(This blog was originally posted here when I was pregnant.)
The number one question I hear from my postpartum clients is, "Why did no one tell me this when I was pregnant?"
As a pelvic floor physiotherapist, I have the opportunity to work with women during pregnancy and the postpartum stages of life on a daily basis. Some women come in because of issues they're currently experiencing such as incontinence, pelvic pain, prolapse or diastasis (abdominal separation), while others come in to prevent these conditions.
I also educate expecting mamas and partners about childbirth including preparing your pelvic floor muscles, positions for birth to decrease stress on your pelvic floor and how to restore these muscles after childbirth.
I'm excited to be going on this journey personally as my husband and I are thrilled to be expecting our first baby in 2016. I can assure all my clients that I practice what I preach by carrying out all of the recommendations I give to them, during my own pregnancy. (*Since this original post, we excitedly welcomed our daughter in January 2016!)
Below are my top 5 tips for pregnancy so you can be informed before childbirth and share this information with other expecting mamas:
1) See a pelvic floor physiotherapist.
A pelvic floor physiotherapist has completed post graduate certification in assessing and treating your pelvic floor muscles which are a part of your Core 4 (pelvic floor, diaphragm, transversus abdominis, multifidus). The gold standard for knowing how your pelvic floor is working is with an internal pelvic floor exam since these muscles exist inside your pelvis.
Your pelvic floor is exactly what it sounds like: the floor of your pelvis, which has many key jobs:
stopping you from leaking urine, stool or gas.
supporting your tailbone, pelvis, lower back, pelvic organs and baby.
contributes to sexual function and lymphatic flow in your pelvic region.
...what other set of muscles is THIS IMPORTANT?
Having a prenatal pelvic floor physiotherapy assessment will let you know how your pelvic floor and cores muscles are working which will help guide you to a more comfortable and confident pregnancy, childbirth and postpartum recovery.
Many women assume these muscles are loose BUT they can actually be tense just like any other muscle in our body. If this is the case, it is important to release these muscles through manual release, breathing techniques and stretches. If these muscles are still tight when the childbirth time arrives, this can contribute to vaginal tearing, plus you could still continue or begin to have incontinence or pelvic organ prolapse.
Pelvic floor physiotherapists also educate about perineal massage and can recommend a device called the Epi-no which can help to prepare your pelvic floor muscles during the final weeks of pregnancy.
Pelvic floor physiotherapists can check if you have a diastasis (abdominal separation) which happens by the end of pregnancy for most women if it's your first child. If it's a subsequent pregnancy, you may be entering pregnancy and already have a diastasis. I recommend abdominal wrapping such as the AB tank or postpartum core recovery shorts such as the SRC recovery shorts to my pregnant clients for the first 8 weeks postpartum along with doing gentle deep core exercises as this is when you have some spontaneous healing of this abdominal tissue. (*Wearing the wrap or shorts on their own isn't enough. The proper deep core exercises are essential in helping your ab muscles return to supporting your body). If your diastasis isn't addressed early on, it can linger for years after childbirth and may contribute to incontinence, pelvic organ prolapse and low back pain.
2) Find a doctor/midwife who matches your thoughts and expectations about childbirth.
In Ontario, we have the option of an obstetrician, family doctor or midwife which are all covered by OHIP (not all family doctors provide obstetric care so it is best to ask your physician). An obstetrician or family physician provides the option of the hospital to have your birth while a midwife can offer hospital, birth center or home birth as options although this does depend on your medical status as there are times where only a hospital will be recommended.
For decisions such as purchasing a home or car, most people shop around and speak to various agents and dealerships. Why don’t we do this for such an important life changing event as childbirth?
Having a trusting and supportive relationship with your doctor/midwife will allow you to relax, experience less tension, feel more informed and empowered during pregnancy and the birth process. I recommend making a list of questions to ask your care provider before your first appointment and at every visit. These may include questions about the care provider's opinions/protocols about: induction, birth positions, epidural, caesarean birth as well as the likelihood that they will personally be at your birth as opposed to a backup or on call provider.
Remember, you are able to change providers at any time during your pregnancy if you don't feel you are being heard or supported, but by taking these steps at the start, you can set yourself and your baby up for a positive pregnancy and childbirth experience.
3) Seek out information regarding the various location options for childbirth.
In Ontario, most women have two options – hospital or home birth - but in some communities, birth centers are a third birth option. Location is also dependent on any medical concerns that arise prior to or during pregnancy which may lead to a hospital birth being the best option offered.
Are you wondering why the birth location may play a role in your birth experience? Tension and fear can have a relationship to the discomfort you can feel during childbirth as well as how labour progress.
You can help minimize these by creating a relaxing and supportive environment which can help increase your positive experience. Only you will know where you feel most at ease. If you have options, take the time to research each location and have tours of each facility. If you had preferred a location outside the hospital, but due to medical reasons you don't have another option, it's worth researching what options within the hospital are available to you to create a relaxing and supportive environment such as a birth tub, birth ball and doula (see tip #4). Creating a list of preferences to create a calming environment can help make your decision on location an ideal topic to discuss with your care provider.
4) Consider having a birth doula.
A doula is a support person for you and your partner during pregnancy and through childbirth. Having a doula during labour has been shown to help reduce the need for interventions such as forceps/vacuum, episiotomy and caesarean birth if these are events you wish to avoid and can help with pain management during labour.
A doula can't make decisions or speak on your behalf but can advocate and guide you on how to ask for information about the pros and cons of various recommendations so you can make informed choices in your birth process.
Doulas offer prenatal visits to get to know you and your partner but also provide education about pregnancy and options during childbirth that are not provided in prenatal classes. I recommend interviewing a few doulas until you find one who fits your preferences for childbirth.
The amount of exercise you decide to participate in is dependent on many factors including your pre-pregnancy level of exercise, energy level and medical status. If you're having morning sickness and/or decreased energy levels, just getting through the day may be the only exercise that your body can handle. And that's totally ok. Don't feel you need to push yourself when you're body is telling you otherwise. It's key to listen to your body and baby each step of the way.
When you find out how your core muscles are working (See tip #1), you will then have a guide as to what the most efficient exercises are for you to work on during pregnancy and postpartum. Along with seeing a pelvic physiotherapist, I recommend finding a fitness instructor who provides one-on-one or group class options and has up-to-date knowledge about how to exercise effectively with women who have or are trying to prevent pelvic floor issues. Some quality postpartum courses include: The Bellies Inc certification which is available across Canada, Julie Wiebe offers online and live courses across the US and Canada and JMG Fitness will be offering a live online course in Fall 2016.
Why push your body until it tells you it's not happy? Why not try to prevent conditions such as prolapse, incontinence, low back/pelvic pain and prepare your body for recovery postpartum ahead of time?
Exercises I recommend holding off during pregnancy are:
Sit ups/crunches (these can increase pressure in your abdomen which can put pressure on your pelvic organs, pelvic floor and low back).
Floor level plank (this can increase pressure in your abdomen which can affect a diastasis).
High impact exercise such as running or jumping (the combination of relaxin in your body which loosens your ligaments/joints, the increasing size of your uterus and baby and having a diastasis, increases the work load of your pelvic floor during these activities which can potentially contribute to incontinence, prolapse or pelvic/low back pain).
Every woman's pregnancy experience is an individual journey. Creating a positive birth experience doesn't necessarily mean all plans are carried out as anticipated. What's important is that you felt informed and supported along the way even if unexpected twists and turns occur in your journey.
Knowledge is power and I wish for every woman to increase her knowledge during the life changing events of pregnancy and childbirth to feel empowered in the process.
If you found these tips helpful please share with other expecting mamas. Click here to find more about how prenatal pelvic floor physiotherapy can benefit you and your baby during pregnancy and prepare you to efficiently recover postpartum.