The pelvic floors role in pregnancy and birth
Your pelvic floor will not push your baby out…
Any one a little shocked by the above statement. I thought I had my first birth prep NAILED because I really understood the way the pelvic floor and the diaphragm work together. I could do good strong holds of my pelvic floor and I spent a lot of time doing my pelvic floor exercises.
However my active labour was medium in length I experienced coached pushing. (Something I said I didn’t want in my birth plan but when faced with it couldn’t say no.) After birth it took 3 / 4 days for me to regain sensation in my pelvic floor and abdominal wall as a result of the coached pushing and the procedure I underwent to deliver my placenta. (for more information on birthing your placenta please see Sara Whickams book and blogs linked here https://www.sarawickham.com/byp/)
In this blog we will look at the pelvic floor and its function
How coached pushing might affect your pelvic floor muscles and post birth recovery
What you actually need to do to support your pelvic floor in pregnancy and birth.
The function of the pelvic floor in pregnancy
Your pelvic floor muscles surround your uretha, vigina and anus, They are connected to other muscle groups via facia, ligaments and tendons. One of the MOST fascinating things about your pelvic floor is that through these deep tissue connections the muscles of the pelvic floor connect to the muscles in the mouth! In fact during your utero development the mouth and the pelvic floor are created alongside each other! That is why you may have heard the phrase floopy face, floppy Fa*y or relaxed mouth relaxed pelvic floor! The muscles are like a little hammock and can be split into 4 quadrants. If you are really keen to know the anatomy or physiology hop on to this link https://www.foundationspelvichealth.com/pelvic-floor-journal/what-exactly-is-the-pelvic-floor
So let’s revise the statement your pelvic floor does not push your baby out. Sure the structure of the muscles that make the pelvic floor do help to support the cervix and keep your baby IN.
Your pelvic floor works as part of a team with your abdomen, thighs, hamstings, glutes, hip flexors even your shoulders to support lifting, walking, jumping and running its part of a system of muscles. Everything is connected and your pelvic floor is right in the centre so it is a really really important muscle group BUT you being able to actively contract hold and or pulse your pelvic floor (otherwise know as a kegal) doesn’t necessarily mean you will BOSS birth! If you don’t know what a pelvic floor contraction is you can visit the NHS website here. https://www.nhs.uk/conditions/urinary-incontinence/10-ways-to-stop-leaks/ NB I do not particularly agree with ALL of the information here but the NHS does make some good suggestions and provide details on how to do a contraction.
The role of the pelvic floor in labour.
How does your pelvic floor work in labour? Your pelvic floor will, by proxy, contract and relax during labour, because it is connected to your uterus as part of the larger system. The hammock of muscles that make up the pelvic floor actually provide a good structure for babies head to rotate on as it navigates through the pelvis. The muscle structure provides resistance for the swivel. However once your baby has twisted down into the lower part of the pelvis the pelvic floor muscles actually need to RELAX they need to really lengthen particularly the back quadrants to support the opening of the pelvic outlet. You can check out my birth positions blog here for more information on how to facilitate that with positioning.
How can we prepare our pelvic floor muscles for labour and birth?
First of all you need to understand where you pelvic floor muscles actually are! And this is when I would say a Kegal is useful. You can watch a little video below of me teaching the technique. Once you have found the muscle you don’t ever need to Kegal again!
What exercises can you do to support your pelvic floor muscles prepare for labour?
Anything at all! All movement activates the pelvic floor in some way so if all you can manage is walking GREAT! But if you want to try to do more Lunges are really useful. Either body weight lunges as you see in yoga flows or weighted if you prefer the gym. You can also do things to activate your hamstrings and adductors (inner thigh muscles) as they are best friends with the pelvic floor. I have a FREE yoga flow that includes these work outs if you email me via the contact page here with the words PELVIC FLOOR I can send you the video. Or you can hop over to my instagram page and checkout the reels for more info.
You can also work on lengthening the back of the body. Most of the women I see have tight posterior pelvic floor muscles. This is due to lifestyle, busy brains. lots of time sitting, internalising our emotions feelings all gathers up in big balls of tension that sit in the pelvis. One of my favourite exercise to lengthen the posterior pelvic floor in is my my birth positions blog checkout the MID PELVIS section here.
Coached pushing in labour
In summary your pelvic floor is not going to push your baby out. In fact when it come to the actual PUSHING your body has a reflex. Called the Ferguson Reflex or fetal ejection reflex. These are really strong contractions that push your baby out of the birth canal. https://www.healthline.com/health/pregnancy/fetal-ejection-reflex#what-it-is
This will happen for birthing women if left alone. Often women birthing in hospital are encouraged to push by a midwife (as I experienced in my first labour) This can be quite tiring and confusing for the mother who has to use her neocortex or thinking bit of her brain to follow the instruction of the midwife. This is counter productive to both the mothers body and the baby, in physiological birth. We need the thinking brain to switch off so that mum can really tune into her body and her baby as they work together to birth. Coached pushing can also really fatigue the pelvic floor and surrounding muscles! Lets think of it like this… If you were an athlete and you repeatedly did 4 push ups for 2 hours with very little rest in-between your muscles would be pretty blooming achey the next day and maybe for a while after. The same goes for the pelvic floor in birth.
This was by far the hardest bit of learning about labour for me. I’d seen so many people “pushing” on TV that I thought I need to train for pushing in labour to make it happen! It turns out what I actually needed to do was stop doing and start feeling. On the three occasions that I pushed in Beatrices birth it was on my own terms I got a feeling that I needed to. I did and out she came. This was the ultimate lesson for me. I finally believed that my body knew best. We just have to be in the right space to listen to it.
That is why I am a huge advocate for yoga in pregnancy, not because of the movement element but because of the time it allows for you to connect to your body. The meditations give you time to get curious about thought processes, you begin to really connect to who you are as a woman. It is that connection, that understanding that inner knowing that you need to find in pregnancy. Not kegals, a beautiful nursery and the best pram money can buy. You need to invest in you! Because you have grown this baby. Your body is made to birth it. It won’t be like you’ve seen on the TV, it could be long, it could be short. If you have invested the time in slowing down and connecting it could just change your life in the most magical of ways.
