Addressing Pregnancy Discomforts Through Movement and Alignment

Addressing Pregnancy Discomforts Through Movement and Alignment

Adriana Lozada: Welcome to Birthful, Mighty Parent or Parent-to-Be! I’m Adriana Lozada, and I am so happy— I’m thrilled— that you are here today as we start a new series, titled Movement and Body Wellness in Pregnancy. Now in this series, we’re going to be focusing on ways you can move and support your body so you feel better during this time when every one of your cells is transforming and your center of gravity is shifting. And because everything is connected, these practices can also help you have an easier birth and an easier postpartum recovery. And who doesn’t want that, right? You so deserve it. 

So to start us off, I’m going to be talking 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. 

More specifically, Molly is a licensed massage therapist, she’s also an Advanced Craniosacral Therapist with both Upledger Institute Techniques Certification and Biodynamic Certifications, she’s an Abdominal Therapy Practitioner and Educator with advanced pregnancy training, and a Spinning Babies® Aware Practitioner. And if that wasn’t enough, Molly is also a Registered Yoga Teacher with additional movement training from Katy Bowman.

Molly sees all ages and stages in her private practice (from newborn babies to elders in their nineties), however, more than half of her practice is helping clients during the childbearing year with fertility challenges, comfort in pregnancy and delivery, postpartum healing and/or newborn feeding issues. And, she’s also a birth doula. 

So yeah, Molly definitely knows about all the incredible structural changes your body is going through during pregnancy and postpartum, why they happen, and how to best navigate them to minimize discomfort and increase stability, which is why I’m thrilled to have this conversation with her today.

You’re listening to Birthful. Here to inform your intuition. 

Adriana: Welcome, Molly! I am so super delighted to have you here on the show, ’cause I love talking to you.

Molly Deutschbein: Oh, thank you!

Adriana: Yeah! And so today we’re talking about structural changes, body changes in pregnancy and postpartum and all that maternity year. Before we jump right in with that, can you tell us a little bit about yourself?

Molly: Well, I am a bodyworker 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 bodywork, and they all come together for a really nice, well-rounded approach to keeping people healthy through the childbearing season.

Adriana: 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?” of “And how does this connect with that?” And yeah, all the things integrate— which is why I thought you were the perfect person to come and talk about these structural changes, ’cause you have this very holistic approach. So I’m very excited.

Molly: Thank you. And I’m really excited to be here. I love sharing your podcast with my clients who are trying to get pregnant or who are pregnant, and they find it so helpful. So I’m grateful to be part of it.

Adriana: Yay! Yeah, let’s spread the word. 

Molly: Mhm!

Adriana: Molly, let’s focus on pregnancy a little bit. What are those structural changes (major things that happen and that we need to know about)?

Molly: Well, we could get so super nerdy with this, let’s be really clear. The 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, y’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 wanna 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. 

Adriana: And why? Why do we need to increase? Like, where does this extra blood flow? What is it? Well, I can’t speak! What is its function?

Molly: 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 to something— I can’t remember. See? Now I’ve lost one of my nerdy numbers! But the uterus grows to like 10 times its original size; y’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’re delivering the baby, if there’s some blood loss, we’ve got some extra, y’know, the body has a little extra to give there so that we don’t bleed out really quickly. But one—

Adriana: A safe gap!

Molly: Yes. Yes. 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.

It used to be— y’know, 30 years ago when I first started teaching childbirth classes— we thought relaxin came on the scene somewhere at the end of pregnancy, because it was gonna help loosen the ligaments of the pelvis and help the baby get out. Well, as it turns out, relaxin affects (of course!) the whole 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 relaxin is active then—  it’s actually produced by the corpus luteum (the stuff that’s left behind in the ovary after the egg is expelled). It’s produced then, and then it’s also produced in what’s left of the endometrium, so both in the ovaries and in the uterus this relaxin is being created right from the beginning of pregnancy. So it helps with this blood volume accommodation of the blood vessels, but it also soothes the uterus so that it’s not going to contract. In those early days of pregnancy, that’s really important, because you’ve got this very delicate set of cells that have to find a place in the uterus when… to start creating the placenta and making a home. And if the uterus was contracting, that would be difficult. So relaxin’s really important for that, too.

Adriana: Yeah! It would be like little earthquakes to this egg that’s trying to settle and move into the uterus.

Molly: I love that. That’s a wonderful image, Adriana! 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 so mamas can get a little distressed when they start to find the fluid is starting to accumulate down there. We don’t want too much, right? I mean, unhealthy edema in pregnancy is not a good sign. But that can be one of the things that gravity is working on those fluids too, and the blood vessels can’t get that fluid up. So it’s really important from the beginning of pregnancy for pregnant people to get their feet up,  y’know, lay down on your couch with your feet up high enough— so that they’re over 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, y’know, 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! That is so good for you, ’cause it really helps pump all of that extra fluid back down into the trunk of your body where your body can accommodate it.

Adriana: I love it. And 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 and help have it accumulate less (’cause it tends to show up more towards the end of pregnancy, that carpal tunnel aches, right, in my experience) but being mindful of that from the beginning, not only just because of you’re trying to love your wrists, but your whole body’s gonna benefit from it.

Molly: Yeah. And the other thing to take into consideration if someone’s really struggling with this puffiness problem, is finding more ways to get protein in the body. Y’know, there’s some controversy about how much protein you really need, and I don’t think a number is as important as “What is your body doing?” 

Y’know, as we go through pregnancy, we can use our body not as a “Oh, this is going wrong,” but “Okay, what is that saying to me?” And there are times when we are not getting enough protein in our food. We might be eating even really good food, and— but I don’t want that to sound like women should be getting more meat, you can get a lot of protein from plant sources— but sometimes that’s a sign, too, that pregnancy requires a little more protein in your diet and maybe you’re just not getting enough.

Adriana: Yeah. And I’ll link Lily Nichols’ episode on eating for pregnancy— which, she has a fantastic book, and that’ll be like if people wanted more information on that, they can extend that way, for sure.

Molly: Oh, excellent. Very good.

Adriana: And I love how you start us with, y’know, that landscape of what that uterus needs to do in order to— along with the fertilized egg…

Molly: Mhm.

Adriana: …to create all that, like, how it stems from that, into the cosmos of the body. What all other changes are needed?

Molly: Well, so as we start to carry the baby around, right— like initially, in the first three months of pregnancy— the uterus is in its usual position for whatever that is for that woman. And that’s another thing we don’t think about very much, is where is the uterus in the pelvis when we’re not pregnant. And that can cause all sorts of interesting symptoms with menstruation. The women who have had painful periods, difficulty conceiving, periods that were where the blood flow was clotty or very dark in the beginning, those are the women that I wanna start working with early because that indicates that maybe the uterus has a little torque on it. It’s got a little torsion.

And so in order to menstruate the uterus has to work really hard. It’s gotta cramp a little harder in order to get all of the menstrual tissue outside of it. 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.

So we’ve got the relaxin and helping to open the pelvis and make all of our structures a little more easy to deal with. It helps make the ligaments a little more stretchy, but we want to be aware that how the uterus is sitting in the pelvis is going to affect how as it grows with baby inside of it, as it stretches and becomes bigger and adds more muscle mass so that it can be… At the end, it’s not just a container at the end; it becomes this big pushing muscle. This… The contractions are used to expel the baby, right? So we want the uterus to be nice and healthy at the end. We also want it to be positioned in such a way that it’s able to work really efficiently. 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.

Adriana: And we’ve started to focus more on, like, “What’s baby’s position?” In generally broad strokes, people are aware of “Well, if baby’s breech, then usually that’s a sign that at this point in time in our U.S. healthcare, usually it’s ‘You have to have a cesarean.'” And then people are aware of, like, baby in a posterior position,  and that might lead to back labor. But it’s a lot more complicated than that! 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.

Molly: Exactly. And that uterine shape is very dependent upon posture. So, as the uterus gets bigger and comes out of— so, at first it’s in the pelvic bowl and makes us need to pee all the time, right?— and as it gets bigger, it expands so that it’s big enough that now it’s above the inlet of the pelvis and starting to come forward a little bit. And so as we move into the pregnancy, it’s normal to get some anterior pelvic tilt, and that’s when you think of someone with their butt sticking out, that’s a little bit more of that dancer— y’know, “ballerina poking-out butt” is more of the normal pregnancy posture. 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 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. 

The other thing is we have some beautifully-fit pregnant people right now, so fit with their abdomens that they’re so tight that it’s hard for baby and the uterus to stretch those abdominal muscles out into the anterior of the body. And not having that right relationship of how the pelvis is tilting, that can cause a lot of back problems. And it— in addition to, y’know, holding the baby in ways that may make it more difficult for the baby to come out easily— it causes a lot of stress in those lower lumbar joints or on the— if baby’s really wedged down— you can start to see some pubis symphysis problems, where there’s a lot of pain right in the front.

Adriana: And y’know, the body communicates with you all the time. So all of these pains and sensations that we always say, “Oh, those are normal for pregnancy,” and they’re normal for “’cause you’re growing a baby,” yes, but it’s… I mean, it’s normal to have some aches because things are shifting, but if you’re having serious discomfort always in the same place, listen to that and go back to your posture and see how this is affecting and what you can do about it. And we often think, okay, like, a chiropractic adjustment will really be beneficial for that or craniosacral or any kind of more intense body repositioning can help, but there’s also— and I’ve learned this from you— many simple things that people can do to improve their aches. So what’s the easiest way to make sure you’re not doing that posterior pelvic tilt, and putting the pelvis in a nice proper position that will allow the uterus to be a cornucopia and not just sitting in a bowl?

Molly: I’ll tell you, in our culture, this is really hard. So, 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. Our pelvis is made so that we are supposed to sit not just on the sitz bones, right? Everybody knows about their ischial tuberosities— that if in yoga class they say, y’know, “Find your sitz bones,” okay, I know where those are, but—

Adriana: (…) those are? Just for those who don’t know about their sitz bones.

Molly: If you put your hand under your butt when you’re sitting in a chair, if you feel these hard knobs that are what you’re sitting on— 

Adriana: And there’s two of them, one on each, like…? 

Molly: One on each side— so those are the two parts of your tripod. We end up sitting on just those two, 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 pubis symphysis 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 sitz bones underneath our butts, and then we’ve got our pubic bone. And if you sit so that you’re on those sitz 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.

Adriana: And we often recommend sitting on an exercise ball— on a, what we call (’cause we’re birth-y people) on a birth ball. Is that just because of how you sit on there? Is that more helpful? You have more propensity to sit properly on a ball?

Molly: I think there’s that, but I think there’s also the fact that you can sit more properly and have softness and you can work with the fluidity of the— y’know, it gives you a little more motion and movement of the pelvis, because there are all these little micro-movements going on, so that’s much more helpful if you’re sitting at a desk all day or y’know, you have to be sitting down. Those little micro-movements can be helpful, but I really caution people who use those… It’s very easy, when you’re used to sitting back, you can train yourself to sit in a posterior pelvic tilt on a birth ball, too.

Adriana: That takes skill!

Molly: Well, and if it’s what we’re used to, it’s what we’re going to move into, y’know? The body likes to do what it’s used to doing.

Adriana: And I think it’s interesting to have this retraining of the body when it’s all… when it’s shifting so much, and that that retraining when things are shifting, it’s like this overarching theme that happens during pregnancy for your mind, for your spirit, for, like, all parts of you have to. Because things are shifting so much, you’re forced to reconsider and just shake it up, right? And hopefully land in a better place than you were before.

Molly: Yeah. Which is great preparation for parenting, right? I mean, every time you think that you’ve got this thing figured out with this little person, something changes. We have to change with it!

Adriana: Absolutely! You were talking about the uterine positioning and what if you do have a generally forward— like, I’ve heard the term “pendulous uterus”—

Molly: Yes.

Adriana: Yeah, and I don’t know what the incidence of that is or… but if it’s high enough that we should talk about it, what can you do or what are some of the things to pay attention to?

Molly: Gail Tully has a great tool for this. What she tells you to do is put a flashlight at your navel, and if the flashlight is pointing straight forward, you are fine. If it’s pointing straight up, hmm, 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— y’know, all sorts of different ways of wearing what in Central America is called a “faja,” wrapping something like a rebozo around the belly. The Japanese have a way of wrapping. We have— if you go to a physical therapist— that we have belly wraps that are, y’know, they’ve got stretchy parts and Velcro parts, 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. Sometimes with the pendulous uterus, there’s a lot of round ligament pain because of that extra stretching, and those of us who’ve experienced round ligament pain, it feels like babies poking straight down into your cervix or straight into your vagina or your labia! And that’s because the round ligament actually inserts there. It’s attached at close to the top surface of the uterus, and that’s one end. And the other end is in your pubic area. So when the uterus is moving in such a way that it’s stretching those round ligaments and they have to stretch a great deal just for the uterus to grow, you can get these shooting pains down into your crotch that are very uncomfortable.

And there are ways to help with that, to release and relax and give that some support. And one of the ways is wearing— and get some professional guidance with this, ’cause 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 bellies some support. 

Adriana: And to give you that support without tucking the tailbone, right? ’cause that’s the, in my mind, positioning if I wanna bring the belly in— I tuck.

Molly: Right! Oh, Adriana. That is such a good point. Yes, because 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, yeah. And it’s really not that hard to do. Often we— like we said before— we move our bodies in the way that we’re accustomed to. And so once we feel that “Oh my gosh, it can be comfortable in a different way,” we can move into that. But it’s hard to come up with those solutions by yourself if you’re… if you don’t know what they are, or you’re not watching other women do those things. 

We live in a culture where pregnancy is still a very private activity. Women don’t talk a lot about some of the more problematic symptoms that they’re experiencing and the solutions that they found, because they feel like those are private things. They’re things that relate to sexuality and relate to bodies, and so it’s hard to find solutions on your own when you live in a place where— even with the internet and mama groups and everything— it can be hard to find honest, complete information. Does that make sense?

Adriana: It does. And I think that’s… Fortunately, I do feel like that’s shifting a little bit. We’re starting to— like we’re doing right here— talking more about it and realizing that we’ve come at this idea of the core from a fitness perspective. And I think now we’re starting to understand that that core is essential for functioning and health.

And that shift, I think, plays an enormous part during pregnancy and postpartum. But yeah, I like that. I think that shift is gonna help us to be more open in our conversations.   

Molly: Well, and I wanna add something to what we were saying before, in terms of what happens to the belly. There’s something called diastasis recti, which— and different people say it different ways too. You might hear it as di-ah-stasis rect-i or in other combinations of those two words.

Adriana: Yeah, I do a combination. I do dia-statis rect-i, so I bunched together those two.

Molly: Who knows? I don’t know the right way to say it.

I’ve heard all the professionals say it all the different ways. But what happens is the six-pack part of a six-pack ab— y’know, there’s the rectus abdominis is in the center of your belly, it’s the most superficial abdominal muscle. And it’s the one where when people have really cut abs, where you see that six-pack and you can see down the middle there’s this line, and inside that line is ligamentous tissue.

So it’s thick connective tissue, but it’s not muscle. And what can happen with pregnancy because you’ve got this rapid growth (y’know, relatively rapid growth) of the uterus and the baby inside the uterus that can create an opening in the linea alba, which is that structure that’s in between the six-pack on either side.

And if that starts to open, there’s no longer appropriate pressure inside of the abdomen. So we can start to see some digestive stuff, because the intestines need the pressure inside the abdomen to stay the same so that they can do their work. As things are moving through there, they need a certain amount of back pressure happening.

And also that’s when that uterus really starts to move forward like that. We often see some diastasis there because the structural integrity of the abdomen isn’t holding. And the irony is that just because you’ve got a really killer set of abdominal muscles doesn’t mean you’re gonna avoid this diastasis recti.

As a matter of fact, many fitness people already have them from working out as much as they do. So it’s not like there’s a way to know ahead of time that this is going to happen or that there’s a way to prevent it as it’s happening. We just need to be aware that this can be a problem and the way we use our core really affects whether it becomes a bigger problem or a smaller problem. And aftercare postpartum is really important in trying to bring those two haves back together as much as possible.

Adriana: Yeah. And I will link to the episode I have on diastasis recti for more information on that, ’cause that’s like a huge topic on its own that’s so, so intricate, and in terms of trying to fix that (’cause doing more crunches is not… it’s gonna make it worse, like that’s not gonna help it out).

Molly: Exactly. That’s the thing— the thing that you think is going to help it is actually gonna make it much worse.

Adriana: Right?! So, in terms of the structural changes during pregnancy, was there anything else you wanted to make sure we talked about before maybe moving on into some moments of birth, and then postpartum and breastfeeding?

Molly: Well, okay, so here’s a nice segue: let’s talk about breasts. As we’re pregnant, right?

Adriana: I’m gonna, like… that’s the perfect, like… I’m just gonna take that outta context and have that be a gif or, like, a meme. Let’s talk about breasts!

Molly: 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.

Adriana: Me too! The day after, yeah. Yeah.

Molly: It was all… Yes, totally immediate. Now, that doesn’t happen for everybody, but it’s a pretty common thing that, y’know, the areolas change color and all of a sudden the breasts just feel like they start getting bigger, bigger, bigger, bigger, bigger! And you’re wondering, y’know, “How many bra sizes am I gonna go up?!” Another important thing in terms of dealing with the changes in structure is that the… As the rib cage is expanding in the later part of pregnancy, and your bras are getting tighter and tighter— because you don’t wanna buy new ones, right? It’s important to have a very loose bra so that, as the rib cages are… As the rib cage 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 axilla (y’know, into the underarm region of our bodies) and all of that is building in anticipation of having this baby. And of course it’s building at a time when your ligaments are being affected by this relaxin; you actually do have connective tissue support tissue in the breast that’s affected by the relaxin too. We need to be really mindful of our posture with our shoulders, because we— 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 that 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— not in a directly-towards-your-back motion, but you wanna imagine your scapulas moving slowly down the back of your rib cage (which is more of a rotation of the shoulders), and that allows your shoulders to stay down, your breasts to stay in a normal position, your chest and your rib cage be nice and neutral with that neutral pelvis that you have. That gives you your structural integrity for carrying the extra weight of these bigger breasts that you’re gonna be carrying around!

Adriana: 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 open, while not sticking out the ribs.

Molly: 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. Y’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 “whew!” up comes that rib cage! So a helpful tip for that is if you feel the bottom of your rib cage just underneath your, 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 a 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 scapulas 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’s under trying to maintain that posture than just thrusting your ribs up— which is why people tend to go for the rib thrust, so that they can fool themselves. And in pregnancy, and especially postpartum when we’re breastfeeding, that rib thrust can really hide a lot of things that are gonna turn into problems later if we don’t deal with them— y’know, we don’t wanna have back problems because we’ve been holding our chest incorrectly. It’s worth paying attention to!

Adriana: Mhm! Oh, that’s such a great point. And I like the visual of what to align for a neutral… like, I have never heard that before, of doing the top of the hip (or that front top of the hip) with the bottom mid-rib where your nipple line is, right?

Molly: That’s a Katy Bowman thing that’s right out of her book.

Adriana: Katy Bowman!

Molly: Yes. Love Katy Bowman.

Adriana: So what else do you wanna talk about?  

Molly: Well, so, y’know… so the structural stuff of pregnancy, we come back to my friend relaxin, right? It 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. The body is still changing— like, we wouldn’t want the body to go into a more rigid form soon after the birth, because everything’s gotta move slowly back into place. The body likes to do things slowly, over time.

So as we are nursing the baby we’re… and you’re…. the baby is growing, right? At first the baby comes out, we think it’s heavy because it’s eight pounds. Well, by six months that might be a 25 pounder! Y’know, with some babies, they are! So as we’re holding the baby, we wanna be very conscious of “What kind of support do we need?”

And 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 wanna make sure that we’re not pulling the breasts down/the baby’s not pulling the breasts down, and that we’re not… Our shoulders aren’t going… y’know, 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. Does that make sense?

Adriana: Yeah. And also because that relaxin is slowly leaving you after that year, you… It’s kind of like you have this chance for the year after to realign and reposition and bring things into whatever shape you want it to be more set into as the relaxin leaves, and then your body’s not… y’know, these ligaments are not as flexible and you kind of, like, now are quote-unquote “stuck” there.

Molly: Right?

Adriana: Yeah. And I really appreciate also the mantra of “Bring baby to breast, not breast to baby.”

Molly: Yeah. Well, especially… I’ll tell you when I— because I see so many mamas with breastfeeding issues, right? We’re working on all sorts of soft tissue restrictions or, y’know, whatever is happening in baby’s mouth and baby’s body is making it difficult to latch. Mamas will twist themselves into pretzels to get that latch right! And often they don’t care if they’re hanging upside down, as long as they can get that baby latched correctly. So some of my work with them is just encouraging them to be like, “Okay, now we’ve got the baby. How do we make this work for you?” Right?! 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.

Adriana: Mhm. Yes. Absolutely. So what else? Like, I’m at your mercy right now, Molly. You tell me where we’re going, ’cause there’s so many options!

Molly: There are!

Adriana: And I don’t know what you consider… I will trust you to consider what is most important for people to know about.

Molly: Well, let’s talk about the pelvic floor.

Adriana: Ah!

Molly: 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 more 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.

Part of the challenge of this is that we live in a society where we do not move our bodies in the way that we were evolved to move, right? I’m not a hunter-gatherer. I am not wandering through the garden next door looking for plants and berries to feed myself. I don’t have to do that— which is a lovely thing, but that means that my body isn’t moving in those ways that would naturally rehabilitate my pelvic floor. So we need to pay particular attention to how we are feeling after pregnancy.

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 as if… doing Kegels is not the magic answer. 

And I confess that when I was a childbirth educator, I did instruct people to do 200 Kegels a day, but that was many years ago. That is no longer a thing, right? And I think you’ve had podcasts where you’ve talked about the pelvic floor. 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.

So if you’re experiencing any of those symptoms, it’s really important to know that you don’t have to live like that for the rest of your life. You really don’t. There are lots of things— with the help of a physical therapist who does pelvic floor care— that you can do to make it so that you’re not peeing when you sneeze, or having hemorrhoids get worse, and, worst of all, if you’re having pain during intercourse, that that has to be addressed. That doesn’t have to stay like that.

Adriana: Yeah. And I really appreciate that… Being a parent requires enough sacrifices, right? That’s the sort of the state of mind that we fall into, of putting ourselves last. And I really appreciate shifting that image. 

Not to say that you don’t sacrifice— there’s plenty that you do. I mean, already you’re giving up your… not “giving up,” but giving/lending your body to this baby for during pregnancy up until your postpartum. Like, you’re still— especially if you’re exclusively breastfeeding, this baby is on you— and your body’s doing all these things, changing still its blood volume to support the needs of your child. 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. If you’re having sex and it’s hurting, it shouldn’t. And really not just go, “Well, it’s part of life!” No.

Molly: No! No, and that’s what I do… y’know, a lot of my clients that I see are having issues with all sorts of different parts of their body, and I’m not a pelvic physical therapist, so I don’t do any of that interior work, but I do help people a lot with “How well are you peeing, can you control your urine? How well are you pooping? And are you enjoying your sex life?” Those three things— which we treat as these very secret, private, oh, and “it doesn’t matter whether it works or not” parts— those three things are fundamental in our ability to move without getting embarrassed and to just enjoy life… Just to be out there enjoying things.

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, y’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.

How are you moving your body in such a way that your body can take care of itself? Just by the way all of those fluids and the energy and the nervous system, that they’re all flowing? Well, we are meant to take care of ourselves. We are meant to go through these structural changes… and then we are also meant to come back around to a healthy, normal place.

After those structural changes, it doesn’t make sense to wreck a woman with her first pregnancy. We… y’know, nature wants you to have more than one! Nature wants you to have lots. So the process is meant to work: from getting pregnant, to being pregnant, to being ready to be pregnant again. Does that make sense?

Adriana: Oh, it does! It makes total sense. And to sustain lifelong health— ’cause it’s not just about the time you’re pregnant, but how these changes and habits and structural realities can affect your life and hormonal changes too, right? How that can affect you 50 years from now, or 40 years from now, 20 years from when you give birth!

Molly: Mhm!

Adriana: 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… like, what does the body normally do? I know for circulatory, for blood, we’ve got the heart that’s pumping things around, so that’s constantly moving. But what about this idea of the lymph? And what is the lymph? What does it do? I know this is like… we don’t have that much time, let me open this Pandora’s box when we’ve got, y’know, 10 minutes left!

Molly: I think that’s an excellent question, Adriana, because we really don’t talk about lymph and lymph is… I think we, when we’re learning about how the body works, when we’re in grade school, we’re taught that the venous blood, the blood that is going back to the heart carrying waste products. We’re taught that that is the part of our body that cleans up after things, but that’s not really true.

Yes, it’s true that the venous blood is carrying some waste products and it’s carrying carbon dioxide back to the lungs so that we can expel them. But the actual cleanup crew is part of our immune system. And the immune system is what holds the 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 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.

We have these things called “macrophages” which gobble up things that don’t belong in the body and  send those off to the bloodstream, too. The lymph is not moved by anything other than gravity and the movement of our body. And I’m gonna focus on breasts, because it’s mostly women who listen to this podcast, I believe. So if our breast tissue extends underneath into our armpit, all of us who wear bras— and I’ve been wearing a bra my whole life because I have relatively large breasts— we have a waist 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.

And 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. And when you’ve got things that don’t belong in the body hanging out with delicate tissue like the breast tissue, it’s like having bad neighbors and bad things can happen.

Those cells can start to do things that they’re not supposed to do. 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.

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 wanna be a clear flowing stream. We don’t want to be a stagnating lagoon somewhere.

Adriana: Mhm, like, I just got the image of the stagnating lagoon with the mosquitoes on top and all the, like… breeding malaria.

Molly: Breeding, yeah.

Adriana: And that’s a great point— and, like, 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 you stagnate the breast milk, so creating mastitis, right? And that’s where my mind always went, to that. But again, poor lymph, we don’t talk about it that much. And the fact that it gets pumped with movement and gravity, I appreciate you saying stretch, just in general, just move your body— not exercise your butt off.

Molly: Well, this is one of the things that… This is a belief that we have in our culture that I wanna challenge. If a person has a relatively sedentary job and then every day… I’ll say every day they work out for 45 minutes, they’re very good, they’re very religious about it, they go to the gym and they work out and they do all the things for 45 minutes. Yes, for that 45 minutes, it gets things moving around and their heart is getting a really nice workout. That is a wonderful thing. But they are still leading an extremely sedentary life, and that’s the part that we often don’t get— y’know, that movement. Our bodies are meant to be moving most of the time and it’s very difficult for the body to take that 45 minutes and make up for the other 15 and a half hours that it wasn’t moving ’cause we were driving in the car, sitting at the desk, watching the television (y’know, whatever it is that we’re doing). And another myth too is that a standing desk takes care of that. Well, no, not if we’re just standing at the desk. We’re still in a static position that’s the same and doesn’t change for many hours at a time.

It’s wonderful that we’ve got apps on our phones and our watches and on our computers. And I encourage people to use them, that remind us, y’know, “Go take a walk around the water cooler,” “Go and run up and down a couple of sets of stairs and then come back to work again.” 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.

Adriana: Mhm. And it’s not knocking the… like, “Stop going to the gym.” It’s not that! Like, no, continue doing your exercising, making sure you’re toning and not super tightening, like especially for pregnancy and giving birth, because you wanna be able to get that baby out without that much trouble.

But yeah, it’s like you’re speaking to me directly in terms of “Don’t just use those little movements that you do once in a while to make up for all the many hours that you’re not moving.”

Molly: Right! Right.

Adriana: Incorporate more movement in your daily life, huh? Yeah. Thank you so, so, so much for being on the show today!  

Molly: Thank you very much, Adriana.

Adriana: That was restorative body educator Molly Deutschbein, who uses gentle bodywork to help parents from conception through postpartum. You can find Molly on Instagram @fasciadoula

Spelled f-a-s-c-i-a doula, or you can learn more at spiritorganic.net.

And you can connect with us @birthfulpodcast on Instagram.

In fact, if you are not driving, how about if you take a screenshot of this episode right now and post it to Instagram sharing your biggest takeaway from the episode? Maybe it was the connection between relaxin and carpal tunnel syndrome symptoms? Make sure to tag @birthfulpodcast so we can see it and amplify it.

You can find the in-depth show notes and transcript of this episode at birthful.com, where you can also learn more about my birth and postpartum preparation classes and download your free postpartum preparation plan. Also, if you find that this podcast is an invaluable resource for you, the best way to support us is by taking any one of my perinatal classes, doing one of my doula workshops, or trying out some of the wonderful products made by our sponsors. That is what allows us to continue doing this work. 

Birthful is created and produced by me, Adriana Lozada, with production assistance from Aysia Platte.

Thank you so very much for listening to and sharing Birthful. Be sure to follow us on Goodpods, Spotify, Apple Podcasts, Amazon Music, and everywhere you listen. 

Come back for more ways to inform your intuition.

CITATION: 

Lozada, Adriana, host. “Eight Questions to Ask Your Care Provider (Especially in Your Second Trimester).” Birthful, Birthful. November 30, 2022. Birthful.com.