This article was first published in the Natural Parent Magazine, Issue 41, Summer 2021. This beautiful artwork is called "Worn With Love" by Katie m. Berggren and is here with permission.
Care of the pelvic floor is a common postnatal concern – one often prioritised as awareness grows. Recently I have been heartbroken to hear that, upon seeking support for pelvic floor function, mothers who rely on babywearing have been advised to avoid it. Knowing the significant benefits of babywearing for both baby and mother, it is disconcerting to hear that babywearing has not been recommended for the holistic health and well-being of families. So how can we balance the two? What do mothers need to know to look after themselves while keeping their babies close?
The pelvic floor
The pelvic floor is a hammock of muscles and soft tissues at the base of the pelvis, between the hips, pubic bone, and tail bone. It has many roles, including support, continence, and sexual functions. Hence it is not unusual for women to experience issues in these areas after having a baby, although issues with pelvic floor muscle function can be experienced by anyone. Soft tissue structures, such as fascia, offer passive support, while muscles offer active support.
Disturbance of support structures in the pelvis following birth (whether vaginal or caesarean) can lead to prolapse, or descent of the pelvic organs, which may or may not be accompanied by symptoms of dragging, heaviness, or bulging. Stress urinary incontinence, which is leaking urine with increased pressure such as coughing, laughing, jumping or the like, is also a common postnatal issue.
Conservative management of the pelvic floor focuses on the active structures, to compensate for any reduction in passive structure support. The pelvic floor muscles are rehabilitated to ensure the right combination of strength, coordination, endurance, and also relaxation. A training program develops the ability of the pelvic floor to provide upwards resistance to downwards pressures, plus releasing when appropriate. Therefore, managing pressures through the pelvic floor is an essential part of managing its function.
Effect of babywearing
Babywearing as an activity increases pressures on the pelvic floor and can be broken down into phases of lift, carry, lift. A recent study measured intra-abdominal pressures during simulation of lifting and carrying a child in a variety of positions (1). It found that intra-abdominal pressure is higher during the lift phases, rather than during the carry phase. So, regardless of babywearing status, lifting a child creates most pressure on the pelvic floor. During the carry phase, the weight of the child increases the pressure on the pelvic floor, whether in arms or a carrier. However, pressure is less when babywearing on the carer’s back, than when holding a baby in arms at the front or on the hip of a carer (1). Although not explicit, it appears that babywearing could be a help rather than a hindrance in caring for the pelvic floor and a child.
Protecting the pelvic floor during babywearing
There is strong evidence that pelvic floor muscle training is an effective conservative management strategy for symptoms of stress urinary incontinence and prolapse, while other lifestyle interventions may also be helpful (2). To protect the pelvic floor, further assessment of individual symptoms and aggravating factors is essential. The following are some general recommendations, however I highly recommend seeking support from a knowledgeable physiotherapist to develop a personalised pelvic floor exercise program. For example, you might need to work on relaxing your pelvic floor before you can work on strength.
Strength and coordination of the pelvic floor muscles is important during the lifting phase of the carry. Strong pelvic floor muscles that activate just before the lift, helps support pelvic organs and manage symptoms of stress, such as leaking or pressure. This is called “the knack” and also helps support with cough, sneeze, laugh or other high pressure events (2).
Endurance of the pelvic floor muscles during the carry phase can be influenced by things such as posture, time of day, type of activities, fatigue and general fitness. Many women with prolapse report worsening of their symptoms at the end of the day, a long walk, pushing a pram uphill or a long carry phase. This indicates the effect of gravity on the passive structures and the endurance of pelvic floor muscles. For mothers and babies who love to babywear, modifications such as reducing carry phase length, wearing on their back, or adjusting timing and structure of activities may be considered while rehabilitating pelvic floor muscles.
As always, good postural alignment is important to protecting pelvic floor function, with a well-fitted carrier that holds baby close and high to minimise displacement of the centre of gravity. Reach out to babywearing families, consultants and libraries if you need help to get the right fit for your carrier.
Other activity modifications
In addition to babywearing, many other daily activities place pressure on the pelvic floor – and any one could contribute to symptoms. It is important to concurrently consider these activities to protect the pelvic floor and improve symptoms (2), including:
Toileting requires increased intra-abdominal pressure with simultaneous relaxation of the pelvic floor muscles to void. Prolonged or repetitive straining can stress the passive support structures of the pelvic floor and worsen symptoms. Straining can be a result of constipation, sub-optimal sitting posture on the toilet, insufficient relaxation of the pelvic floor muscles amongst other manageable factors.
Coughing and sneezing requires strength and coordination of pelvic floor muscle contraction. Repetitive coughing and sneezing can place strain on the pelvic floor and worsen symptoms, so managing asthma, allergies, smoking and other conditions can help pelvic floor function.
Maintaining a healthy weight helps pelvic floor function by optimising body weight pressure and can prevent progression of prolapse
Modifying tasks such as heavy lifting and other strenuous activities that involve breath holding, bearing down or postural changes such as back arching, may be helpful.
Summary
In and of itself, babywearing is not necessarily detrimental to pelvic floor function. Avoidance of such a wonderful parenting tool as babywearing, without consideration of other factors, is not helpful for families. Please seek the support of a knowledgeable physiotherapist for an individualised pelvic floor program and tailored advice for you and your baby, before you throw the baby carrier out with the bath water.
Kato x
References
1. Coleman et al 2015 “Effects of walking speeds and carrying techniques on intra-abdominal pressure in women”, International Urogynecology Journal, 26(967-974), https://doi.org/10.1007/s00192-014-2593-5
2. International Consultation on Incontinence 2017, www.ics.org