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How to protect your pelvic floor (and your lady bits!) in birth.

Pregnancy is often filled with lots of discussion about baby names, research of car seats and choosing colours for nurseries. What we aren’t usually as comfortable talking about is the importance of protecting our pelvic floor and perineum for our future postpartum health.

So what is your pelvic floor?

Part of your deep core, consisting of a group of muscles that stretch from your pubic bone in the front to your tailbone in the back. Our pelvic floor muscles have several important tasks:

To support, and hold your internal organs in place (bladder, uterus, rectum);

To maintain bladder and bowel control and prevent any leaking (ie when you sneeze, cough, jump or lift);

To stabilize your hips, pelvis and spine;

Allow for optimal sexual function without any pain.

During pregnancy these muscles need to be strong and functional so they can support the extra weight of the baby and help protect you from leaking urine while you are pregnant and after your baby is born.

Make sure to do appropriate pelvic floor exercises that strengthen the muscles (many are told to do Kegels but do them incorrectly).

Equally important are relaxation techniques for the pelvic floor muscles so you are able to expand and open for your baby as it makes its way through the birth canal.

Eat a balanced diet high in fibre and stay well hydrated to avoid constipation. The straining that comes with constipation will add additional stress on the pelvic floor muscles and can contribute to pelvic organ prolapse.

And what about my perineum?

As your baby makes his entrance into the world, you might end up with a tear. Often the tear occurs in your perineum – the soft skin between your vagina and your anus. Because of its proximity to where the baby exits the vaginal canal, as well as the pressure put on it while pushing, this delicate area is prone to tearing—especially for women having their first vaginal birth. While nothing can 100% guarantee no tearing, there are some things you can do to help protect yourself from a more serious tear.

Perineal massage is done to stretch and increase flexibility in the perineum in preparation for birth, in hopes of keeping the area intact—or at least minimizing perineal trauma during delivery.

Some women do it for themselves, and others will ask their partners to help. Often, it is done throughout pregnancy. The research does seem to suggest there is some benefit to perineal massage, however the difference hasn’t proven to be huge. So if you’re not comfortable with it, don’t stress. If you are comfortable with giving it a try, perineal massage can only help!

Get your midwife/doula/partner to apply warm compress to the perineum when baby is crowning can help prevent tearing. Some women find it uncomfortable and distracting however give it a try as it may help.

Birth in an upright position - there is now plenty of research to suggest that birthing upright can help prevent perineal trauma. Look into different upright positions beforehand and go through them with your partner so they can suggest them on the day! And even if you think you may have an epidural, ask about possibility of birthing kneeling and supported on the bed.

Birth babies head slowly, as much as is possible. This may involve spontaneous (as opposed to coached) mother led pushing, listening to your body, and not rushing the process of birthing babies head. It makes sense to “breathe your baby down” in order to slow down the process (and relax your body!).

Avoid episiotomy if possible. Research now suggests that in most cases, an episiotomy increases risk of a large tear. While there are definitely some circumstances where an episiotomy may be medically necessary, it would be worth discussing with your care provider before the birth to see their attitudes toward this practice.

Labouring in water has been shown to reduce the occurrence of perineal tears, and reduce the use of epidural which by extension allows you to stay mobile and birth upright/in comfortable positions for you. Waterbirths (giving birth in the water) appear to be more likely to have 1st or 2nd degree tears but less likely to have 3rd or 4th degree tears.

I would also always recommend that women seek advise from their GP/women’s health physio therapist should they still be experiencing any pelvic issues, incontinence problems or pain in the perineum after six weeks postpartum. It is very common and there is no need to be embarrassed as it can be helped and there is no need to suffer in silence.

If you would be interested in learning more about this or anything else related to birth please get in touch with me via the contact form, my social media or on 083 8345 954.

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