Anatomy Trains

A student recently asked me to discuss prenatal and postpartum fascial changes in terms of “normal” tension, moving to expansion and contraction. So, I’d like to talk about this in three ways:

1) Movement function: You can see the body as seven hinged ‘masses’ (meaning heavy bits: the head, chest, pelvis, arms and legs) with six rotational ‘spaces’ or swivels in between (the neck, waist, shoulders, and hips). In pregnancy, you add a large incompressible mass into the waist section. In early pregnancy, this makes little difference, but by the last months, and the last two weeks in particular, the weight of the baby and the amniotic fluid tend to lock together the rib cage and the pelvis masses into on big mass. This puts special movement requirements on the woman in late pregnancy (not to mention difficulty breathing – ever tried running upstairs in the ninth month?).

Clinically, I find many women need restoration of the rotational aspect of the waist, and that exercises and awarenesses that go in this direction are very helpful.

2) Tissue stretching: Without doubt, the growth of a baby stretches tissue, a day at a time, and of course the pelvic floor tissues in a hell of a hurry. Linea alba diastasis, stretch marks in the dermal layer, and a less-than-adequate pelvic floor tone are all common sequelae from pregnancy and delivery. Inevitably, the uterus sits more forward than backward, because of the lumbar spine behind. All the abdominal muscles and fasciae are stretched, and despite the well-toned mother’s best efforts, the baby tends to stick out over the pubic bone in late pregnancy. This position puts great strain on many organ and ligament attachments – too many to predict, as it depends on the mother’s posture and the baby’s position.

Assisted restoration can use bodywork, exercise, and such devices as sacral belts when necessary. Natural restoration varies due to the mother’s inherent fascial elasticity, muscle tone, and nutrition – and whether they are nursing or not.

3) Birth hormones: A cousin of oxytocin called relaxin is secreted in the mother’s body starting a bit before birth (it varies) and some time after birth (longer with nursing), and this causes fascia all over the body to relent a little – making the mother a bit like someone with ligamentous laxity or hypermobility. It’s a good idea to release the ligaments around the pelvis to make the birth easier, but it makes restoration harder.

Oxytocin is also the love drug, and fixates the mother on the child, to the detriment, sometimes, of herself. Good bodywork soon after delivery can be vital in restoring proper span to the pelvic floor and proper joint relations, but often the mother is ignoring her own feelings in favor of the baby’s well-being. It is up to us, members of her community, to make sure she gets the proper post-natal care. I have a very baby-friendly practice – on the breast, on your stomach, beside you on the table, beside the table in a basket – whatever the mom wants. But get in here and get the pelvis re-aligned before the relaxin disappears (certainly by about 6 months in most) and restoration gets harder.

In general, fascial tissues restore slower than muscular ones, though muscular effort can aid the fascial restoration. Fascial tears or adhesions will slow or distort muscle action. Malalignment in the SI joints or pubic symphysis affects both. All these are most easily adjusted and combed out in the first couple of months after birth.

In a proper society, we will make sure that all mothers have sustained pre- and post-partum structural care that will ease the birth process and speed the restoration to full function afterward.