Postpartum Ergonomic Tips

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Postpartum is a time where there is continued risk for joint hypermobility due to hormones such as relaxin still present in the body and the hormonal influence of lactation. These hormones effect the ligaments and connective tissue which are being stressed by the biomechanical and ergonomic positions of childcare activities.
 
Other things that can influence musculoskeletal pain postpartum include:

• Sleep deprivation (increases acute pain, decreases pain tolerance, increases sensitivity to pain stimuli, increases fatigue and negative mood, and decreases cognition)
• Depression
• Degenerative joint disease
• Chronic pain syndromes
• Hypothyroidism (increases risk of  carpal tunnel or tarsal tunnel syndrome)

Ergonomic assessments during breastfeeding may be beneficial to prevent joint injury, promote proper body mechanics and allow for energy conservation. Finding an optimal position for mother includes a neutral position that allows for balanced posture and avoids musculoskeletal strain. A neutral spine is a comfortable spinal position that creates equal pressure for all vertebra and discs.

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Tips to Conserve Energy

• Simplify tasks
• Organize work spaces to eliminate unnecessary bending, twisting, lifting and carrying
• Roll or slide objects rather than carry or lifting them
• Make sure to add frequent rest breaks. Rest when baby rests! Rest after eating. Rest before becoming overly fatigued
• Sit instead of standing (requires less energy)
• Use gravity-eliminated positions that require less energy expenditure. For example a side-lying position with a pillow placed between knees/ankles during breastfeeding. This promotes a neutral spine and decreases energy use.

 
Tips to Protect Joints and Promote Proper Body Mechanics

• Avoid a prolonged tight grasp or pinch especially when wrist is bent
• Avoid staying in one position for long periods of time
• Minimize repetition
• Avoid bending, extending, or twisting the wrist during activities
• Use a power grasp (loose grip, keeping all the fingers together, thumb straight)
• Avoid reaching, grasping, and lifting with the palms down (especially with the wrist bent). Instead, lift objects from underneath with palms up (with wrist straight)
• Avoid leaning over a work surface or twisting the torso while lifting (especially into the crib)
• Keep objects close to body while lifting
• Maintain a straight or neutral spine while lifting
• Use a wide base of support (feet wide)
• Lift with leg muscles instead of bending at the back
• Use a golfer’s lift (bend at the hips while raising one leg behind)

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Photo: Preventing Musculoskeletal Pain in Mothers Ergonomic Tips for Lactation Consultants Article

Lifting the Baby Tips
✔When lifting a baby, scoop one hand under babies bottom and use your other forearm to support the body.
✖ By not lifting the baby under its armpits, you protect yourself from thumb tendonitis.
✔When baby is on the floor, bring baby close to your body and then stand up.
 
Carrying the Baby Tips
✔ When baby is heavy, carry baby with one forearm under the baby’s bottom and the other arm to support the baby’s chest.
✖  Avoid carrying the baby on one hip because this stresses the pelvis and surrounding musculature. Instead try a sling with padded shoulders or a baby-carrier to support baby’s weight.
✖ Avoid carrying the baby in a portable car seat. Using one hand to carry it will put stress of pelvis, spine and surrounding musculature. Car seats also create hip flexion in the baby while in a stroller there is the option of a reclined or semi-reclined position which allows these muscles to stretch.
✔ Use a stroller instead of the car seat for mama ergonomics. Adjust stroller height so wrists are straight.
✔ Carry the baby manually. This has been shown to promote symmetrical head-shaping and strengthen the infants neck and shoulder muscles. The American Occupational Therapy Association, the American Physical Therapy Association, and the American Academy of Pediatrics highly recommend giving infants a variety of positioning experiences in order to get enough supervised tummy time throughout the day. Carrying a baby manually promotes the infant to practice modified tummy time.

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Photo: Preventing Musculoskeletal Pain in Mothers Ergonomic Tips for Lactation Consultants Article

Bottle-Feeding the Baby Tips
✔Try a side-lying position for both feeder and baby (this is a gravity-eliminated position). This will allow feeder to pave the flow of the feed
✔ Have one arm supported by a pillow, palm up where the baby will lie head in hand and feet by the chair. Make sure arms are relaxed and shoulders lean against chair to discourage rounding of shoulders, slumping back and forward head posture. Hold bottle loosely in other hand (avoid tight grip and wrist flexion) 
✖  Avoid a heavy, wide bottle
 
Tips for Moms
✔ Use a foot stool to position knees bent, slightly higher than hips creating a semi-reclined position
✖ Do not cross legs or placing an ankle on opposite knee. This creates stress in the ligaments of the low back, pelvis and knee
✔ Have one arm supported by a pillow, palm up where the baby will lie head in hand and feet by the chair.
✔ Sitting semi-reclined may require a small pillow or rolled towel beneath the low back to allow for neutral spine position. This does allow baby to be secured with gravity on mom, which decreases the effort needed for mom to support baby
✖ Try not to lean forward as this increases stress on the back of the neck and upper back as well as rounding the shoulders. Aim for a more reclined position.
✔ When using the cross-cradle or football hold, support baby and forearm with a flat pillow underneath to promote neutral wrist and forearm. A rolled towel should be used as indicated to allow neutral positions

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Disclaimer: The advice provided in this article is for information purposes only. It is meant to augment and not replace consultation with a licensed healthcare provider. Consultation with a Chiropractor or other primary care provider is recommended for anyone suffering from a health problem.  

References:
1. Roberts, D. (2011). Preventing Musculoskeletal Pain in Mothers Ergonomic Tips for Lactation Consultants. Clinical Lactation, 2(4), 13-20.
2. Hummel, P., & Fortado, D. (2005). Impacting infant head shapes. Advances in Neonatal Care, 5(6), 329-340. 
3. Pendleton, H.M., & Schultz-Krohn, W. (Eds.) (2006). Pedretti’s occupational therapy practice skills for physical dysfunction. St. Louis, MO: Mosby.