Mom and Baby Safety Concerns from a Whistler Physiotherapist and Mom
Most of us who live in Whistler and the Sea to Sky Corridor are here because we are active, outdoorsy types, so when we are pregnant, and our activities are limited, we look forward to the day we can do everything again. Unfortunately, many of us don’t know the recommendations of how and when to return to certain activities for our own or our baby’s safety, or the reasons why these recommendations are made. Through my women’s health and sports physiotherapy practice, as well as being a mom in the community, there are a few things I see on a day to day basis that make me uneasy and always unsure of when to provide education. No one wants unsolicited advice but at times I also feel the obligation to keep my community safe. This article is intended to provide you with information as to why certain recommendations have been made so that you can make the best decisions for yourself and your family.
Biking during Pregnancy:
By 12 weeks the uterus is starting to sit above the level of the pubic bone, therefore it no longer has boney protection. Headset and handle bar injuries are common. If you are a mountain biker think of a time you fell off or forward on your bike and put the headset or handle bars into your pelvis or abdomen. Biking, road and mountain, has a high risk of pelvic fractures. You need your pelvis to support the 20ish pounds that is going to be sitting on top of it, so a pelvic fracture is not ideal. On the extreme end, impact to the uterus could cause placental abruption. This is where the placenta is sheered from the uterus, which can lead to fetal and maternal death.
Personal Story: At 11 weeks of pregnancy with my first child my sister, a perinatal nurse at Squamish General Hospital, saw a photo of me biking. She immediately called me to explain why I am not allowed to bike anymore. I might not have listened to this advice except I could hear the fear and sorrow in her voice as she explained situations she has been present for that resulted in loss of the child after bike accidents.
Running, Plyometrics, and Heavy Lifting During and After Pregnancy:
Many women can do these activities. Many can’t. After about 8 weeks of pregnancy our ligaments, connective tissues, and muscles start to relax to allow the uterus to grow, the belly to expand, and for birthing baby. The uterus, placenta, and baby are also growing and increasing the load onto these structures, which are now looser. Impact and heavy lifting activities increase the downward pressure into our pelvic floor and onto the bladder and rectum. If not performed correctly these exercises can increase the risk of pelvic organ prolapse and incontinence by adding too much load to a lengthening tissue.
Here are some rules of thumb as to when it is time to stop an activity during pregnancy:
- You leak urine or gas when doing the activity
- You get pain in your abdomen, pubic bone or sacroiliac joint areas
- You can feel/see a bump or gap (diastasis rectus abdominus) along the line of your abdominals (the linea alba)
Once we have had baby our tissues follow normal stages of healing (as with any connective tissue change/injury). It takes about 6 weeks for the ligament, muscle, and connective tissues to return to a shortened position (up to 6 months to be at a fully shortened position). At this point you can begin body weight strengthening to work on technique while the tissues are still more fragile and weaker. By 12 weeks, if you have been working on technique and alignment, the tissues should be strong enough and adding weight is often appropriate. As with any return to run program a person should be strong in their core, quads, gluteals, hamstrings, calves, and tibialis anterior. Strengthening takes a minimum of 8 weeks to make changes. This brings us to about 5 months for most people to start running.
Here is how to know you MIGHT be ready to return to running:
- You are a minimum of 3 months postnatal
- You do not leak, ever
- You do not have any feelings of bulging into the vaginal area
- You do not have an abdominal separation or bulging at the linea alba
The Canadian Physiotherapy Association and the UK’s National Health Service recommend seeing a women’s health physiotherapist at 6 weeks postnatal and before beginning any new exercise program to assess the abdominals, pelvic floor, any scars (perineal, vaginal, c-section) for return to activity safety and to develop an individualized care plan.
In BC it is the law for anyone on a bike to wear a helmet. This is extra important for those soft little melon heads babies have. However, until a baby’s neck is strong enough to hold the weight of their head and a helmet up a helmet should not be worn. An infant’s neck is not considered to be fully supportive of their head until they can stand or walk independently. The average for this to occur is 1 year (8-24m is considered normal for walking). The neck should then be strong enough to support the weight of a helmet, however there is no good measure for when this is. The other concern with baby wearing a helmet is the thickness of the helmet between the infant’s head and the seat. The helmet can cause the baby’s neck and head to bend forward, possibly impacting baby’s airway. This is similar to leaving a baby sitting in a car seat for too long.
Strapping is also a concern with biking. In a car seat the straps are designed to keep baby locked into place, knowing they are tight enough with the strap pinch test. If you cannot get baby strapped in as tight as in a car seat, then there is more risk that baby is going to be moving from side to side and forward and back. This can put undue strain on baby’s neck and spinal cord and causes the brain to move inside their skull. Baby’s don’t have the ability to right their body the same as we do as they don’t have the same muscular control, so quick stops, turns or changes in speed will increase the risk they move about.
Terrain is another concern. Even paved paths can be rough from gravel, cracks, curbs, etc. All of these will increase the amount of perturbation baby’s neck and brain are taking. As baby’s brain is smaller than its skull it can jiggle inside, with some speculation this could lead to micro concussions or damage to the developing brain. Each bike trailer is designed differently, some will tolerate these bumps better than others.
Risk of fall is the last concern, but that one is self-explanatory, and I am sure everyone knows why.
Has any of this been proven? No. Researchers haven’t bothered to study infant-biking nor would anyone be willing to test the theories in life. It is a compilation of concerns and recommendations from paediatricians, physiotherapists, and national health agencies based on knowledge of infant development.
- Thule Bike Carrier User Manual:
o Never exceed 25km/hr, and slow to less than 10km/hr around corners and rough roads.
o Child must be old enough to wear a helmet and to sit upright unattended when trailering. Consult a pediatrician if child is less than one year old.
o Only use the infant sling for strolling.
- American Association of Paediatricians
o Don’t put a kid under 12 months old on a bike under any circumstance
If you feel biking before age 1 is best for your family, there are many cycling pages explaining how to make it safer and what to watch for.
Swinging or Picking Your Kids by the Arms:
Small children have looser connective tissue and joints, which makes it easier for elbow and shoulder dislocations to occur. Although unlikely to happen, swinging a kid by their arms or pulling a baby up to sitting by their arms is a risk for dislocations, and unfortunately a way that they do occur.
After reading this you might be saying, yes, there are many situations that can lead to worst case scenarios. Many people like to state that the risk of driving is a higher risk than any of the above, however sometimes it just isn’t worth taking the risk if we don’t NEED to. I have compiled this information because these are all concerns I had as a new mom and topics I needed answers for before making my own personal decisions on what I was going to do. I wanted to present you with these topics because these are our sports and hobbies in Whistler and you will be seeing so many moms around the area doing them, making them appear to be the norm, but that doesn’t mean it is the best option for you.