Preventing Hip Injuries in Birth
Dear Emily - I started having pain after the birth of my first child and didn’t get it checked out until after my 3rd. It’s a labrum tear in my right hip. I swear it’s from my husband pushing my leg back to the wall when pushing…
Dear Emily - I just read your Facebook post and wow! I feel like this was written about me. The nurse pulled my legs back in an effort to help me and I haven’t been able to walk without pain ever since. My care provider says to give it time. It’s been 3 months…
Dear Emily - 18 years ago my husband was asked to hold my leg and bring it back towards my ear....my SI joint was permanently damage on that side. Required a fusion to fix it… And it’s still not fixed. Do you have any ideas for me…
Sound Familiar?
Maybe You are thinking… Wow. I wonder if this is what happened to me?
I receive these kinds of messages frequently enough to know that this is a problem.
That pain that all three of these women felt may be caused by impingement or part of the labrum (the joint lining) getting snagged. It may feel like a “catching” or just a constant dull ache in that hip… or both. This can happen when the legs are pushed back to the shoulders by OTHER people during birth. And, for the most part, it’s preventable with a bit of education.
How many of you had someone pushing back on your feet during pushing?
Holding the feet can be risky for both the birthing person and the helper who is holding the foot. (For the “Helper”, it’s shoulders and backs that get hurt, but that’s another post...). A very common injury to the mother is a Hip Labrum Tear. This happens right in the capsule of the joint (the pink area in the graphic below).
So, how should a “helper” actually help?
The key?
Do not pull back or push back on the legs
but rather hold up the leg as in a support.
Dear Helper- IF-IF-IF you are going to hold the foot of a birthing person, please do so like the graphic below shows. This promotes external rotation and protects the hips from internal rotational force into the joint.
So, you might ask, why not just use the stirrups or the “leg holder thingys” attached to the bed? Well, for starters — they are not a one size fits all, even though they can be moved a bit. And if an epidural is in use, you may have no way of knowing if you are getting nerve pressure damage from extended use.
Remember how long pushing can take?
Are you thinking about your legs?
NO.YOU.ARE.NOT.
You are thinking about getting that baby out!
Inevitably, someone says (and sometimes that is me when I doula), “reach under your thighs and pull them to you”. It’s great for traction and hip-safe for a mom to do ON HER OWN or with correct hand placement of the helper… But here is the hard part: It’s really hard for your support team of Helpers to not overly HELP. Especially when they see baby is about to be born and in their exuberance, they push your legs back hard!
What happens next? You may already know that 4TFM moms can start our gentle Postpartum Recovery Fitness classes as early as 10 days after birth. These mommas come hobbling in to our PPR classes and say, “I’m doing okay but my hip is just killing me. It hurts right here” while she places her hand in what is known as the “C-sign”.
The c-sign
She hasn’t told her care provider yet (I mean, let’s get real here - she left the hospital at 2 days postpartum and was sore everywhere anyway) and is thinking that she has to wait for the 6 weeks appointment to get it checked. WRONG!! That’s a long time to be in pain! This momma needs to call her OB and get seen by an ortho or physical therapist. The pain is constantly achy or it may be an intermittent, sharp stabbing pain that feels like something is “catching” in the joint. She will likely have lost her range of motion in that joint ( because who wants to move when it hurts, right?) and may hobble a bit. She may say it hurts when she lifts her leg to put pants on… “right here in that front part of my hip”. And it aches right there in the back where her thumb is… Tenderness may be experienced right down and around to the pubic joint and into the leg. It really hurts when she rolls out of bed to get to her baby. One mom told me that she made her hubby change sides of the bed so that she didn't have to roll over on her sore hip. Does any of this sound familiar? If so, please call your care provider! Do not suffer for weeks on end!
Prevention is the Best Cure!
The easiest way to try to prevent this hip injury during birth is for your support team to keep their HANDS OFF of your feet. If you are wondering how the difference of the two hand holds might feel, try this is “Happy Baby” pose… put your hands over-and to-the inside of your feet and gently pull your feet about an inch closer to the ground - do you notice that your knees naturally turn out to the sides? Now do the same thing only with your hands on the outside of the foot. Now do you notice that you tend to pull your foot out thus forcing the knee and hip sort of feel like they are being driven into the hip joint? How does that feel in your hip? Quite different, right?
Dear Support People- Sometimes a birthing momma may ask for your help and, in this case, you have two helpful options:
The best is to simply hold under her calf and not touch the foot OR
Use an OVER THE FOOT hold as shown in the graphic. Remember that this hold causes the knee to move out and externally rotate the hip joint so that the hip joint is not ground into the capsule
And always ENCOURAGE her efforts! Every step of the way!
I hope this is helpful to you- whether you are a birthing mom or a support person or a birth professional. If you have suffered from this sort of hip injury, I hope that you can get help quickly. Don’t wait. Call your provider. And if you are about to have a baby, I hope this will prevent injury. To my dear OBs, Midwives and Nurses - watch those hips!
Please pass the gift of education on to your friends and share this post!
Let us know in the comments if this is helpful to you or if you have questions.
Reference:
Brooks, A. G., & Domb, B. G. (2012). Acetabular labral tear and postpartum hip pain. Obstetrics & Gynecology, 120(5), 1093-1098.