The most common question we get asked as pelvic floor physiotherapists is “What can I do to protect my pelvic floor during birth?” The answer is…it depends.
Research in this area is a bit scarce, so I’ve written this blog based on a few different courses I’ve completed that discuss the little bit of research we do have.
Most women when they book their Pregnancy WOF want to know “a few exercises to stop them from having problems afterwards or get back to sport/running/exercises ASAP afterwards”
And the reality is these magic exercises simply do not exist.
Remember the biggest risk factors of leaking and prolapse are genetics - if Mum, Granny and older sister have had issues and/or surgery then you are more likely to have issues too. This is due to the make up of your connective tissue - the stretchier it is, the more at risk you are of these problems developing.
Pregnancy and labour is so very different for every woman, and each individual pregnancy is different. However, we do have some research that helps us predict a woman’s risk of:
prolapse and/or incontinence after birth (vaginal or c-section),
perineal trauma and anal sphincter tears 3rd and 4th degree tears(first and second + births)
anal incontinence - both faecal and flatus
And what this risk might be in the short and long term.
To predict and assess these risk factors, the pregnancy WOF is completed over 2 appointments:
first one before or around 20 weeks (can be done before 30 weeks at the latest)
second one at 36 weeks.
We assess the strength and tone of the pelvic floor via a vaginal exam (if appropriate), assess how well the pelvic floor can contract and relax. You can then be taught how to contract/relax if needed during the first appointment. We also take some measurements of the perineum.
Between 32 and 35 weeks, there is a big surge in hormones that literally cause the connective tissue of the pelvis and pelvic floor to soften and lengthen. By 36 weeks, the changes to the perineum have peaked and we can re-measure and re-assess the perineum and pelvic floor. If the length of the perineum is shorter that we would expect, and/or the pelvic floor is not able to relax and descend like it should, we can tach you how to relax and even start perineal massage/stretching the pelvic floor and perineum to help the pelvic better prepare for birth.
Having these assessments done before birth, and then around 6 weeks afterwards helps again to predict who is at higher risk of pelvic floor dysfunction in the future, and allows us to give women personalised advice on appropriate return to sport and exercise timeframes, as well as starting pelvic floor physiotherapy earlier to manage symptoms before they become bothersome.
This is an exciting time in pelvic health, we still cannot predict everything, but it gives women the power to take control of their bodies during labour and help predict who is at risk of significant risk of birth trauma, allowing them to discuss their options with their birthing team.