Hypermobility and Pregnancy

With the rise of greater understanding around diagnoses like Ehlers-Danlos Syndrome and others that impact mobility and collagen production, it’s becoming more and more important to discuss the impact on pregnancy and birth. I don’t see many in the birth worker communities discussing this topic so I decided to do a deep dive! Read on to see some of the impacts hypermobility can have on pregnancy and birth as well as some tips on management.

Common Issues:

Heartburn

This is a burning, acidic feeling in the esophagus (gullet) caused by stomach acid leaking. Spicy foods, caffeine, alcohol, citrus fruit, and (despite what friends may tell you) milk can all make symptoms more likely; whilst eating small regular meals, drinking water (to dilute the acid), avoiding late evening meals, and lying on your left side at rest can all help improve symptoms. If symptoms persist, see your GP for a prescription for safe antacids.

Pelvic girdle pain (PGP)

This used to be called ‘symphysis pubis dysfunction”. The increased laxity and instability of the pelvic joints cause pain all around the pelvis, which can range from mild aching after sitting still, to considerable disability requiring the use of crutches or a wheelchair. Some studies have found that whilst the general pregnant population has a 7% incidence of PGP, this is increased to 26% in women with hEDS/HSD. Symptoms can begin earlier in the woman with hEDS/HSD and it may take a lot longer for them to disappear after birth. Some women with hEDS/HSD continue to suffer from PGP for many years after childbirth and considerable support may be needed.

Back pain

This may occur with or without pelvic girdle issues. There is a natural lordosis (swayback) in pregnancy and good posture can help to correct this just enough to reduce over-stretching of the ligaments. Try to tuck your tailbone under as you sit and walk, and ‘walk tall’. Consider the chair you use in the house and at work and ensure that your feet can rest comfortably on the floor. Use a small cushion for your lower back and raise your legs on a comfy stool if it helps. Pace your activity and avoid overdoing it on good days. This may mean asking for extra help with household tasks and sitting down for ironing, washing up, etc. Take great care when lifting – avoid if possible but, otherwise, bend your knees, keep your back straight and bring the item to be raised in close before picking it up. Avoid twisting as you lift. Most NHS physios run back care classes for pregnant women and your midwife should have details of these.

Heart palpitations

Many people with hEDS/HSD are used to heart palpitations and ‘flutters’. These may increase, or become apparent for the first time, in pregnancy. Tell your GP who can arrange a quick ECG to ensure that there is nothing to worry about. The palpitations should return to normal-for-you after the birth as hormone levels settle down.

Mental Health

It has been noted that people with hEDS/HSD appear to be more prone to anxiety and depression. It is vital that mental health is monitored and, where appropriate, treated in pregnancy to reduce the likelihood of postpartum mood disorders.

Perineal tears

Your perineum is the area between your vagina and your anus and is the skin that gets stretched open as your baby is born. Women with hEDS/HSD are more prone to tearing and may take longer to heal.

Precipitous birth

Early labor (from 0 to 4cm) may last as long as that of an unaffected woman, women with hEDS/HSD are more prone to a precipitate (very fast) active labor. As good as this sounds, it can be intense and frightening without the proper education and support. Let your birth team know that you may labor very fast from 4cm and that your caregivers need to monitor you carefully and take heed if you want to push suddenly.

Baby’s Position

Due to the lax ligaments and joints within the abdomen and pelvis, babies of women with hEDS/HSD may come through the pelvis and be born in a less standard position. They may come through “sunny side up” or with their heads at an angle (asynclitic) or even with their head facing side to side in your pelvis.

Pelvic Pain Solutions

• Ask to be referred to a physiotherapist who can offer help and support by teaching exercises, providing specialist pregnancy belts, and suggesting simple lifestyle changes to minimize pelvic instability. It may be wise to request a referral early in pregnancy in order to get advice to reduce the

  likelihood of PGP occurring.

• When sitting and lying, try to keep your legs parallel and hip-width apart. Avoid crossing your legs or sitting at awkward angles.

• Avoid standing on one leg for dressing (sit on the bed or chair to put on socks).

• Keep legs comfortably together when moving in and out of the bath, bed, and car or when turning over in bed.

• In bed, rather than simply putting a pillow between your knees (this is often recommended but can make the pain worse), put a pillow or two between the whole length of your legs – there are ‘body pillows’ sold specifically for this purpose and the investment might be worthwhile.

• Put a warm hot water bottle or heat pad on the lower back.

• Use a TENS machine on the back.

• Avoid lifting heavy objects.

• Change position regularly to reduce stiffness and aching.

• Maintain your usual exercise routine. There seems to be a particular benefit for those with hEDS/HSD from hydrotherapy.

Back Pain Solutions

• Massage

• Warm baths

• Heat packs (do not put these on your tummy)

• Fidgeting

• Gentle, daily stretching without over-stretching

• TENS

• Hydrotherapy

• Pregnancy Pilates

• Mindfulness meditation

• Distraction (music, reading, crafts, cooking, etc)

Mental Health Helpers

• Eat healthily and regularly. Small meals more often throughout the day can be a game changer!

• Get out in the fresh air and sunshine! Ground yourself, and walk barefoot in the grass.

• Take part in regular gentle exercises such as walking, swimming, or pregnancy yoga/pilates

• Learn mindfulness meditation and consider downloading an app for pregnancy mindfulness

• Set a regular going-to-bed and getting-up time

Perineal Health

• Perineal massage: the jury is still out as to whether doing regular massage of the perineum helps to prevent tearing but women report being better prepared emotionally for the sensations of the head being born when they have massaged regularly antenatally. Use simple massage oils, such as olive oil or grapeseed and be gentle – the hEDS/HSD tissues are more prone to bruising.

• Don’t push too soon: request that you are not encouraged to push until you have a natural urge. The urge to push is a reflex and so will ‘kick in’ when you are ready to push. Waiting until this time rather than trying to push before you are ready will allow your baby to come down a little more slowly, allowing for a gentler stretching of tissues.

• Keep your sutures clean: daily bathing or showering without using soaps and creams on your perineum can reduce the risk of infection. There is no evidence to support the use of essential oils such as tea tree, but a cold gel pad in your pants may soothe and reduce bruising and swelling.

• Do your pelvic floor exercises: these simple exercises are taught to all pregnant women. Most forget to do them. DON’T FORGET! They can help your tissues return to normal after birth and reduce the likelihood of urinary and fecal incontinence long-term.

Most importantly, have proper support! Make sure your care provider understands the impact of your health on pregnancy. Hire a doula or find support groups that can educate you and be there for you when the time comes. What are some topics you feel are missed? Let me know below!