that there are some structural issues happening with the pelvic floor and there is help for that. It’s not… Doing Kegels is not the magic answer. What’s important is that there are going to be muscles that have stretched too much and muscles that are too tight. If we do Kegels and keep tightening those other muscles, it’s just going to make the problem worse.
We need to strengthen the weaker muscles and stretch the ones that are too tight and bring balance back to the pelvic floor.
Lozada: You’re already physically sacrificing enough. Let’s try to take care of yourself as much as possible and understand that pain is a huge way in which the body communicates, and if you’re feeling pain, like if you’re breastfeeding and it hurts, it shouldn’t.
Lozada: If you’re having sex and it’s hurting, it shouldn’t.
Lozada: And really not just go, “Well, it’s part of life.”
Deutschbein: So, what I really encourage all of my clients to do, especially my pregnant and nursing mamas, is to find ways to incorporate a bigger spectrum of movement in their lives. Is there a way for them to actually, instead of putting everything right where they don’t have to reach for it once they’re getting past that initial postpartum period where they feel they can actually move around, but you know, can you stretch up to reach things? Can you put things where you need to squat down to get them? Incorporate these natural movements that help your pelvic floor, help pump the lymph and blood around and out of your breasts to keep them healthy, help pump and move the lymph around your digestive tract to keep that healthy, and your uterus healthy. Yes.
Lozada: Tell me a little bit more about the importance of these pumping the lymph around, because you’ve mentioned it a couple of times, but I don’t think that’s something that you… Like what does the body normally do?
Deutschbein: I think that’s an excellent question, Adriana, because we really don’t talk about lymph. Lymph is a fluid that’s made up of white blood cells and something called interstitial fluid, which is kind of extra water, cellular matrix water, that’s kind of wandering around in the body. And it flows in between the cells, that’s the interstitial part, but it also flows in these very delicate vessels, the lymph vessels, between all the different parts of our bodies and intermittently it gets filtered by the lymph nodes. And in the lymph nodes, they pick up things that don’t belong and send those into the bloodstream. So, if our breast tissue extends underneath into our armpit, all of us who wear bras, we have a waist, a band around the bottom of the bra, and then often if you’re wearing an underwire bra, there’s a hard metal piece that goes right into your armpit.
What that does is it presses on the skin, both where that elastic band is underneath and where the underwire is. That means that the lymph, this cleaning out part, this cleaning out fluid that runs around and picks up all the stuff that shouldn’t be there, gets stuck. It begins to stagnate. So, we want to have movement, and this is where reaching for things and using your arm and your shoulder like a pump, how the muscle that’s underneath the breast, that big pectoral muscle, using that as a pump when we’re reaching for things or hanging from stuff actually helps to push that lymph out of there. But what we need to do is not have… We should have parts of the day where we’re not wearing really tight bras, so that our breasts can get that lymph moving in and out and clearing everything through.
Our bodies are all liquid and we want to be a clear, flowing stream. We don’t want to be a stagnating lagoon.
Lozada: That’s a great point and you went to a more holistic perspective on it. I’ve always had a very narrow view of why you don’t want underwire in your bras during postpartum while you’re nursing, because it can… One of the things it can do, that binding, is stagnate the breast milk. So, creating mastitis, right?
Lozada: And that’s where my mind always went to that, but again, poor little lymph, we don’t talk about it that much.
Deutschbein: Get your body moving. Get that lymph moving. Get your blood moving. Get your heart beating. Because that’s what our body needs for health, is flow. Everything flowing. I’ve worked with enough first-time moms and my own first-time mom experience was that until I actually had the baby, I had no idea what my life was gonna be like as a recovering parent, someone recovering from a cesarean with a newborn. So many times we think that we’re gonna take our maternity leaves to finish our master’s degree, or we’re gonna get the house painted, or just… We just don’t realize how much work it is to take care of a little human.
Lozada: Insane! And so, there’s the thing, right? I think just… If you don’t do anything else, you don’t have another takeaway from this episode other than start preparing your mind for the fact that postpartum is a moment to embrace slowness. Because otherwise, your mind drives you crazy. You know, your body’s screaming for this calm and you’re like, “I’m not getting anything done, dah, dah, dah, dah, this baby’s taking up all my time. Of course it is, but dah, dah, dah, and I am use… Did nothing today.” It will drive you crazy.
Deutschbein: Yeah. My favorite thing that I like to say to people is look, if you’ve had breakfast and a shower before noon, you are a rock star, so let that be your measure of success.
Lozada: Thank you so, so, so much for being on the show today.
Lozada: You’ve been listening to a Best of Birthful episode. To listen to the original, longer version of this episode, click on the link in the show notes. And there are many more where this came from. Look for episodes with the words Best of Birthful in the title to continue your deep dive to inform your intuition. You can find the in-depth show notes for this episode at Birthful.com. You can also connect with us directly on Instagram. We’re @BirthfulPodcast.
Birthful was created by me, Adriana Lozada, and is a production of Lantigua Williams & Co. The show’s senior producer is Paulina Velasco. Virginia Lora is the managing producer. Cedric Wilson is our lead producer. Alie Kilts contributed to the production of the Best of Birthful series. Thank you for listening to and sharing Birthful. Be sure to subscribe on Apple Podcasts, Amazon Music, Spotify, and everywhere you listen. Come back every week for more ways to inform your intuition.
Lozada, Adriana, host. “Best of Birthful: How Your Body Changes with Birth.” Birthful, Lantigua Williams & Co., August 18, 2021. Birthful.com.
About Molly Deutschbein
Molly (Mary) Deutschbein sees all ages and stages in her private practice from newborn babies to elders in their nineties. She uses gentle touch modalities, mindfulness practices and client self-care education to help her clients achieve a deeper connection to their bodies, lessen or eliminate pain, increase function and feel more content. More than half of her practice is helping clients during the childbearing year with fertility challenge, comfort in pregnancy and delivery, postpartum healing and/or newborn feeding issues.
Molly is a NYS licensed massage therapist (2005) and an Advanced Craniosacral Therapist with both Upledger Institute Techniques Certification (2006) and Biodynamic Certification (2015). She is a certified practitioner of the Arvigo Techniques of Mayan Abdominal Therapy™ (2012) with advanced pregnancy training, and she is a Spinning Babies® Aware Practitioner.
Molly’s original career in computing. As she had her two daughters she developed a desire to understand birth, parenting and traditional healing modalities. Molly was an independent childbirth educator and peer lactation counselor for six years, supporting hundreds of families as they added a new member to their family. She is a certified doula (The Matrona) who has attended homebirths, VBACs, a breech birth and many variations on “normal” births. As a volunteer, Molly had staff privileges at Strong Memorial Hospital from 2005 to 2010, where she worked weekly as a member of the Palliative Care team bringing gentle massage, craniosacral therapy and Reiki techniques to patients with chronic illnesses, receiving cancer treatment or moving into end of life in hospice.
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