It seems like it's a weekly occurrence in my practice to field this question: My back has been hurting ever since I had my baby. Did my delivery have something to do with it? Is it the way I hold my baby?
There is a little bit of a trick to answering this question: women want to know if any one of a number of variables surrounding the delivery has influenced how their back feels at the present moment. Problem is, variables happen every day, and so it is really hard to pinpoint any one of them and to say, "That's it! That's the root cause of the pain!"
Even so, women will ask me about a wide variety of potential factors that may or may not contribute to their back pain: epidurals, duration or intensity of pushing, C-sections, posture, rapid labors, perineal tears, and weight gain. They also ask me about the way in which they are breast or bottlefeeding their babies, how they hold and carry them, and sleep postures after baby arrives. Let's take a look at several of these factors in order to either confirm or deny their impact on the health of our back.
Women will often come into the clinic and tell me that they had an epidural, and one of these questions might follow:
"I had an epidural when I delivered my baby three months ago. Could that be contributing to my back pain?"
The short answer: Potentially, yes.
Or a woman might say: "I had an epidural when I delivered my baby 2 years ago. Could that be contributing to my back pain?" The short answer: not likely.
Let's look at this on a large scale for just a moment. If epidurals used for pain relief during labor did in fact cause back pain, then thousands of new moms in the Fox Valley alone would be complaining of chronic backache every year. That simply doesn't happen. Now, if we were to survey new moms who had an epidural (or even not) within twelve weeks of their delivery and ask if they had a backache, a significant percentage of them would say, "yes."
So, it could just be the actual delivering of a baby that does it, and/or it could be the short-term effects from having an epidural placed that does it. And to complicate matters, there are a host of daily activities related to caring for an infant that could cause or aggravate a backache.
Rapid Labor or Back Labor
The amount of time spent pushing is more directly related to pelvic floor trauma than it is to back pain. Interestingly, a strong and healthy pelvic floor is important in order to have a strong and healthy back.
There is a bit of physics in the explanation of this phenomenon, so I will give you the short version. There is a closed pressure system involving our diaphragm, abdominal musculature, intervertebral discs, and pelvic floor. If any one of those areas is compromised, then the other areas are stressed. If the stress is great enough, then signs and symptoms will follow. So, as far as the pelvic floor is concerned, if it is "bottoming out," so to speak, then the other areas will have to work harder, and you may develop symptoms over time. Concerning the back, the symptom would be pain.
Having a C-section is definitely a potential risk factor for developing lower back pain, particularly in the short term. The surgery itself involves making an incision through the lower abdominal wall, thereby cutting the lower abdominal musculature. Now, if we take a step backward a moment, we may recall the saying, "strong abdominal muscles lead to a healthy back." As we stated previously with the pelvic floor, the abdominal muscles are a part of a closed pressure system, thereby making the converse also true: weak abdominals can contribute to low back injury and pain.
There are solid reasons why your physician gives you lifting restrictions after you've undergone c-section, and one of those reasons is potential back injury. Your body needs that full six-week recovery in order for the abdominal muscles to heal enough to start working properly again.
Whether you're breastfeeding or bottle feeding, the way in which you are feeding your baby can most definitely contribute to both lower and upper back pain. The lower back pain component is related to sitting posture while you feed your baby. If your baby is like most babies, he or she tends to eat when you would rather be sleeping. And since you'd rather be sleeping, I am fairly certain that correct posture is not the thing that you are thinking about during a 3am feeding. Slouching into that glider rocker is more like it. Rounding out the lower back into the shape of a "C"-Yes! That is how the middle of the night feedings go. Usually to be followed by a, "Wow, it hurt to get out of that chair!" response.
A very similar circumstance precedes upper back and neck strain followings feedings. Typically, it's due to the fact that we are looking down at our baby while he nurses. It's natural, after all, to watch our baby eat; it's part of the bonding process. Problem is, we end up with a terrible neck, shoulder, and upper backache out of the deal. Bonded baby equals kinked neck.
If you are an experienced mom, did you hold your baby consistently on one side? And if you were good and switched back and forth between sides, are you constantly resting the baby on one hip? If you were standing in one place for prolonged periods of time, hip and lower back strain can occur. Likewise, if you were holding your baby when sitting, were you allowing your arms to rest on armrests of the chair, or were you making your shoulder and upper back muscles do all the work?
Weight gain is another factor that can affect our spine health after baby arrives. It is totally normal to gain weight while you are pregnant. It most cases, it is preferred! The only exception to that rule is the case where a woman started out too heavy. So, the important thing to keep in mind is that making good food choices and maintaining an active lifestyle will help you lose that baby weight in a safe manner. It may not happen overnight, but certainly the weight will come off.
Sometimes finding the cause of your backache is very clear, and sometimes it is not. If you can figure out some daily activity that causes your pain, try changing it and see what happens. If however you cannot figure it out, or self-modification doesn't seem to be helping you, then you may need to take the next steps with your provider.
Michelle Landsverk is a Doctor of Physical Therapy at PT Center for Women, 3232 Ballard Road, Appleton, WI 54911. To make an appointment with Michelle call or text 920.729.2982.
PT Center for Women is one of the only physical therapy centers in Wisconsin that specializes in pelvic pain and pelvic muscle dysfunction, offering women of all ages comprehensive evaluation and treatment for their physical therapy needs.