Preparing For Childbirth—Pelvic Floor Style

I love helping women prepare for childbirth—I really do. In fact, it made me want to consider becoming trained to be a doula a few years ago! Unfortunately, most of the women I have helped have either been women who were already seeing me for low back or pelvic girdle pain during their pregnancies or physicians/physical therapist colleagues who were wanting to be proactive in preventing future pelvic floor problems.

So, who should work with a pelvic physical therapist during pregnancy? Honestly, EVERYONE. I’m serious. A skilled pelvic PT can do so much to help a woman not only have a safe and healthy pregnancy (helping to manage pain that creeps in, fitting for support belts/braces if needed, coaching to help get the right exercise routine, and much much more), but we also can do quite a bit to help a woman prepare her pelvic floor for delivery.  My dream is that one day all women will be encouraged to work with a pelvic physical therapist while pregnant and after delivery. I think we would see happier mamas, and reduced problems in the long run.

So, how can a pelvic physical therapist help you prepare your pelvic floor for childbirth?

1. We can help you manage low back or pelvic girdle pain. I know what you’re thinking: this post is about preparing for childbirth, not treating pain during pregnancy! And you’re right, it is. But, pain during pregnancy matters for delivery.  We know that women with pelvic girdle pain during pregnancy tend to have tender pelvic floor muscles. Tenderness in the pelvic floor is often accompanied by a difficulty lengthening or relaxing the pelvic floor, which is totally needed for vaginal delivery, right?  So, in improving pain levels, we also improve the pelvic floor muscles’ ability to relax, which can assist in improving delivery. Did you know that close to 50 percent of women experience low back or pelvic girdle pain during pregnancy? Most tend to think it’s normal, but it really isn’t (Once again, common is not the same as normal!) The great thing is that there is so much we can do to help this pain get better! (1)

2. We can help you learn what your pelvic floor muscles need to function optimally. There used to be the thought that ALL pregnant women needed to be doing lots and lots of kegel exercises. But, as you saw above, we now know that there is a huge population that doesn’t really need to try to tighten constantly, but rather, needs to learn to lengthen, drop and open the pelvic floor muscles. But should some be strengthening? Absolutely! A recent review found that performing strengthening while pregnant can reduce both urinary and fecal leakage during delivery. (2)  However, it’s important that these recommendations are individualized, and that is something a skilled pelvic PT can help you with.

3. We can teach you proper pushing mechanics. This is actually one of my favorites. I generally will spend a session with all of my pregnant women helping them learn how to push in a way that will encourage the pelvic floor to open, and lengthen. Pelvic PTs can use SEMG biofeedback to help you visualize what your muscles are doing and retrain the most helpful pattern of muscle lengthening. I also focus on learning breathing strategies to learn how to coordinate the breath with the pelvic floor, and to encourage using the diaphragm in the best way we can. This helps women to feel more prepared to push when the time comes.

4. We can help you find out which positions for labor/delivery work best for you. For me, this is typically something I work on while helping women learn the right way to push. Now, some hospitals will require women to push in a certain position, but if your doctor is open to you laboring or delivering in different positions, it can be helpful to learn which positions are the most comfortable and relaxing to you. Typically, we try a variety of positions and see which position leads to the best muscle relaxation and helps facilitate the best pushing pattern. Now, of course all of this planning can go out the window depending on what happens during labor/delivery, but it is always helpful to practice and have a few ideas going in. I find this helps women feel prepared and can calm fears heading into delivery.

5. We can teach you perineal massage techniques to help your pelvic floor stretch during your delivery. Did you know that massaging and gently stretching the opening of the vagina in the third trimester can help to reduce trauma and tearing during delivery? Well it can-especially during your first delivery! Perineal massage is a safe (for most women) procedure that can help to not only improve the flexibility of the muscles near the vaginal opening, but also, can help a woman learn what relaxed vs. contracted feels like, and can help a woman to recognize the stretching sensations she will feel during her delivery. (3) It is important to note that there are times when a woman should not perform perineal massage, so it is always important to consult with your obstetrician or midwife before getting started.

Read more about the pelvic floor in this informative YogaUOnline interview with Leslie Howard - Your Body's True Foundation: The Role of the Pelvic Floor in Structural Balance.

Deepen your knowledge of pelvic floor health - Study with YogaUOnline and Leslie Howard - The Female Pelvic Floor: Keys to Lifelong Health.

Reprinted with Permission of Jessica Reale, PT

Jessica Reale, PT, DPT, WCS is a board-certified specialist in Women’s Health and treats pelvic floor disorders in men, women and children at One on One Therapy in Atlanta, GA. She received her doctorate in physical therapy (DPT) at Duke University School of Medicine and was the director of the largest pelvic floor rehabilitation program in South Carolina prior to relocating to Atlanta in 2015. Jessica is passionate about helping her patients achieve optimal health through individualized treatment plans integrating the most current research.  She is actively involved in educating the community and other professionals, and has lectured at support groups, conferences and universities. Jessica writes regularly about all issues related to pelvic health at her blog, www.jessicarealept.com

Resources:

(1) Fitzgerald CM1, Mallinson T.  "The Association Between Pelvic Girdle Pain and Pelvic Floor Muscle Function in Pregnancy"  http://www.ncbi.nlm.nih.gov/pubmed/22290191

(2) Boyle R1, Hay Smith EJ, Cody JD, Morkved S. "Pelvic Floor Muscle Training for Prevention and Treatment of Urinary and Fecal Incontinence in Antenatal and Postnatal Women" http://www.ncbi.nlm.nih.gov/pubmed/23616292

(3) Beckman MM1, Stock OM.  "Antenatal Perineal Massage for Reducing Perineal Trauma"  http://www.ncbi.nlm.nih.gov/pubmed/23633325