Our bodies go through innumerable changes throughout pregnancy and postpartum, and this includes our pelvic floor. A lot of patients come into physical therapy stating they want to have a strong pelvic floor for birth, and this is a great goal with some asterisks for what it truly means. I am passionate about education and empowering women to better understand how their bodies change in order to accommodate this pivotal time. Below are 5 tips for helping achieve this goal of resilience.
1. Learn the true potential of these muscles.
Our pelvic floor musculature is under our voluntary control– much like our biceps or quads when we are doing strengthening exercises or simply squatting and lifting our baby. You can do the same movements as with other muscles– you can contract, relax, and stretch these muscles. Because they are located in a discrete region of the body, it may be tricky for some individuals depending on their previous relationship with this area (wink wink… constipation, painful intercourse, painful periods, urinary leakage). So I encourage patients to grab a mirror, and take a peek at their perineum to see if they can get this area to move the way that their brain cues these muscles to move. For some, it takes some time to get familiar with this region. A pelvic floor therapist is wonderfully equipped to cue and coax these muscles to respond to what you want them to do.
2. Use the most vital tool you have… Your Breath.
The diaphragm and pelvic floor muscles have a symbiotic relationship, and we can use this to our advantage when preparing the pelvic floor for resilience. When the diaphragm contracts or relaxes for in breath and out breath, the pelvic floor muscles do the same. The beauty in this is that we can use the breath to manipulate what happens at the pelvic floor– and so this is one of our most important tools when it comes to strengthening and lengthening these muscles. In addition, utilizing our breath stimulates our Vagus Nerve which supplies our parasymphathetic nervous system. Because all musculature and body systems are supplied by our nervous system, it is crucial to hack into this wonderous network that is responsible for stimulating the cascade of events that leads to labor and delivery.
3. Recognize the role that the pelvic floor has during pregnancy.
The pelvic floor functions to stabilize and support our pelvis and the organs within it throughout pregnancy. As your body navigates a growing baby, the pelvic floor is slowly adapting to this load. It is strength training at its finest- progressive and gradual loading for improved vigor and power. But the pelvic floor muscles need a break too. A strong pelvic floor (or a strong muscle), is also a flexible pelvic floor. Taking the time to relax the pelvic floor with breathing exercises and stretches helps the pelvic floor rest and regenerate in anticipation of taking care of a larger load (namely baby, plus some fluids).
If you are doing pelvic floor contractions (Kegels), which are OK for some individuals depending on their reason for doing them, keep in mind to offset with relaxation and flexibility. Additionally, postural awareness helps with this if you have an occupation of sitting or standing in place for long periods of time. Certain postures can furthermore put greater stress on the pelvic floor muscles that are already working overtime. Doing an ergonomic assessment for yourself if you sit or stand for prolonged periods of time can be a huge favor for your pelvic floor as well as back, pelvis, and hips.
This is helpful awareness for anticipation of vaginal or cesarean deliveries because the pelvic floor is playing a part throughout the entirety of the pregnancy regardless of outcome.
4. Recognize the role that the pelvic floor has during delivery.
Get those muscles out of the way! This is their break time. Our uterus has a huge job to do… get that beautiful bundle of joy out of their bubble and into your arms. Don’t let the pelvic floor delay baby greeting you. Birth prep education in pelvic floor PT centers around pain management education during labor and improving pelvic/muscle mobility to assist with delivery. Practicing tip number 1 helps with this process. The last few weeks before a vaginal delivery, it is vital to know how to relax and lengthen these muscles that have been working very hard. Practicing a bearing down motion with a mirror or with tactile cues (such as your hand at your perineum) is helpful in knowing how to use these muscles to help the uterus do its thing. Think of having a bowel movement and you need to give a little extra push- that is what we are trying to do to help Baby get out. I recommend practicing this with your perineal stretches if you have discussed this with your provider.
5. Nurture Your Nervous System
Increased stress, exhaustion, and anxiety lead to an upregulated nervous system which can directly affect the pelvic floor. Have you ever experienced increased tension and pain in your neck when you are stressed? Well, the pelvic floor muscles carry much of our burden in the same way. Yet we find ourselves more susceptible to looking for other causes of problems down below if things are not feeling quite normal. Healthy coping strategies for stress and anxiety throughout pregnancy and postpartum are important to pelvic floor health and wellness for supporting your most basic functions. These strategies differ from person to person, but exploring different avenues with your health and wellness providers (midwives, doulas, doctors, physical therapists, acupuncturists) can help make nurturing this system one of the best ways to take care of your pelvic floor during pregnancy and beyond.
This blog is written by Natalia Avelar.
For more information about Natalia Avelar, DPT, PRPC and pelvic floor physical therapy services, visit www.peacepelvichealth.org or contact Natalia@peacepelvichealth.org for Email Inquiries. Phone and telehealth consultations available via above contact.
