Carrying with a weakened pelvic floor

Everyone who has had a baby, however their baby was born, will find that their pregnancy has had an effect on their pelvic floor and that this affects how they carry their child.

What is the pelvic floor?

The pelvic floor is a complex group of muscles, connective tissues, nerves and blood vessels in a flexible hammock structure that supports and keeps the pelvic organs in place (the uterus, vagina, bowel and bladder.) The pelvic floor helps us to keep control of bodily functions, by relaxing and contracting to allow exit and entry. It is mostly under unconscious control; but can be be consciously managed (choosing not to urinate just yet, for example).

Pregnancy, especially the first pregnancy, is associated with changes to the pelvic organs, which generally tend to descend further into the pelvic bowl. The pelvic floor becomes less effective at controlling urination and defecation. These changes are accentuated after vaginal delivery, and urinary incontinence and prolapse are more common after several vaginal births. Fortunately for most women, pelvic floor muscle function recovers in the year after delivery (it can take a little longer if breastfeeding) with appropriate pelvic floor exercises and stretches.

Up to half of all women will experience some degree of prolapse (a bulging of the vaginal wall downward or a descent of the cervix/uterus) in their later years without symptoms, but 10-20% of women will have symptomatic prolapse. Please see your GP if you have symptoms, and don’t delay.

How to care for the pelvic floor in the postnatal period

The advice given to women in the postnatal period to encourage pelvic floor function to return is usually to

rest in the first few weeks and be aware of discomfort
avoid overloading the pelvic floor
take care not to become constipated
do gentle pelvic floor exercises and stretches (not just squeezes! Many women have over-tight pelvic floors and need to learn how to relax them too.)
work on core abdominal and lower back muscles, eg pilates or yoga – babywearing can also help with this by encouraging a good posture
keep active, and gradually build up tolerance
avoid heavy lifting

This then brings us to the question…

Can I carry my baby in the postnatal period? And can I carry my baby if i have a weakened pelvic floor or even a prolapse? Does this count as heavy lifting!? Is it safe to babywear at all?

Carrying in the postnatal period with a focus on pelvic floor health

Read more about general carrying in the postnatal period here (including after a Caesarean section.)

Mothers’ and babies’ bodies have evolved to spend the “fourth trimester” period in intimate close contact, and babies expect to be carried. We are a carrying species, after all, so yes, mothers can and should carry their babies in the postnatal period. Often, babies insist on it (especially if they have reflux, for example)! This is normal human parenting practice.

The advice given in the postnatal period is to “carry nothing heavier than your baby”.

Some useful guidance how to do this well;

Listen to your body. If carrying causes pain, stop and seek advice. There may be some simple things you can do to improve your experience and comfort.
Lightweight slings that keep babies high up and mostly central are optimal here. Wraps (woven or stretchy, ring slings, meh dais and structured carriers with very soft or no waistbands that can be worn high) will all work well.
Avoiding pressure around the centre/lower half of the abdomen/pelvis (this can push pelvic organs further downwards as well as irritate a caesarean scar) – so avoid bulky waistbanded carriers worn tilted downward, or wrap carries with big knots that press around the waist or middle. Please note every woman’s body is different and this is a general guide.
Keep baby close enough to kiss in the chest-to-chest or chest-to-back positions to bring both centres of gravity close together. This avoids having to compensate for a weight hanging away from the parent’s body and will be far more comfortable on recovering joints and spine (as well as being much safer!)
Good posture is key; an aligned spine rather than one that is pulled forwards into a curve at the shoulders, or held in a sway back position will be more comfortable while carrying. It will also affect baby’s position and may cause them to slump, adding to the sensation of their “heaviness”.
Some people find that lumbar supports and thick padding may feel supportive and comfortable, as it encourages better posture, however some of the original discomfort may be due to poor positioning. Seek help from a sling library and/or a physio/chiropractor if your sling causes pain or weariness.
Bring your centre of gravity down to the floor to lift your baby, rather than bending from the waist.
Make a conscious effort to engage your pelvic floor and breathe gently in whenever you pick up your baby.
Lift baby out of their car seat and carry them separately whenever you can, rather than in their car seat. Car seats typically weigh anything from 10-20lb and are carried by their handles, putting a lot of strain on a recovering postnatal body and pelvic floor. If baby is asleep and you really don’t want to move them, ask someone else to carry the car seat and baby for you. If you must carry the car seat, keep it high and central (image of this thanks to TummyTeam)
As you get stronger and your baby grows, and babywearing remains comfortable, you are likely to have been working on rehabilitating your core as you go!
Your options for carrying will increase in time. Many women find that back carries work well as there is less downward pressure over the abdominal region with this position, especially as babies get heavier. Back carries can help improve a slumped shoulder posture or tendency to sway backwards to compensate for loose front carries, and engages a different set of muscles. Most of the world’s people opt for back carrying with heavy loads for good reason!