Now, let's talk about the musculoskeletal system
and all the changes that happen there.
So, there are a couple of
things we have to consider.
But the first one, is progesterone.
And what does it do? It relaxes things.
And we have lots of joints,
that are under the influence
of progesterone and also,
its friend, “Relaxin.”
So, having movable joints,
in general, is usually okay.
Having hyper-movable joints however,
can sometimes cause some discomfort.
So, let's look at what that might be.
So, in this first graphic what you
notice is a change in the balance point.
So, because of the relaxin and also
because of that gravity
uterus being pulled forward,
what a client might experience,
is “Lumbar lordosis,”
so that's when you have sort of a sway back.
And I remember this one and I think
about my back hurting and I might say,
“Lordy lordy, I got some lordosis.”
That may not work for you but give it a try
or you might just remember,
because, that was so wacky.
Let's continue our conversation
about relaxed joints.
Let's look at this graphic, this is the pelvis,
there are lots and lots of
joints within the pelvis,
they do not escape the influence
of relaxin and progesterone,
so, all the joints in the pelvis,
may also become hypermobile.
Now, there's actually some good parts of this,
when you're in labor and cletus the
fetus needs to navigate the birth canal,
you need for all those joints to be
mobile to allow the pelvis to open.
However, when you need to do almost
everything else you do with your pelvis,
like walk around or move, that can
sometimes become pretty uncomfortable,
but it is a normal physiologic change.
So, we need to be aware that
that increase in relaxin,
causes the loosening of the joints
and we need to think about
recommendations of things,
like, exercise, because hypermobile joints,
can also increase our chances of having injury,
when we're doing our ordinary activities.
Now, let's talk about the rectus muscle.
So, the rectus muscle helps us
to have that nice little six-pack
or help somebody, to have a nice little six-pack.
But during pregnancy,
it actually has to separate and
open to allow what to come through?
The uterus, exactly.
Now, this also can contribute
to protrusion of the umbilicus
or it may be flat, so you may
have had an innie or a flatty
and now you have an outie and that can all happen
because of that separation.
Now, let's look at more
detail at the pelvic girdle,
so, we're looking at a diagram here
and we're specifically going to pay
attention to the symphysis pubis,
we talked about this a little bit
in the softening of the joints,
but sometimes the symphysis
pubis, can completely separate
and you can imagine how that would
make walking almost impossible
and so, for some unfortunate few, having
a disruption that severe can happen.
Now let's talk about the respiratory system
and all the changes that happen there.
So, again, I want to bring you
back why do we need more oxygen?
Because, we're breathing for two.
And so, we want to make sure
that we are fully oxygenated
with every breath that we take.
That's a song, I think.
Anyway, let's think about what
happens with the diaphragm,
so, the diaphragm, in order to
accommodate that growing uterus,
is actually going to shift
up about, four centimeters.
And so, why is that important?
Because it actually is going
to widen the subcostal angle
and it also may change the shape of the chest,
so, we may go from having a normal sized chest,
to having a barrel chest, we normally
associate barrel chest with COPD,
but it's also a consequence
of third trimester pregnancy.
We experience a 20 to 40%
increase in tidal volume,
so, we can have more oxygen.
We have a 20% reduction in residual volume.
There's also an increased sensitivity to CO2,
which will allow the client
to take breaths more often,
to increase the amount of
oxygen in the bloodstream.
Now, the client might notice that
they're having shortness of air,
they may say that, because, they
notice their breathing more often,
it's an interesting phenomenon,
about how you might become
aware of your breathing.
However, the provider is not
going to notice any change
and what I mean specifically
here, is, if we put a pulse ox on,
then what we'll find is that
oxygenation is completely normal.
Now, we never want to ignore what a client says.
If they feel like they're short of air,
we always want to listen to
their lungs and do a pulse ox,
to double check that everything is okay,
because maybe something really is wrong,
but if we don't find anything,
we can reassure them,
that this is a normal physiologic change.
Now, let's talk about the integumentary system.
The integumentary system,
also, under the influence of
our estrogen and progesterone,
undergoes quite a few changes.
Now, the estrogen can cause an
increase in melanin in our skin.
Some clients will notice, a blotchy sort
of hyper pigmented look that on their face
and on their neck and sometimes
on the upper parts of their chest.
This is known as, “Melasma” or “Chloasma.”
So, two words that mean exactly the same thing.
They may also notice this on their cheeks,
on their neck and on their forehead.
It affects about maybe 50 to 70% of clients,
especially clients of color.
Now, the good news is,
is that, this will go away after
pregnancy, so that is reassuring.
Next, I want to talk about the, “Linea nigra.”
So, you can see on this graphic this
sort of line that goes down the middle,
it looks like it separates the umbilicus.
This, is also from the increase in
melanocytes that are a result of the estrogen.
Now, this may go above the umbilicus,
it may go below the umbilicus
and for most clients it's
going to fade after pregnancy.
Notice, I didn't say go away,
because often it will still be there,
but it will be much, much lighter.
Now, I want to talk about stretch marks,
which is, almost the bane, of
almost every pregnant person,
although I consider it a badge of honor.
But the separation of the collagen,
comes under the influence of what?
We're talking about relaxation? So…
So, the separation of the collagen,
is what allows, the stretch
marks to begin to develop.
This affects about 50 to 80% of clients
and it may occur on the abdomen,
on the thighs and as we talked
about already, on the breast.