Benefits of Pelvic floor physical Therapy during pregnancy
You don’t have to have anything wrong to attend Pelvic Floor Physical Therapy during pregnancy. In fact, there are a myriad of benefits to seeing a women’s health physical therapist prior to giving birth. Pelvic Floor PT can prepare a woman for labor and delivery to reduce the risk of pelvic floor injury. Giving birth is a significant event that requires both physical and mental strength and preparation. If you are proactive during pregnancy, your Pelvic Health Physical Therapist can help you achieve your delivery goals and keep your aches and pains at bay.
Your pelvic floor physical therapist can assist with birth preparation by providing extensive education on the labor and delivery process to minimize the risk of pelvic floor injury. This includes:
Perform perineal massage
The perineum, the area between the vagina and the anus, is commonly where tears occur during delivery. Perineal massage is when 1-2 fingers are inserted into the vagina to apply downwards and sideways pressure to the perineal muscles in order to improve circulation and tissue elasticity, which will allow these muscles to stretch easier during the birthing process. Perineal massage is associated with a decreased risk of severe perineal tears and postpartum complications. Your pelvic floor physical therapist can perform this for you during your PT sessions and also educate you and your partner on how to do this at home.
Optimize hip, pelvic and spine mobility specific to your body to help open the pelvis during delivery
Your pelvis needs to open in a few different ways to allow the baby to descend into the birth canal. Assessments of your hip, pelvic and spine mobility will allow your PFPT to come up with individualized exercises specific to your body to create more space in the pelvis for an easier delivery.
Discuss ideal positions for the first and second stages of labor to help the baby engage in the pelvis and descend through the birth canal.
Labor is broken up into 3 stages. The first stage of labor is when you are having contractions, which help dilate the cervix to 10 centimeters. During this stage, the goal is to open the pelvic inlet, or the top part of the pelvis.
View of the pelvic inlet from the top of the pelvis
As seen in this video, we incorporate movements such as hip external rotation and posterior pelvic tilts to create more space in the pelvic inlet.
The second stage of labor is the pushing phase and ends with delivery of the baby. During this phase, the goal is to create more space in the pelvic outlet (bottom of the pelvis) to allow for birth of the baby. This can be achieved with hip internal rotation and anterior pelvic tilts, as shown in the image below.
During the active stage of labor, expanding the pelvic outlet via hip internal rotation provides additional space for the baby to emerge
Turning your knees in and feet out creates more space for the pelvic outlet. This also allows movement in the tailbone which creates more space for the baby to transcend.
The third and final stage of labor is delivery of the placenta, which hopefully should deliver on its own with minimal assistance.
5. Instruct breathing and pushing techniques (hint: you don’t have to push on your back and you don’t need to hold your breath!)
One of the best ways to prepare for childbirth with your pelvic floor physical therapist is to practice pushing. Contrary to what you see in the movies, pushing on your back with your hips wide while holding your breath is not optimal for delivery. In fact, being off your back in an upright birthing position can decrease instrument assisted birth, shorten active pushing phase, and reduce the risk of perineal trauma/tearing. Also, breathing while pushing can protect the perineum. Your women’s health physical therapist will educate you on how to breathe while pushing in different positions to reduce pelvic floor injury.
Cappuccino Physical Therapy teaches many different options for hip internal rotation in our birth prep program.
6. Educate you on how to optimize core and pelvic floor healing early postpartum.
Your core and pelvic floor go through significant changes during pregnancy, and one of these areas will experience significant trauma depending on which way you deliver. Your PFPT can teach you ways to reduce pressure on the core and pelvic floor early postpartum to facilitate early tissue healing.
7. Treat pregnancy related aches and pains
Pregnancy-related aches and pains are a universal experience for many expectant mothers. The body undergoes significant changes during this miraculous journey, and it's only natural that discomfort may accompany the process. However, these ailments can be treated successfully with pelvic floor physical therapy. Common conditions during pregnancy include:
Round ligament pain
Sacroiliac joint pain
Pubic symphysis diastasis
Low back pain
Hip pain
Pelvic pain
8. Provide exercise modifications to allow you to exercise safely throughout pregnancy.
Exercise is very important during pregnancy. Some of the benefits of exercise during pregnancy include decreased gestational diabetes, decreased risk of C-section and instrumented assisted vaginal delivery. There are also benefits for the fetus. While exercise is safe during pregnancy, some modifications should be made in regards to high impact activity and heavy weight lifting, especially in the third trimester to reduce the risk of developing urinary incontinence or pelvic organ prolapse. Your women’s health physio will educate you on how to exercise safely during pregnancy and modify your exercise accordingly based on your goals.
At Cappuccino Physical Therapy, we specialize in preparing women for childbirth. Our extensive birth preparation program starts in the second trimester and lasts throughout pregnancy. Our goal is to help you reduce the risk of pelvic floor injury and allow you to feel empowered going into birth. If you are pregnant and want to learn more about how we can help you reduce the risk of pelvic floor injury during delivery, click here for more information.
References:
https://link.springer.com/article/10.1007/s00192-020-04302-8
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5364755/
Cappuccino Physical Therapy is a pelvic floor physical therapy clinic in Thousand Oaks, CA.
