Childbirth, scoliosis and physiotherapy

Ann Mayne, Clinical Physiotherapy Specialist in Women’s Health and Jill Mantle, Fellow of the Chartered Society of Physiotherapy, look at childbirth, scoliosis and physiotherapy.

Specialist women’s health physiotherapists have a unique combination of skills, understanding and knowledge about a wide range of musculoskeletal problems that may occur during pregnancy and postnatally. Women with pre-existing musculoskeletal conditions such as scoliosis can benefit from advice and treatment both antenatally and postnatally.

The impact on a woman’s body of pregnancy, delivery and the postpartum period varies greatly from woman to woman, and even from pregnancy to pregnancy in the same woman – regardless of any known disability. For example, back pain and pelvic pain are common problems at some stage of pregnancy (Mogren 2005, Wang 2004); for a few women the pain may be severe and even disabling.

Most women’s pain improves after delivery. Pain is usually in the lower back or over the pubic bone at the front. The hormonal changes of pregnancy affect all joints, not least the joints in the pelvis, in general making them more lax. In the case of the pelvis this facilitates the baby’s passage through the bony ring of the pelvis. Occasionally there is pain in the upper back, often associated with increased size and weight of the breasts. Good posture and back care are very important and care is needed with lifting.

In pregnancy there is also progressive weight gain, particularly abdominally and on the hips and thighs. Increased weight puts extra demands on joints and muscles. It is wise for all pregnant women to try to control their weight gain, and to listen to their bodies about what they do and how they do it. Those who are normally very active or do heavy work may need to reduce their activity a little towards the latter part of pregnancy.

Scoliosis varies greatly in degree and affects each person individually, and in whether or not it progresses through life. Add to this the variability of problems in pregnancy, and it will be appreciated how difficult it is to predict how each pregnancy will affect a woman.

Ideally, women’s health physiotherapists are members of the antenatal team and contribute to routine antenatal classes. Anyone seeking specialist physiotherapy advice should ask their midwife. Regrettably the current financial difficulties have resulted in some obstetric physiotherapy posts being cut. Anyone who experiences problems accessing a specialist physiotherapist should contact the Association of Chartered Physiotherapists in Women’s Health.

References

Mogren IM and Pohjanen AI. 2005. Low back pain and pelvic pain during pregnancy: prevalence and risk factors. Spine, 30(8), 983-991.

Wang SM et al. 2004. Low back pain during pregnancy: prevalence, risk factors, and outcomes. Obstet Gynecol.104(1), 65-70.

Useful sources

Pregnancy and Scoliosis by Anita Simonds is a booklet that describes the risks of pregnancy and labour for a woman with scoliosis. It is available, price £1.50, from the Scoliosis Association UK

Anaesthesia

The professional organisation that provides patient information is the Obstetric Anaesthetists’ Association.

Physiotherapy

The Association of Chartered Physiotherapists in Women’s Health (ACPWH) has produced a useful set of leaflets called Fit for pregnancy, Fit for birth and Fit for motherhood. To obtain print copies write to ACPWH, c/o Fitwise, Drumcross Hall, Bathgate, Edinburgh EH48 4JT or e-mail gillian@fitwise.co.uk.

There is also a second edition of Physiotherapy in obstetrics and gynaecology, edited by J Mantle, J Haslam and S Barton (2004), published by Butterworth Heinemann, ISBN 0 7506 2265 2, which contains a great deal of useful information.

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