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Our in house physiotherapist, gives birth to Tom, shares her experiences.

After 8 months of drooling over our precious new baby boy and travelling across the globe to introduce him to our family and friends, I am overjoyed to be back working at Body with Soul. In this newsletter, I would like to share some aspects of my latest adventure of being pregnant and giving birth and will link it in with some tips on women’s health issues.

As a healthcare practitioner, being on the receiving end of care is always a fascinating and enriching experience. Since both our children were conceived through IVF (in-vitro fertilization), I have had my fair share of being in the ‘patient’s chair’. It has been an emotional and physical rollercoaster, but I feel unbelievably fortunate to be where I am now: a healthy Mum of two healthy and totally adorable kids! However, even more interesting to me, as a physiotherapist specialising in women’s health, are the vast changes that take place in our bodies as a result of pregnancy and delivery.

Considering how challenging it was for us to conceive, I was very happy to have two straightforward and healthy pregnancies. I also managed to have a normal delivery with both of them and to resurface fairly unscathed. The first one, in London, was a long affair and I eventually needed an epidural. The second one, in Singapore, was not as short as I had been ‘promised’ by many second-time Mums…but, it was the most incredible water birth experience. With the physical and emotional support of my amazing doula and hospital midwife, and the comforting presence of my Obstetrician overlooking it all, I practically delivered our son myself. It was undoubtedly one of the most extraordinary moments of my life!

In both instances, I diligently practised what I preach in relation to the infamous pelvic floor muscles. The Cochrane Review-internationally regarded as the highest standard in evidence-based health care-recommends that women, who are over the age of thirty and having their first child, should practise antenatal perineal massage to reduce the risks of perineal trauma and post-natal perineal pain by performing antenatal perineal massage from the 35th week of gestation. This can be done by the woman herself or by her partner, and it has been shown to have a protective effect even if it is practised as little as once or twice a week. My husband deserves a gold medal for helping me out with this one. It was well worth it, and I was truly relieved to have an intact perineum both times!

Once the baby arrives, all our energy and focus tends to be directed towards our gorgeous little person. Pelvic floor and abdominal muscles many times end up literally at the bottom of our list of priorities. Until symptoms start to appear… For many women, these symptoms (such as urinary incontinence or pelvic organ prolapse) won’t appear until menopause, which makes it even easier for them to ignore the importance of strengthening these muscles. I strongly feel that women should look after these muscles as much as they look after their teeth, hair and skin. Even when I was feeling utterly exhausted from juggling our new family dynamics, being sleep deprived and breastfeeding, I would still do a set of pelvic floor exercises. I have simply seen too many times the consequences of overlooking these in the hope that they will strengthen by themselves!

Whilst pregnant, I gained more weight than any book or doctor would ever recommend! The first time around, six years younger, I did not feel the impact of carrying so much extra weight nearly as much as I did this time (at nearly 40!). In the first few months after delivering, I clearly felt the pressure that this placed on my pelvic floor, abdominal, and lower back muscles. Being overweight made me feel sluggish and heavy, and it was particularly hard to do any higher impact exercise, such as running, which I love! So, my baby turned five months and I thought to myself: I need to break this cycle and feel good about myself again. I somehow reconnected with my fragile willpower, and once I saw the first 5 kg come off, I immediately started to feel better and exercising became easier. The first part involved eating sensibly (and cutting out the cakes, muffins and cookies which had become part of my daily diet!) together with consistent, disciplined, low impact aerobic exercise. Three months later, I have managed to drop 12 kg and I feel like myself again! The biggest success to me is being able to run again and not feeling like my lower back, abdominals or pelvic floor will give up on me. Although there is a lack of hard scientific evidence, clinical experts advise new mums to resume running only once their periods have returned regularly and it is generally better to do it after you have stopped breastfeeding (especially if there is a strong family history of pelvic floor problems, which may indicate a genetic collagen issue). The main reason for this guidance is to prevent pelvic organ prolapse (ie. The bladder, womb, or rectum losing their internal support and shifting position inside the pelvis).

Our baby has steadily decided to put on himself almost all of the weight I had lost. At nearly 8 months, he weighs 10 kg and is proving to be a huge challenge to those of us who handle him! I am constantly assessing and re-assessing our ergonomics at home, in order to prevent neck, shoulder, wrist, and lower back problems. These can so easily creep up on us when we don’t think of our postures and daily repetitive movements. Once again, I boringly (but passionately!) preach for regaining the strength in all those important muscles. Overall upper body strength and flexibility is just as important as core strength, and can help to prevent overloading of joints, tendons and ligaments.

Having knowledge of my anatomy and physiology has definitely empowered me, in as much as I can understand the changes that my body has gone through. Nonetheless, I do not wish to simplify or generalise complex issues. Every person has her own ‘story’…and, even in the fittest of women, pregnancy, labour and delivery can take unpredicted turns and leave enduring consequences such as pain and loss of function. Finally, I urge all women to tune in to their bodies, to prevent symptoms from occurring, but if they do, to seek help quickly and deal with it effectively.

Monica Donaldson