Navigating Pregnancy and Birth with Hypermobility
Photo Credit: Erin Heuser Photography
When the joy of a positive pregnancy test arrives, most women expect certain changes to their bodies. However, for those with hypermobility, pregnancy can bring unique challenges that often go unaddressed in standard prenatal care. Understanding these challenges can make a significant difference in managing pain and discomfort throughout pregnancy and beyond.
Understanding Hypermobility: More Common Than You Think
Hypermobility affects approximately 10-20% of the general population, with women being affected more frequently than men. Yet many women don't realize they're hypermobile until pregnancy exacerbates their symptoms.
Dr. Jane Simmonds, a physiotherapist specializing in hypermobility disorders, notes that "Many women go through life adapting to their hypermobile bodies without realizing their experience differs from others. Pregnancy often becomes the first time these differences become problematic."
Hypermobility exists on a spectrum, from benign joint hypermobility to more complex conditions like Hypermobility Spectrum Disorder (HSD) or Hypermobile Ehlers-Danlos Syndrome (hEDS). While a formal diagnosis requires medical evaluation, there are signs that might indicate you're hypermobile:
- You can bend your little finger back beyond 90 degrees
- Your thumbs can touch your forearms when bent backward
- Your elbows or knees hyperextend beyond a straight line
- You can place your palms flat on the floor with knees straight
- You've often been called "double-jointed" or unusually flexible
- You experience frequent joint dislocations or "popping"
- You suffer from chronic musculoskeletal pain without clear cause
The Science Behind Pregnancy and Hypermobility
During pregnancy, all women experience increased joint laxity due to the hormone relaxin, which helps prepare the body for childbirth by loosening the ligaments around the pelvis. For hypermobile women, this natural process compounds their already loose joints.
A 2019 study published in the Journal of Women's Health Physical Therapy found that women with joint hypermobility experienced pelvic girdle pain at significantly higher rates than their non-hypermobile counterparts (78% versus 37%). The pain also began earlier in pregnancy and persisted longer postpartum.
Research from Castori et al. (2012) further indicates that hypermobile women experience more frequent pregnancy complications including:
- Earlier and more severe pelvic girdle pain
- Higher rates of symphysis pubis dysfunction
- Increased risk of premature labor
- More rapid labor progression (sometimes leading to precipitous births)
- Greater postpartum joint pain and instability
These findings underscore the importance of identifying hypermobility before pregnancy to implement proactive management strategies.
Preconception Planning for the Hypermobile Woman
If you know or suspect you're hypermobile and are planning pregnancy, consider these evidence-based recommendations:
1. Strengthen Your Core and Pelvic Floor
Dr. Sarah Duvall, a physical therapist specializing in prenatal and postpartum care, emphasizes the importance of pre-pregnancy conditioning: "Building core and pelvic floor strength before pregnancy gives hypermobile women a significant advantage. The stronger these muscles are before pregnancy hormones kick in, the better supported your joints will be."
Research supports this approach. A 2018 study in the European Journal of Physical and Rehabilitation Medicine found that women who engaged in specific core stabilization exercises before and during pregnancy reported significantly less pelvic and low back pain.
Practical step: Work with a physical therapist familiar with hypermobility to learn proper core engagement patterns and pelvic floor exercises at least three months before trying to conceive.
2. Address Existing Pain and Alignment Issues
Don't assume that pregnancy will merely add to your current discomfort—take action to resolve existing issues first.
"Pain is not normal, even with hypermobility," explains Dr. Linda Bluestein, an anesthesiologist who specializes in treating hypermobile patients. "Addressing alignment issues, muscle imbalances, and pain before pregnancy sets the stage for better maternal outcomes."
Practical step: Seek evaluation from healthcare providers knowledgeable about hypermobility. This might include rheumatologists, physical therapists, or chiropractors experienced with hypermobile patients.
3. Optimize Your Nutrition
Research suggests that certain nutritional deficiencies may be more common in people with hypermobility. A 2018 study in the International Journal of Rheumatic Diseases found that vitamin D deficiency was significantly more prevalent in hypermobile individuals.
Additionally, some research indicates that hypermobile patients may benefit from supplements that support collagen production and joint health, though more studies are needed in this area.
Practical step: Before conception, work with a healthcare provider to check for common deficiencies including vitamin D, magnesium, and B vitamins, and establish a prenatal nutrition plan that supports connective tissue health.
During Pregnancy: Managing Hypermobility
If you're already pregnant and dealing with hypermobility-related challenges, these strategies can help:
1. Find Proper Support Garments
A 2017 systematic review published in PLOS ONE found that pelvic support belts significantly reduced pain and improved function in pregnant women with pelvic girdle pain. For hypermobile women, these supports can be particularly beneficial.
Sarah Wilson, a physical therapist who specializes in women's health, explains: "Support garments don't just help with pain—they provide proprioceptive feedback that hypermobile women often lack, helping them sense where their bodies are in space."
Practical step: Invest in quality support garments including a properly fitted pelvic support belt, compression stockings for blood pooling issues, and supportive maternity bras to reduce upper back strain.
2. Modify Your Movement Patterns
Hypermobile women often unconsciously move into end-range positions that can strain already lax ligaments during pregnancy.
Dr. Carolyn Vandyken, a physiotherapist specializing in pelvic health, advises: "Learning to move within the 'mid-range' of your joints can significantly reduce pain and prevent injury during pregnancy. This means avoiding hyperextension and being mindful of posture and alignment during daily activities."
Practical step: Work with a prenatal physical therapist to learn modified movement patterns for everyday activities like sitting, standing, getting in and out of bed, and lifting.
3. Choose Appropriate Exercise
While staying active during pregnancy is important, the type of exercise matters significantly for hypermobile women.
A 2018 study in the British Journal of Sports Medicine found that pregnant women who participated in water-based exercise programs reported less musculoskeletal pain than those who did land-based programs—a finding particularly relevant for hypermobile women.
Practical step: Prioritize low-impact, controlled exercises like swimming, prenatal Pilates (with a trained instructor who understands hypermobility), and gentle prenatal yoga with a focus on stability rather than flexibility.
4. Assemble Your Support Team
Research from the British Journal of Midwifery indicates that continuity of care from healthcare providers who understand a woman's specific needs leads to improved birth outcomes and maternal satisfaction.
Dr. Jessica Harsevoort, who specializes in hypermobility disorders, states: "Having healthcare providers who understand hypermobility can make a tremendous difference in pregnancy management and birth planning."
Practical step: Be direct with your providers about your hypermobility. If they seem unfamiliar with the condition, consider seeking additional providers who have experience with hypermobile patients. This might include specialized physical therapists, chiropractors, or doulas with relevant experience.
Birth Considerations for Hypermobile Women
Labor and delivery present unique considerations for hypermobile women. Research suggests that hypermobile women may experience:
- More rapid labor progression due to less tissue resistance
- Increased risk of perineal tearing due to tissue fragility
- Potential for joint dislocations during pushing if positioned improperly
However, hypermobility doesn't necessarily mean a more difficult birth. With proper preparation and support, many hypermobile women have positive birth experiences.
Practical step: Discuss your hypermobility with your birthing team well before labor. Create a birth plan that includes positions that support your joints and prevents hyperextension during labor.
Postpartum Recovery for the Hypermobile Mother
The postpartum period can be particularly challenging for hypermobile women as relaxin levels remain elevated for up to six months, especially if breastfeeding. This prolonged ligament laxity can lead to increased pain and joint instability.
A 2020 study in the International Journal of Environmental Research and Public Health found that hypermobile women were more likely to experience persistent pelvic girdle pain and delayed recovery of core function after childbirth.
Practical step: Plan for additional physical therapy support postpartum, and consider arranging for more help at home during the early months. Prioritize restoring core and pelvic floor function with guidance from a specialist before returning to regular exercise.
The Long View: Parenting with Hypermobility
Remember that managing hypermobility doesn't end with pregnancy and birth. The physical demands of parenting—lifting, carrying, and endless repetitive movements—can strain hypermobile joints.
Practical steps for the parenting years:
- Choose baby gear with your body in mind (higher changing tables, ergonomic carriers)
- Learn joint-sparing techniques for carrying and lifting your child
- Continue prioritizing core strength and joint stability exercises
- Establish boundaries around physical play that might strain your joints
Embracing Your Unique Body
While this blog post focuses on the challenges of hypermobility during pregnancy, it's worth noting that hypermobility can also bring strengths. Many hypermobile women report good flexibility during labor and an intuitive understanding of their bodies' signals.
The key is knowledge and preparation. By understanding how hypermobility affects pregnancy and taking proactive steps to manage it, you can minimize discomfort and focus on the joy of bringing new life into the world.
Whether you're planning a pregnancy, currently expecting, or navigating the postpartum period with hypermobility, remember that you're not alone. With the right support and strategies, you can have a healthy, more comfortable pregnancy and transition to motherhood.
Disclaimer: This article provides general information and does not substitute for medical advice. Always consult with healthcare providers regarding your specific situation, particularly if you suspect you have hypermobility or a related condition.
