Pregnancy can be an exciting, scary, beautiful, and/or strange season of life. Many important and often challenging physical, mental, emotional, and spiritual changes occur during this time, as well as afterward. One facet of physical changes involves your pelvic floor muscles, a group of muscles at the bottom of your pelvis that contribute to bladder and bowel control, sexual and reproductive function, and pain-free movement.

In fact, quite a bit changes for this part of your body, and we want you to have as many tools in your “birth tool bucket” as possible when it comes to pelvic floor health during the pregnancy, labour, and postpartum periods.  Birth isn’t something that happens to you as a passive participant; it is something you can step into and out of with agency as an active participant. 

Pregnancy

The first thing to point out is the “changes” that occur during pregnancy are more aptly regarded as adaptations. Pregnancy is not a condition or dysfunction, rather it is a process your body can adapt to, often quite remarkably!  That said, some adaptations can contribute to negative physical symptoms in some people. While you might often understand relaxin (the hormone that softens ligaments), a weak core, or genetics to be culprits for any issues you experience, the reason for negative symptoms is often more complex than that, since a whole dynamic system is adapting!

If you think of your pelvic floor muscles as a trampoline spanning the base of your pelvis–extending from pubic bone to tailbone and sitz bone to sitz bone–essentially the trampoline is holding progressively more weight as your baby grows, which places more demand on the trampoline’s “springs” and “material” over time.

The increasing weight the pelvic floor muscles are supporting also makes circulation through the pelvis more challenging, since there’s more pressure to manage at baseline. In short, your pelvic floor muscles are working increasingly harder for you! Your body figures out ways to meet this increase in workload, but sometimes needs additional help, particularly when urinary leaking, gas leaking, pain, pressure, vulvar varicosities, or hemorrhoids show up. To prevent and/or help these issues, we can help make sure that during pregnancy your pelvic floor muscles have a strong ability to contract, have enough endurance to maintain a contraction, have optimal flexibility to relax and lengthen, and are coordinated enough to open for bowel movements, and eventually, for birth!

Labour 

While there are many things that may feel out of your control during labour, recent research shows there are many things you can do to leading up to and during birth that can optimize your experience and reduce risk of pelvic floor injury, specifically moderate to significant muscle tearing (3rd and 4th degree tears) and pelvic organ prolapse. 

First, performing perineal massage as well as exercises that “open” the pelvis and relax your muscles in the several weeks leading up to your due date are useful in two ways. First, they help reduce the risk of tearing during delivery. Second, they give you the opportunity to practice breathing and relaxing into any discomfort or pain. We recommend getting guidance from a pelvic floor physiotherapist for these exercises, as there are customized modifications made depending on the person.

Second, learning about different pushing techniques and delivery positions can help the second stage of labour (pushing and delivery) progress better. The position you push and deliver in can impact how efficiently the pelvis expands as the baby descends, and your pushing technique influences how much pressure goes through the pelvic system overall. Again, we recommend getting guidance on these techniques as they often take some practice. 

Third, while understanding and optimizing mechanics is really important, equipping yourself with breathing, relaxation, and resilience strategies as well as a diversity of pain management options is crucial, regardless of what your birth plan is or what your birth ends up being. Hormones have a powerful influence on your body, especially cortisol, the “stress hormone.” When too high, cortisol can interrupt the hormone oxytocin, which helps labour progress. Thus, optimizing birth is not just about mechanics, but about your mental state as well. 

Postpartum

Since birth is a physical, mental, emotional, and sometimes spiritual process, your recovery from birth will be as well, regardless of the type of delivery. The first 12 weeks postpartum are often called “The Fourth Trimester” for this reason, and enough space should be given to recovery, transition, and adjustment. 

Physically, muscles that have been worked differently or harder during pregnancy, labour, and delivery are recovering in length, healing from tearing or incisions, and rebuilding their capacity to move and activate. There are gentle activation exercises specific to pelvic floor as well as more general in nature that are safe to perform early postpartum to help restore coordination and movement. There are also supports you can wear that are most helpful early on, like abdominal wraps and/or compression shorts. Keep in mind the goal of these suggestions is less aesthetics and more to give support and optimize your ability to function.

Finally, given the impact of the “event” of birth, we recommend getting a postpartum check up around 6 weeks postpartum to assess the need for any specific rehabilitation. While we recommend this to anyone regardless of how straightforward or complex birth was, we particularly emphasize the importance of a check up if any of the following symptoms persist within the first couple months. Know these are common, but are not normal, and can often be resolved, especially if addressed early.

• Urinary leaking 
• Strong urinary or bowel urgency (you’re running to the bathroom frequently)
• Pelvic pressure or heaviness
• Persistent hemorrhoids, constipation, or pain with bowel movements
• Pain with arousal, orgasm, or sex
• Pain anywhere in the torso or pelvis with activity or movement (walking, lifting, carrying, sleeping, etc)
• “Doming” or “bulging” of your abdominal wall, diastasis recti (DRA)

As we hope you can tell, we at The Mama’s Physio are passionate about empowering you in your pregnancy, delivery, and postpartum stages. We believe that while you are walking into some unknown, you can do so with lots of knowledge and tools at your disposal, and we at The Mama’s Physio would be honoured to journey with you for all or part of your experience.

By Sophia McLean – PT, DPT

Sources:

Barker, Sarah, Tyler Muffly, and Shereen Sairafi. “A Multidisciplinary Approach to Prevention and Management of Obstetric Anal Sphincter Injuries.” Denver, CO, February 2020.

Dufour, Sinead. “Pelvic Health Solutions: Pregnancy, Pelvic Girdle Pain, and The Pelvic Floor.” Abbotsford, BC, January 2019.

Rost, Cecile and Susannah Britnell. “Evidence based management of pregnancy-related pelvic girdle, sacro-iliac and pubic pain.” Vaughan, ON, July 2019.

Lally, Joanne E, Richard G Thomson, Sheila MacPhail, and Catherine Exley. “Pain relief in labour: a qualitative study to determine how to support women to make decisions about pain relief in labour.” BMC Pregnancy and Childbirth 14, no. 6 (2014): 1-10.

Lee, Lily, Jessica Dy, and Hussam Azzam. “Management of Spontaneous Labour at Term in Health Women.” The Journal of Obstetrics and Gynecology Canada 38, no. 9 (2016): 843-865.