#AskTheExpert: Anastasia Uvarova: The Pelvic Floor Part 2 – During Labour and Delivery

We’re very pleased to have Anastasia Uvarova joining us again in Part 2 of this series on the Pelvic Floor, today telling us about its important role during labour and delivery.   

With so many changes occurring and issues affecting our Pelvic Floor function during pregnancy, labour, delivery and post-birth, we guessed that you will want to hear quite a bit about it! So, we’re doing a three-part #AskTheExpert with Anastasia on this topic, with: Part 1 covering the Pelvic Floor changes that occur during pregnancy and what it’s important to know during this stage of your life; Part 2 discussing the Pelvic Floor Before, During and Immediately After Birth and Part 3 telling you more about your Pelvic Floor Post-Birth and how to maintain healthy function for life.

Last time we talked about the pelvic floor anatomy, its general function and its importance in pregnancy. Today we will discuss pelvic floor function during the actual process of labour and delivery, where during this time it takes prime importance. The pelvic floor muscle overlies the diamond-shaped pelvic outlet through which your baby passes during labour and birth.

The Levator ani, the largest muscle of your pelvic floor, will undergo its maximum overstretch during labour to help your baby enter the world. Labour can be considered a marathon for a woman’s body, as the pace is sustained over a long period of time and picked-up gradually towards the end. Continuing with this analogy, the final pushing stage can be compared to the ‘final sprint’; where your pelvic floor overstretches relatively fast to its full capacity in a short period of time. Like any other muscle of the body it can be traumatized by such a ‘sprint’. However, there are ways to minimize the trauma to your pelvic floor during labour and birth and to maximize its recovery.  Please, read on if you have had/are having a caesarian birth, as the information is equally important for you C-section mums as well. Let’s begin!

Is there any way I can prepare my Pelvic Floor for actual labor?

During the process of labour it is crucial to be able to fully relax your pelvic floor muscles; the less resistance baby’s head gets on the way out, the fewer traumas will be sustained to the muscle. However, here I really want to emphasize that a ‘relaxed’ pelvic floor is not the same as a ‘weak’ or ‘not exercised’ pelvic floor. Considerable conscious practice is needed to ‘let go’. This is why I teach full contraction always followed by full relaxation. In a good prenatal class it should be the case too, whether this is through Pilates, Yoga or antenatal preparation.

Also, I must add that all of your body is interconnected. Hip, low back pain, tension in your neck and jaws all can affect our mental and physical ability to relax. Therefore, it is really important to address any major physical pains during pregnancy, as extra tension in your body will not serve the pelvic floor well and your well-being in general.

I would also advise to consider and discuss with your healthcare advisor alternative positions for the pushing stage to the one where you are on your back. From a physiology point of view being upright or in a neutral position (on your side or all-fours) is best for the pelvis as it can open up to its maximum and reduce strain on your pelvic floor muscle.

I am having/have had a caesarian birth, so there’s no need to worry about my Pelvic Floor, right?

I must admit that there is quite a big misconception about the pelvic floor in this respect. Firstly, I should mention that some degree of ‘damage’ has already been done to your pelvic floor during the nine months of pregnancy and therefore, all mums receive stress to their pelvic floors regardless of their ‘mode’ of delivery. Secondly, if it was an emergency caesarian, a mum may have undergone an extensive pushing stage, maybe even a failed attempt at instrumental delivery. All this can stress a pelvic floor greatly. Thirdly and most importantly, during caesarian section the abdominal muscles and fascia are cut. Deep abdominal muscle and fascia act as a synergist or simply speaking, best buddies, during contraction of pelvic floor muscles. Because of pain in the operation site and temporary loss of muscle integrity, abdominal muscles cannot contract effectively (or at all). This can lead later to a weaker pelvic floor and generally, the ‘core’ muscles and essential muscular support system of pelvis and spine.

What can I do to speed up or improve my chances of better Pelvic Floor recovery straight after birth?

Even in the most uncomplicated and easy delivery, some bruising to your pelvic floor will occur. In more complex cases, there can be some tearing and scars. It is important to keep the area clean and to avoid over-stressing it. I would recommend only essential walking and standing for the first few days (for some women even, this could be weeks)… Let the floor be dirty and pass on your grocery list to someone else! You can buy a soft-filled semicircle travel pillow and sit on it to avoid extra pressure to your perineum. Start some Kegel contractions as soon as you can do them, even if it is only three at a time. It will be a good indicator of your progress and ability to sustain muscle tone.

What should I expect pain level/sensation wise around my Pelvic Floor after labour?

This depends on so many factors: pushing duration; tears; cuts; assisted-delivery and a woman’s pain-threshold in general. Some women describe this as a ‘bruised feeling’; others as a ‘heavy, gel-filled’ feeling and some just get up and go like nothing has happened! Rest assured, things will get better day by day.

Is there anything that I need to be aware of that signals a potential Pelvic Floor injury/dysfunction after birth?

The most common indicator of this would be a urinary or even a faecal incontinence or major problems during sexual intercourse. It is common to experience some pain and discomfort when resuming intimacy after birth (again, after both vaginal and c-section), but major pain and absolute inability to have sexual intercourse is not normal, and should be checked with your specialist. Any persistent sensations like burning, throbbing or the opposite, a lack of any sensation should be addressed with your specialist. Also, dull otherwise unexplained lower-back pain can be an indicator of a pelvic floor problem.

Can Pelvic Floor problems be spontaneously resolved without special exercises and treatment?

The short answer is “Yes” with a “But”! Mother Nature cleverly provided us (well, most of us) with bones and pelvic floor muscles that stretch well and restore quite well most of the time. What she has not taken into consideration is the way modern women birth (positions, assisted deliveries), the lifestyle (a lot of sitting, not so much moving) and expectations (getting back to circuit-training at 40 days post-birth!). Helping your pelvic floor to recover, doing things gradually and lowering expectations (mostly society’s rather than your own) will help your body to restore and function well for many years to come. Steps I have mentioned previously will help you to avoid possible complications such as chronic pelvic and lower-back pain, organ lowering and prolapse in the future. It is worth the effort, your body will be grateful to you!

Thanks for joining us again Anastasia, to give us a really important insight in to how our pelvic floor is so vital during labour and birth and what changes to expect, even if we have undergone a C-section!

We’re really looking forward to the final part in this series, where you’ll be telling us more about our Pelvic Function post-birth and what we can do to maintain healthy function for life!

Anastasia is a practicing, qualified Physiotherapist and Clinical Pilates Instructor, with a special interest in musculoskeletal (MSK) dysfunctions in pregnancy, pelvic floor dysfunctions and post-partum rehabilitation. She acquired her training from the University of Bradford, UK and later the Pelvic, Obstetric and Gynecological Physiotherapy Association, UK. Working for five years as an MSK Physiotherapist and after having two children of her own, Anastasia has seen firsthand the extended physical struggles women can experience post birth as a result of poor Pelvic Floor function. Anastasia’s passion about this subject has motivated her to raise more awareness of woman’s health and continence issues in Cyprus. Anastasia has written several Physical Health- and Fitness-related articles for the online media in both Russian and English and has presented this topic in a number of public presentations for both professionals and the general public. She believes that a gradual and individual approach to physical well-being in pregnancy and post birth is the key to helping avoid many complications later in life.

A-Z Physio Health offers a professional consultation and treatment on pelvic floor, musculoskeletal dysfunctions and clinical Pilates (private and groups) in pregnancy and post-partum. You can find and contact us on Facebook @azphysiohealth, visit our website www.azphysiohealth.com or call 22446988 for more information.

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