Pregnancy, Childbirth and the effects on the Rider’s body

I have been wanting to write about this topic for ages, but wasn’t quite sure how to approach the area. Then last week I was reading my parents’ newspaper – The Telegraph – and it had a supplement about Women in sport, specifically mother’s who compete and the challenges they face. Sadly there were no equestrians included, although the stories were all incredible anyway, and I look up to all the athletes interviewed. I mean, Sophie Power – she is completely phenomenal! And so, the timing seems right to discuss this area here.

However, getting back to pregnancy and riding, and we enter a bit of a minefield. Anyone who has been pregnant will be all too aware of how for those few months when you are public with your ‘status’, your every move will be monitored and analysed and commented on endlessly. The vast majority of this is well intentioned – and I have to admit that I am probably guilty of this – but none the less it is maddening and largely unhelpful. At times it can also be quite upsetting when the well meaning comments are actually critical, and when the hormones of pregnancy are added in to the equation that can make such comments even harder to take. Not least, this is because for most – if not all – riders who continue to ride through pregnancy, it has been a conscious decision to continue riding, after much thought and usually discussion with family and midwives/consultants.

To give you a bit of my own experience, I rode through both of my pregnancies. The 1st time I had no qualms, in part because I was only riding 1 horse – Baz – and I knew him inside out and knew exactly what I would let myself do with him. He is a quirky boy, but having ridden him for years I felt comfortable that my body knew his spooks and that I wouldn’t put us in situations where I felt I would be at risk.

My 2nd pregnancy was not so straightforward. Without going in to lots of details, it was a very stressful time, and I was considered to be a high risk pregnancy. I discussed my riding with my midwife and consultant, and both were happy for me to continue. As by then I was also riding Lizzie – who was 5 and quite cocky – I did back off and had cut down to schooling her once a week in a proper enclosed sand school. I continued riding Baz up to the end and was back on him within 10 days. I didn’t ride Lizzie properly for several months afterwards, but this was only because as I was breastfeeding I just didn’t have the time to ride her and allow for the young-horse issues that can so easily crop up.

Getting back on Baz and working him as normal was incredibly therapeutic. No matter how much you love your new baby, equally there is something so physically and emotionally therapeutic about getting back on a horse. I found that the sleep deprivation and sudden change in focus to my hands carrying and protecting this tiny baby completely altered my perception of my hands. I kept imagining them as huge, almost cartoon-like apendages, magnified by my brain – probably thanks to the Homunculus – and quite disturbing. Once I started riding again, and my hands resumed their ‘normal’ role, they started to return to their normal representation in my brain, and my whole body started to feel like it used to.

It is also good for a new mother not to neglect herself in the sense of abandoning everything that went before. That is a recipe for disaster in terms of mental health because you are still the same person with the same likes and dislikes and activities that make you happy, even if your priorities have changed somewhat!

So what are the physical considerations for a woman who is going to ride during pregnancy and in the first few months afterwards?

I will start with ligament laxity. In preparation for the process of birth, as the hormone Progesterone increases during pregnancy, this makes the ligaments throughout the body become more lax. That is to say they become more stretchy to enable the ligaments around the pelvis to stretch enough during labour for the bones of the usually stable pelvis to separate. The downside of this is that as all ligaments are affected, so potentially all the joints in the body are more susceptible to moving into ranges they aren’t used to, and so the risk of injury is increased. Many of you will be aware of the problem of pelvic pain during pregnancy – Pelvic Girdle Pain or PGP, and this is due to excess motion in the pelvis which means it is unable to provide the solid and stable support base that it usually does. Weight bearing can become excruciating as the shear forces passing through the pelvis cause movement between the bones. This can make pretty much anything to do with horse care a challenge as load is involved at every turn. On top of this, sitting astride and attempting to grip the saddle can be painful, and the twisting involved in mounting and dismounting may be impossible. If this is you, then riding is unlikely to be something you can do during pregnancy. But even if you don’t suffer with PGP, you still need to bear the increased laxity and the risks it carries in mind. Back pain in particular is something you can be at increased of, so caution is needed with any heavy work. For some women, widespread joint pain can be an issue, although for most affected this tends to be only weight bearing joints; this is due to the combination of increased weight and the ligament laxity.

Linked closely with this increased laxity is the good old pelvic floor. I am perhaps a little unhealthily obsessed with the pelvic floor, but then as a Physio who teaches Pilates I think I can be excused this! During pregnancy the work of the pelvic floor increases as the weight above increases, but also as the ligament laxity around the pelvis increases. Normally the pelvis is kept stable by a combination of ligament support and it’s natural shape, so when the ligament support reduces, that role is added on to the workload of the pelvic floor. As I have talked about before, the pelvic floor is also important when it comes to back pain, and so as the chance of back pain increases then so does the need to work the pelvic floor. The poor pelvic floor are also going to be stretched beyond all recognition during labour, and asked to work in the opposite way to their usual supporting role – essentially helping with pushing the baby out – and so can get very stretched. This temporarily compromises function in just about all women, but if your pelvic floor were weak already, this will make the job of reactivating and strengthening post-partum even harder.

For some women, the physical efforts of riding can be too much for the pelvic floor in this state, especially on top of the physical nature of general horse care. Whatever the situation, doing pelvic floor exercises are essential during pregnancy and if I am honest, ad infinitum afterwards. The last thing you want is to finally get back to jumping for example – having got yourself and the horse fit, sorted childcare etc – only to find that a weak pelvic floor prohibits this. I think that whilst the subject of weak pelvic floor is discussed when you are pregnant, it is definitely one of those areas where the potential future consequences are not fully divulged. Along with delights such as sleep regressions in your baby – I didn’t know these were a ‘thing’ until one hit us, and then I found out they are really common – so much of the negative side of all things baby related is not talked about, and I am pretty certain this is in part to avoid putting the fear of God into women. One of the women interviewed in the Telegragh supplement is a rubgy-playing midwife, and even she was taken aback at her continence problems when she 1st returned to exercising. I will admit that I too was horrified at the toll taken on my body, as was a physio-friend of mine. We had treated countless women with pregnancy-related conditions between us over the years, yet neither of us really understood until we experienced it ourselves. I feel so strongly now that all women, but particularly those who participate on exercise regularly, really need to know what is going to happen to their bodies IN FULL, and know exactly what they need to do. We are very good at just getting on with things when it comes to looking after horses, and when you add a new baby to the equation, that is amplified, but as a new mother, you have to focus on your body too. My late cousin’s wife is a midwife, and she told me that days after she had their 2nd baby she was out digging snow away from their driveway so that an ambulance could get there if my cousin needed it….with as she so eloquently described it, her ‘perineum flapping in the wind’. That is the reality. Your perineum will flap and it will take time to get back to how it was, so preparing beforehand and getting into the habit of doing pelvic floor exercises whilst pregnant is crucial.

The other big – and hopefully obvious – aspect of pregnancy that is arguably more important for horse riders than it is for other athletes, is the presence of a bump. Your abdominals not surprisingly will stretch, and are quite simply, weaker. You can’t therefore rely on them to provide mechanical support they normally do. For riders the bump adds 2 new factors to the riding equation: Firstly you are very likely to feel there is a risk to your baby simply by the fact that it is between you and your horse or saddle pommel; Secondly – and you may not be aware how much this will impact you until it does – is that your centre of balance will be completely altered and your biomechanics will be totally different to what you and your horse are used to.

The change in biomechanics is huge, although this is very dependant on the size, shape and location of your bump. I was very lucky to have small, neat bumps, but despite this they got in the way riding and seriously restricted my diaphragm and therefore ability to breathe. If you have read my previous posts about the role of the lumbar spine when riding, you will be familiar with the reasons for having the spine in a neutral position but able to move freely yet under control. Once there is a bump in situ, the lumbar spine is tipped back into a flexed position. This locks the spine and the combination of this plus bump means a largely immobile spine compared to normal. Not only does this compromise the ability to ride effectively, but it reduces the ability to go with the horse should it move suddenly/spook.

This change in position in the saddle also changes the angle through the seat and so where the rider’s pressure sits. This obviously impacts on the use of seat aids, and therefore what the horse is going to feel and respond to. For me, I felt that my contact was totally wrong because I was tipped back, and my legs were just in the wrong place and too slow.

Pregnant ridign posture
Competing Lizzie at 5 months pregnant

All of this, especially if you add in restricted breathing, will also make riding generally much more tiring. Tiring because you have a great bump stuck on your front. Tiring because you can’t breathe. Tiring because you are using your body in a way that is not normal for you. Tiring because, well, pregnancy is generally very tiring!

Sooooo, in summary, your body is taken over and has a life of its own as it grows and loosens. You may feel unnatural fear about riding, you will probably be exhausted. Your pelvic floor become unreliable yet you still want to do all the mucking out and hay-heaving that you normally do. Your back will probably ache, and quite possibly other joints too.

However, there are also lots of positives to riding during pregnancy too. Apart from mental wellbeing, physically keeping active and doing a form of exercise that your body is used to is very beneficial. Your body will cope better overall – unless you have a specific condition which precludes exercise – if you keep a reasonable level of fitness. Using your body as normal means you will maintain normal muscle tone, better balance reactions, and cardio/respiratory function for example. This is all good preparation for childbirth itself, because unless you are one of those lucky (?) ladies who has a speedy delivery, labour is a marathon, and the fitter you are the better you will cope. To a degree anyway… The fitter you are then generally speaking the quicker you will also recover from labour, although this always depends on if you have had any complications. .

Once you have recovered from the shell shock of becoming a mother and feel able to get back to your horse duties, there are a whole load more considerations when it comes to your body.

Importantly, you need to allow for the fact that it takes 12 weeks for your progesterone levels to return to pre-pregnancy levels. Therefore, you can’t just assume that tiredness and baby-duties aside, you can pick up where you left off. As your ligament laxity will gradually resolve, you need to allow for this as you start to take on the more physical side of general horse care such as mucking out and lifting. On top of this, your abdominal muscles and pelvic floor don’t magically ping back to normal.

If you are just going back to hacking this is unlikely to cause major problems, but if you have plans to be schooling or jumping, especially competitively, then you really need to factor this in. Jumping especially is going to require not just a return of core strength but also dynamic stability. For this you need you pelvic floor and abdominals to be working normally, plus have had time to re-develop your balance reactions and upper/lower limb strength. It might sound strange, but if you are breast-feeding then you also need to consider that your body shape may well be rather different to pre-baby and you may be a little more ‘top heavy’ than usual. You will also need to consider timing your riding around feeding times, and this can be very prohibitive if you lack assistance on the ground. Quite apart from anything else – and I make no apologies for being blunt here – when you need to feed you really need to feed and it becomes rather uncomfortable. Personally, the thought of squeezing into my well-fitting body protector in those early months makes me squirm! Oh, and nursing bras are completely USELESS for riding. If someone can develop a bra that does both the nursing function and offers the support required for riding (think sitting trot….) then they will do very well. Riding also cannot be the only sport where the 2 need to go hand in hand, but maybe everyone else just does what I did and resort to a ‘normal’ bra of some type, and have to half strip in order to feed their baby.

My Diastasis Rectus!
A minor form of diastasis rectus

Have you come across the term ‘Diastasis Rectus’? It is the medical name for when the abdominal muscles split down the middle. This might sound very dramatic, but there is a natural join in the middle called the Linea Alba- part of what contributes to the shape of the 6 pack. For a lot of women during pregnancy, when the abdominals stretch, the force on the this little area of fascia is too much, and it splits. Unfortunately, it doesn’t reattach by itself, and so for most women afflicted by this, hard work on core strength to get some degree of closure of the gap is the only option. For a few, surgery is actually necessary, but this is in extreme cases. Mechanically, having a small gap in your abdominals is not the end of the world, but obviously, it does mean that there is a permanent ‘weak’ point in the core, and for me even now, I have to specifically focus to recruit my deeper abdominals to prevent ‘doming’ when I do a sit-up type action. I suspect it will always be the case now but I live in hope. This doesn’t worry me because I work on my core and am mindful of how I use my body, but for anyone who isn’t so rigorous then of course this can increase the chances of core-weakness related issues long term. When I say ‘weak’ point, I don’t mean that your insides are about to fall through, or that your spine is suddenly totally unsupported, but by losing a large area of attachment the mechanical strength of the abdominals is compromised.  Low back pain is the obvious consequence to think of here, but when you think or riding and how the stability of your trunk is crucial to being able to have a strong seat and independent hand then you can see how important a Diastasis Rectus might be for a rider. So the lesson here is, if you have a Diastasis Rectus and you want to keep doing a physical activity like riding, keep working on your core!!!

I hope that in writing this I haven’t come across as totally negative. I just want to put it how it is. If you want to combine pregnancy and children with horses and riding for the long term you have – I repeat HAVE – to be prepared and keep working on your body for the long term. This is I am sure a topic I will return to, and may well add to in the future. If you are interested in this at a higher level, the English Institute of Sport has the SmartHER resource to help female athletes deal with, amongst other things, the areas of pregnancy and post-partum recovery.

Louise

 

Published by Louise Towl Physio

I am a Chartered Physiotherapist with Pilates training, and I am an ACPAT (the Association of Chartered Physiotherapists in Animal Therapy) and RAMP (Register of Animal Musculoskeletal Practitioners) registered Veterinary Physiotherapist. Away from work I have ridden all my life, competing in various disciplines and now focussing on dressage. With my retired horse, Baz, I competed at Advanced level, and I now have a younger horse, Lizzie, who is currently competing at Elementary.

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