Who We Are DR. PAM’S Month by Month · Month by Month PREGNANCY HACKS Dr. Pamela Woodward Who We Are DR. PAM’S Dr. Pamela Woodward is a family chiropractor with a specialty in

Month by Month

PREGNANCY HACKS

Dr. Pamela Woodward

DR. PAM’SWho We Are

Dr. Pamela Woodward is a family chiropractor with a specialty in care for pregnant women and their little bundles of joy. In her studies, but more importantly from her patients, she’s managed to assemble some helpful ways to manage your pregnancy – even when you don’t feel much like glowing.

What to do when you feel like your baby is beating you up from the inside…and you aren’t even in the delivery room yet!

Sciatica doesn’t have to have you dragging yourself through the end of your pregnancy with these suggestions.

Contact Us

Dr. Pamela Woodward serves her patients at First Step Chiropractic, located in the heart of the Mt. Washington section of Baltimore, Maryland.

1501 Sulgrave Avenue, Suite 302 Baltimore, MD 21209

Phone: (443) 869-3626 Email: [email protected]: www.firststepbaltimore.com

Congratulations! You’re pregnant!

I’m writing this under the assumption that the initial shock has worn off and that you’re ready to get down to business in order to navigate this whole growing-a-tiny-human thing.

The good news is that most of it takes care of itself; you don’t have to think too much about it. (Okay, okay, you might not be able to think about anything else. But you can!)

The not-so-great news? Sometimes it can feel like you’re just along for the ride. Lots of moms in my practice have reported feeling frustrated that everything isn’t always sunshine and rainbows 24/7. Even the best pregnancy is bound to hit a couple of rough patches.

But let’s get back to the good news: pregnancy has never been known to last forever. And bonus good news: There are some things you can do along the way to manage some of the common issues that arise in the meantime.

Disclaimer: I’m breaking these conditions down by month, but this is not a one-size-fits-all timeline. You may find that some issues arise earlier, later, or not at all for you. Every women and every pregnancy is different. Remember that with second, third, (and additional) pregnancies, it’s not your body’s first rodeo, and you may notice things showing up a little sooner than in your first pregnancy. And of course, you should always check in with your doctor, obstetrician, or midwife if you have any concerns during your pregnancy! They are smart cookies and, trust me, they’ve heard it all before. Just like they told us in grade school, there’s no such thing as a stupid question!

Month 1: Is this real life?!

This part of pregnancy can seem a little surreal. Even with the positive pregnancy test, even if you’ve been trying your darnedest to procreate, there is still this “Oh my gosh, what have we started?” moment that seems to come on at some point for every mom (and dad) when you reach the point of no return. And if you are fortunate enough to be planning for a pregnancy or realize pretty quickly that something is going (or growing) on, then it’s time to get to work! At this point, it’s about creating the best possible environment for your little jellybean. Put your team together – your OB or midwife, your massage therapist, your acupuncturist, and (of course) your chiropractor.

It goes without saying that, at this point, you should stop all forms of smoking and drinking. Some doctors will support the reintroduction of a glass of wine a little later in pregnancy, but that is something you should definitely discuss with them first, in tandem with figuring out what makes you comfortable. But in the first month and trimester, your baby’s nervous system is growing fast – so let’s keep out what might hinder that process (this is, after all, a chiropractor writing – and we chiropractors are all about a happy, healthy nervous system).

You can also support your baby by watching your diet. Or rather, you can support yourself, because that little guy is going to take whatever he needs from you. So the pre-natals they recommend? Those are to put back all the goodies the baby is taking. Get used to it, mama. Some women report the pre-natals to be incredibly harsh on their stomachs, so a couple tricks that my patients have reported to me include never, ever taking them on an empty stomach, breaking them up to take with meals over the course of the day, or getting a brand with lower iron levels. Of course pre-natals become slight-ly less important if you are eating a diverse and healthy diet. So if you’re having trouble taking a full dose, make sure you are at least bolstering your fruit and veggie intake with all different colors and textures.

And no matter what, get your folate! Again, this is very important for neural tube development. Talk to your midwife or OB if you are struggling with your pre-natals – there are options for you! Another important thing to include with your nutrients is some form of omega-3. This fat is key for developing a healthy brain and heart in your little munchkin – and this need only increases in subsequent pregnancies.

Month 1 | Pregnancy Hacks For more information, visit FirstStepBaltimore.com

Month 2: “Things are so, so real,” you whisper to your toilet...

Morning sickness is a lie. Any of my patients that suffered from this condition will tell you that it is definitely not confined to the morning. It’s any time of day: morning, noon, night, meeting, movie…you name it. It’s not always full on Exorcist puking, but it can range anywhere from that to a low grade nausea that refuses to quit. No one is quite sure what causes morning sickness. My personal favorite explanation is that your body sees your precious baby as an evil invader and will do anything in its power to get rid of it. Fortunately, those little ones are pretty tough and most of the time the only one worse-for-wear when it comes to morning sickness is mom. Lucky you!

Just like we don’t really know exactly what brings morning sickness on, we also don’t have a one-size-fits-all cure. I wish we did, because there is nothing more heartbreaking than a mom that just wants to be excited about her pregnancy but can’t seem to step away from the trashcan long enough to enjoy it. Here are some ideas for coping with morning sickness that have worked for moms in my world:

Hang in there, most women will see these symptoms taper off around Week 14. If it goes much past this, or if you are struggling to make it through your normal daily activities, talk to your OB or midwife about the possibility of a condition known as hyperemesis gravidarum. Until then, thank your lucky stars babies are cute…it just might make up for all of this.


Eating something bland before they even move in the morning. This gives something other than you for your stomach acids to go after in the morning.

Ginger. Everywhere, in everything. Ginger tea is a good choice and relatively easy to find.

Freeze some slices of lemon and suck on them when nausea hits. It may seem counterintuitive, but the lemon juice seems to calm the stomach despite being traditionally considered acidic.

Drinking plenty of clear liquids. Some women find that this means a sweet, clear liquid. Others respond better to pure water. Whichever suits you, just make sure you are staying hydrated. This can help with nausea, but will also keep you from finding yourself in more dire straits. If you are showing signs of dehydration, such as confusions, dizziness, or dark urine, seek medical attention immediately.

Diffusing peppermint oil in the air, or putting a drop in a tablespoon of coconut oil and rubbing over the stomach.

Month 3: I would love to keep reading, but I’m falling asleep already...

I’m going to take this to mean that you’re in month three of your pregnancy and I’m not a terrible writer. Hey, you are growing a human. This is not easy work! The biggest thing here is to be gentle with yourself. You don’t have to be superhero. Take some time to rest. At this point you may not feel comfortable telling people about your pregnancy yet, so make sure you have some pre-packaged outs for times that you can’t handle the thought of meeting up for a night on the town after barely making it through work.

Make sure that you’re comfortable at night so that even if you can’t rest during the day, your sleep is restful. This might mean bumping your partner from their spot. Approach this conversation openly, and explain that from here, rest is the best thing for all of you. It doesn’t mean you never get to see them or cuddle, it just means that the guest room might need to get some extra attention while you sleep as much as you can.

Sleep is an important aspect in establishing the cyclical nature of the release of key hormones. Put away your cell phone, get some light-blocking curtains, and get some quality shut-eye while you still can!


Month 4: Pushing without production, i.e. constipation

It’s interesting that one of main reasons that I will see infants in my practice is one of the little things that will fly under the radar for moms-to-be. Perhaps it’s an embarrassment thing, but best to get used to talking about poop now – it’s incredibly telling from a diagnosis standpoint, and you’re going to be talking about it a lot when the munchkin makes their appearance…and possibly for years after, should you have a little boy.

Constipation is a common problem throughout pregnancy, and there are a number of reasons for that! Firstly, the same plexus of nerves that innervates the lower digestive tract is the one that goes to the reproductive organs as well. You can guess which takes priority right now. That’s where your chiropractor can be helpful – we are all about proper nerve func-tion. Secondly, even though it may feel like your baby is only growing straight out from your belly, they are going back as well. This compresses the lower intestines, making it harder for you to take care of business. Straining is frustrating, and can also lead to the early generation of hemorrhoids. So here are some ways to manage your trips to the bathroom with minimal damage.


One thing I suggest to all of my patients, pregnant or not, is to put yourself in the best biomechanical position to poo. Surprisingly, this is not in a seated position. Gravity is not on your side here and it is more difficult to use your core (yes, you still have one) while sitting on a traditional toilet. We’ve been doing things wrong for years! The best thing you can do is position stools on either side of the toilet to bring yourself into a squatting position. The Western world has gotten it in its collective mind that squatting is a big no-no. Which is a shame since it’s actually a fantastic position not only to defecate, but also to deliver. So consider squatting for #2 to be your birth training. Engage your core and use your legs to give your digestive tract some assistance.

Month 4 continued...

Equally helpful to your digestion is your diet! Fiber is your friend:

Above all, keep staying hydrated. This is the best thing for your bum – and your baby!

Try all of these things, and make sure you check with your doctor before trying any over-the-counter stool softeners or laxatives, especially castor oil! Castor oil is an old go-to for stimulating labor, which is not what you want to be doing just yet.


Beans are high fiber, as are prunes, but if you get bored with the old standby there are plenty of other options. Dried apricots have plenty of iron in addition to fiber (much gentler on your tummy than the iron found in pre-natal vitamins, too).

Add some brown rice to your beans and you’ve got a hearty fiber-rice meal.

And a spinach and strawberry salad with some balsamic vinegar is not only full of fiber and antioxidants, but also tastes delicious!

Month 5: “It felt like the baby was punching me in the lady bits...”

Especially prevalent in my moms with shorter torsos (says the doctor wistfully as she looks at her 5’0” frame in the mirror), pain at the bottom of the belly and into the labia is especially common. Now that you’re starting to actually look like you’re carrying a human baby (and not a pizza baby), your body is having to shift to support your growing uterus. This means the support structures on the underside of the uterus that typically just get to hang out are put to work.

The big player here is your round ligament. Don’t let the name fool you, though; this is not your typical ligament. It has muscle fibers in it that, when overworked, will not up and form trigger points, just like those in your shoulders. And just like those in your shoulders, they respond well to massage. The perfect person to point you in the right direction of these trigger points is your chiropractor, since we work with these same points when performing the Webster Technique. They feel like tiny little BBs on the underside of your protruding belly, anywhere from your hip bone to your pubic bone. Do a little poking around to find them since they aren’t always right at the point of pain (trigger points notoriously cast a wide net of discomfort away from their actual location). Pressure over the point will cause it to relax – and hopefully give you some relief. Like any other muscle or ligament, regular massage of the round ligament will help keep it in good shape to handle the hard work ahead, since baby isn’t done growing yet!

For some women, there is another issue that can cause pain in the lady parts, and this is a subluxation of the pubic bone. This just means that as the pubic symphysis widens (and trust me, this IS a good thing – you want all the exit room you can get!) the joint becomes less stable and can slide just slightly out of place. This is incredibly sensitive area, though, so the slightest misalignment can cause plenty of discomfort - sharp, stabby discomfort that often creeps up on you as you sleepily roll over at night. Again, the best thing you can do here is see your chiropractor. We’re the gurus of joint subluxation, so this is right up our alley. In the meantime, you can do your best to avoid rotational movement in the pelvis. Try to bring your knees over at the same time when you roll over.

Work on strengthening your pelvic floor muscles, and if you haven’t invested in a birth ball yet, now is the time. And be careful going up and down the stairs – take them one at a time if necessary. It’ll be good practice for following your toddler around one day soon.


Month 6: What a pain in the butt...and leg!

Sciatica is far and away the most common thing to bring pregnant women in to my office. If they’ve never seen a chiropractor before they tend to sit as far away from me on the exam table as possible and in whispered tones tell me that they heard that their sister’s coworker’s cousin’s best friend had sciatica and nothing seemed to work until they saw a chiropractor and by some miracle, they were cured and also had the best birth of all time. Who wouldn’t want that? “No pressure or anything, doc, but fix me on up!”

The good news is this is one of the more straightforward issues we tend to deal with in pregnancy. That being said, each person and pelvis is different. So what can you do when that sudden pain (and most of my patients do say it comes on pretty suddenly, somewhere between 20 and 32 weeks) kicks you in the rear? In addition to getting adjusted to take the pressure off the sciatic nerve and allow the piriformis muscle (a little guy in the rear end that sits right on top of the sciatic nerve) to relax, there are a couple of at home tricks you can use to help you get back on your feet through the end of your pregnancy.

If you haven’t looked into prenatal yoga and massage yet, now is the time. These practitioners work wonders on a piriformis muscle. Just make sure you’re going to pregnancy-specific classes and seeing a therapist who is experienced in working with pregnant women. For when money or time is a little tight, pigeon pose is going to be your best friend. Later in pregnancy, when getting on and off thefloor is a luxury no longer afforded to you, you can place a folded leg on the bed or a chair in front of you (bent at the knee with the outside portion of the thigh and calf lying on the bed) and lean forward, allowing your belly to drop between you and the bed as necessary. You should feel a good stretch across the butt. That’s your piriformis muscle. And it needs you. Please consult with a doctor before starting any exercise or stretching regimen to make sure it is safe for you and your baby!


Month 6 continued...

For women who can’t maneuver their ways into pigeon pose, a tennis ball or foam roller is going to be your best friend. You can place it on the floor and sit with one side of your butt over the ball. Roll your muscles over the ball breathing through the discomfort, and using your upper body to control just how much weight is over the ball at a given time. You can also do this on a sturdy wide chair, or against a wall.

Finally, look at how you’re sitting most of the day. If you’re finding yourself cross-legged (lady-like at work or pret-zel-style with your toddler) or with your legs curled underneath you on the couch watching a movie marathon while you still can, stop! These positions further stress out the piriformis muscle and sciatic nerve. So give it a break. Feet flat on the floor, please, or at least propped up straight in front of you. This is another great opportunity to work in the birth ball!


Month 7: Who replaced my ankles with painful sausages?!

Third trimester! Almost there, ladies! Just a couple more hurdles to get over – though with the shape of your legs right now, that might not seem entirely possible. Before I continue, it is important that you discuss swelling with your doctor or midwife. They will be monitoring your blood pressure closely for signs of pre-eclampsia, a potentially serious condition that can come on in your final trimester. But even with perfect pressure, that does not always mean you’ll be swelling free. And while the ankles are often the most noticeable, the condition is not confined to the lower extremities.

A couple of things to keep in mind: do make sure that you are checking your wedding rings or other regularly worn jewelry every couple of days to make sure that you can remove them comfortably. It would be heartbreaking to have to have a treasured piece of jewelry cut off to save a finger, but it does happen. Better to keep an eye on the digits and switch to wearing them on a chain around the neck for the end of your pregnancy.

You also may want to invest in a pair of comfortable open shoes. Flats are your friend right now. They will help to prevent the curve in your low back from increasing any more than it has already, too (high heels notoriously increase lumbar lordosis). While you’re out, pick up a pair of support hose for work days that you’ll be on your feet for any extend-ed period of time. Your chiropractor may also have Kinesiotape – a souped-up athletic tape that promotes drainage of edema (swelling). From a diet perspective, foods rich in Vitamins C and E along with potassium are important for reduc-ing swelling. Also keeping a low salt diet will help, as salt in the body encourages water retention. And though it sounds counterintuitive, keep your water intake nice and high in these last couple of months – even if it means getting up to go to the bathroom what feels like 100 times a day.

And what about the leg cramps? Those guys are like Charlie Horses on steroids, according to my patients. Again, water is going to come into play here. Stay hydrated. And if you’ve been supplementing with potassium-rich foods, you may want to consider your magnesium intake as well (almonds are a good source of this mineral). A balance of electrolytes is key for proper muscle function. Some of my moms swear by keeping a heating pad close by – if you do use this method, make sure you only are applying it for 15 minutes at a time, and only to the calf. Do not fall asleep with your heating pad - it’s not safe for you, your house, or your baby!


Month 8: Assume the position

Hand on the low back, belly out. You know the move. This pregnancy stance is actually really important so that you don’t end up flat on your face. Your center of gravity has shifted forward at the belly, so the upper part of your body will lean backwards to counterbalance.

The problem is, this deepened arch can be incredibly stressful for your low back. So what’s a girl to do? Since the baby doesn’t seem to be done with growing, it’s on you to adapt.

There are support braces, or belly bands that bring a lot of moms relief. A word of warning: don’t get too dependent on them – you don’t want your muscles to weaken, so 24/7 brace wearing is a no-no in this situation. Absolutely key are hip flexor stretches.

Bust out that birth ball (hasn’t that been useful?!) and practice tilting your pelvis forward to open up the joints at the low back. Your chiropractor will help that process during your adjustments, too.

Try not to spend too much time seated, and be up and walking when you can – walking benefits your heart, your muscles, and your joints, and it will help prepare your cervix for delivery.


Month 9: (Heart)burn, baby, burn

If you’ve been charting the growth of your baby by comparing it to produce sizes, it may be feeling lately like you are gestating The Great Pumpkin. They are push-ing up and out on everything – including your stomach. It’s for this reason that you may be noticing an increase in acid reflux and heartburn lately. Simply put, there is no room for your internal organs, now that baby is just about ready to make her appearance. Still, a growing baby means not eating is not an option.

As you can see, there are plenty of options for you to test drive while you get bored waiting for baby to make an appearance! Naturally, I’m also inclined to suggest seeing your chiropractor – they’ll work with the bones in the area of the nerves that innervate the stomach and esophagus to make sure that everything is moving the way it should! It’s better than taking up stock in antacids, at least…


There are a couple of things you can try to help manage your symptoms here. Small meals are key, as is avoiding eating those meals before bed. You can try elevating the head of your mattress with all of those pregnancy books you’ve read a million times over by now. (You can print this out and add to the pile, too. I promise it won’t hurt my feelings.) Some moms swear by a glass of milk to calm the stomach. Also you can dust off your ginger tea from early pregnancy and use that for settling the stomach. Others swear by apple juice/cider/vinegar.

Showtime!

Whether your baby decides to make her appearance right on schedule or decides to stay nestled for an extra week or two, it’s time to prepare for delivery. Hopefully, you will have taken the opportunity to attend a birth class, be it Lamaze, Bradley, or Hypnobirthing. Something that will help you work your way through the contractions, whether you plan on having a drug-free birth or not. It will also help you manage the mental stress that comes with having your birth plan go out the window…or go exactly according to plan.

Even if you haven’t taken a class, remember to breathe! Ina May Gaskin, the mother of modern midwifery explains that relaxing the muscles of the face (think not clenching and screaming) will allow muscles at the other end to relax more easily as well. And this is a lady who’s helped a lot of babies into world, so she’s the first person to whom I listen.

Also, the more you can be up and moving around in labor, the better. Birth ball is ready for the big show. You’ve been practicing your squatting. Try hanging out on all fours. All of these positions (as opposed to the traditional feet-up litho-tomy position allow for a wider pelvic outlet (read: more room for baby to escape). Some hospitals will not allow for this much motion, so make sure you labor at home while you can.

Massage is also helpful during delivery – have your doula or husband massage along your low back, but also your legs and thighs and basically anywhere that makes you feel better. Don’t be afraid in between contractions to explain what is and isn’t working for you. Some women needs someone to talk to them through a contractions, others want complete silence. Don’t be afraid to make your voice heard – literally and figuratively. This is your birth just as much as the baby’s – do what works for you, and don’t let anyone make you feel like you’re doing it wrong.

You’ve got this, mama!

Showtime! | Pregnancy Hacks For more information, visit FirstStepBaltimore.com

The Fourth Trimester

Oh you thought it was over? Good try. The take home message here is make sure you have a team around you that makes you feel supported at all times. This includes your partner (maybe), your family (maybe), your friends (maybe), and anyone else you can think to bring on to give you the back-up you need as you adjust to your new role. Hopefully you can include a chiropractor on that team (even better if it’s those of us at First Step Chiropractic!). Just know that there is no problem that you can bring to your team that can’t be managed. A whole new host of adventures comes with having a baby – but that’s another e-book.

The Fourth Trimester | Pregnancy Hacks For more information, visit FirstStepBaltimore.com

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Who We Are DR. PAM’S Month by Month · Month by Month PREGNANCY HACKS Dr. Pamela Woodward Who We Are DR. PAM’S Dr. Pamela Woodward is a family chiropractor with a specialty in