Hospital Bed

• Becka B. Unfortunately, lower back pain is incredibly common (and almost unavoidable) throughout pregnancy and after. But there are certainly some things you can be doing now, preventatively, along with having a postpartum plan. It's important to keep in mind that women who experience increased LBP prior to giving birth are far more likely to experience it after - and experience it longer. As your pregnancy progresses, your abdominal muscles loosen/weaken and the ligaments stabilizing your pelvis have taken a significant toll as hormones kick in to help your uterus expand to accommodate baby. This creates a pelvic instability and a significant stress on your joints that very often leads to pain. Now, the hormones we can't do much about. How long they linger postpartum is different for every mom and relies on your lymphatic system, a passive system that filters away metabolic wastes over time. Some individuals have very fast, efficient systems, some are slower. Drinking plenty of water (especially when pregnant) can help your lymphatic system do its job efficiently. So can movement. Never underestimate the power of a gentle stroll. Walking the hallway, the dog, getting the mail - these are all things that, while simple, can help get you moving postpartum. As for the physical stabilization of the pelvis and lower back, you can preemptively help yourself by being very mindful of your posture, even doing exercises like wall angels, Keigles or prenatal yoga to strengthen the pelvic floor and posterior chain of your body, will help you significantly in the long run. I cannot stress PREEMPTIVE CARE enough. Now to your specific question about being in the hospital bed, the most common 'mistake' I see when visiting my patients post birth is their complete lack of consideration for their own posture while breastfeeding. It's understandable, of course. You're a new mom and your first priority is to get your little one latched on and feeding. But this often comes at the expense of your back. Your shoulders round, you looking loving down at your baby, straining the back of your neck and lengthening the entire posterior chain of your body - all the way down to your lower back. Be sure to ask the lactation nurse to show you proper posture for YOU. You should be able to fully support your baby without compromising the integrity of your entire spine. Bolstering with pillows and self awareness go a long way! After you get home, you can start a gentle exercise routine (check in with your physician before starting any exercise) to regain range of motion and stability in your lower back. Walking is a great first step (pun intended) and eventually swimming, when okayed by your care giver to get you moving without putting a lot of undue pressure on your already stressed joints. Pelvic tilts are a fantastic way to specifically address the LBP you are worried about. Lie on your back with your knees bent and your feet flat on the floor. Inhale and allow your belly to expand with your breath. Exhale and tilt your tailbone toward your belly button, keeping your hips on the floor until you close the gap between your lower back and the floor. This is a very subtle movement. At the top of the tilt, tighten your buttocks and hamstrings, hold for 3-5 seconds, then release. Repeat 8-10 times every day. *if you have had a c-section, wait at least 6-8 weeks before you begin this exercise. As always, get your physician's approval regardless.

• Becka B. Also, if you have access to a good massage therapist, I would highly recommend at least a couple sessions prior to the birth to help prepare your body. It can also help make the birthing process less stressful in your body overall - an obvious plus! The same therapist can be immeasurably helpful in relieving some of the lower back and joint pressure while simultaneously helping to promote your lymphatic system after giving birth. Getting those hormones (particularly the Relaxin, which likes to linger) out of your system will help you get back to a more stable and less achy you. Look for a "Certified Prenatal Manual (or Massage) Therapist" in your area. Not all cities/states require certification (or licensing for that matter) but you can still make it a requirement of the caregiver you choose to work with. If they are certified, that means they spent a significant amount of time in focused continuing education to be a better therapist for your needs.

Prenatal massage

• Becka B. This is purely a matter of preference and one therapist may give you a different answer than I will, but here's my two cents... I have my prenatal clients lay prone (face-down) for as long as they are comfortable. There is no danger in laying prone, even if you are showing a bit, and moving to sideline is a matter of comfort for the mom. In my practice, I never use the parenatal pillows or cutouts and opt for sideline once the client feels uncomfortable face-down. My reasoning here is that I simply have no consistent way to control how much pressure is being applied to pelvic area during the session. That said, I have spoken with several colleagues who have expressed trust in some of the newer prenatal bolstering systems. Being a private, in-home therapist, it simply has not been practical for me to look into these large bolstering systems, and sideline has always worked very well for me (I do have several clients, if not the majority, who prefer sideline after having tried both). I would absolutely stay away from generic cutouts in the table themselves. If you do decide to use a therapist who utilizes a bolstering system, it should be just that - bolstering. Supportive. Customizable. Your pregnancy and your belly is unique to you and should be treated as such. Bottom line, it really comes down to your preference and comfortability, luv. For me, if you decide to use a therapist who uses bolstering equipment, I would make sure that they are "prenatal certified" and that their equipment (if they are, in fact, using a bolstering system) is up to date - i.e. not 10 years old and is showing significant wear.

c-section

• Becka B. This is an excellent question and has been the subject of a personal campaign of sorts for me over the years. As you already know, c-section recovery is never fun. But you absolutely have options beyond medication and rest! I spent some time working on the postnatal floor of a Chicago hospital and found it unbelievable how many women went home after c-sections with little to no relief and no post surgical self care instruction beyond medication, being encouraged to go to the bathroom and rest. Much of the pain and discomfort experienced after this procedure can come from the fluid that accumulates below the incision, a common surgical side effect called lymphadema. Swollen feet, legs and lower abdomen can be incredibly uncomfortable - but this can be addressed! A licensed massage therapist can perform Manual Lymphatic Drainage, a gentle clinical modality that aims to assist in moving the excess fluid out of the damaged area so it can be processed naturally by your lymphatic system. If you're fortunate enough to have access to a massage therapy program where you give birth, this can easily be performed while you're still in your hospital bed. I often arrange to visit my clients at the hospital immediately following birth as I find it is those first couple days that can be so excruciating for mom. You would be amazed by not just the positive physical but emotional effect this type of treatment can have on both mom and dad before you have to return home. Finding a private, or concierge, massage therapist, while not as common, can be in indespensible at this time. If they can't come to the hospital, arranging for an in-home session can be a wonderful way to find some relief and relaxation time without having to leave the house. Ultimately, having this treatment performed sooner rather than later can make all the difference in your total recovery time! Beyond having a therapist assist your lymphatic system manually, you can help it yourself by staying hydrated, elevate your legs when reclining and making sure you do stay moving when possible. Water, gravity and movement promote the system as well, and will assist in healing over time. Side note: later on, you can talk to your manual therapist about post-surgical scar tissue massage. They can help reduce the scarring which in turn can help your regain strength and stability in your core when you return to your workout routine.

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Neck and shoulders after nursing

• Becka B. This is by far one of the most common postpartum complaints I come accross, and fortunately, one of the most correctable. If you have the means, getting yourself on a plan with a myofascial specialist (a massage therapist who knows how to address the imbalances in shortened/lengthened muscular tissue) can be immeasurably helpful in speeding up the process. However, we don't all have that available to us! When we breastfeed, we shorten the muscles of our chest, anterior shoulders and anterior neck - this means we lengthen our upper back and posterior shoulders and neck. In both cases, the muscles become weak and painful. At home exercises like wall angels and neck strengtheners can help counteract months of forward posturing. Here is a good video demonstrating a beginner's version of wall angels: http://youtu.be/SmEu3hTJnTE I recommend my clients to do 2 sets of 10 every day. If you are doing these correctly, THEY SHOULD FEEL HARDER THAN THEY LOOK! There should be a burning sensation through your upper back/posterior shoulders and form pressure in the lower back. If not, check in that your lower back, elbows and wrists are firmly pressed to the wall throughout the entirety of the movement. I haven't found a video for the anterior neck strengtheners that I love online, so I'm going to shoot one for you today and post back when it's ready! Hands down, though, integrating wall angels into your daily routine will be immeasurably helpful.

• Becka B. I wanted to forward along this link to the anterior neck strengthening exercise I recommended: http://youtu.be/UZ8mfU3lvCQ

• Molly Thank you SO much!! This is so helpful.

Massage for toddlers?

• Becka B. Absolutely! Massage is appropriate at every age, starting day one... the birthing process isn't stressful just for mom! As for your toddler, lymphatic drainage techniques help kiddos just as it helps adults, and the muscular pain and tension associated with teething can be helped with some focused, gentle manual therapy. You will want to look for someone certified in infant massage. Certification and licensing requirements will very by city and state, but you can be confident in someone certified, as they took significant continuing education classes to obtain that specialization. There may also be classes available in your area for you to learn how to provide the therapy for your child yourself. It can be a wonderful bonding experience for both parents and comes with the added benefit that your child will get some relief from their aches and pains. Where are you located?