Pelvic Floor Function and Preparing for Birth

“The pelvic floor is the bottom of the tote bag. Someone with a weak pelvic floor (too loose or too tight) has a tote bag that is about to have the bottom fall out!” ~Leslie Howard

As I traverse my own journey in preparing for birth, I have a few things that I would like to share. This particular post was inspired by a recent exchange I had in a FB group for home birth minded people. While I won’t go into the details of the FB thread, I will say that it inspired me to provide some education around pelvic floor health in relationship to preparing for vaginal birth while minimizing trauma to the pelvic floor.

First, what is the pelvic floor?

The pelvic floor consists of several layers of muscles that support the pelvic bowl, maintain organs in proper alignment and allow for functional movement of the pelvis and legs. Essentially, the pelvic floor is doing a lot of work for us all the time! It allows for external sphincter control for the bowel and bladder. It keeps organs lifted and creates stability for the torso (working in conjunction with the abdominal muscle network). It also works in conjunction with the diaphragm for optimal breathing.

The pelvic floor is our base, literally and also energetically. While some pelvic floor muscles can be accessed externally, most are only palpable vaginally or rectally. With that said, the pelvic floor muscles are very receptive to touch; however, most people only seek out body-based pelvic floor therapy when there is already dysfunction present, such as pain, incontinence or prolapse.

Part of my hope in writing this for you is that you will consider the benefits of body-based pelvic floor therapy just like you might consider a massage or a chiropractic adjustment. We have a ways to go, but this is the category that pelvic floor therapies need to be placed in for optimal health and wellness, especially for women.

The pelvic floor and modern lifestyles

The pelvic floor is greatly effected by how you move in your every day life. Western-centric culture, which generally includes a lot of sitting in chairs that aren’t designed for supporting good body biomechanics, contributes to pelvic floor dysfunction over time. Meaning that while the body is very adaptable and resilient, the pelvic floor may be adapting in a way that doesn’t support overall pelvic health. This can lead to hypertonicity or hypotonicity, or some combination of those factors.

Another common modern phenomenon affecting the pelvic floor is overuse or overexercising. This includes the many women who are engaged in intense yoga practices, cycling, long time dancers, horseback riders, runners and those who love cross fit. This is common in our culture at this moment; however, many of these activities can lead to excessive tone in the pelvic floor.

We also have to consider that the pelvis and the pelvic floor muscles store the somatic memories of sexual trauma and shame, which I would argue affects all of us in some way. It’s challenging to live in western-centric culture without having experienced some level of shame around sexuality.

These are all things to be aware of when you consider the proper functioning of the pelvic floor during pregnancy and birth. Pregnancy puts a great strain on the pelvic floor due to the additional weight, shift in gravity center and natural downward pressure of said weight. Yet, the pelvic floor is resilient and is most definitely capable of supporting a healthy pregnancy, birth and postpartum period without dysfunction.

However, we also need to consider the reality of what the condition of the pelvic floor is before pregnancy. If the function is already compromised from long-standing lifestyle factors, such as excessive sitting, overexercising or sexual trauma then it’s worth considering to get some additional support for pelvic floor health before giving birth vaginally. 

Vaginas work, babies come out

Within the group of people who are proponents of undisturbed birth, there is a general turning away from any intervention. This comes with good reason and I consider myself someone who is planning an undisturbed birth, knowing that that alone supports optimal pelvic floor function.

There is an understanding among midwives, doulas, childbirth educators and birth keepers that vaginas work as they should and babies come out. Indeed this is true. And it’s also true that sometimes vaginas tear, labia tear, perineums tear. Sometimes birth is traumatic or causes an injury to the pelvic floor. This is also true. Both can be true simultaneously.

When birth is traumatic or causes a lasting injury, it doesn’t mean that person is flawed or broken or her body didn’t work as expected. Birth is complex and includes many moving pieces from position of birthing to the woman’s perception of the other people in the room to all her prior pelvic experiences.

So, while it’s ideal to think that the pelvic floor can adapt to all these moving parts and pieces of the story to work perfectly in letting the baby pass through the birth portal without any tearing or trauma, it’s not exactly realistic given the information we have about modern pelvic floor function.

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I do believe that for the majority of women if they truly have an undisturbed birth where the body is the primary guide on the journey, then tearing or trauma will be minimal. However, this won’t be the case for all women. Not to mention that the vast majority of women are not choosing to birth in an undisturbed environment.

The question becomes, what do we do?

Part of the story definitely needs to revolve around education, educating women about the pelvic floor in general and also educating health professionals about the pelvic floor and how it’s resilience and health impacts birth specifically. We need to encourage women to trust their own bodies for sure and provide education around the benefits of undisturbed birth. However, it can’t stop there.

Women don’t need someone else telling them that their pelvic floors aren’t prepared for birth. That is not what this is about. I want to be very clear on that. Women’s bodies are not broken. Women are not to blame for this.

By far the most useful tool for women preparing for a vaginal birth and unsure of their pelvic floor health is to see a qualified professional to receive hands on, hands in pelvic floor therapy. This could be a pelvic floor physical therapist, sexological bodyworker or another practitioner with extensive training in this area.

Side note: If you’re local to Southern California, I recommend Whitney Sippl in Orange County, Lara Catone in Los Angeles and Kimberly Johnson in San Diego.

Beyond that here are some tools that I have used personally during pregnancy and would recommend to others:

  • Constructive rest and relaxation to release tension and down-regulate the sympathetic nervous system.
  • Make friends with your own pelvic floor by using a Njoy Pure Wand vaginally to release pelvic floor tension and stretch tissues in a comfortable, self-directed way.
  • Daily movement and walking. Prenatal yoga can be a great addition if it’s taught by someone with experience in this area.
  • Try to avoid sitting in a reclined position as much as possible. Sit on the floor, on a cushion or birth ball instead.
  • Gentle massage to the inner thighs, which benefits muscles that attach to the pelvis as well as energetic pathways that have a profound effect on the pelvic floor muscles.
  • Epsom salt baths to help bring magnesium into the muscles and soften tissues. This also builds yin energy in the body, which is essential during pregnancy and birthing.
  • Regular chiropractic care, massage and acupuncture.
  • Use an Epi-No Childbirth and Pelvic Floor Trainer (not available for purchase in USA). This device can be used to prepare for vaginal childbirth starting at 36 weeks of pregnancy. This can spark a lot of controversy within the birth community, just like perineal massage. However, I’m including it because it has helped many women and there is research indicating it’s effectiveness, which you can read here. (I have not used this yet but will write about it specifically sometime in the future.)

All of these tools are possibilities for connecting more deeply with the pelvic floor and birth portal prior to giving birth. They are not here to be a list of things you “should” or “must” do to prepare for physiologic birth. Some women will do none of the above and have perfectly intact perineums with minimal trauma after birth and some women will do all of the above and still experience some degree of trauma. That is the mystery of birth. We cannot plan or prepare for every potential situation.

Yet, that doesn’t mean doing nothing is the best option. With the increasing number of women having pelvic floor dysfunction after giving birth, it is important to consider using these tools and help women  make informed decisions about what may benefit them individually. I really believe that if you feel called to engage with a practice or healing modality it is for a reason and it will serve you in some way. My goal in sharing this information is that women have options, especially those who have some degree of fear around tearing or trauma during birth.

Final thoughts

These practices and tools may need to be modified after giving birth (or in the pre-conception window), so be sure to seek out professional support for your pelvic health. In an ideal setting, this would be routine care at 6 weeks postpartum. Until then, we must advocate for ourselves and make pelvic health a priority in all phases of life.

Further Resources

The work of Katy Bowman, which you can explore here.
Leslie Howard Yoga
Magamama: Expert Care for Women and New Moms

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