Pregnant mum 4

Introduction to Motherhood

Written by Rebecca Willoughby

I have an interest in treating expectant and new mums as well as those considering motherhood.

Over the coming months I’d like to share some thoughts and information with you regarding pregnancy and your new little ones.

Many have heard about the discomforts felt through the phases of pregnancy, but have you considered preventive treatment prior to pregnancy, to ensure your body is in a better position throughout? These may not necessarily stop issues from arising entirely but they may help your body to cope with the changes.


Maintaining light-to-moderate activity is often recommended in the management of issues that arise through pregnancy. It is easier to maintain this exercise if a good level of fitness is established before becoming pregnant. If you are not already doing regular exercise when you first consider pregnancy don’t start suddenly. Instead, warm to it gradually starting with purposeful walks and working up to an exercise plan that works for you.


Weight is never an easy subject and it’s very difficult to change. If it’s possible to have a BMI below 27 before you become pregnant you are in a better situation through pregnancy for many issues. It is essential that if you try to lose weight it is done in a sensible controlled manner before becoming pregnant: do not suddenly increase exercise and diet excessively and always seek advice from a professional, such as your GP, before making any major changes.


If you’re a smoker it’s ideal to stop before becoming pregnant as it increases many risk factors. Ensure you seek advice from a professional such as your GP first.

Posture through pregnancy 

With computers and desk work as part of daily life (whether at work or home), we often strain the muscles around our shoulders and neck much more than we should. Carrying heavy laptops and hand bags (normally on one shoulder), leads to uneven muscle tone and strain through the joints. This in turns leads to headache and anxiety.

One of the first issues that expectant mums come to see us about is discomfort and pain in the upper back, shoulders and neck. This can be caused by the increase in breast size, which occurs during pregnancy and is exacerbated in patients whose posture is poor in the first instance.

If you know your posture is less than perfect, here are some suggestions to consider before entering into pregnancy:

  • Alternate the side on which you carry your bags.
  • Get up every 30 to 45 minutes from desk work and roll your shoulders up, back and down a few times to get the circulation going and relax the muscles.
  • Do gentle stretches of your neck and shoulders for a couple of minutes in the morning and evening. Avoid dropping the neck backward. Rotating down and side to side, holding the stretch as you feel it. Use a deep breath to help.
  • Check your computer and desk are set in an ergonomically correct manner (i.e. your screen should be 5 degrees below your horizontal eye line and your keyboard and mouse should be at a comfortable position with your shoulders relaxed and your elbows at 90 degrees. You should also ensure that your seat is the right height and angle for you. With your knees dropped below your hips. And if necessary, use a foot rest.

If you need guidance with your workplace position, please ask your practitioner when next in the clinic. 

First Trimester Changes

During your first 12 weeks of pregnancy your uterus will expand to about the size of a grapefruit and will rise just above the brim of the pelvis.

Many women have a slight shortening of the central abdominal muscle and as a result the pelvis tilts backwards slightly causing the lower back to flatten (losing your lordosis). The muscles of the front of the thigh therefore need to be able to stretch slightly to allow the pelvis to do this. It’s also important for the middle of the back to be moving well so that it can cope with the new adaptations.

Increase in breast size is one of the first things to physically change in pregnancy, the increased weight causes changes in head and neck carriage.

As the uterus enlarges upwards the organs are forced upwards resulting in diaphragm tension.

Back Pain

Changes in posture throughout pregnancy often result in back pain and tension in the buttock region. This is usually caused by the muscles adapting to the ever changing anatomy of pregnancy, aiming to keep you upright, as your tummy enlarges.

Before becoming pregnant think about maintaining good mobility and suppleness through the back, buttocks and legs. This will make it easier for you to adapt to the changes as they occur. Yoga, Pilates, stretching and rocking your pelvis from side to side or in circles can all help do this. Please ask your practitioner for more guidance if required.

Second Trimester Changes

The pelvis usually starts to roll forwards, although on occasion the pelvis is still tilted backwards at 24 weeks. The forward rolling of the pelvis as well as the increase in abdominal weight leads to an increased arch through the lower back which means the lower back and muscles of the front of the thigh having to shorten and contract while those at the back of the thigh have to shorten.

The continued uterus enlargement results in further displacement of the organs and increased pressure on the diaphragm. The lower ribs have to expand outwards and the sternum has to elevate. The bladder also has increased pressure on it and the ligaments surrounding the uterus are put under strain which can result in abdominal pain. The increase in abdominal pressure results in a poor pressure gradient for the blood to return from the legs, which often results in varicose veins and haemorrhoids. Try sitting up straight, with your back supported, and your legs straight out in front of you.

Breast enlargement will often increase the curvature of your upper back, which in turn can result in increased neck extension (neck tilted backward) to allow you to look straight ahead. This can cause significant tension around the neck and shoulders and may result in headache. Other side effects may include, pain down the legs, swelling in the ankles and pain in the front of the pelvis on walking.

Make sure you have regular bra size checks and change bra size accordingly so that you aren’t having incorrect pressure loading on your back, shoulders and ribs.

Third Trimester Changes

The low back starts to arch with the increased abdominal weight at this phase in your pregnancy and back ache may become more intense. This is because your spinal anatomy is being pushed to its’ limit and associated muscles are having to work very hard indeed. Your pelvis will roll further forwards and your abdominal muscles and front of the pelvis will have to support the weight. The bone at the base of the spine (the sacrum), which is situated between the two pelvic bones will tip forwards. In turn the coccyx (situated below the sacrum) needs to be mobile and the pelvic floor has to stretch.

The top of the uterus drops a little and falls forwards and down resulting in altered breathing mechanics as strain is put on the ribs and diaphragm.

Your hips will roll outwards to allow expansion of the pelvis. This can result in increased tension in the buttock muscles as well as a change in loading of the knees and ankles.

Alternative Third Trimester Posture

In roughly 1 in 5 the pelvis does not tilt forwards in late pregnancy. This means that throughout pregnancy you have a backwards tilted pelvis, a flattened low back curve and often they do not look heavily pregnant. This results in increased loading on the pelvic floor and ligaments found at the back of the pelvis, often causing discomfort in this area and the low back.

I hope you have found this article of use. Being a new mum can be wonderful but also scary, so remember we are here for you at any time, should you need our guidance. Osteopathy can be hugely beneficial through the stages of pregnancy, not only for your body, but also as an educational support system. We truly believe that educated mothers are far more likely to have relaxed and manageable births. Because knowing what to expect reduces all the stress of an unknown event, leaving you to do what you need to do.

Please note: Whilst osteopathy is an excellent treatment to have throughout pregnancy, it does not replace the medical care and guidance you need throughout to ensure the health of you and your baby. Should you ever become concerned about your health or that of your baby, please visit your doctor immediately.

Pregnancy for a Second Time

Written by Rebecca Willoughby

The information below is for first time and subsequent pregnancies alike.

No one but your family can decide on the time between children, however if you have suffered with issues such as Gestational Diabetes, Diastasis Recti or Symphysis Pubis Dysfunction it may be worth considering the time between children more carefully and what measures you put in place to help your body recover between pregnancies.

Painful or Difficult Walking (Symphysis Pubis Dysfunction & Pelvic Girdle Pain)

This is not dangerous to the baby but can cause severe pain for mum. Symphysis Pubis Dysfunction is pain at the front of the pelvis while Pelvic Girdle Pain causes pain mainly in the back of the pelvis. There is sometimes pain in the pelvic floor area.

It’s estimated that 1 in 5 pregnant women suffer with pelvic pain to some degree.

In the majority of cases it occurs in the second and third trimester. Occasionally it occurs after labour.

It is important to take preventative steps and seek help as soon as symptoms are felt.


  • Pain localized to the front of the pelvis (Pubic Symphysis): Shooting, Stabbing, Burning, Grinding and Clicking
  • Pain radiating to lower abdomen, groin, pelvic floor and front of the thigh
  • Pain on walking, going up and down stairs, getting up from a chair, standing on one leg, bending the hip or taking it out to the side, turning over in bed, moving your legs apart (getting in and out of the car, shower or bath).

If you had Symphysis Pubis issues in your first pregnancy ensure that you follow the advice you were given during your first pregnancy from the very beginning of your subsequent pregnancy. Just as a reminder:

It is important to avoid pain causing activities such as fast walking, climbing stairs, taking legs apart (getting in and out of the car, shower or bath), however it is also important to maintain mild to moderate exercise within painless limits. Take regular rest breaks throughout the day and after exercises. Swimming is a great exercise as you are not weight bearing on the pelvis but maintaining some fitness (N.B. avoid breast stroke). Yoga and Pilates are also good for maintaining suppleness as well as abdominal and pelvic strength, but avoid any positions that lead to taking the legs apart from each other.

Other advice that might help:

  • Get help with household chores
  • Wear flat, supportive shoes
  • Avoid standing on one leg – sit down to get dressed
  • Keep knees together when getting in and out of the shower, bath or car – a plastic bag on the seat can help to swivel
  • Avoid squatting and open legged postures
  • Sleep on your side with something between your knees to keep the top leg level
  • Take the stairs on at a time or go upstairs backwards or in a sitting position
  • Avoid bending and twisting to lift anything
  • Avoid carrying a child or bag on one side
  • Avoid crossing your legs
  • Avoid strenuous work during pregnancy
  • Try to avoid poor posture and excessive weight gain

Most relaxing posture for Pubis Symphysis

  • Lie on your back or in a semi seated position
  • Have your knees and hips flexed
  • Move feet approximately 12-18 inches apart
  • Now bring the knees together
  • Lie on your back or in a semi seated position
  • Have your knees and hips flexed
  • Move feet approximately 12-18 inches apart
  • Now bring the knees together

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