Pregnancy and Parenting

Pregnancy

You may have a pre-existing injury or your RSI might be triggered during pregnancy. The effects of an overuse injury are unpredictable, so you need to do everything you can to reduce the strain on your muscles during pregnancy.

There are ways of avoiding strain on hands and arms, such as sitting on chairs that are a little higher. If you need to help yourself get out of a chair, don’t bend your wrists but support yourself by clenching your fists and keep your knuckles in a straight line with your arm.

As your tummy gets bigger, it’s a temptation to hold anything that you’re doing up at chest height. If you do this for any length of time, you may reduce circulation in your arms. It’s advisable to do any needlework early in pregnancy, when you don’t have to hold your knitting or sewing at chest height to see what you are doing.

Pregnancy is a good time to:

• talk to your insurer (if you are on worker’s compensation) about increasing or starting household help after the baby is born. You may be able to get help managing the baby as well
• learn relaxation techniques which will help you to reduce the effects of overuse injuries. Yoga schools often run classes in relaxation and ‘beginners’ or ‘pregnancy’ yoga
• visit an Independent Living Centre to get useful advice on managing your baby successfully and on the latest products to reduce the strain
• build up a store of frozen meals for the first few months after the birth, for example pasta sauces
• plan ahead for the support you need after the birth. It will be very helpful if you can get time away from your baby to relax, to maintain therapies and to get some exercise

Labour

Nursing staff in the labour ward may be unaware of the additional problems caused by overuse injuries. Many of the positions suggested during labour put a lot of strain on the arms, hands, neck and back. Develop a birth plan with your midwife or obstetrician that includes strategies for avoiding positions that may aggravate your condition.During birth, you may forget to protect yourself, so your partner should be aware of what you need in order to help you

The first days after birth

If possible, it will be very helpful if your partner is present for demonstrations at the hospital on bathing, feeding and caring for the baby.You may need to ask that the nurses wait until your partner can be there; many physical and emotional issues arise in the early days.

It can be very rewarding for partners, family and friends to help with the care of your baby. Partners can develop more confidence and a closer relationship by helping with nurturing tasks such as rocking, soothing, bathing and taking the baby for a walk.

Self-awareness and care

One of the keys to successfully managing a baby when you have an overuse injury is to limit household tasks and focus on your child. This may mean that you need to cut back on cooking, washing and cleaning. You may have to lower your standards in housework (most mothers have to do this anyway, as children and mess go hand-in-hand).

Remember that the most valuable thing you can give your child is your love and attention.

If you are in pain, you can easily become less patient and more irritable. So think hard about what is important to you at this time of your life for you and your baby.You may need to explain to your partner, family and friends why, for example, you are choosing to cut back on housework.Try and stay clear in your own mind about what your priorities are.Don’t forget to seek help from a supportive doctor, maternal and child health nurse, lactation consultant, counsellor or occupational therapist. If you can afford it, a cleaner once a week could make a big difference.

↑ Back to top ↑

Keys to managing successfully

Try and foresee difficult situations and work out how you are going to deal with them so that your arms don’t end up getting damaged. As the parent of a small child, you usually don’t have the option of taking a holiday or a rest. This means that you have to be even more careful about not exacerbating your injury than you would normally be. You might have to learn to be very up-front about your injury – and ask for what you need.

Nappies

The whole process of changing a wriggling baby, scraping, soaking, washing, hanging out, bringing in and folding nappies can place a lot of strain on your arms. Weigh up the pros and cons for you with the following possibilities.

Disposables

• Some are easy to fasten, some are really difficult (experiment)
• need changing less often, as they absorb a lot
• don’t need washing

Nappy service

• about the same cost as disposables
• can be used with easily fastened velcro pilchers,
• don’t need washing
• come ready folded

Regular nappies (cloth)

• lots of washing and folding
• easier to fasten with a ‘Snappy Nappy’ than with a pin
• can be hard to get on a wriggling baby
• easier if you own a drier
• nappy liners can be washed and re-used when wet and disposed of when soiled, reducing the need to scrub nappies

All-in-one nappy and pilcher

• easy to put on and to fasten
• can take much longer to dry than regular nappies

Velcro-fastened pilchers

• can use a regular nappy with more layers than usual, so you need to change them less often
• easier to fasten

Nappy changing

Set up a nappy changing area with everything you need on hand. This may be a changing table at a good height for you, preferably one with a tray underneath for nappies etc ‑ or it could be a changing mat on the floor next to some shelves. It’s a good idea to hang a mobile overhead to hold baby’s attention and also to keep a supply of toys and distractions nearby. Women with RSI have emphasised it is vital to think about the set-up of the bathroom, baby’s room and kitchen.

Clothing

If you find it difficult doing up jumpsuit poppers, put your baby in a short nightgown. You can then change the nappy without having to do anything with the rest of the clothing. Change your baby only when necessary, rather than as a routine. If buttons are difficult to manage, buy envelope-neck nighties (available by mail order from the Australian Breastfeeding Association – see “Social Contacts” at the end of this kit) or you could replace them with velcro circles. These can be stuck on and then stitched over. Another alternative may be zips or velcro at the crotch of jump suits which makes nappy changing easier. Zips can be made easier to operate by inserting a split ring into the zip pull. Use socks instead of booties, or in warm weather, let your baby enjoy her feet.

Encourage your child to participate in dressing activities at an early age and to dress herself or himself.

Choose clothes with large openings and easy fastenings at the front. Check clothes you’re buying for unnecessary fastenings. Buy shoes with buckles or velcro fasteners.

Bathing

You can buy baths for small babies that give them a lot of support and leave your arms free for washing them. You can buy a sling that supports your baby to lie safely in a baby bath or in an adult bath with or without you. (However, never under any circumstances leave a baby or toddler unattended in the bath.) Most equipment is available from baby equipment stores and large variety stores with a baby equipment section.

Babies can be “spot washed” with a flannel, rather than needing a full bath every day.

Preparation for bath time is essential:

• Arrange everything you need around you before beginning bathing
• Wash your baby in or near the kitchen sink. Some people like to wash a baby on the draining board and rinse off with a spray attached to the tap.
• Why not leave the bathing to your partner while you take a walk or have a rest? Bath time is a good opportunity for parents to get to know their babies and share a pleasurable activity with them.

When the baby grows beyond the baby bath, again you can use the kitchen or laundry sink. This helps you to maintain good posture and makes lifting easier and safer. A bath seat supports babies that are almost able to sit by themselves in the bath. When the toddler progresses to the family bath, use a step or stool and encourage the toddler to climb in with your help, rather than being lifted in.

↑ Back to top ↑

Carrying and holding

One of the biggest problems if you have an overuse injury is carrying your baby. When your baby gets to about four months, you can use a ‘hippy-chick carrier' which is rather like a large stiff bum bag with a very wide strap that goes around your hips. This will enable your baby to sit on your hip with just a little support from your arms. It will take your baby through from about four months to two years. Parents we know with overuse injuries have found it incredibly helpful.

However, you still may not be able to hold your baby for a very long time because just supporting your baby places a static load on your arms. If your arms are really sore and your baby is crying to be picked up, try sitting down in a chair or on the floor with him, perhaps looking at a book or playing with a toy together. Even if you’d like to get on with your chores and hold your baby with the other arm, giving up on the chores for a while may be easier for both of you. Another idea with a crying baby is to lie down on a big bed together and cuddle or play.

Baby slings, particularly those worn across the back and with a waist strap can be useful, but they may also worsen shoulder and neck problems. There are many types of slings available; try them out in the store for comfort and ease in putting on and taking off or discuss this with an occupational therapist.

Don’t forget outdoor stores as a good source of baby-carriers, especially ones designed to sit on the hips. Unfortunately, the most expensive ones are also the most comfortable!

It’s also possible to reduce carrying by arranging equipment so that it’s near at hand and easily accessible. Keep sterilising equipment, cutlery, bowls, etc. close to kitchen benches and preferably feed your child near this area to save carrying .

Soothing baby

Many commonly used soothing techniques are difficult for the mother with an overuse injury. These techniques include patting, rocking, pushing backwards and forwards in a stroller and holding for long periods. Leave these to other people – your partner, friends and relatives.You’ll develop your own soothing techniques which could include:

• singing
• soft reassuring talk
• sitting with your baby in a rocking chair
• foot-rocking baby in a bouncer or baby chair
• swinging with your baby in a hammock or swing-seat
• a dummy
• breast-feeding your baby.

Most of these techniques won’t need to be used after your baby is about six months old and is more settled.

Be very careful about holding your baby for long periods of time, even if you are sitting and your baby is partly supported. Your lack of movement means less blood flow to your arms and any prolonged load on your muscles, even if slight, can be damaging. Discuss soothing and settling problems with the maternal and child health nurse.

Feeding

Check with your doctor before breast-feeding that none of your medications would be harmful if transmitted to your baby in your milk.As well as all the health pluses of breast-feeding, there are practical advantages too:breast milk is warm, sterile and ready to go! However, the static holding involved may be very fatiguing and painful. On the other hand, unless someone else is generally available to bottle feed your baby, this involves even more holding (the baby and the bottle as well).

If you have an overuse injury and you wish to breastfeed, find a really supportive chair. An old fashioned arm-chair with armrests is probably the best thing.Use a pillow or two to prop your baby up while you’re feeding (the same with bottle feeding).Just because you are not supporting your baby’s weight doesn’t mean you can’t give your baby the warmth of your affection by putting your arm lightly around her.When your baby gets bigger, you may find that you can rest him/her on your knee by crooking your leg up onto your seat if you’re away from your armchair.Specially shaped cushions are available from baby shops and catalogues to support babies during breast-feeding.

If you’re feeding your baby lying down, be very careful not to rest baby’s head on your shoulder or upper arm, as this can cause a lot of soreness in those areas and in your forearms.Your baby can lie flat beside you, below your outstretched arm as you lie on your side and feed.You need to have your head on a cushion or the edge of a pillow.Make sure the pillow doesn’t get in the way of your arm. This ‘lying flat’ position won’t suit all babies or mothers, so do talk to a lactation consultant or other health professional if you need help to find a way of feeding baby comfortably.

If you are bottle feeding and your grip is weak, a bottle holder may be useful. Bottles with handles or a contoured grip may be easier to grasp.

A light mug may be easier for you to hold than a bowl when introducing solids. Whenever possible, adapt your food to suit your baby as this avoids preparing two meals. When your baby is learning to feed herself, put down newspapers that can easily be thrown away. A blender or food processor will eliminate chopping and mashing.

The Independent Living Centre has a display of jar and bottle openers which can be purchased at most chemists. Finger food – a carefully trimmed cutlet bone, some cooked vegies, a rusk or crust – is fun for your baby and helps you, BUT always stay with a baby who is feeding him/herself, as choking can occur.

Baby seats which hook onto an adult dining table can be used from about four or five months to three years.The soft cloth versions are more suitable for younger children and baby can be given extra support with a pillow. These seats enable your baby to sit at a table with the family, play with their toys and be involved in family dining and other activities. Another option is a wheeled highchair.

↑ Back to top ↑

Lifting

When you have to lift, hold the baby very close to your body, with both arms taking as little weight as possible through the wrists: develop a scooping method to take the baby’s weight on your forearms instead of on the hands and wrists. Use the muscles in your legs to lift by squatting to pick up baby and then standing up.Encourage your toddler to stand with her back to you, arms bent and held slightly away from the body.You can then lift her taking the weight on your forearms, instead of hands and wrists.

Often babies and toddlers demand to be lifted because they want your attention or they want to be held, so a cuddle on the floor or a game will meet their needs just as well. For a toddler, you can sit down and encourage them to climb onto your lap. Alternatives to lifting include distraction with a toy, some food such as a rusk, the television, some music, or getting down on the floor to play. Your toddler will also learn to understand a firm statement: ‘I can’t come to you now, I’m going to finish this and then I’ll be with you.’

Sleeping

You have several choices here:

Baby sleeping with you

This has the advantage that you don’t have to get out of bed and lift her out of a cot to feed during the night. However, it has the disadvantage that your own space for sleeping can be limited and you can get a poor night’s rest. If you decide that you want to sleep with your baby, it’s best to have as large a bed as possible. Because there's some research that indicates a higher risk of Sudden Infant Death Syndrome if babies sleep in the same bed as their parents, the example below would be a good one to follow:

Bassinettes

These put your baby at a better height for lifting in and out, but can only be used for three to six months. Those on castors can be useful as your baby is easily moved (Castors on cots can however cause problems where a vigorous toddler can move the cot).

Cots

When buying a cot:

• refer to “Choice” magazine for those cots that meet the Australian Standard. Many still have hazards.
• consider the height of the sides (for lifting your baby in and out),
• look at whether the catches on the drop side require one or two hands to operate,
• consider the possibility of an outward opening side,
• and think about an adjustable height base to reduce lifting.
• Fitted sheets can reduce lifting when making up a cot.

One of our members has had a modified cot built which minimises the pain involved with lifting her baby.

Car travel

Car safety capsules and seats can be a major problem for people who suffer from overuse injuries. Mount the capsule on the passenger side of the car rather than the middle, where it is extremely awkward to get your baby in and out.

In general, it is better to put the capsule into the car first and then place your baby in the capsule. Even though you might be tempted to lift out the capsule with the baby in it while you do some shopping or pop into the bank, this can put a big strain on your arms. There are baby-seats available for babies from birth onwards – if your baby isn’t under the weight recommendation, this could be a better option than a capsule.

Prams and strollers

Pushing a stroller can be very difficult when you are suffering from an overuse injury. Some strollers are much easier to push than others. The large ‘jogger’ type strollers with really big wheels are easiest to push but not always great for busy and crowded shopping malls. Shop around, try out friends’ strollers with children in them before you buy one. You can also try out strollers in large shopping malls that lend them out to shoppers at little or no charge.

One thing you can do is to enlarge the handles of your stroller with bradflex, available from plumbing suppliers, or bubble wrap. Limit yourself to short walks so that you don’t have a long exhausting trip home with sore arms.

You could also look into getting a stroller modified to be easier to push or even self-propelling. One of our members found this very helpful:

When buying a stroller, think about the following:

• Can you vary the way you push it – use different arm positions?
• Can you fold it up easily (a foot operated folding mechanism is easier)?
• Are the handles at a comfortable height?
• If you’ll be using it mostly in shopping centres, is it easy to manoeuvre? Some strollers are much easier to turn than others.
• Are the straps holding the baby easy for you to fasten and unfasten?
• Is it light enough for you to lift in and out of the car or bus?

The selection of a good pram or stroller is important – an occupational therapist can be a great help here. Other points:

• Prams are heavier than strollers but are better balanced.
• Strollers that are light are generally poorly balanced and inclined to tip back.
• Foot operated brakes and collapse mechanisms are preferable.
• One continuous handle is easier than two separate handles.

↑ Back to top ↑

Helping your child to help you

From about six months on, many babies are learning to understand short simple phrases. By repeating the same phrases as you do things with them, they will learn to help you in achieving every day tasks like dressing. For example say ‘arms up’ as you lift their arms to get a jumper on. Say ‘move back’ as you get them into the right position in their car seat.

Build on their natural desire to do things for themselves as they get older. In the short term a toddler feeding herself may create quite a mess (a sheet of plastic or some newspaper on the floor will make this easy to clean up – or have a picnic outside in good weather). In the long term a child who can feed herself will make life much easier for you.

Give your child plenty of time to accomplish tasks for themselves. A two year old can get in and out of a car, put on trousers and jumper, climb into a high chair, flush the toilet, and accomplish many other tasks with pride and pleasure.

Getting exercise

When you can’t go for walks because you can’t carry or push your baby, it can be really difficult to keep up the exercise that promotes circulation and healing for people with overuse injuries. Try to get into the habit of making a time for your partner or a friend to mind your baby or to go for a walk with you so that you can keep up your exercise. Maybe somebody can mind the baby while you go for a swim or do some water exercises. Perhaps a friend with a baby is happy for her stroller to hold both her child and yours while you go for a walk together.

Social contacts

Many women with young children find that they are very isolated. A mother with an overuse injury can be even more isolated because of the difficulties involved in transporting the baby. Make every effort to meet other mothers in your neighbourhood. The following are worth exploring:

• The ABA holds weekly coffee mornings and welcomes bottle-feeding mothers as well as breast-feeders. The ACT and Queanbeyan region can be contacted on (02) 6258 8928
• The Play Groups Association can let you know about a play group in your area and you can join when your baby is very young. Phone 6285 4336.
• Child health clinics hold parenting courses for new parents in local areas and these can be a great way to make contacts.
• Parent groups at the Canberra Hospital.

As well as meeting people through theses groups, you can often learn about local resources such as toy libraries, pick up useful parenting tips and see children at different stages of development.

↑ Back to top ↑

Health, Parenting & Care contacts

ACT Community Care has a range of pre and post-natal services available at Child Health Centres and regional health centres. More information is available as follows:

• Postnatal, Parenting Information Referral Service (PPIRS): 6205 2000 (9am-4.30pm)
• Tresillian After hours helpline: 1800 637 357
• Maternal and Child Health Clinics Appointment Line: 6207 1043
• Independent Living Centre, ACT: 6205 1900
• Australian Breastfeeding Association, ACT: 6258 8928

Products

Hippy Chick Child Hip Seat

Cost: $115-50 (including postage) – cheque or credit card. (02) 4861 7674

Email: physio@hinet.net.au

Hug-a-bub

Suitable for newborns and up, this sling distributes weight more to the carrier’s back than shoulders. It’s very wide over the shoulders and distributes weight evenly between the back, waist and shoulders. They’re expensive at over $100, but you may be able to pick one up second-hand. It would also be worth trying one out first. More information at www.hugabub.com, or call 1300 555 632 or (02) 6685 5589

Velcro-fastened nappy holders – Earthbasics www.earthbasics.com.au

For useful products, talk to an occupational therapist, the Independent Living Centre or the RSI Association. It’s also a good idea to look out for useful new products in parenting magazines and the ABA newsletter.

Experiences of motherhood

Karen Jackson, Dutch RSI Association

I was impressed with your 'baby and rsi' pack - especially the bit where it reminds you that unless you don't do stuff like cleaning, you will be in more pain and therefore be less patient with your baby. I applied for a home help when I realised that! It's funny but I've struggled with household tasks for years, not wanting to go to the trouble of getting a cleaner just for myself, but now someone else's well being is involved it's been much easier to justify.

Perhaps some of the points below might be helpful to your readers?

Washing

I think the pre-birth 30% extra blood flowing around in my body and the hormone Relaxin (sic - great for relaxin') lulled me into a false sense of security with regard to what I'd be able to achieve once Kay was born. Also I had underestimated things like washing. I only took Kay's clothes into account but not the (many!) extra changes of clothes for me and Derek. One thing I never knew about baby poo stains on white cotton, is that you don't actually have to go to too much trouble to get rid of them. The sun does it for you! And there was I scrubbing away, soaking the things in various chemicals, and so on. Durrrr!

Nappies

Pre-formed cotton nappies that you 'just' soak and wash at 60 degrees (and insert a fiddly liner into, and peg out on the line to dry, and change more often than disposables, etc., etc.) seemed a great idea at the time but I wish I'd left this environment-friendly bit to the non-rsi sufferers of theworld. We now operate a dual system. Kay's dad's in charge of cotton nappies, I use disposables!

Bibs

I've found the bibs that just pull over the head the best. No trouble to fasten at all. Velcro fastening ones come in a close second. The ones that you tie are hopeless for me.

Job sharing

We are doing pretty well. My husband is in charge of bathing and bedding Kay, which gives him some good contact time with her. It's a lot in addition to his already busy schedule of working full time, shopping, cooking, massaging, etc. but we are hoping to move nearer to his work to at least cut down commuting time. And at least he's been relieved of cleaning.

Transport

I live in a 3rd floor flat with no lift and mice in the cellar. Which means a lot of pram carrying if I want to take Kay out in it. I have convinced myself that mice only come out at night (!?) and that therefore it's ok if my husband carries everything down to the cellar in the morning pre work and takes it back when he gets home. If you know otherwise please don't tell me.

Spontaneous short trips out I do with a baby carrier in the form of a huge length of cotton jersey (about 3.5 metres), tapered at the ends. It takes some practice but you can spread the cloth in such a way that the weight is really well distributed, even around your hips. The only disadvantage is it's not easy to get a distressed baby out of there quickly (or indeed to get her back in afterwards!). And it's sometimes too hot in summer.

We don't have a car. Trains would be a nightmare were it not for the fact that there's always someone willing to help you with a pram. If you're going to do much train travel remember to get a small pram too. They don't all fit. Kneeling buses are my favourite - a synch even on your own. Trams get the thumbs down - narrow and steppy - though not impossible if you're determined and it's not rush hour.

Once Kay can sit up alone she'll be able to travel by bicycle of course, like all good Dutch babies. We're looking forward to that!

Feeding

I plan to continue breast feeding Kay for as long as possible. It saves faffing with bottles, is always on tap and is great stuff by all accounts.

One advantage of not working is that I can afford to do that. I use a banana-shaped feeding cushion so that I don't need to hold her at all, or alternatively I feed her lying down - either on the bed or on the floor. That way when she nods off I can sneak away unnoticed and peg the washing out, make a phone call, type a quick email or whatever. If we're out and about I find it easiest to sit on the floor with my back against a wall and support her with my legs. Or in a restaurant I do the same but on chairs. It was tough at first to keep my shoulders relaxed while feeding. I tended to 'freeze' in one position and not dare to move in case I disturbed her. Sometimes, if she's crying very persistently, I still make the mistake of grabbing her any old how instead of arranging everything for maximum comfort first. I always regret it. Ouch!

Anyway, the babe awakes so I must away. I hope (some of) the above is useful. I'm cc-ing this to rsi UK and New Z. in case they can use it. Younever know. Might saves somebody's hands.

All the very best,
Karen Jackson
International Section
Dutch RSI Association

↑ Back to top ↑

Quotes from mothers

↑ Back to top ↑