New South Wales
Did you know that many mums need to relearn how to breathe after we’ve had a baby? It might sound silly, as it’s something that happens automatically without thinking. Claire Dunn, Women’s Health Physiotherapist at Sydney Advanced Physiotherapy in Lindfield explains why learning to breathe is so important.
The main muscle of breathing is the diaphragm, a beautiful parachute-shaped muscle that sits across your body at the bottom of your lungs. As the diaphragm presses down into your belly, it draws air into the lungs through your nose and mouth. It’s a similar action to sucking kids’ paracetamol into a syringe from the bottle.
As air is sucked into the lungs by the diaphragm, the lungs expand like balloons inflating and pushing the ribcage out in all directions.
This system works well with ‘quiet’ or relaxed breathing – when we’re sitting or moving about without much effort. If you are breathing rapidly because you’re feeling stressed out, or breathing heavily like during exercise, you will use muscles in your neck, shoulders, and belly to get oxygen in more quickly or in greater volumes. If all is well, we should be able to go back to relaxed breathing where the diaphragm does the bulk of the work.
During pregnancy, your ribcage changes shape to make space for your uterus as it grows within your belly. The lower part of the ribcage is pushed wider, and the ribs rotate backwards and up so that there is less space between each rib, particularly at the front. It’s a bit like a slinky toy getting squashed on one side.
Your diaphragm is also getting pushed up from below – hence the breathlessness we often feel in the later stages of pregnancy. The up-and-down action of the diaphragm is restricted because there is something big and firm (your uterus) blocking it from expanding fully down into the belly with each in-breath.
So while your might think that it’s only the pelvic floor and tummy muscles that get a rough time of it when you’re pregnant, the poor old diaphragm also deserves some special attention to help it recover.
In fact, if you don’t breathe well using the diaphragm, the pelvic floor and deep tummy muscle (transversus abdominis) will not function very well either. This is due to the close functional relationship of these muscles as they work to support your spine, pelvis and pelvic organs.
And this brings me back to why I teach breathing to all my postnatal physiotherapy clients!
Breathing well can be a critical ingredient, for example, in resolving that tight, aching neck and shoulders associated with sitting to feed your baby for long hours. Or taking the strain off those painful wrists that have never recovered from late-pregnancy carpal tunnel syndrome.
If you breathe with your neck muscles all the time instead of using your diaphragm, the joints in the neck will eventually get tight and the muscles will get tight. The tendons, muscles and nerves in your wrists will be under extra pressure as you struggle to stabilise the shoulder joint where it meets the ribcage.
Sometimes you need to retrain your diaphragm to expand and lift up correctly, and mobilise your ribcage out of that pregnancy-related compression and stiffness. Then your neck and shoulder muscles will be free to do the job of supporting your head and arms against gravity.
Symptoms of pelvic organ prolapse (where the bladder, uterus or bowel move down inside the pelvis) can be made worse or maintained by poor breathing patterns. Often there is just too much pressure on your organs from above because your ribcage is very stiff (like the bucket handles have rusted up) and your tummy muscles are helping you to breathe.
A very tight pelvic floor, causing symptoms like hip pain, tailbone pain, chronic constipation, or pain with sexual intercourse, can also come back to a dysfunctional breathing pattern. If your diaphragm isn’t pulling it’s weight, other muscles will take over the task of getting oxygen in and out. Your pelvic floor muscles are then under added pressure to do the job of holding together your pelvis and support your organs, causing the muscles to become tight and painful.
Your diaphragm not functioning well can also impact things like your ability to return to sport. You will feel more breathless than you perhaps should, and running will become much more difficult.
Mindfulness is a set of practices that has been used with great effectiveness for over a decade to help people manage the symptoms of depression, anxiety, chronic pain, and many other conditions.
One of the central skills of Mindfulness is to take a set period of time to pay close attention to your breath in a non-judgemental way, using the breath as a sort of ‘anchor’ for a busy or anxious mind.
Studies have shown that just 6 mindful breaths, slow and deep, can create a significant change in the chemical activity into your brain. Taking a ‘mental tea-break’, as one of my patients calls it, can help your to move from a hyper-alert, hyper-reactive ‘fight or flight’ state to a calmer, more rational, more contented one. What person – particularly in the world of raising babies and children! – wouldn’t want to have access to this almost magical skill!
When we are trying to get to a new place with our movement, behaviour, or habitual patterns of thought, we first need to know where we are now. Mindful attention to our own breathing pattern is the first step in understanding what we need to change.
Sit in a comfortable position with your back supported and feet flat on the floor. Rest your hands open in your lap.
Now start to bring your awareness to your body where it touches the chair and floor. Feel the weight of your body. Notice the air moving in and out of you, without trying to change anything.
Notice whether your breath is deep or shallow, fast or slow, smooth or jerky, warm or cool, restricted in any particular area and full in another. If your mind offers any judgements or observations, just tell it ‘thanks Brain’ and gently bring your attention back to the breath.
Feel how the breath moves your body. With each in-breath you might experience a sense of fullness and stability, and a softening and release as you breathe out.
Try and hold this focus on breathing for 4-5 breaths, with eyes close or softly focussed on one spot in front of you. Then, slowly bring your awareness back into the room, into your body on the surface, and open your eyes.
You may have come across meditation apps like Headspace, Smiling Mind, Calm, or even the perinatal-specific Mind The Bump. Apps like these can help you as a ‘beginner meditator’ to experience the benefits of giving your nervous system a rest from the hectic pace of #mumlife in our hyper-stimulating world.
(NB: If you have ever experienced severe anxiety or depression, psychotic episodes, or other complex mental health issues you need to consult your doctor before undertaking mindfulness exercises as in some cases they can make you feel worse.)
Your friendly local women’s health physiotherapist can teach you about optimal diaphragmatic breathing, and getting your body to be both mobile and stable depending on what you want it to do.
At Sydney Advanced Physiotherapy, we specialise in women’s health conditions from pregnancy-related pain, to postnatal recovery and pelvic floor health. We also like to look at our patients as a whole person and not just a sore back or a pelvic floor, so we can incorporate Mindfulness exercises into your breathing re-education programme, if that interests you. Once you have learned the basics, our Mums-and-Bubs movement classes, with a maximum of 5 participants, can help you build strength and endurance for the specific activities you want to get back to or do better.