Posture in pregnancy
MABEL LUM FITZHUGH, R.P.T.
MICHAEL NEWTON, M.D.
Jackson, Mississippi
TH E English language emphasizes the role
of muscles in the childbearing process. A
woman is said to carry her baby during preg-
nancy and to labor to push it out. Previous
papers in this series have explored the body
mechanics of first and second stage labor. 1 - 3
This report will concern itself with the
carriage of the baby during pregnancy.
The value of good posture during preg-
nancy is several-fold. It corrects extreme
lordosis with its accompanying backache. It
diminishes the bulge in the silhouette of the
pregnant patient, thus making her appear
less pregnant. Fatigue is minimized since
there is better circulation and less physical
strain when the body is held in correct align-
ment.
Postural malalignment in pregnancy
In the standing position equilibrium de-
pends upon the balance of tonus on the
four sides of the body. If the segments are
held out of their normal and most favorable
alignment, certain muscles will be stretched
more than they should be for optimum
tonus. Others will be contracted in the effort
to maintain the equilibrium.
In pregnancy the growing uterus stretches
the muscles of the abdominal wall and lowers
their tonus. The added weight and forward
expansion mechanically tends to increase
lordosis. This in turn causes further atonicity
and overstretching of the abdomen and
shortening and hypertonicity of the extensors
of the lumbar area of the spine.
From the Department of Obstetrics an1i
Gynecology, University of Mississippi
School of Medicine.
1091
When a woman starts her pregnancy with
lordosis already present these effects tend to
be exaggerated. Overstretching of the ab-
dominal wall, together with an increase in
lordosis results in a tendency for the pelvic
bowl to be tipped down anteriorly and the
growing uterus to slide forward, further
stretching the abdominal muscles. This is
more marked in later pregnancies when the
abdominal wall becomes almost a pouch or
hammock supporting the uterus.
The physical effect of these changes is
such as to cause increasing strain on the
lumbar area giving rise to backache. Circu-
latory disturbances may also result. Gold-
thwait4 states "Faulty body mechanics, with
the consequent congestion of the abdominal
and the pelvic organs and the pressure of
these organs on the iliac veins and the ar-
teries in the pelvis, as well as the diminished
pumping action of the diaphragm on the
abdominal and pelvic veins is a very impor-
tant factor in the cause of varicose veins of
the legs." The increased prominence of the
abdomen is also a psychological handicap to
the pregnant woman.
Body mechanics of posture
correction
The logical approach to the correction of
this difficulty is by realignment of the pelvis.
When the pelvis is carried in a more level
position, the center of gravity of the uterus
tends to move posteriorly. Its weight is there-
fore carried more directly on the pelvic
bones with less protrusion against the ab-
dominal wall. Accompanying this is a flat-
tening of the lordotic curve, leaving only
the normal incurve of the lumbar vertebrae

1092 Fitzhugh and Newton
Fig. L
which IS necessary for spinal flexibility.
A necessary corollary to the change in
pelvic alignment is slight flexion of the
knees. Hyperextension of the knee joint com-
monly accompanies lordosis and tends to
increase as pregnancy advances. The woman
braces her standing position by pushing
back strongly with her knees. It is difficult
to rotate the pelvis when the knees are
locked in hyperextension. Slight flexion of
the knees is necessary to reduce hyperex-
tension and enable correct alignment of the
pelvis to take place. By these methods the
stretching to which the abdominal muscles
are subjected is reduced and their tonus is
increased.
Pelvic tilt exercise for posture
alignment
The following simple pelvic tilt exercise
for posture correction can be taught during
an office visit or in the course of a class
instruction for expectant parents. The exer-
cise can be done using the back of a chair
or other support of the same height. How·
ever, to encourage the use of the exercise
frequently throughout the day, it is helpful
to suggest that the kitchen sink be used for
the exercise, each time the woman ap-
proaches it in her work:
1. The woman stands about 1 Y2 to 2 feet
away from the sink (taller women will need
to be farther from the sink, whereas shorter
At"il J.i, l%:1
Am, J, Ohst, & {;yn<'G,
women will need to be closer) (Position A
in Fig. 1
2. She bends forward at her hip joints
and places her hands on the edge of the
sink with anns straight. Now she raise~ her
hips. This drops her abdomen and increases
the lordosis (Position B in Fig. 1). At the
same time r,he inhales.
3. Next she rounds her back, tucking her
buttocks under her and exhales. Knees
should be slightly flexed during this ma-
neuver in order to get full rotation of the
pelvis (Position C in Fig. 1 .
4. The movement is repeated three times.
First, the hips are raised during inhalation.
Then the buttocks are tucked under during
exhalation.
5. Now the mother drops her hands from
the support and stands erect by being told
to "raise your breast bone straight up.'' The
shoulders should be relaxed, knees slightly
flexed, and buttocks tucked underneath. The
\Vcight should be evenly balanced on both
feet (Position D in Fig. 1) .
The patient is instructed to do this exer-
cise 12 times a day or whenever she ap-
proaches the sink. Furthermore, she is asked
to endeavor to maintain the level position of
the pelvis whenever she is standing or walk-
ing.
Advantages of the pelvic tilt exercise
The advantage of this exercise over the
maternity support is that the exercise keeps
 Volume 85 Posture in pregnancy l 093
Number 8

the muscles in good condition. The well-
designed maternity support will help a
woman to tuck her buttocks under. How-
ever, it takes over some of the action of the
muscles and may tend to leave abdominal
and back muscles weakened after delivery.
There are four advantages of this par-
ticular pelvic tilt exercise for posture cor-
rection in pregnancy. First, the pelvic rota-
tion accomplished with the hips flexed at an
angle of 30 degrees has the effect of en-
abling the woman to achieve a greater de-
gree of movement than when it is done in
the erect position. In this way the low back
is given increased flexibility which may be
of advantage during labor and delivery.
Second, the lumbar area is carried through
a large range of movement with special em-
phasis on the rounding out it receives as the
buttocks are tucked underneath. The spinal
erectors receive a measure of relaxation and
stretch which relieves the static strain they
have been undergoing in the lordotic pos-
ture, when the weight of the dependent
uterus drags on the lower back.
Third, the tonus in the abdominal wall is
increased by the rotation in the forward
flexed position. The muscles are given a
greater amount of shortening than when the
pelvic tilt is performed in the erect standing
position. Another significant point in this
maneuver is the effect it has on the trans-
versus abdominis muscle. From a slack sling
it is changed to a snug support. No effort is
required to keep it in adequate tonus as long
as the pelvis remains level and the knees are
not hyperextended.
Finally, circulation of the lower leg may

2 3

Fig. 2. Mrs. R. B., para i, gravida ii, age 27. Pain in low back and low abdomen with leg
strain. Received instruction at 8 months' gestation. Experienced immediate relief. No pain
during ninth month, when standing in corrected position.
Fig. 3. Mrs. D. V., para ii, gravida iii, age 26. Extreme pain in lumbar area and low
abdomen when first seen at 7Y2 months' gestation. Relief experienced when standing position
was corrected and maintained. No further pain.
 Ap,iJ L•. l%.1
1094 Fitzhugh and Newton :\m. J, ()b,t. & (;ynrc.

4 5
Fig. 4. Mrs. M. B., para 0, gravida i, age :!8. Lordosis complicated by scoliosis. Back pain
since childhood, aggravated by pregnancy. Seen first at 5 months' gestation. Practiced exercise
and corrected standing position with gradual benefit. Pain-free at 6 )1; months. No further
pain during pregnancy.
Fig. 5. Mrs. E. M., para iii, gravida iv, age 27. During first pregnancy, swelling in leg vein'
was first noticed at about the seventh month of pregnancy, but no pain was experienced.
Swelling and pain began at the fifth month of the second pregnancy, but were relieved by
putting the feet up. In third pregnancy swelling and pain began after the third month. There
was low back pain and varicose veins in both calves. In the right leg there was a 1Y, inch
diameter swelling on the medial aspect of the right leg midway between the ankle and knee.
She wore elastic bandages during the day. Extreme pain was suffered at night which was
only partially relieved by massage. At six months of pregnancy the pelvic tilt exercise was
taught and correct standing position achieved. Emphasis was put on the importance of hold-
ing the knees relaxed or slightly flexed. Pain was gradually relieved. After 2 weeks the
bandages were discarded. At 8 months of pregnancy no pain day or night was experienced
except after long-continued standing. The swelling of the right leg diminished. Both pain and
swelling could be reinduced hy standing for one minute with knees hyperextended.

be improved by emphasis on holding the
knees relaxed. There tends to be compres-
sion of the veins at the back of the knee
when the knees are hyperextended.
Effect of the pelvic tilt exercise
Figs. 2, 3, 4, and 5 show silhouettes of
women who were taught correct posture
through the use of this posture alignment
exercise. To be especially noted are the de-
crease in lordosis and the "less pregnant
look" that accompany corrected posture.
The following case history suggests that
the pelvic tilt exercise can be beneficial even
in extreme cases in grand multiparas:
Mrs. C. E., a 33-year-old para viii, gravida ix,
was first seen when 6 months pregnant. She had
been experiencing pressure pain in the lower
abdomen for the previous month. This pressure
pain had become increasingly severe with each
pregnancy, but had never begun so early. Low
back pain was also present. She was taught the
pelvic tilt exercise and the erect standing posi-
tion. She practiced the exercise faithfully and
Volume 85
Number 8
said that it felt good to do so. One month later
she reported no more abdominal or back pain.
It had gradually diminished during the 3 weeks
following the first lesson. At follow-up visits
later in pregnancy she reported no recurrence of
back or abdominal pain.
Summary
A simple pelvic tilt exercise is described
which is effective in correcting posture in
REFERENCES
1. Fitzhugh, M. L., and Newton, M.: Phys.
Therap. Rev. 36: 1, 1957.
2. Newton, M.: S. Forum 7: 517, 1957.
3. Newton, M., and Newton, N.: Obst. & Gynec.
15: 28, 1960.
4. Goldthwait, J. E., Brown, L. T., Swain, L.
Posture m pregnancy 1095
pregnancy. It levels the pelvis so that the
weight of the uterus is carried farther back
in the pelvic bowl rather than resting for-
ward on the abdominal wall. Correct posture
gives a psychological lift since the figure
looks less distorted.
Furthermore, correct alignment helps to
alleviate backache and muscular fatigue, and
possibly may also improve circulatory diffi-
culties.
T., and Kuhns, H. G., Essentials of Body
Mechanics in Health and Disease, ed. 5,
Philadelphia, 1956, J. B. Lippincott Company,
p. 175.
2500 N. State St.
Jackson 6, Mississippi