By Tessa of www.tessayoga.co.uk, May 16 2017 09:20PM
In my Pregnancy Yoga classes, I am always talking about the importance of MOVEMENT during labour, and of using positions that use GRAVITY to aid dilation and the baby’s descent. However, there’s another important factor in the equation: BALANCE in the mother’s body.
You may have heard of wanting the baby to be in the Optimal Foetal Position (OFP) ahead of the birth; with the baby’s head down, bottom up by the ribs, chin tucked in, and with the baby’s spine away from the mother’s back. There are positions that the expectant mum can rest in to encourage OFP, but if there is an imbalance in the mum’s body with all the positions in the world the unborn baby may not be able to get into that position ready for the birth.
The imbalance can be caused by asymmetry in the pelvis caused by postural habits, like carrying a bag always on one side, or tight muscles within the pelvis such as the deep core psoas muscle. This can make it difficult for the baby to turn into an easier position ready for birth.
I would thoroughly recommend going to see a chiropractor as an MOT for the mother’s body at the beginning of the third trimester, before the baby starts to really put on weight, in order to support balance (or before, if you have pelvic pain, sciatica or heartburn). Locally I recommend Anne Loader, http://www.aclchiropractic.co.uk/ or Kelly at Dynamic Family Chiropractic http://www.dfchiropractic.com/. However, there are things that the expectant mum can do at home that will also encourage balance in her uterus.
Five things that a pregnant woman can do to promote balance in her womb to maximise her baby moving into the Optimal Foetal Position ready for birth:
1) Sit upright or leaning forward – minimise slouching – to stop muscles tightening;
2) Walk barefoot whenever you can (and tiptoe);
3) Keep symmetry in your body when sitting – avoid crossed legs;
4) Use pillows between your knees AND ankles at night;
5) Release tight muscles
[In this photo, you would be in a slouching position with your pelvis tipping back. What you want is to have the front joint (where the grey represents the pubis symphsis) tipped forwards and touching your chair, and the inverted V of the sitting bones on the chair seat. Hopefully you don't have screws like that holding your pelvis together!]
In more detail….
1) Sit upright or leaning forward – minimise slouching!
Most people think of the pelvis like a bowl, but actually the ‘bowl’ is tipped forwards and underneath are the sitting bones. Not just in pregnancy, but in life, it is better for your spine and the muscles at the front and back of your body if you are sitting on the sitting bones (obviously because that’s why they’re called that!) rather than tipping off the back of them. Otherwise some of the deep core muscles, such as the psoas, can tighten from the change in posture and in turn that affects the space that your baby has in utero, but also to move over the pelvic brim during birth.
* on an exercise / birth ball (make sure your hips are higher than your knees to get the correct position) or leaning onto the ball while watching TV,
* kneeling (you can put cushions between your feet and underneath your bottom so that it is comfortable)
* rocking on a rocking chair (the action backwards and forwards is really beneficial for your pelvic muscles)
* sit on the floor – this will mean that you change position often, rather than get stuck in a slump on the sofa!
The ‘torch test’ can tell you if the position is supportive: imagine a torch shining straight out of your navel. If the light is pointing up towards the ceiling, you are slouching. If the light is shining straight ahead or towards the floor, you are in a good position.
You might have come across these positions in relation to Optimal Foetal Position, but I want the expectant mamas to think also about the effect on their bodies of good posture.
2) Walk barefoot whenever you can (and tiptoe!)
When you’re at home kick off your shoes and walk around barefoot. What happens in your feet directly affects your hips and pelvis (and upwards!) Most shoes have a heel and with any thickness of heel, you are tipped forwards from your natural axis. This can be even more problematic once a woman moves into the third trimester and there is more weight being carried by her skeleton (and all to the front). The combination of being tipped forwards and extra weight is a common cause of back ache during pregnancy.
In addition, the relaxin hormone (that circulates during pregnancy to prepare your pelvis for some minor movement during the birth) affects other joints too. This means that your feet and the arches can flatten. You might then think that therefore you need more support, such as raised arches in your shoes. However, you want your feet to spread properly as you walk to support how your body has evolved to move. (See https://nutritiousmovement.com/about/ for fantastic information on this.)
Simply by coming up on to tiptoes in a balance you can help to keep your feet moving optimally and give your feet a stretch. In the Pregnancy Yoga classes (www.tessayoga.co.uk), we do a number of different exercises to keep the feet healthy and release tension in the feet. This in turn helps the cervix to dilate during the first stage of labour. As Uma Dinsmore-Tuli says: “the feet are the wings of the pelvis”; that is, healthy feet = healthy womb.
I thoroughly recommend Barefoot Shoes that do not have a heel, but provide a protective layer without any restriction to the foot’s natural movement (https://www.vivobarefoot.com/uk). They also do children’s shoes.
3) Keep symmetry in your body when sitting – avoid crossed legs!
Many people have heard that crossing your legs can cause varicose veins, but here I am concerned with balance in the pregnant woman’s body. By crossing one leg over the other, you create a twist in your pelvis and this creates tension or a slight twist in the lower uterus. I believe this asymmetry and accompanying tightness can sometimes be sufficient to cause an obstacle to a baby descending during the birth or the ‘failure to progress’ that can lead to a cascade of intervention.
In the Pregnancy Yoga classes, we do sit cross-legged on the floor for some of the movements, but we change which leg is in front half-way through. As individuals, we have a tendency to always cross the legs with one in front or the other every time, and this can lead to imbalance over time (just as sitting on a seat with legs crossed at the knees or ankles can). Becoming conscious of these habits is very helpful.
(Conversely, asymmetry during labour can be very helpful. For example, from kneeling if you step one foot forward into a lunge this creates asymmetry. Or stepping out of a birth pool creates asymmetry. This can create more space through the pelvic girdle. (To imagine how, picture a bottle half filled with water – if the bottle is tipped over to 45 degrees the surface area increases.) This can allow a baby to tuck a chin under or move a hand out of the way, thus decreasing the surface area of the baby to move through.
4) Use pillows between your knees AND ankles at night
Another way to maintain balance in the expectant mother’s body is to keep the knees and ankles the same distance apart as the hips. It is important to remember that the hip sockets are at the front of the pelvis, rather than the sides. Using pillows or cushions between the knees and ankles prevents the leg hanging down and pulling on the hips, which creates a twist in the pelvic floor and hip joints. This may also help with uncomfortable hips at night and pelvic pain, whether in the sacroiliac joints or pubic symphysis.
5) Release tight muscles
If someone knows or suspects that they may have tight muscles in the torso and through the pelvis to the femur (thigh bone), there are exercises/ positions to release them. For example, I know when my right psoas muscle is tight because the hip sounds as if it is clicking when I lower my right leg and it is straight. By doing a psoas-releasing exercise for a couple of minutes this noise will disappear for me.
Up to 30 weeks (or earlier if it is uncomfortable): the woman can lie on her back with her knees bent. Then she places cushions under her hips to lift them up from the floor slightly and support them (two cushions or pillows should be sufficient, or two yoga blocks). Then she extends one leg out so that it is straight with the heel on the ground and relaxed (i.e. the foot can turn out) for two minutes. Then she bends that knee up and straightens the other leg for another two minutes. Afterwards, with both knees bent, she pushes into her feet to pull the cushions out of the way, and rests for another two minutes on the ground.
30 weeks and over: the woman can sit on the front edge of a sofa and lean back onto a pile of cushions / her elbows. She stretches one leg out straight and relaxes it for two minutes. Then she changes to stretch the other leg out straight for two minutes. Then she sits upright on the sitting bones and rests for a further two minutes with the knees bent and feet on the floor.
Forward-leaning inversion – for balancing uterine ligaments
Suitable throughout pregnancy, except during nausea or heartburn.
Start on hands and knees. Drop down on to the forearms with the elbows under the shoulders. Pad the knees if necessary to be comfortable. Relax the head. Take three slow breaths here (if you know golden thread breath this is a great position to practice it in – see here for a description www.tessayoga.co.uk/pregnancy-resources).
IMPORTANT: Then sit kneeling for another three breaths. (Leaning forwards creates space and length, and the resting is where the balancing can take affect.) Cushions or 2/3 yoga blocks can be put between the feet and under the bottom if it is uncomfortable to sit directly on the heels when kneeling.
For other useful releases, visit http://spinningbabies.com/learn-more/techniques/
With this information I certainly do not want to give pregnant women something else to worry about, but I hope it will help them and their supporters an inkling of how important it is to prepare the mum’s body for the birth rather than only focus on the baby’s position.