Demanding work environments are seeing pregnant women working as long as they can prior to giving birth to save PTO days, and seeking the most comfortable shoes for pregnancy
Lumbar and pelvic pain are common in pregnancy. 1 One of the contributing factors to pelvic destabilization may be found in abnormalities of foot structure. A recent study investigating changes in the feet of pregnant women found that “…pregnancy is associated with a permanent loss of arch height and rigidity,” most notably in a woman’s first pregnancy, setting off a search for the most comfortable shoes for pregnancy, including the proper orthotic inserts. 2
As care providers for pregnant women, chiropractors have the unique opportunity to assess the feet and determine if they are a contributing factor to the patient’s pelvic imbalances. If contributory, then ancillary support in the form of pelvic stabilizing orthotics can be considered in addition to chiropractic. The practitioner must also determine whether the patient would benefit more to receive them while pregnant rather than waiting until postpartum.
The most comfortable shoes for pregnancy: considering factors in foot structure change
Three factors appear to change foot structure, thereby affecting the kinematic chain which connects the lower limb and pelvis. A practitioner may need to update a patient’s orthotic inserts if any of these three criteria occur. Pregnant women are often affected by each of these factors:
- Changes in the shape of the foot arch may make an orthotic become outdated. Pregnancy considerations suggest ligamentous laxity from the relaxin hormone may alter the foot arches and length.2
- The loss or gain of more than 20 pounds of body weight can affect the customized fit of an orthotic. A pregnant woman will continue to gain weight until giving birth.
- Surgery can affect the customization of orthotic inserts. If a child is born by cesarean section, the surgical intervention could affect the pelvis and lower extremities.
For these reasons, I once exclusively suggested pregnant mothers wait until after giving birth before purchasing pelvic stabilizing orthotics. Following a few pivotal patient experiences, I began to implement orthotics as part of the pregnancy care plan for a select group of patients after meeting a woman presenting with severe lumbopelvic pain worsening as her pregnancy progressed. She was a nurse working 12-hour shifts at the local hospital. She was already struggling to stand for her 12-hour shifts even though she was only in her second trimester and wearing over-the-counter orthotics. She feared her pain would force her to use limited paid time off work (PTO) before giving birth.
She was desperate to save all her PTO for after giving birth because she felt it would minimize the challenges of pumping breast milk during work hours. Breastfeeding was one of her top priorities. Her lumbopelvic pain during pregnancy affected her postpartum goals of maximizing paid maternity leave and breastfeeding.
She was panicked and crying when I met her one day, and my heart ached for her. I wanted to offer her every home care option I could to enhance her pregnancy care plan. Her activities of daily living, personal goals and examination findings suggested she would respond well to pelvic stabilizing orthotics. Had she not been pregnant, I would have suggested custom orthotics immediately, but my mentality at the time narrowed her options by suggesting she wait until several weeks postpartum.
Given her dire circumstances, I mentioned pelvic stabilizing orthotics during her pregnancy. I informed her that her customized fit might change after the baby was born, and she requested the orthotics anyway. One week later, she called me in tears not from pain, but because she felt hope again. She confidently returned to work and could save her PTO for the future.
Chiropractic adjustments, in conjunction with custom orthotics, changed the course of her pregnancy, maternity leave, and breastfeeding relationship.
Educating patients to provide options
One of the most important things during pregnancy is to empower the woman and help her feel supported. First, we must ask the patient to clearly define her personal goals. Then, we must educate the mother with all her available options, letting her make the ultimate decision. Her current needs and goals while pregnant might outweigh the costs of ordering a second pair of orthotics postpartum. As practitioners, we cannot always predict this for the woman; we must ask her.
As I asked my pregnant patients to define their goals, many told me they wanted to be able to work as long as possible with the most comfortable shoes for pregnancy before their baby was born in order to maximize maternity leave. Some needed to be able to stand more comfortably on their feet for lengthy periods of time because their family, personal or work situations simply required it. Despite being told to rest more, some insisted that was a luxury they could not afford. They needed a tool, in addition to chiropractic adjustments, to make these goals more achievable.
Addressing lower-extremity fatigue
After the nurse, other prenatal patients came with similar issues. I met a pregnant cashier who stood on concrete floors all day and did not qualify for paid maternity leave at all. For her, working with the most comfortable shoes for pregnancy until her birthing day and as soon as possible after giving birth was her personal goal.
Then, I met a pregnant mother who desperately wanted to walk to the playground each day with her toddler to soak up those one-on-one memories with her firstborn before the new baby arrived. However, her lower extremities fatigued so much during walks that she just couldn’t walk anymore. I refused to say there was nothing more that could be done for these pregnant women. Telling them to lower their expectations or change their job or family requirements was not a feasible or fair option. We had already implemented chiropractic adjustments, prenatal exercise and stretching programs, and ergonomic changes at home and work. However, I repeatedly found a select group of women responding well to our pregnancy care plan, but their personal goals still required additional support. Finding the most comfortable shoes for pregnancy with pelvic-stabilizing orthotic use during pregnancy satisfied this group of women and enhanced their lives.
Bringing relief in the moment
I am always honest with my mothers, informing them that their customized fit might change in the future, or over-the-counter orthotics may be a helpful option too. However, the results have consistently spoken for themselves.
Pelvic stabilizing orthotics can be an effective part of a comprehensive pregnancy care plan when justified by the exam findings and patient goals. As prenatal chiropractors, we must ask our patients how we can fully serve and support them best, especially while they support our next generation.
Melissa O’Loughlin, DC, CACCP, has been in private practice for 14 years with a focus on pregnancy, postpartum and pediatric care. She graduated summa cum laude from New York Chiropractic College and is a member of the International Chiropractic Pediatric Association. She can be contacted at chosenspotchiropractic.com.
References:
- Hall, H., Cramer, H., Sundberg, T., Ward, L., Adams, J., Moore, C., Sibbritt, D., & Lauche, R. (2016). The effectiveness of complementary manual therapies for pregnancy-related back and pelvic pain: A systematic review and meta-analysis. Medicine, 95 (38), e4723. https://dx.doi.org/10.1097%2FMD.0000000000004723
- Segal, N.A., Boyer, E.R., Teran-Yengle, P., Glass, N., Hillstrom, H.J., & Yack, H.J. (2013). Pregnancy leads to lasting change in foot structure. American Journal of Physical Medicine & Rehabilitation, 92 (3), 232-240. https://dx.doi.org/10.1097%2FPHM.0b013e31827443a9
