“When is intervention necessary?”

Pregnant and healthy? Hormonal changes, increasing anatomical strain, and individual factors can cause problems that significantly impact the body of a mother-to-be. Categorizing them and treating them, if required, is a major part of supporting pregnant women for Gynecologist Dr. Susann Jäkel – this includes medical products, such as braces or compression stockings.

Table of Contents

• Preventing pain with exercise
• Step-by-step treatment
• The simpler, the greater the compliance
• Compression for strained veins
• Treatment when clear indications exist

“Hormones like relaxin loosen ligaments and joint connections including the sacroiliac joints or the symphysis. With increasing weight and circumference, the body’s center of gravity changes and affects its statics, which can cause hyperlordosis of the spine. The blood volume increases by around 30 to 50 percent – which is extreme for the female body,” says Dr. Susann Jäkel and adds: “It’s a fine line for us gynecologists: What is still physiological and when is intervention necessary?” This is a daily balancing act for the physician who runs two practices in the German cities of Gera and Jena with two colleagues. She covers a wide spectrum – from regular pre-natal care to supporting risky pregnancies. She also draws on her experience from her specialist training at the Hospital for Obstetrics at Jena University Hospital and as a practical obstetrician. When providing care, Dr. Jäkel also relies on close cooperation with the midwives associated with her practices. The challenge is to provide comprehensive support to women despite a limited number of appointments. That is why an extensive discussion about the medical history is key during the first appointment where the pregnancy is determined.

“Of course, that only takes place once we’ve taken a picture of the fetus with the ultrasound, we’ve seen the heart beat, and have confirmed that everything is ok.” The questions that follow are about the family situation, existing conditions, consumption of medication, as well as vaccinations, and information on maternity guidelines or further examinations is provided. Pointing out the imminent physical changes is just as important in Dr. Jäkel’s mind. The whole body starts to prepare for the pregnancy, with the mother herself being less of a priority. This is just natural but pushes the body to its limits. Sooner or later, pain may start to occur – the later the better. “Pain is a warning signal. If something hurts, the system shows that it’s subjected to excessive strain. If the mother isn’t feeling well, it’s not ideal for the baby either. Remember therefore: Pain reduction is key.”

“When prescribing medical products during pregnancy, we adhere to the motto: When clear indication exists.”

Dr. Susann Jäkel

Preventing pain with exercise

Making sure the women stay as mobile as possible is the best prevention of possible symptoms in Dr. Jäkel’s eyes. “Exercise. Tell your coaches you’re pregnant so they can be considerate. Everything is allowed, except horse-back riding, ball games, as well as martial arts or extreme sports. Find out what makes you feel good.” Additionally, she recommends to invest five to ten minutes in mobility exercises at home. A yoga mat is a MUST. A Pezzi ball and instructions can be easily obtained from the internet. Those who are interested can look up specifically adapted exercises in apps. “We don’t need frantic exercise but consistent movement. If pain occurs, actively counteract it. Rest can trigger a cycle that exacerbates symptoms.” If a pregnant woman mentions pain in the back or pelvis area, Dr. Jäkel will deliberately ask about exercise. To alleviate pain, she advocates gradual measures: physiotherapy, taping, braces – when needed, they are increased to try and keep further options open. The gynecologist with an additional certification as a manual therapist has some contrary views on physical therapists’ common concerns to treat women in sensitive stages of pregnancy with too much caution. “Pain exists but it has to be treated. No extreme manipulation but targeted exercises that bring relief.”

Step-by-step treatment

Dr. Jäkel can often see where a patient is hurting when she enters the room. A manual examination will then confirm a loosened symphysis or a spine subjected to excessive strain. If exercises and physiotherapy do not have the intended effect, taping can be considered as another option. It provides proprioceptive stimuli, helps loosen tension, gently lifts the belly, and can promote lymph flow. An additional effect: The patient will take home an immediately noticeable measure. If firmer structures than a tape bandage are required, lumbar or pelvic braces can be a useful addition.

Compared to models that generally only lift the belly, Dr. Jäkel prefers the Spinova Mum lumbar brace where she was involved in the development. Thanks to dorsal stays and an individually adjustable tensioning strap system, it has a lordosis-reducing effect on the lumbar spine. The straps that run underneath the belly stabilize the pelvis, relieve the symphysis, and exert an effect on the sacroiliac joints using removable viscoelastic pads.
“I wasn’t aware of any medical product offering this combined treatment approach. So, during my time at Jena University Hospital, I worked on the development of a lumbar brace for pregnant women together with Bauerfeind, supervised by Prof. Dr. Ekkehard Schleußner,” Dr. Jäkel explains. Her practical experience, expertise in manual therapy as well as taping, and insights from wearing tests were included in the development process and contributed to the Spinova Mum being a new treatment option on the market since 2024.

“Many patients feel a relieving effect immediately. Some of them want to take the lumbar brace home there and then.”

Dr. Susann Jäkel

The simpler, the greater the compliance

In addition to the medical function, Dr. Jäkel attached great emphasis to easy handling during the product development. “Women must be able to don the brace quickly and without any additional aids – without a mirror, even without looking. That improves compliance.” The breathable mesh material also helps with compliance. “We can show samples of the brace during our practical work. They can be donned as a test to demonstrate function and mode of action so we can see whether patients respond positively to the product. Many patients feel a relieving effect immediately. Some of them want to take it home there and then,” says Dr. Jäkel and laughs. To clarify use, she points out that braces should be worn exclusively during the day and when the person is active. The crucial point is that women become mobile again. This combination is the key to exert effectiveness.

Despite all positive effects, the following applies: Braces are not prescribed preventatively but based on a diagnosis and specific to the indication. This is also relevant to the prescription. As an alternative to prescribing the product by its specific name, it can be described as a back brace with additional elements for lordosis reduction and stabilization. “The notes in the available information material are useful,” Dr. Jäkel suggests and elaborates: “If a suitable indication exists, we usually prescribe the Spinova Mum from the second trimester of pregnancy. Before that – when the belly doesn’t yet protrude over the pelvic girdle – a pelvic brace can also help relieve the symphysis or sacroiliac joints.” The important thing in any case is: If the brace is used specific to the indication, there will be no risk to the baby at any point. “The brace is positioned on the pelvic bones and cannot cause an interruption of nutrient supply. It can’t even be donned so firmly that it would lead to an impairment without the mother feeling extremely uncomfortable.”

Compression for strained veins

Even during early stages of pregnancy, hormonal and physiological changes can impact the venous system of the leg. The vessels expand, the function of the venous valves reduces, and the return flow of blood slows down. Additional water accumulation exacerbates the strain. Up to 40 percent of pregnant women have suddenly occurring or progressed varicose veins. The current German S2k Guidelines for Compression Therapy recommend this treatment for congestion and edema, as well as dizziness and nausea. “Women need support during their everyday activities – at work or when looking after their families,” Dr. Jäkel highlights. Physicians therefore ask specific questions about symptoms and provide a prescription when needed. Compression stockings can promote venous hemodynamics by improving the blood’s return flow and reducing congestion. On her prescriptions, Dr. Jäkel generally recommends wearing Compression class II thigh-high stockings with a closed toe during the day, or alternatively, pantyhose with a pantyhose top. “Depends what each person prefers to wear. Compliance is the important aspect.” Experience has shown: If women feel relief, they will consistently wear the stockings – oftentimes for the entire duration of the pregnancy. Use is recommended from the first symptoms occurring to six to twelve weeks after giving birth to support postpartum regeneration and to reduce the risk of thrombosis. The likelihood of a venous thrombotic incident increases over the course of the pregnancy and reaches its maximum during the postpartum period. Appropriate compression products can provide beneficial support.

“Women need support during their everyday activities – at work or when looking after their families.”

Dr. Susann Jäkel

Treatment when clear indications exist

Are there other indications that may occur during pregnancy where Dr. Jäkel would also use medical products for treatment? “Symptoms typical during pregnancy can include problems with the wrist, carpal tunnel syndrome, for example. A hand brace would provide pain relief,” the gynecologist explains. She is also open to treating changes in foot posture with foot orthoses. “It’s rare for patients to ask me directly. We usually follow up on midwives’ tips. I will then refer patients to an orthopedic surgeon so they can be fitted with precisely adapted foot orthoses,” says Dr. Jäkel and summarizes: “When prescribing medical products during pregnancy, we always adhere to the motto: More isn’t automatically better. Symptoms vary widely from each person so we need clear indications. Only then can a brace, compression stocking, or orthopedic foot orthosis help relieve pain and enable movement.”

Lumbar brace for pregnant women: Spinova Mum
The Spinova Mum has been primarily designed to gently treat back and pelvic pain during pregnancy and postpartum regeneration. The brace provides three kinds of relief. It provides lordosis reduction, it stabilizes the pelvis, and gently lifts the belly – using a unique strap system. Find out more.

In the article “It’s about staying active,” midwife Maria Werner shares her observations on how medical aids can relieve and support pregnant women.

Pictures: Andreas Wetzel, Bauerfeind AG