Moving Comfortably Through Pregnancy: Body And Movement Awareness Education For Pregnant And Postpartum Women

Many women experience awkwardness and discomfort in their movement during
pregnancy. Many women feel strain as they pick up and carry their new babies after delivery.

However, back pain and awkward movement can be prevented or reduced through learning to rebalance the pelvis and spinal column as the body changes during pregnancy. And the same efficiency of body use will help women handle both the physical demands of lifting and carrying the newborn baby and the emotional stresses of raising a child. In addition, learning to make more efficient use of breathing and posture can help women manage the pain of delivery more comfortably. Much of the discomfort in pregnancy stems from inefficient use of the pelvis. Inefficient patterns of pelvic use are those in which unnecessarily high levels of pelvic muscular tension are maintained, in which the pelvis does not support the weight of the torso in an architecturally stable and strain-free manner, or in which the pelvis and legs do not serve as the power source for large body movements. Moving in efficient, anatomically appropriate ways will reduce back and leg strain, muscular fatigue, and general awkwardness and will increase comfort, safety and productivity for pregnant and postpartum women. As a means of explaining the nature of efficient pelvic use, I will describe a few of the exercises I have developed to help people understand and improve their awareness and control of their body use. The three elements of muscular tension, weight support and power initiation are all related, and techniques for dealing with them form a coherent teaching progression.

MUSCULAR TENSION & RELAXATION

Women (and men too) generally carry excess tension in the belly, breathing and pelvic floor musculature. In order to help women notice this and understand its effects, I start by asking them to consciously tighten their bellies, anal sphincter muscles and genitals and then walk around. They immediately experience how stiff and strained this makes their legs, hips and lower backs and their bodies and movement as a whole. Then I have the women stand and alternate tightening their bellies and letting them plop out. Next I have them release their bellies without doing a preliminary tightening . Women generally experience a noticeable release even though they had not first tightened their bellies consciously, and they realize from this that they had been unconsciously holding themselves tight and that they probably hold themselves tight all the time. As a further step, I have women touch their bellies and experiment with their breathing until they discover how to soften their breath and drop it into the pit of their bellies, expanding both the belly and the lower back as well as the chest when they inhale. This is frequently a novel sensation since many people suck in their gut as they inhale. However, once they feel this new style of breathing, people find it easy to understand how sucking in the gut and preventing movement in the belly rigidifies the belly, chest and back and constrains the free operation of the diaphragm and breathing.

Needless to say, in our culture many women feel funny about the idea of letting their bellies hang out, but once they get the hang of this free and easy style of body use and breathing, they discover that it is incredibly relaxed, comfortable and strong. It doesn't usually take long to convince women that feeling good and feeling powerful by breathing in the anatomically natural way is more important than our cultural rule of sucking in our gut and looking trim and stiff. Along with releasing the belly and softening the breath, softening and opening the anus and the genitals is important in releasing pelvic tension. Just as with the unrelaxed style of breathing, our culture encourages women (and men too) to close and compress their pelvic floor muscles. Most women find it relatively easy to release their vaginas when they think of it, though often they initially feel uncomfortable doing so and cultivating this as a normal state requires a lot of practice. When I have women release their bellies, breathing and pelvic floor muscles and try out walking this way, they generally feel that their movement is more relaxed, freer, better balanced, more graceful, more coordinated and much more powerful. Beyond the physical comfort and effectiveness, they feel that moving this way also results in a personal, emotional sense of assertive power and calm sensitivity.

Learning to perceive and reduce pelvic tension helps women deal with the anxiety and pain that they may experience during labor and delivery, and there is a simple exercise which will allow them to practice handling pain well. By pressing hard into various nerve points – for example, the web of the thumb – I can give women the opportunity to experience and practice with intense non-injurious pain. (Of course, I explain this exercise carefully beforehand and offer it as a choice not a requirement since the exercise would not be helpful for women who did not want to try it.) Although they are initially quite distressed by the pain, they quickly discover that when they maintain a soft and open pelvic focus and manner of breathing, they can greatly reduce the intensity of the pain. When pregnant women discover that they can keep a steady, alert, relaxed mind/body state and not let even great pain overwhelm them, it vastly increases their self-confidence and willingness to face the pain of labor. This process of pain management is obviously related to such techniques as Lamaze or Bradley, but in the teaching I do it is just one element of a broader picture of appropriate body use that applies to every facet of life, not just labor and delivery. The next two sections will link relaxation to body support and power.

PELVIC ALIGNMENT & WEIGHT SUPPORT

Relaxation of the pelvic musculature reduces direct tensing of the muscles, but a lot of tension and inefficiency in pelvic use is indirect. It is caused by holding the body in postures in which the pelvis does not support the weight of the torso in an architecturally stable and strainfree manner. Rather than holding the bones in a well aligned stack so that they take the weight of the body, these anatomically unnatural postures require increased muscular effort to prevent the body from collapsing, or if this effort is not applied, then a different kind of strain occurs as the body hangs down on the joints and ligaments. To help women feel this, I ask them to sit on a flat chair without touching the back support. Then they experiment with the movement of slumping down and sitting up straight. Most people believe that straightening up is done by throwing their shoulders back or by arching their backs, and practically no one notices that straightening up is really a function of pelvic rotation. As they experiment with the movement of slumping, women feel how their chests cave in, their heads fall forward and down, and their backs get round when they slump. They readily feel that both slumping and trying to sit up by throwing the shoulders back or arching the back cause physical strain. After a while, they notice that as they slump, their pelvises rotate backward (the direction in which the guts would spill to the rear out of the pelvic bowl), and they feel that as they sit up from the slump, their pelvises rotate forward. They realize that when the pelvis is rotated backward, the stack of vertebrae does not have the pelvis as a level foundation on which to rest and the back curves and slumps down. They notice that rotating the pelvis forward provides a foundation for the spinal column and the torso as a whole and thereby creates upright posture. They also notice that rotating the pelvis too far forward results in a swaybacked posture, which is tense and strained.

Beyond paying attention to simply the placement of the pelvis, it is also important to attend to which muscles are used to move the pelvis. The most effective and comfortable way to rotate the pelvis forward involves using muscles deep in the core of the body rather than muscles along the surface of the back, and this is something that most people have never experienced. The pelvis is essentially bowl-shaped, and there are basically two ways to tip a bowl forward – lifting the rear edge or lowering the front edge. Using the muscles of the back to lift the rear edge of the pelvis shortens and arches the back and creates tension and instability. This is why people will endure sitting up "straight" for a few minutes and then give it up as uncomfortable. Using the deep internal psoas muscle to create a movement which in effect drops the front edge of the pelvis creates a very strong and comfortable physical organization of the pelvis and spinal column. Done correctly, there will be a feeling of spaciousness and "dignity" in that area of the body, and that feeling is the sign of the engagement of the psoas in the movement. Rolling the pelvis forward using the psoas leads to a new way of sitting that is stable and relaxed. To help people experience this, I will lightly press straight down on the tops of their heads. (Of course, I first make sure that they are not experiencing any back or neck pain that would make this inappropriate.) In this new way of sitting, the spinal column is neither overly arched nor rounded. It sits squarely on the pelvis, and there is a feeling that it takes very little muscular effort to maintain the alignment. All the pressure of my push is transferred down through the bones to the "sit bones" (the ischial tuberosities) and onto the surface they are sitting on. This form of body organization produces an experience of comfortable and effortless physical weight support, and it indicates to people how strong and comfortable their movements can be when they are executed with correct biomechanics.

Moving from a slumped to a balanced sitting posture Any deviation from this ideal position of pelvic and vertebral alignment is less stable and supportive. If the pelvis is rotated forward and the lower back is lordosed, the pressure applied to the top of the head will result in arching and buckling of the body structure as a whole. If the pelvis is rotated forward and the lower back is slumped, the pressure on the head will result in the body collapsing into a slump. This new awareness of pelvic balance can be extended into larger movements such as standing, walking and lifting. As one example, when most people hold a weight out in front of their bodies, they counterbalance the forward and down force of the weight by leaning their head and shoulders back. You can see this by asking someone to pick up a weight and hold it out at arm’s length. However, that creates a swayback curve and compresses the lower back. Instead, aligning the pelvis correctly and sticking the tailbone slightly back and out allows the pelvis and lower torso rather than the shoulders and upper torso to act as the counterbalance to the forward weight. This opens and lengthens the back and frees up the hips and legs. It also allows the weight to be supported by the leg muscles rather than by the back. All this results in much easier and stronger movement as well as better balance.

MOVING FROM A COLLAPSED TO A SUPPORTED STANDING POSTURE

This pattern of pelvic balance and postural support is very important during pregnancy. As the fetus grows, a pregnant woman's center of gravity shifts forward, and most often the expectant mother throws her shoulders back to balance the weight of the fetus. She creates the characteristic pregnant swayback posture as a means of handling the weight hanging off her forward edge. This increased curve makes the woman's posture biomechanically weaker and contributes to low back pain and the awkward, strained pregnant waddle. However, it is not necessary to endure these discomforts during pregnancy. It is relatively easy for most pregnant women to eliminate the waddle and back pains by learning how to use the pelvis as the core of their standing and walking and the counterbalance to the growing weight of the fetus. Along with exercise programs and childbirth classes, this kind of body and movement awareness education is very important for a safe and comfortable experience of pregnancy.

POWER INITIATION & MOVEMENT

The discussion of weight support already hinted at the importance of pelvic balance in large movement activities. Though the focus in that section was on support of the body itself or the weight of the growing fetus, the same understanding of pelvic balance is important for a pregnant woman who picks up any external object. Many pregnant women have other young children and pick them up. Whatever pregnant women may lift, they will avoid a good deal of back strain if they know how to refrain from arching their backs as they lift. And of course the same principles of movement will apply for postpartum women. However, beyond simply maintaining structural balance, it is important to use the legs and pelvis rather than the back and arms as the actual source of movement and power in activities involving pushing, pulling and lifting. Most women are not aware of the function of the legs in movement initiation, and there are a number of exercises I use to help them develop this awareness. I have women start working on this by standing and pushing on a wall with their hands, placing their feet far enough from the wall that their bodies incline forward quite a bit. I ask them to bend their knees and then straighten their legs as though they were trying to push the floor backwards away from the wall. I have them try this with their pelvises rotated so that their tails are tucked under, with their backs arched, and in correct pelvic alignment. It is easy to feel that the correct orientation of the pelvis maximizes the thrust of the feet on the floor and that it is the thrust on the floor which creates the power of the hands to push on the wall. This awareness can be applied in many activities. As one example, we can look at the pushing/pulling movements of such tasks as raking earth or using a vacuum cleaner.

Normally in doing a job people restrict their awareness to just those body parts which seem to be directly involved. Most people when vacuuming believe that the hands, arms and shoulders are doing the holding and pushing, so those body parts are what they are aware of and use most. In addition, most people bend forward at the waist and use their backs to hold their arms in position. However, this is a strained way of moving and will lead to fatigue and possible back strain. It is possible instead to use the hips and legs to create the forward/backward movement and to use the torso and vertebral column to transmit this movement to the arms and hands and thus to the vacuum cleaner. In this more efficient way of vacuuming, the legs are spread a comfortable distance apart, the back foot is turned out a bit in order to improve balance, and the torso is rocked forward and backward on the legs. The back stays erect and the vacuum cleaner stays connected to the pelvic movement so the arms and back do very little work. Common, unbalanced pattern of movement Balanced use of the legs and pelvis for movement initiation.

It is also important to use the legs and hips as the clear and conscious power source for lifting, turning, standing up from sitting, sitting down, walking, running and so on, and I generally include examination of these and other fundamental movements in body education for pregnant women. Beyond that, it is interesting and useful to examine the particular movement tasks that women do in their daily lives and show them how to apply principles of centered movement to those tasks. I have helped pregnant women with such things as piano playing, tennis, working at a computer, gardening, housework, driving in a car, comfortable sleep postures and so on.

CONCLUSIONS
The three elements of pelvic relaxation, correct positioning and correct power initiation are important to every woman in moving effectively, safely and comfortably whether she is pregnant or not. However, they assume special importance for pregnant women. Whatever women do while they are pregnant and in the time following delivery, it is important that they maintain biomechanical integrity. Their bodies are changing and especially vulnerable to the strains and discomfort of applying physical effort in inefficient ways. Moving correctly will help pregnant women avoid strains and injuries. In addition, when women first experience what it is like to use their bodies in an architecturally integrated and powerful way, they often light up with enthusiasm and exhilaration. Pregnant women who carry this sense of bodily enthusiasm with them through their pregnancy feel much better about themselves, about their ability to move and work, and about the pregnancy itself.