by: Justine Picciano, DPT
A recent article in the New York Times entitled, “Surge in Narcotic Prescriptions for Pregnant Women” discusses the astonishing increase in narcotic drug use amongst pregnant women in the United States. According to a study published in the journal Obstetrics & Gynecology, nearly 23 percent of pregnant women enrolled in Medicaid filled an opioid prescription in 2007, increased from 18.5 percent in 2000. Opioid and narcotic drug use during pregnancy is largely understudied, with fewer than 10% of Food & Drug Administration (FDA) approved drugs having sufficient data to determine fetal risk. Are there alternative options for women suffering from pregnancy related pains? Why the sudden surge in drug use when little is known concerning the risks and benefits? Are you stuck in a rut and just don’t know who to talk to about your pregnancy-related aches and pains? Read more to find out what all the fuss is about drugs and what our star physical therapists at Renew can do for you during your pregnancy.
About half of women will suffer from some sort of low back pain or pelvic pain during their pregnancy. At Renew Physical Therapy, we treat many pregnant women who have severe low back pain, sciatica, pubic bone pain, upper back pain, and pelvic pain that is debilitating, restrictive, and negatively impacts quality of life. Have you ever thought to yourself, “Well I’m pregnant so I might as well expect pain,” or heard individuals say, “You’re pregnant, it’s normal to be in pain!” We want to dispel this misconception: although pregnancy-related pain is common, you do not need to suffer through nine months of debilitating pain! Let’s look at some of the research out there to find out how pregnant women are managing their pain and what options are available.
As I delved into the research behind pregnancy-related pain and treatment options, I was shocked to find that many women do not report their pain to their healthcare providers. Or, when reported, women are not necessarily offered treatment options for their pain. A study which surveyed pregnant women about pregnancy-related ailments found that only 32% of the respondents with pregnancy-related lumbar pain (PLP) informed their prenatal care providers of the problem. Of the women who did tell their health care providers, only 25% were given treatment option recommendations for their pain (Wang et. al., 2004). This is an extremely small percentage of women who are advocating for themselves and seeking out the help of medical providers, and more shockingly, an even smaller percent of health care providers who are encouraging proper treatment of this extremely common pregnancy-related pain. Another study by Skaggs et. al in 2007 reported that 85% of surveyed women reported not being offered treatment of their musculoskeletal disorders during pregnancy. Just because pregnancy-related back and pelvic pain is common does NOT mean it is normal, or that it is untreatable.
So, what are your options to get relief now?
On the drug front, acetaminophen is recommended by MD’s as a safe pain reliever that, according to a 2010 study, does not increase the risk of birth defects. However often times it is just not enough and women are left in excruciating pain. Few studies investigate the effects of opioid use in pregnancy. One study in 2011 showed that certain birth defects, including spina bifida and certain heart defects, were linked with first trimester opioid use (Broussard et. al 2011). Another study in 2013 found opioid use in the periconceptional period was associated with a moderately increased risk of neural tube defects (Yazdy et. al. 2013). The Centers for Disease Control and Prevention (CDC) has recently launched a website, Treating for Two, which offers those who are expecting guidance on medication use during pregnancy. It is extremely important to speak with your doctor and weigh the risks and benefits when considering use of narcotic drugs during your pregnancy. However, it is a valid treatment option and many women we see at our healing center complement their physical therapy exercise regimen with use of narcotic drugs under the supervision of there doctors or midwives. This helps them function and continue their daily activities, whether it be caring for their other children, working, or maintaining their social wellbeing. We cannot emphasize enough how important it is to discuss any use of medications or supplements during your pregnancy with your doctor or health care provider.
Although prescription narcotics and opioid use is on the rise during pregnancy, many doctors are still hesitant to prescribe these powerful drugs when the effects are largely unknown. Dr. Edward Michna, a pain specialist at Brigham and Women’s Hospital, does not prescribe narcotics for low back pain in pregnancy and instead suggests alternatives such as acupuncture, biofeedback, and physical therapy. The physical therapists here at Renew specialize in treating pregnant women with conditions including, but not limited to, low back pain, sciatica, neck and upper back pain, pubic bone pain, and pelvic pain. Using trademark secrets to help combat pregnancy-related pain, the therapists at Renew will work with you to prescribe the appropriate stretches, strengthening exercises, supportive belts, self-care tools, and will help develop a comprehensive home exercise program so you can become your own healer. We can discuss with you labor positions that may or may not exacerbate the musculoskeletal, orthopedic, or neuromuscular condition you have using our biofeedback technology to simulate labor positions and proper “pushing” technique for stage two of labor. This can help minimize risk of exacerbating certain orthopedic conditions during the high physical demands required during labor, as well as maximize postpartum recovery.
In our clinical experience, we find that women who come to us early on in pregnancy are able to learn the proper tools and techniques to keep them pain-free, modify their activities to combat and prevent injury, and continue their busy lives as New York City mom’s and mom’s to be. With Mother’s Day upon us, why not treat yourself to a session of physical therapy where you can learn the tools you need to stay out of pain, prevent injury, and prepare yourself for the physical and mental demands of motherhood?
For now, here a few tips to get you started on the road to healing:
1. The first step to getting relief may be to talk with your doctor or midwife about your options. Be honest and do your research! The CDC’s Treating for Two website recommends bringing suggestions to the table to start the discussion. “I heard some women get physical therapy during pregnancy”, or “I saw this list of medications online that can be safe to use during pregnancy, is this true or are any of these safe for me?”
2. Learn how to activate your deep core muscle, the transverse abdominis (TrA), which can help support your spine, pelvis, abdominal organs, and improve sacroiliac joint stability.
• The TrA can be found by putting your hands inside and to the side of your front hip bones. When correctly activated, the TrA can be felt on either side of your hip bones. You will feel for an increase in tension under the skin. If you feel a big tension or if the muscle pop out into your hands when performing the TrA holds then you have overdone it and you are training your outermost abdominals and obliques (which look pretty but do very little for you).
• Imagine that your front hip bones are two sides of a hot dog bun. Now imagine that you are bringing the two halves of the hotdog bun together. Now hold these for 5 to 10 seconds. Repeat one set three times daily. Remember Its very important avoid holding your breath and to do this abdominal hold with gentle effort.
• Additional Tip: If you are pregnant and belly is showing, watch sideways in a mirror. The TrA has the power to actually lift the baby up towards your nose, as if the belly button is elevating and you are hugging your baby in and up towards the spine.
• For more information on the transverse abdominis and our core training program, see our recent Renew PT blog, “The New Core: Restoring Pelvic Power and Relieving Pain” here.
3. Come see us at our healing center to get a comprehensive evaluation and learn our trade secret tools and techniques, such as our coveted “Should and Should Not” list, and get yourself on the road to pain relief during your pregnancy.
For all you mom’s and mom’s-to-be out there, don’t wait to put yourself on your list! You are truly goddess warriors and an inspiration to us all. If you desire a consultation with our star physical therapists to learn how to decrease your pain and improve your daily function during your pregnancy, please do not hesitate to call us, Renew Physical Therapy, 212-213-4660.
Broussard CS, Rasmussen SA, Reefhuis J, Friedman JM, Jann MW, Riehle-Colarusso T, Honein MA; National Birth Defects Prevention Study. Maternal treatment with opioid analgesics and risk for birth defects. Am J Obstet Gynecol. 2011 Apr;204(4):314.e1-11. doi: 10.1016/j.ajog.2010.12.039. Epub 2011 Feb 23. PubMed PMID: 21345403.
Desai, R., Hernandez-Diaz, S., Bateman, B., & Huybrechts, K. Increase in prescription opioid use during pregnancy among medicaid-enrolled women. Obstetrics & Gynecology, 123, 997-1002. Retrieved April 30, 2014.
Feldkamp ML, Meyer RE, Krikov S, Botto LD. Acetaminophen use in pregnancy and risk of birth defects: findings from the National Birth Defects Prevention Study. Obstet Gynecol. 2010 Jan;115(1):109-15. doi: 10.1097/AOG.0b013e3181c52616. PubMed PMID: 20027042.
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