Breastfeeding has so many benefits for you and your baby, but it is demanding, mentally, physically, and emotionally. In case you need to hear it, you matter too! Taking care of your baby begins with taking care of you.
Movement can be a great way to meet some of your physical and mental needs throughout the day. Breastfeeding requires a lot of sitting and forward posture, at least early on. While there is no one perfect posture, variety of postures and movement are key. For a breastfeeding momma, that will mean spending non-feeding time getting out of sitting and rounded positions and maybe even trying a variety of positions if a particular one is becoming painful.
If you are having difficulty with breastfeeding, I highly recommend getting help from a lactation specialist. See my post on breastfeeding resources for more info.
If you are having neck, back or shoulder pain during or after feedings, here are a few things to get you started:
Positioning, Support, and Posture
First, let’s address the positions that you are suddenly spending a lot of time in.
One of the best pieces of advice [that I did not initially listen to] was to “bring the baby to your breast and not your breast to your baby”. You can start with pillow support to raise the baby up off of your lap without requiring much effort from you. Here is my favorite pillow because you can strap it to you and be “hands-fee”. However, you do not need a fancy pillow, you can start with the pillows you have.
“bring the baby to your breast and not your breast to your baby” – my lactation consultant
Another thing that can be helpful is a supportive chair. I would recommend finding a seat with just enough lumbar support to keep your back supported in a comfortable, neutral position. I personally enjoy a higher backed, reclining chair because they make it so much easier to rest your head and to bring the baby to you using gravity, like we discussed above.
Check your posture, is there tension in your jaw, shoulders and neck? Are you hunched over your baby? Rest into your chair/supporting surface. The early days of feeding can be difficult, so implement this advice as you can, however it works for you.
The last thing would be to change up your feeding postures. If a certain position is not serving you or your baby, try another. Kellymom has great resources on this. If you are having pain in upright feeding positions, sidelying or reclined feeding may offer some relief, especially if you are struggling with oversupply. The video below shows safe sidelying feeding.
After you have addressed feeding postures, here are some movements to help you feel great.
When you have clearance for these types of movements from your medical provider, you can begin to gently connect with your body in different ways. Some providers are okay with clients beginning posture, deep breathing, and sidelying rotation stretch exercises around 2-4 weeks after a vaginal birth. If you have had a C-section, sometimes, you may take a little more time to heal and begin these closer to 2-6 weeks with clearance. The other exercises can typically be started after you have had your 6 week clearance visit. At the end of the day, you know your body best; these exercises should feel like a gentle stretch and should not be painful. Stick with it, it takes time to make changes. Exercises below should not be painful. If you continue having pain, see a physical therapist that focuses on helping postpartum clients. We see clients in parts of Greater Cincinnati, doing just this.
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Let us know how changing position and adding movement into your day makes you feel.
Preparing to welcome a new babe into your family can be overwhelming. Here are some tips and local resources to help you prepare to rock your birth (including getting ready for what comes after).
Written By: Alex Courts, DPT, PCES
There are so many options for preparing for birth these days, so what really matters? As I write this, I am expecting my second daughter in September and preparation is in full swing, so I get it. While birth usually doesn’t go exactly according to our best made plans, one thing we can do is prepare to make decisions that align with our own preferences no matter the circumstances. As a doctor of physical therapy with training in obstetrics and a childbirth prep instructor, I’ve gathered my favorite resources to simplify your prep and help you feel confident heading into birth.*
Here are my 5 steps to preparing for birth (and beyond):
Decide Your Birth Preferences
Discuss Your Preferences with Your Provider
Prepare Your Body (and Mind) for Birth
Prepare for Postpartum
Below you will find a free birth preferences worksheet, my favorite resources, exercises, and more.
While you can do these steps in any order, this order will allow your values and preferences to guide your preparation, so let’s get started with step 1:
“How will I know my birth preferences if I have never given birth?” – this is a legitimate question in a day and age when most women give birth in the hospital, so family members do not have as much opportunity to witness the miracle of birth. Cue the endless googling! An alternative to scrolling through endless blogs, instagram, and youtube videos, would be talking with trusted friends and family to hear real birth stories. Documentaries and podcasts can also be great options for learning about birth and hearing real birth stories.
Here are 2 of my favorite resources for researching options for birth:
a great resource to learn the pros and cons of various interventions that may be offered to you during birth
If this is your first baby, give yourself plenty of time to research. I am biased, but I highly recommend a childbirth class to learn how to turn your birth preferences into an action plan on your big day. While it’s never too late to change your mind, deciding what birth class you would like to take at around 20 weeks is a good idea. Some classes are up to 12 weeks long, so you want to have time to sign up for these classes (and complete them) before baby makes their debut! I often recommend that first time families take a class before 30 weeks in the rare event that they decide they would like to change providers based on the preferences they discover after class. Some providers require you to establish care by 32 weeks.
And if you are an experienced mom wanting to have a different birth experience this time around, I still encourage you to do your research and sign up for a birth class. If you are fairly confident in your birth preferences, I have worked with some families as late as 36 weeks. These families are ready to rock their birth with class so fresh on their minds.
STEP 2. GET SUPPORT
Once you have narrowed down your preferences for birth, start lining up support for pregnancy, birth, and postpartum. Here are a few options to consider when it comes to support:
What setting do you plan to give birth in?
Hospital, Birth Center, Home?
What type of provider would you like to attend your birth?
Did you know there are doulas for pregnancy, birth and postpartum?
Your partner, friend or family member can even act as a doula if you do not want a formal doula at your birth
Would you like any other support during pregnancy?
Here are a few other professionals that can help during pregnancy: dietitian, mental health professionals, physical therapists, fitness professionals, prenatal yoga instructors, health coaches to name a few
You are not only going to be caring for a newborn but also caring for yourself as you recover from birth. Based on personal experience and feedback from past clients, I recommend lining up support for AFTER birth. For ideas on postpartum support, see Step 5.
There are lots of options for support available, so figure out which ones would serve you best and start discussing your birth preferences with your birth partner and doula (if you choose to have one) to prepare for the next step.
STEP 3. DISCUSS YOUR BIRTH PREFERENCES WITH YOUR PROVIDER
Now that you have a better idea of your own preferences and are feeling supported, it is time to formally write them down and start to discuss them with your trusted provider. Here is an example of a Birth Preferences Worksheet that you can fill out and review with your provider.
When should you do this step?
I personally don’t think it is ever too early to start having discussions about the type of birth you would like. As I mentioned earlier, some providers require care to be established by 32 weeks, so I recommend starting to talk with your provider about your non-negotiable birth preferences by early third trimester. You may want to start this process even earlier if your provider is part of a large practice in which there are multiple providers who could be present the day you give birth. You will want to set up appointments with different providers each visit, starting as early as you feel comfortable to get a feel for each different provider – their views are not always the same. This gives you time to make a change if you find that your provider is not supportive of what is important to you.
You should plan to have your hard copy of your birth preferences worksheet signed by your provider by 36 weeks. This is a great opportunity to review any hospital/center/provider policies, so don’t be alarmed if your provider wants to have a respectful discussion about certain parts of your plan. Typically, your provider will keep a copy and you will want to keep a signed copy for your records. This document should be available in your medical record for anyone attending your birth, but it is a good idea to keep hard copies in your hospital/birth bag to share with anyone present at your birth. Delegating this responsibility to your partner is a great idea. They can help advocate for your birth plan while you are focusing on your labor.
Hopefully getting the sign off on your birth preferences is a weight off of your shoulders! Now that all the big things are lined up, you can solely focus on preparing your body for birth with our next step!
One area that can be key for preparing for birth is your pelvic floor. Have you heard of it? The pelvic floor includes the muscles and supporting tissues at the bottom of your pelvis where the baby will come out in a vaginal birth. Pelvic floor muscle exercises (also referred to as kegels) during pregnancy are gaining popularity; if you want to learn more about this, see this post later. Pelvic floor muscle coordination and the ability to relax your pelvic floor during the pushing phase has the potential to reduce pushing time3 and chances of tearing4. See the video below to learn how to start preparing your pelvic floor to stretch as needed for birth.
If that video didn’t scare you off and you are ready to take it one step further, another important option for preparing for an unmedicated birth is perineal massage. Just as we might stretch a tight muscle or massage a scar, perineal massage can be a way to prepare your pelvic floor to stretch for a vaginal birth. I personally think this also helps you mentally prepare for some of the sensations you may experience during an unmedicated birth. This allows you to experience these natural processes of birth with familiarity and the knowledge that baby is almost here, rather than fear. This technique is something that should be cleared with your provider if you would like to perform it after 35 weeks of pregnancy. You can find more detailed information on this topic here.
Now that we have started physically preparing for birth, let’s talk about how equally important it is to prepare mentally. The benefits of psychological prep for birth are not all in your head! According to Dr. Jade Wu, using mindfulness in childbirth has been associated with feeling:
And having a “better postpartum recovery”5
Here are a few ways to incorporate mental preparation for birth:
One thing most first time moms feel unprepared for is postpartum recovery and the demands of caring for a newborn. I will keep this section short and sweet but packed with key things to consider lining up to make the next step in your motherhood journey just a little easier.
Postpartum Support ideas:
postpartum doula/friend/family support
childcare for older siblings
meal train or freezer meal prepping at the end of pregnancy
list of local postpartum support professionals to contact if you need them
lactation, physical therapy, mental health, nutrition specialists to name a few
If you want to avoid sending your partner out to the store for feminine products, here is a post on some of the key things I like to have on-hand for postpartum recovery. And if you want a deeper look into postpartum recovery, here is a blog post and instagram live that gives you a more realistic idea of what postpartum recovery looks like. All too often, moms feel unsupported after their 6 week clearance visit with their obstetric provider. I want you to know ahead of time that recovery takes time and that there are people out there to support you as you continue on your journey in motherhood. Feel free to contact me for additional support.
HOW ABOUT YOU?
What steps are most important to you to prepare for the birth of your babe?
About the Author:
Alex Courts, DPT, PCES is the author of this blog post and owner of Vibrant Physical Therapy & Wellness. After the birth of her daughter, Dr. Alex noticed gaps in maternal health care that were echoed by fellow moms. She began focusing her career on filling these gaps and helping moms navigate the physical journey of motherhood starting with education, prevention and exercise support in pregnancy and continuing with postpartum physical therapy and exercise services. To learn more about Vibrant Physical Therapy & Wellness, including our childbirth prep classes, see our home page or schedule a discovery visit to discuss your goals with Dr. Alex.
ACOG Committee Opinion No. 766 Summary: Approaches to Limit Intervention During Labor and Birth. Obstetrics & Gynecology. 2019;133(2):406-408. doi:10.1097/aog.0000000000003081
Campbell DA, Lake MF, Falk M, Backstrand JR. A randomized control trial of continuous support in labor by a lay doula. J Obstet Gynecol Neonatal Nurs. 2006;35(4):456-464. doi:10.1111/j.1552-6909.2006.00067.x
Kamel R, Montaguti E, Nicolaides KH, Soliman M, Dodaro MG, Negm S, Pilu G, Momtaz M, Youssef A. Contraction of the levator ani muscle during Valsalva maneuver (coactivation) is associated with a longer active second stage of labor in nulliparous women undergoing induction of labor. Am J Obstet Gynecol. 2019 Feb;220(2):189.e1-189.e8. doi: 10.1016/j.ajog.2018.10.013. Epub 2018 Oct 12. PMID: 30321525.
Abdelhakim, A.M., Eldesouky, E., Elmagd, I.A. et al. Antenatal perineal massage benefits in reducing perineal trauma and postpartum morbidities: a systematic review and meta-analysis of randomized controlled trials. Int Urogynecol J31, 1735–1745 (2020). https://doi.org/10.1007/s00192-020-04302-8
The following guest post was generously created by Brittany Balke, who I bonded with initially over lack of sleep in motherhood and chronic pain on instagram. We share a background in the field of physical therapy and share a similar perspective on health and wellness, so if you enjoy my content, you will value hers as well. Brittany is an experienced mom who helps others let go of the guilt and focus on their wellness according to their values, not what society or someone else is telling us.
Few things turn your world upside down like becoming a parent, whether for the first time or the umpteenth time.
Good health becomes more valuable than ever as you expend your energy between babies and big kids and everything else in your life. And yet, the time and mental energy you have for taking care of yourself is also more limited than ever!
So I’m not here today to add rules to your list. In fact, I’d actually like to tell you about three health rules that you can just drop ASAP. I’ve listed a few guidelines for what you might do instead, but they are exactly that: guidelines.
“There are good foods and there are bad foods.”
We can also replace the words “good” and “bad” with words like “healthy” and “junk” or “clean” and “garbage” (all vocabulary I’ve heard in real life). This is called moralizing of food choices, and it can pack some hefty unintended consequences. There’s benefit to changing to a mindset that food is just food, and there are multiple ways it can nourish us, even if it is not the most nutritious option. Food can and does nourish us nutritionally, but it can also nourish us socially, emotionally, and spiritually.
This is called moralizing of food choices, and it can pack some hefty unintended consequences
Typically, people will label food as “bad” or “junk” because it is perceived as being less nutritious. I say “perceived” rather than “is” because sometimes food moralizing comes with unsound claims about nutrition. For example, carbohydrates are typically demonized; however, they are highly important for multiple functions of the body, not the least of which is mood and energy regulation. Chemicals are another misunderstood component of food, particularly because the definition of “chemicals” isn’t consistent among different claims. If you want to learn the basics of nutrition needs, ChooseMyPlate.gov is a great place to start. If you need more personalized help, a registered dietitian can help you best address your individual needs while honoring science and research evidence.
“Okay that’s fine, but what happens when I emotionally eat this whole box of cookies because I’ve decided they’re no longer bad?” The funny thing about that is restriction—such as occurs when we moralize foods as bad or junky—is more likely to lead to that binge than a more mindful approach. It’s also more often associated with negative self talk: “I ate the garbage food, therefore, I’m gross.” Now of course, that’s not true: eating “bad“ foods doesn’t make you “gross“ any more than eating “good” foods makes you a Nobel Peace Prize candidate. But this is where our minds tend to wander the moment we label our foods this way, and this can also contribute to overconsumption. The book Intuitive Eating and its workbook explain this in further detail.
Now, with that said, I DO understand the importance of not letting social or emotional nourishment overshadow your nutritional needs. Instead of seeing food as good and bad, you can begin to mindfully notice what kind of nourishment you’re seeking and receiving. Spend a couple or a few days recording what you ate and why. (The I Ate app is an awesome way to do this. It’s pre-set with prompts about your emotions and hunger and other circumstances). How hungry were you? How did you feel before and after you ate? If you’re consistently turning to food for emotional or social nourishment and ignoring the nutrition component, that information can help you make more choices to nourish those areas of your life with things other than food.
August is National Breastfeeding Awareness Month and I am celebrating by sharing some great resources.
First, I just want to acknowledge that breastfeeding is hard. It almost broke me. Motherhood is tough, but trust me, you are tough too. You have heard it before, but raising kids takes a village – that village is not just for the kids, it is for mom too. In this day and age (especially in a pandemic), our support is now virtual in addition to in-person. So here are some virtual breastfeeding resources.
Personally, I lucked out and found an amazing, free breastfeeding support group at my local hospital. Unfortunately, many in-person support groups like Baby Cafe and La Leche League are postponed, but that doesn’t mean the support is postponed too! There are many local and national support groups that can be found online. If you are in the Cincinnati area, I have found SW Ohio Breastfeeding Moms to be a very supportive group.
One-on-one Lactation Support
General support can be so helpful, but sometimes you really need hands-on or virtual eyes-on support. There are varying levels of training for providers and my understanding is that the IBCLC is usually the most in-depth and hands-on training. If you are local to Cincinnati or Mason, Ohio and need help finding lactation support, contact me for local resources.
Optimizing Movement with Breastfeeding
See the video below for Alex’s favorite stretch or see our more recent post Guide to Neck, Shoulder and Back Pain with Breastfeeding for some tips on movement and positioning. Working with a physical therapist knowledgeable to women’s health can also help support you in your breastfeeding journey and keep you moving in ways that bring you joy and address your pain. If you are local to Cincinnati, contact us to start your journey to self care. If you want to stay up-to-date on services we offer in the community, sign up for our email list below.
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Happy breastfeeding! What are your go-to resources?