Bengkung Postnatal Abdominal Wrapping

The traditional Malaysian Bengkung wrap is normally 12-20 meters of fabric. What is unique about the Bengkung style is that it encompasses both the core and the hips. The functionality of wrapping the core is to:

Benefits

  • Relieves back pain.

  • Stabilizes loosened ligaments.

  • Support of the spine improves energy level.

  • Improves posture leading to better breastmilk supply and expelling breastmilk.

  • Encourages repair and closing of the abdominal muscles - diastasis recti.

  • Material on hips encourages the cervix to close faster and supports weakened perineum.

  • Holds together the muscles of the abdominal walls allowing for ease of muscle retraction.

  • Provides support to the torso while vital organs return to their pre-pregnancy position.

What Day Should I Begin Wrapping My Core?

Vaginal delivery with no complications abdominal binding should begin as soon as a new Mother feels up to it, targeting Day 5. A wrap should be worn for the first six weeks and even longer if the Mother is not satisfied with her healing. The pressure of the wrap should be snug, but not too tight. There should not be excessive pressure on one part of the body than another. If there is unequal support, re-wrap your client. It normally takes 4-5 practice wraps to become used to wrapping this type of postpartum garment.

Wrapping vs. Binding

Binding is tighter around the core than wrapping.

Cesarean delivery light abdominal wrapping, for comfort can begin after stitches are healed with no pressure on the incision. Women have commented that their incision and abdomen feels protected with something around it. Normally after 14 days more snug wrapping can occur above the incision area. After 4 weeks, and the incision has healed, staples and/or stitches have been removed; and the care provider has cleared the mother she can begin normal binding. These time frames are all estimates, it depends on a mother's medical condition.

Release of Retained Elements of Water, Fat and Air

During pregnancy, a woman's body retains water and fat, and establishes pockets of air that serve as insulation, and protection, for a growing baby. This causes a Mother's body to swell and expand, including her organs in the womb area such as the cervix and vagina.

The water retained by human cells supports the amniotic fluid in the placenta. The purpose of the air is to cushion a growing baby as well as the mother's internal organs and bones, as her center of gravity shifts as her baby grows larger. Therefore, an expecting mother's body becomes increasingly swollen over the pregnancy and more so during the eighth and ninth months. When the baby is born the retained, or excess, water, fat and flatulence are no longer needed and the cells will naturally release and shrink back to their pre-pregnant size. The purpose of a postpartum abdominal wrap is to speed-up this process with constant support of the core and perineum floor.

It will take 4-5 practice ties before she finds her comfort zone. Encourage her not to give up and remind her all that it does to help her body heal.

Why do women get an after pregnancy abdominal pooch?

When the baby and placenta are birthed this leaves an empty cavity in the lower abdomen that is temporarily filled by the internal organs when they drop down.

As the organs shrink and reposition back they are supported by, and put weight on, the already stretched abdominal muscles that are also relaxed due to the relaxin hormone, which is in the body for three months. The organs push out on the stomach muscles which can stretch them permanently.

Post-Pregnancy Conditions addressed:

  • Back support.

  • Cesarean incision support.

  • Diastasis Recti.

  • Spine and Posture Realignment.

  • Pelvic Floor Relaxation.

  • Weakened Core and abdominal muscles.

The self-wrapping, Bengkung style of abdominal binding is the best-known design to help heal diastasis recti as it keeps constant supportive pressure on the abdomen, core and hip areas. During pregnancy, musculoskeletal changes are stimulated by hormone secretions and the continuous expansion of the uterus.

Some of these changes include:

Back Support

Due to the longer, holistic design of the wrap, binding supports a mama's back and so relieves the back pain associated with the immediate postnatal period. This also helps to reduce the strain involved in lifting and carrying a baby as well as provides back support when breastfeeding as most women don't realize they are slouching.

Diastasis Recti

Diastasis recti is the expansion and separation of the abdominal wall. A growing fetus and the increasing weight of a developing baby puts pressure on the abdominal muscles and can stretch the abdomen as much as 50%. The abdominal muscles (rectus abdominis) on either side are joined by a narrow fibrous strip (linea alba) that thins as it stretches. Hormonal changes which happen during pregnancy also cause connective tissue to soften.

Diastasis recti is quite common although there is little research on it. According to a study in the Brazilian Journal of Physical Therapy, 68% of women had diastasis recti above the naval, while 32% had it below. When the muscles separate, their strength is reduced, and can lead to back pain.

The condition is more likely to occur where the abdominal muscles were weak prior to pregnancy.

It is vital that the abdominal wall returns to its pre-pregnancy location to protect internal organs and properly support the torso.

Pelvic Floor Relaxation

The pelvic floor provides balance, body stabilization, and vital organ support. The pelvic floor is the base of the core muscle system, attaching to the abdominal muscles and the sacroiliac joints.

During pregnancy, hormones cause ligaments to stretch, which loosens the pelvic floor structure.

This natural realignment allows the pelvic bones to open for the baby's birth and makes a mama feel a bit wobbly on her feet.

After birth the pelvic floor can remain loose and unstable for up to five months. The pelvic floor acts as the support system for the lower intestine, colon, and bladder, these vital organs may be less supported for a few months immediately postpartum. This lack of organ support is the primary reason why women suffer incontinence when coughing, sneezing, or laughing after giving birth.

Longer Design - Encompasses the Hips

A longer design of a post-pregnancy wrap provides holistic support to the abdominal and pelvic organs, including the muscles in the pelvic area. Support to the pelvic area and perineum is very important in the immediate weeks after birth. The cervix dilates 10 cm when active labor is reached, which is equivalent to the size of an average bagel; it must also close 10cm, which according to the medical community takes on average six weeks. Therefore, a longer-designed wrap that includes the hips allows for constant gentle pressure encouraging the cervix and pelvic muscles to shrink faster without being further stretched by hanging skin or an unsupported body in an expanded state.

Steady, pressured support on the hips allows the body, or cervix, to 'close' faster than if left in its expanded state.

How Long is the Binding Worn?

Abdominal binding is most effective during the first 8 weeks postpartum but can be useful for support after that time frame. It's never too late to start binding. It has been noted to be most effective when done on a daily basis and worn for 8-12 hours a day for six weeks. A new Mother can choose to bind and wear the wrap for shorter periods of time. Modern moms choose not to exceed 12 hours a day as they feel their body needs time to breathe and relax without the wrap in place.

When Not to Wear a Postpartum Abdominal Wrap

If a new mother is going through significant hot flashes, as her hormones re-balance, allow for the body to finish this process. If the flashes are constant the wrap shouldn't be worn as the mother may overheat. If the hot flashes are intermittent the mom may wear her wrap but should monitor the flashes and remove wrap as necessary. She needs to pay attention to the cues her body is providing her. A postpartum wrap is meant to be somewhat comforting and supportive with an acceptable amount of constriction as it isn't meant to stretch. A wrap should not be extremely uncomfortable and restrictive. If a mother feels this way, she should re-wrap her torso.

Two Things to Do Your Homework on Before Labor

Over the years as a birth works there are two things that I see often overlooked or not understood enough before going into labor that I recommend all expectant parents to really read up on and educate themselves on.

Those two things are Pushing and Fetal Monitoring.  

Pushing:

For a first time moms pushing with or without an epidural can take time. Educating yourself on pushing positions and strategies can be really helpful! As a doula I am there to guide but having an understanding of your options and what feels best can set you up for a more peaceful and empowered pushing experience.

Mommy Labor Nurse has some really great resources that I recommend: 

https://mommylabornurse.com/how-to-push-during-labor/

https://mommylabornurse.com/pushing-with-epidural/

Fetal Monitoring:

During labor for a hospital birth the nurses #1 job is keeping the baby on the monitor to watch heart tones. Understanding the how, why, what and pros and cons of fetal monitoring going into labor will help you feel better about your options and decrease fear about the effects of labor on your baby. 

Evidence Based Birth Resources:

https://evidencebasedbirth.com/fetal-monitoring-podcast/

https://evidencebasedbirth.com/fetal-monitoring/

5's of Soothing

Newborn babies do not have the developmental ability to self-soothe. They need help from adults to calm them down, comfort them and get them to sleep. How do you do that?

Use the 5 S’s of Soothing from @happiest_baby.

The goal is to recreate the calming elements of the womb.

1. Swaddle
2. Side-Stomach Position
3. Shush
4. Swing/Sway
5. Suck


Hospital Bag Checklist

On average, parents who deliver vaginally stay in the hospital for one to two days. If you deliver via c-section, you’d be looking at closer to three or four days. Keep your length of stay in mind as you select what to pack in your hospital bag. 

Tip:  Ask your hospital what they provide for mothers and take those things off your hospital bag checklist. 

HOSPITAL BAG CHECKLIST FOR MOM

• Photo ID, insurance info, hospital forms and birth plan

• Eyeglasses (if you wear them)

• Cell phone and charger

• Two or three pairs of warm, nonskid socks (for walking the halls before and after labor)

• A warm robe or sweater you don’t mind sacrificing to the cause

• Lip balm (hospitals are very dry)

• Headband or ponytail holder 

• Sugar-free hard candy or lozenges to keep your mouth moist during labor (candy with sugar will make you thirsty)

• Non-perishable snacks (find out if your hospital room as a fridge)

• 2 maternity bras and nursing pads 

• Toiletries and personal items: hairbrush, toothbrush, toothpaste, deodorant, face wash, shampoo, conditioner, lotion, contact lens case and solution (remember, travel-sized products are your friends)

• Loose, lightweight clothing (maternity wards can often be hot)

• Comfortable going-home clothes in six-month maternity sizes, and flat shoes

•Nipple Cream

•Adult Diapers (The hospital will provide pads, but adult diapers might be more comfortable.)


Optional hospital bag checklist items for mom

• Very light reading (think magazines and newspapers, not War and Peace)

• Earbuds to listen to music on your phone

• Bath towel (the hospital will probably supply a very thin, small one)

• Hairdryer

• A comfy pillow from home (with a case that can get ruined, in a pattern distinguishable from hospital white)

• A few pairs of maternity underwear that can get ruined (the hospital will have disposable pairs, if preferred) 

• Breastfeeding pillow

•Eye Mask for sleeping

HOSPITAL BAG CHECKLIST FOR BABY

• Approved infant car seat 

• A coming-home outfit (bring clothes in different sizes to make sure they fit!)

• Warm blankets

HOSPITAL BAG CHECKLIST FOR PARTNER

• Cell phone and charger

• A change of clothes

• Toiletries: toothbrush, deodorant, face wash, shampoo, conditioner, contact lens case and solution

• Snacks (you don’t want your partner eating all of yours!)

• Entertainment, whether it’s something to read, listen to or watch

• Camera or video camera with batteries, charger and an extra memory card

• Any daily prescription medication



Eating & Drinking During Labor

“The issue of eating and drinking during labor should be reframed as one of bodily choice.”

“In many hospitals, patients are told not to eat or drink during labor. The medical term for this is “NPO,” which comes from the Latin nil per os, meaning nothing by mouth.

In a recent survey of mothers who gave birth in U.S. hospitals, 60% of them reported not drinking during labor, and 80% said that they did not eat (Declercq et al. 2014). When people are free to eat and drink as desired during labor, as is typical in U.S. freestanding birth centers, most of them (95%) choose to eat or drink.

The uterus is mostly made of muscle tissue. Muscles use fuel as they work and require enough nutrition to meet these energy needs

The issue of eating and drinking during labor should be reframed as one of bodily choice. Low-risk laboring people, including those with epidurals, have the right to choose whether or not they would like to eat and drink during labor. Maternal satisfaction should also be considered. We know that women often complain about their distress in being denied food and drink in labor.” -Evidence Based Birth

As your doula I provide evidence based information to help you feel empowered in the choices you want to make during your birth….That is to say if you want a banana during labor, I’m getting you a banana! 🍌

Counter Pressure

Counter-pressure consists of steady, strong force applied to one spot on the lower back during contractions using the heel of the hand, or pressure on the side of each hip using both hands. Counter-pressure helps alleviate back pain during labor, especially in those women experiencing “back labor.”

Questions to ask your provider

You are sitting in the room at your prenatal appointment, your quickly checked vitals and then says: “Do you have any questions?” You freeze. You know there are questions you should ask but in the moment forget what to say.

Your doula can help you prepare a list of questions to take to your next appointment.

Review these questions and decide which ones are best for you to save to your phone to ask your provider as you prepare for birth.



  • Will you be available around the time of my due date? If so, will you be the person who delivers my baby?

  • If you are unavailable when I go into labor, who is your backup and will they then deliver my baby?

  • What reason(s) would be needed to recommend that labor is induced?

  • What happens if and/or when labor is induced?

  • Under what circumstances will a C-section need to be performed, instead of having a vaginal birth?

  • Do you support VBACs – vaginal births after Cesareans – and what are the prenatal expectations for a VBAC being possible?

  •  How far past my due date will you let me carry before induction?

  • Do you support natural childbirth?

  • What are your preferences regarding eating, drinking and walking during labor?

  • What fetal monitors do you routinely use?

  • What positions do you support for labor and delivery?

  • Is water birth an option?

  • Are there any medical interventions (IV placement, breaking water) that are routine?

  • What comfort measures do you find most effective during labor?

  • What hospitals and/or birthing centers are you in contract with, and where can I deliver my baby if I want to ensure you will attend the birth?

  • How many support people am I allowed to have with me during labor and birth? How many visitors am I allowed to have afterwards?

  • What pain management options will be available to me? Are there limitations on how and when I can have pain management during labor?

  • What are the hospital’s or birthing center’s policies on delayed cord clamping/cutting?

  • How can I ensure skin-to-skin contact with my baby immediately after birth, or ensure skin-to-skin contact with a family member immediately after birth following a C-section?

  • How can I ensure breastfeeding is initiated as soon as possible after birth? If I am unable to be with my baby in the hours (or days) following birth, how do I request a pump to begin pumping colostrum for my baby?

  • Will a lactation consultant be available immediately after the birth of my baby?

  • Is my partner or support person allowed to cut the umbilical cord?

  • Will my baby be in the room with me throughout our hospital stay?

  • What tests, vaccines, and exams will my baby receive after birth? What tests must be performed before we are allowed to go home?

  • How soon will the baby need to visit a pediatrician after we leave the hospital?

  • How soon after delivery will I have an appointment with you for my postpartum check-up?

  • If my baby needs to go to the NICU, how can I ensure myself or my support person will accompany them? Who will provide updates on my baby’s health status and condition, and how often will I receive those updates?



Benefits of Nettle

This week I attended a @dasc_doulas Circle gathering for Orange County birth workers. We talked about the benefits of herbs during the birth and postpartum period. @alhoutwisdom recommended Nettle.

Nettle leaves are high in iron and calcium, they can also be a source of folic acid, an essential nutrient during pregnancy. Nettle strengthens the kidneys and adrenals, while relieving fluid retention. Nettle also supports the vascular system, it can prevent varicose veins and hemorrhoids during pregnancy. Postpartum, nettle can increase breast milk production. Nettle tea has a rich, green taste and can be mixed with other herbs. 🌿