Best place for labor prep? 

Pelvic floor therapy! When it comes to optimizing the mother’s experience through labor and healing postpartum, pelvic floor therapy is one of the best things moms can do during pregnancy. We cannot begin to tell you how often we hear from our postpartum clients that they wished they had come in during pregnancy to get ahead of some of their concerns. 

Who needs pelvic floor therapy?

Pelvic floor therapy benefits all pregnant people and is not dependent on preference, ways of laboring, or symptoms. We are here to support all in the journey! Each person’s experience, pelvic floor, pregnancy, and delivery will be better because of pelvic therapy involvement. A survey of pregnant individuals reported that “it was important to them to know their pelvic floor dysfunction (PFD) risk because it would: support informed choice, motivate them to undertake preventative activities; and allow preparation if PFD occurred” (Bugge et al., 2020). In other words, knowledge is power! The more aware you are of your body’s processes and patterns, the more motivated you are to get ahead of any pelvic floor issues.

Should a pelvic therapist be a part of prenatal care?

Pelvic floor therapists are an integral part of the birth team to help mothers prepare their minds and bodies for birth. These specialists are best positioned to guide you through the rapid changes of pregnancy, birth, & postpartum as they address musculoskeletal, orthopedic, neuromuscular, and nervous systems. Pelvic floor therapy helps with maintaining activity and comfort throughout this transition. They have the unique ability to intervene anywhere along the pregnancy and postpartum journey as any concerns arise or to support an optimal pregnancy, birth, and recovery if no symptoms or concerns are present. 

Research indicates that “perceived levels of control during childbirth are consistently predictive of satisfaction with childbirth and have been proposed as the main variable related to childbirth satisfaction” (Townsend, Brassel & Granyer 2020).  Pelvic therapists can help you to feel prepared and as in control as possible when making decisions during the birthing process, which improves your overall satisfaction with your birth. 

What about vaginal tearing during birth?

Vaginal tearing is an example of an area where appropriate education and strategies to minimize risk of tearing are beneficial in preparation for birth. While this may be a scary topic for some people that they may rather brush under the rug, it is beneficial to press pause to learn about the different degrees of tears that are possible, how they may impact your daily life, how to decrease risk and severity of tearing with breathing and positional strategies, and how to support optimal healing and recovery. 

What kind of leakage is normal in pregnancy?

No leakage! There are ways you can not only optimize your pelvic health to support pregnancy, birth, and postpartum recovery, but also strategies you can use to prevent urinary, bowel, and sexual health concerns from occurring or decrease their severity. 

Many people associate urinary leakage with being pregnant or a history of having babies. This type of leakage, known as stress urinary incontinence, is seen with coughing, sneezing, laughing, or impact and is something that may occur if the muscles of your pelvic floor are not activating either strong enough or timely enough. While this is common, we encourage you to not settle for this as your “normal.” Pelvic floor therapists can help determine if you are at risk for developing something like this depending on the state of these muscles and their ability to move through their full range of motion. Perhaps you have experienced this here and there, but it is not consistent yet. This can be stopped in its tracks as well as prevented from worsening or reoccurring. 

Kegels are good for what?

Not a whole lot! Have you been told to do hundreds of kegels a day to prepare for birth? This recommendation is outdated and does not take the context of your whole body into the equation, not to mention is the opposite of what we want to occur during birth. While you do want your pelvic floor muscles to stay strong to maintain continence and other bodily functions during pregnancy as baby grows, it is important for them to also be able to go through the full range of motion to move out of the way for baby to pass through during a vaginal birth. 

Oftentimes when people are doing kegels, they are not even sure if they are activating the right muscles. This often leads to overactivation and overly tight muscles that do not respond or lengthen optimally like we need them to during birth. A tight muscle is not necessarily a strong muscle. In fact, it is usually the opposite. If a muscle is shortened or tight, it often cannot move through its full range and limits its ability to function properly. When it comes to kegels, we recommend swapping them out for more whole-body movement, attention to your postures in different positions, and better management of your pressures or breath. 

What if I am having a planned C-section?

Believe it or not, pelvic therapy can be extremely helpful for mothers during pregnancy to prepare for what to expect during and after a cesarean delivery, whether planned or unplanned. This is a major abdominal surgery with little time for recovery for mom as she is adapting to baby’s needs, sometimes also caring for a toddler at home, and trying to heal all at the same time. After almost every other major surgery, physical therapy or occupational therapy is mandated in hospitals before patients are discharged and sent home. Since this is not the norm in the United States, we recommend preparing for this experience with pelvic floor therapy while pregnant, regardless of ideal birth plan, to best equip you for optimal healing postpartum. Pelvic floor therapists are equipped to provide education, resources, and strategies that can be used in the early postpartum days to support optimal healing of the core, desensitization of the incision site, and mitigate risk of pelvic floor related issues, such as urinary or bowel concerns. 

What is postpartum pelvic floor therapy?

Postpartum pelvic therapy is essential for anyone that has given birth. The pelvic floor muscles stretch 25 - 245% during birth (Svabik, Shek & Dietz, 2009). Almost instantly, mothers are needed by their babies to be carried, bathed, rocked, comforted, etc. well before the 6-week clearance from their OB. All of this requires returning to movement and lifting during daily activities. Pelvic therapists are skilled in helping postpartum moms navigate this transitional period after birth but well before the clearance for exercise to prevent any discomforts or pelvic floor dysfunction that may be common (but not normal) for new mothers, such as urinary leakage. 

Around 6-week postpartum, pelvic therapists can complete an internal pelvic floor muscle assessment to better inform individualized strategies to support you through this time based on how your muscles are working. They will also do an assessment of your posture, breathing strategies, how you are lifting or feeding your baby, and more to determine if any modifications in these areas would be beneficial for your healing. If any diastasis recti, urinary frequency, leakage, prolapse or pressure, difficulty holding back gas or bowel movements, constipation, pain with sex, pain from tearing, or any other related concerns come about, your pelvic therapist will help you to resolve these concerns in the clinic and give you strategies you can implement at home. 

At our clinic, we welcome moms to bring in their babies as well if that is helpful for making the appointment. This also allows the pelvic therapists observe your body mechanics and patterns and give you advice and strategies that may help your overall concerns in real-time. If you are not sure if you would benefit from pelvic therapy during pregnancy or postpartum, give us a call. We are happy to discuss this with you and explore how to get you feeling as confident as possible throughout your pregnancy, birth, and postpartum journey! 

For more information on pelvic health, related concerns, and other helpful tips we wrote a large blog “The Complete Guide to Everything to Know about Your Pelvic Floor Health and Pelvic Floor Therapy”

References

Bugge, C., Strachan, H., Cheyne, H., Wilson, D., Pringle, S., & Hagen, S. (2020). Investigating
pregnant women’s and heathcare professional’s views about knowing a woman’s individual risk of future pelvic floor dysfunction: A feasibility study for a randomised controlled trial. In Proceedings of UKCS meeting, https://ukcs. uk. Net.

Svabik, K., Shek, K. L., & Dietz, H. P. (2009). How much does the levator hiatus have to stretch during childbirth?. BJOG: An International Journal of Obstetrics & Gynaecology, 116(12), 1657-1662.

Townsend, M. L., Brassel, A. K., Baafi, M., & Grenyer, B. F. (2020). Childbirth satisfaction and perceptions of control: postnatal psychological implications. British Journal of Midwifery, 28(4), 225-233.