How Pelvic Floor Therapy Can Help With Birth Preparation

I see many women in the clinic during pregnancy, and honestly, I wish I saw more. I wish every woman could have at least one pelvic floor therapy visit during pregnancy.

What Do We Do In Pelvic Floor Therapy For Birth Prep?

There are a few main areas I address in a pelvic floor therapy session for birth preparation:

1. Checking for any pelvic floor muscle tightness

2. Assessing kegels

3. Practicing how to push properly

4. Testing different birthing positions

Checking For Pelvic Floor Muscle Tightness

If the patient is comfortable I will do an internal vaginal assessment to check if there is any tightness in the muscles or any tender spots.

I do this because in vaginal delivery the pelvic floor muscles are going to stretch, a lot! We want to give them the best opportunity to stretch without tearing. If we find tightness or tenderness in the muscles during pregnancy, we can address that prior to giving birth.

Kegels

To be honest, kegels are not that important to me during pregnancy, and espeically at the end of pregnancy while we are preparing the body to give birth.

I check whether or not the patient can do kegels properly as part of the overall assessment and to get them familiar with how to use the pelvic floor muscles.

I assess this in two ways:

1. I feel with my finger during the internal assessment how they kegel

2. I use a biofeedback machine that has sensors that attach to the pelvic floor muscles that gives us a measurement of muscle force.

   
   

When I am assessing a person's ability to do a kegel, I am also assessing for muscle endurance, reaction time, compensations and the degree of difficulty to activate those muscles. Those are all important pieces of information, too.

Practicing How To Push Properly

Something most humans never think about is how to push. Some people are naturally good at this and some need practice, which is good to find out ahead of time. Yes, labor and delivery are "natural" processes, but that doesn't always mean your body automatically knows what to do.

I usually assess this with the biofeedback machine attached.

A misconception about giving birth vaginally is that the pelvic floor msucles will push the baby out. I think that is why there is often emphasis on kegel and pelvic floor muscle strength.

What should happen to push the baby out is the abdominal muscles are used to push down and out through the vaginal canal. In labor, this should coincide with the uterine contractions, and that combination is what pushes the baby out. We want the pelvic floor muscles to stay soft and relaxed and be able to stretch as baby comes through the canal. If you contract the pelvic floor muscles, then they will be in the way and can lead to more tearing, a more difficult birth, or in some cases, c-section.

Birthing Positions

With the biofeedback sensors still attached to the pelvic floor muscles, I will test different birthing positions with the patient. I will test things like lying on the back, lying on the side, squatting, kneeling and other positions. What I am looking for is where the pelvic floor muscles are most relaxed and least active at rest. This is different for every person. There is no one best birthing position, it depends what feels good for you.

You may hear different birth educators or pelvic floor therapists saying things like this position is better than that position. As of this publication we have no research to say one is better than another. That is what I see clinically, as well. It varies a lot depending on the person.

Generally what I find and what I tell my patients is that if you are comfortable in a certain position, then most likely your pelvic floor muscles will be relaxed, and visa versa. If the person is uncomfortable in a position, then the pelvic floor msucles probably won't be very relaxed.

For example: if the patient isn't someone who goes to the gym and exercises a lot (I'm speaking from USA culture) then they probably aren't going to be very comfortable squatting. It will feel like work for them and their pelvic floor muscles likely won't be relaxed. So, even though you may read that squatting is the best way to give birth because gravity is helping, which is true, but it may not be the best position for you!

How Does All This Help With Birth?

The goal of pelvic floor therapy training during pregnancy and for birth preparation is to reduce the risk of tearing with a vaginal birth and reduce the need for interventions surch as forceps or vaccuum assisted delivery. It may also reduce the risk of needing a c-section.

What I tell all my clients is that birth is natural and a lot of how it unfolds is out of our control, but learning about the pelvic floor and how to push optimally can help.

Less tearing and less medical assistance during birth should lead to a better recovery. Having knowlede of the pelvic floor and what to expect postpartum is also helpful and another part of what I teach my clients in the clinic.

When Should I See a Pelvic Floor Therapist During Pregnancy?

I recommend that everyone come once during their second trimester to get a baseline assessment of the pelvic floor muscles. This way, if there is something that needs to be worked on, there is time to work on it.

Then I recommend for the specific birth prep that patients come between 30-35 weeks gestation. Doing this stuff before then doesn't usually translate that well to delivery time. There are also specific stretches and things to start doing at 34-35 weeks gestation that we can address at that visit.

How Can I Do This During Pregnancy?

If you are local my recommendation is to come see me during your second trimester for an initial evaluation. You can also look for a pelvic floor therapist near you, if you are not local to me.

I also have an online course where I go over all of these things and what you can do at home to prepare your pelvic floor for birth. Obviously you won't get the hands on assessment of the pelvic floor therapist, but the course teaches you what things you can do on your own (which is a lot).

You can find out more about the online birth prep course here.