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What Will Pregnancy & Birth do to me Down There?

Notice the baby's head resting on the bladder.

Notice the baby’s head resting on the bladder.

The Wall Street Journal reports today on a lesser discussed aspect of ‘bouncing back’ after pregnancy: pelvic floor strength. The piece came to me via Jezebel, where the blogger unfortunately covered this story as “pregnancy f*cks up” your body rather than focusing, as WSJ did, on the lack of good information and care given to women America. “I had more than one OB,” explains one mom to the WSJ, “and nobody ever said anything to me about pelvic health.”

Yes, pregnancy and childbirth can tax your body. It’s a big upheaval and a considerable transformation to grow another human. But the info we get about prevention and treatment for issues that can arise is confusing at best. Mostly our bits are ignored.

Your pelvic floor muscles, which form a kind of hammock criss-crossing beneath the reproductive organs, support all manner of organs and bodily functions including, notably, going to the bathroom. But a strong pelvic floor isn’t just about not peeing when you sneeze– these muscles actively support a lot of weight and activity. As the WSJ reports, a substantial percentage of older women develop pelvic floor issues such as stress incontinence (peeing when you sneeze, cough, laugh, etc) and organ prolapse (when the cervix/uterus drops down from its perch higher in the pelvis). Age is a big part of it. And genes. And fitness levels/weight. And whether you smoke. Number of pregnancies is a contributing factor. So before we start hating on pregnancy, let’s think more about how we can get the support we need.

In France, all women who give birth are assessed for pelvic floor problems and assigned specific, straight-forward exercises and tips for regaining strength. They work with a physical therapist for weeks or more; some women need just a little instruction to get them going, others need more targeted work. All of them receive good education about how to prevent problems! The WSJ points out that most women in the US rely on prenatal classes for help with pelvic floor questions and exercises. It’s great that there are knowledgeable yoga and birth teachers out there but not all women attend these classes for whatever reasons.

Most women have temporary stress incontinence during the third trimester because there is literally a baby’s head pressing down on the bladder, crushing it to a fraction of its former size. The WSJ points out that some mothers develop diastisis recti, a situation where the stomach muscles separate during pregnancy but then do not drift back together, forming a bulge (hernia) running down the center of the abdominals. The reasons why this happen are myriad, a lot of is luck of the genetic draw. But diastisis recti is less likely to happen if caught early and mom is given some good advice about how to minimize the problem. Once diastisis recti is in full effect, it can be impossible or very hard to reverse. Surgery (out-of-pocket) is an option.

Anyone who has had pelvic floor problems that went untreated for too long is pissed off at their care-providers. I’ve heard women rant and complain that in all those prenatal visits, the well being of their vagina and supportive muscles was totally glossed over if ever discussed. You’d think ob/gyns would be all about chatting about vaginal health. Dentists teach you how to floss. In France, the physical therapist inserts a finger, asks you to clench, asses your strength and offers you a plan for maintaining or improving it. Enough about France, though. Since Obamacare is unlikely to throw in vaginal gymnastics, gratis, we have to do the work ourselves.

Here are some ideas to start get you going. Do what you need to do, based on your body/genetics/circumstances.

Talk to your midwife or obstetrician during pregnancy about ways to prevent problems.

Do your kegels. The idea is to clench the muscles around the vagina and tighten them in an inward and upward motion. Women sometimes do them incorrectly and push down and outward. It’s totally fine to do these during pregnancy.

But not just kegels. The muscles in lower abdominal/buttocks/pelvic area are all connected and related– general “active lifestyle”/physical fitness will help your pelvic floor throughout life. Take some classes (maybe yoga) that help you identify these various muscles so that you can engage them even when you’re not at the gym. Once you know how to do it, you can be engaging your pelvic floor while typing at a desk.

No routine episiotomies, please. An episiotomy is an incision in the pelvic floor muscles given during the pushing phase of labor. These should not be given routinely. Avoid one by getting a doctor or midwife who rarely performs them.

When pushing, try a semi- or fully upright position so that gravity can play a part. This is possible with a low-dose epidural. Use of an epidural does, statistically, seem to increase pelvic floor issues but if you want or need an epidural ask that it be turned down for the pushing phase and/or get the epidural as far along in labor as possible. These steps might give you a bit more control. Interestingly, c-sections do not seem to reduce your odds of developing incontinence later in life. (Here’s a full breakdown on research into prevention of pelvic floor problems).

Get a referral from your ob/midwife to a physical therapist for a pelvic floor check-up after giving birth. Insurance may pay for this so look into it! You may only need one visit to get the instructions for exercises you do by yourself.

No sit-up exercises (that involve piking your body) during pregnancy and for the first several weeks after pregnancy. You should wait several months (or more) if you feel that your abdominal muscles may have separated or if you are in pain. Carrying a newborn and swaying, rocking, walking and doing some basic pelvic floor exercises will be plenty. Yes, it’s important to engage these muscles but its all about going easy and respecting the work your body has done giving birth!!

So, yeah, pregnancy is hard on the body. It’s also a time of incredible growth and change for many women and so I hesitate to linger too long on the havoc-wreaking aspects. We are born to give birth. Our bodies stretch and adapt. Sometimes the pregnancy is tougher than that and we need help. There are people who can help– they are out there!

Ceridwen Morris is the author From the Hips: a Comprehensive, Open-Minded, Uncensored, Totally Honest Guide to Pregnancy, Birth and Becoming a Parent. She writes frequently about women’s health, is a certified childbirth educator and teaches private and group childbirth classes in New York City. 

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