How Carrying Your Baby Front Facing Out Affects The Spine and Moms Pelvic Floor by Dr. Maya Pande

I'd like to introduce to you Dr.Maya Pande.  I had the pleasure of working with Dr.Pande at the Bellies to Baby's Event where I came in and demo'd babycarriers and we discussed different carrying options and dove into the whole FFO(Forward Facing Out) debate.  I know some of you like to wear your baby facing out and I respect your choice. The argument I always hear is 'baby wants to see what's going on'. That's great, although I suggest your baby would much rather see you, but you can always carry baby on the hip and back and they can see you and everything else perfectly well.  Hips need to be properly supported, as it takes 2 years for your child's hips to develop. However rather than understanding anatomy and how the body grows and develops, people want studies that show proof.  Those haven't been done as FFO I think started in 1992 when Baby Bjorn first publicized this carrying position which only seems to be popular in North America.  The emphasis is strong with their brand.  For me it's about prevention.  We won't know how kids are until they are much older.  Afterall if it did start in 1992 those kids are now 20 years old! If they had issues growing up in any carrier worn FFO how does that get documented to the general public if there are issues due to FFO?
I hope you'll find the below article written by Dr.Pande informative.
If you look at photo's from all over the world babe's in slings, wraps and Mei Tai's are always in a proper position and are never shown forward facing out.  Maybe they know something we don't?

Happy Babywearing and Happy Babywearing Safely!

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How carrying your baby front facing out affects the spine and moms pelvic floor

By Dr.Maya Pande

I was so pleased and flattered when Erica asked if I would write a blog post on the effect of front facing in (FFI) carriers versus front facing out (FFO) carriers on the spines of both the baby and the mother. I know that there is a lot of debate lately about whether to carry your baby facing in or facing out. This article is focused on sharing information about how the position they’re carried in affects their spine and hips.

I want to touch on two specific complications that may be prevented by carrying baby facing in instead of facing out.
Spinal Curvature: First a tiny anatomy lesson. Don't worry, it's easy!

When a baby is born, their spine is shaped in a "C" curve.  As they get stronger and older, their spines develop into the "S" shape that is normal for adults.

If the baby is forward facing out(FFO), the "C" curve is decreased.  Why?
Mainly because the middle of their spine is being pressed up against the hard breast bone of the adult who's holding them.  This is basically like being backed up against a wall.
This straightens out the "C" curve prematurely putting unnecessary stress on their spine and nervous system.  Depending how often and how long a baby is held facing out, this can affect the development of their spine.

Why do you want to avoid this? The spine protects the nervous system which is an extension of the brain. The nervous system is used to transmit information from the brain to the rest of the body and therefore controls all of the body's systems.  When the a bone of the spine is misaligned, or compressed or compromised in any way, the nervous system gets stressed and overloaded.  This affects the body's overall ability to be healthy.

By carrying a baby facing in with their knees bent and their bum lower than their knees(see picture below, also known as the "M" position), their "C" curve is supported and this allows their spine and nervous system to develop normally.

photo courtesy of JePorteMonBebe

The "M" position in Manduca, knee's higher than bum

A closer look at proper positioning in a TULA carrier.
Same "M" position

Hip Dysplasia:  Hip dysplasia is basically a deformation of the hip joint which can cause decreased mobility and affect walking.  This is more commonly heard of in older adults, but it can also happen to babies.  After birth, it takes a few months for the hip joints to naturally stretch out from the fetal position.  Until their hips stretch out on their own, it's important that they be supported in that fetal position.  Some FFO carriers can force the baby's legs to dangle and hang straight which stretches their hip joints prematurely.  This may lead to hip dysplasia or even dislocation, in susceptible individuals.
(edit: June.1/12 by Dr.Pande)
These two conditions can go undetected because neither of them cause pain in your little one.

One of the left is not optimal, picture on the right is the ideal position
photo from hipdysplasia.org

  Because hip dysplasia can go undetected (and therefore untreated) in infants, sometimes, because of the weakness of that joint, it can result in arthritis of the hip later in life. 
Research supports that hip dysplasia can increase the risk of developing arthritis in later years and  hip dysplasia is one of the risk factors associated with the onset of hip osteoarthritis.

Mom's Spine:  A FFO carry can affect you too! Your mid back is already under a lot of strain because of all the bending over that you're doing now: breastfeeding, bending over a crib or the changing table, picking up your baby. When you carry your baby in a FFO carrier position, the weight of the baby tends to be distributed over your shoulders which can increase your mid back tension and cause pain.
Carrying your baby facing out also may force you to push your hips forward when you walk. This puts more pressure on the already weak pelvic floor. Using a FFI carrier position makes you use core muscles to support yourself, and decrease the pressure placed on the pelvic floor, better allowing it to heal after birth.

Regardless of which position you carry your baby, what do you do if you start to notice a problem
with you(such as back pain, easily tired when walking, can't get comfortable) or the baby (such as excess fidgeting while in carrier, trouble crawling or walking, uneven muscle tone in legs).

1) Carrier: If you are carrying your baby in the FFO position, try switching to forward facing in.  Depending on the age and head control you can wear baby on your back or even on the hip.
Erica can help you with that and/or show you other carriers to help ensure you're babywearing comfortably.
This change may be enough to make the difference.

2) Health Care Practitioner:  Consult your provider to see if there's something more serious going on.

3) Chiropractic Care: Chiropractic care is gentle enough for little spines and there are chiropractors who focus on infants and children in their practice.  They gently assess your baby's spine to find out of there are any misalignment's or constraints to their development.  Then they explain what they've found and what can be done.  The adjustment is a slight pressure on their back.  No popping or cracking at all!

Carrying your baby is important for bonding, and let’s face it, it’s just wonderful. I mean, who doesn’t like to hold a cute, sweet smelling baby? By carrying your baby FFI, you’re supporting his or her spine and hips, providing comfort and getting a good cuddle out of it too!

About Dr.Maya Pande

Dr. Maya Pande is a chiropractor who practices in Toronto at Yonge and Eglinton at Pande Family Wellness Centre. She focuses on moms, moms-to-be and their little ones.  She is certified in Webster Technique which is a low force chiropractic method used to balance the pregnant pelvis and can help the baby get into the proper position for birth. For her non-pregnant patients, Dr. Maya uses a gentle technique that's safe for patients of all ages (her youngest patient was 2 days old!). She has been in practice and working with old and young families, for 15 years.



Pande Family Wellness Centre
2221 Yonge Street, #504
Toronto, ON M4S2B4
416-486-1234
www.pande.ca