Optimizing your pelvic floor recovery post-birth actually starts in pregnancy!
Pregnancy itself is a risk factor to developing pelvic floor symptoms due to hormonal changes that cause softening/weakening of connective tissue and ligamentous tissue, plus the weight of the growing baby directly on the bladder and pelvic floor.
On top of this, childbirth (particularly vaginal birth) is another risk factor to developing pelvic floor dysfunction and perineal trauma. This risk increases with large baby weight over 4kgs, long pushing stage and forceps delivery.
My goal is to educate and empower women to be proactive during their pregnancy and immediately after giving birth to help reduce the risk of developing pelvic floor issues, such as perineal tears, prolapse, incontinence and painful sex.
What you can do to optimise your pelvic floor recovery:
1. Have a pelvic floor assessment with a Women’s Health Physiotherapist during your pregnancy. This internal assessment is ideal at the start of your second trimester, but worthwhile any time past this stage. In this assessment, the tone of your pelvic floor muscle is established (i.e. any tightness or tension), strength, contraction technique, endurance, motor control, ability to relax the muscles fully, and co-contraction with the deep abdominal muscles.
2. Start pelvic floor exercises during pregnancy. After having the internal assessment, an individualised exercise program focusing on strength and relaxation is tailored for you. The aim is for you to go into birth with a strong pelvic floor that relaxes completely and without any pelvic floor tightness/tension (as this can impede a vaginal birth). As a starting point to learning pelvic floor exercises you can download this Free Pelvic Floor Guide here.
3. Exercise safely during pregnancy. A combination of low-impact cardio and strength training (like Pilates) during pregnancy is really important to keep you fit and strong so you can have an active birth – which has been shown to reduce the second stage of labour duration. Due to the changes that occur in the pregnant body, it’s important to avoid high-impact exercise (e.g. running, jumping) and heavy weights from the second trimester to avoid additional pressure on the pelvic floor.
4. Birth preparation. At around 35 weeks, it is ideal to go through birth preparation to help achieve a smoother, empowered birth. This preparation should cover diaphragmatic breathing, pelvic/hip opening stretches, optimal birth positions, pushing technique, perineal stretching, the risks associated with birth instruments, the disadvantages of an epidural and more.
5. Perineal stretching. From 35 weeks onwards, it is recommended to do perineal stretching/massage, which has been shown to reduce the incidence of perineal tears. The alternative is using a device called the epi-no.
6. Optimal birth positions. Upright birthing positions, such as all 4’s, forward leaning on knees, squat or lunge, open up the pelvic outlet and allow gravity to assist the baby’s descent. Sidelying position (with your leg supported and foot higher than knee) is also a better position for your pelvis than lying on your back.
7. Optimal pushing technique. A way to help you push efficiently and effectively using your breath and upper abdominals without excess pressure on the pelvic floor is called the “coffee plunger push”. It's important to do this correctly via an internal assessment with a qualified women's health physiotherapist.
8. Warm compress. Using a warm compress on the perineum during the second stage of labour has also been shown to reduce perineal tearing and episiotomy.
9. Pelvic floor rehabilitation post-birth. Start 4-5 gentle pelvic floor exercises day 1 post-birth. Gradually increase holds and repetitions over the coming weeks. Use ice and compression on the pelvic floor immediately post-birth to assist healing and avoid straining when using your bowels.
10. Adequate rest. The first 6 weeks are a time for healing and recovery, so it’s essential that you rest horizontal everyday and don’t do housework. Even if you feel good, that doesn’t mean you should over do it.
11. Gradual & safe return to exercise. Many women return to exercise too quickly and end up with pelvic floor issues. Gradually increase walking distance every few days, reconnect to your core muscles and rebuild muscle strength safely. This online program The Postpartum Academy has a complete recovery Pilates program to follow from week 1-2 post-birth, focusing on healing the pelvic floor and abdominal separation.
12. Have a 6-week assessment with a Women's Health Physiotherapist. This includes an assessment of your abdominal separation, pelvic floor, any scar tissue, plus your bladder and bowel health. You will be given individualised exercises and strategies, such as scar tissue massage, and guidance on safe return to exercise.
13. Ongoing support from a Women's Health Physiotherapist. Continue to work with a qualified women's health physiotherapist until you achieve the results you desire e.g. to be asymptomatic, feel strong, return to high-impact exercise, have pain-free sex.
Anna Scammell is a Masters-trained Women’s Health & Pelvic Floor Physiotherapist in Sydney, and Founder of The Whole Mother. Anna specialises in pregnancy, postpartum & the pelvic floor, offering online consults for patients in outside Australia. She is also the Founder of The Pregnancy Academy and The Postpartum Academy- online educational & exercise programs teaching women how to have a healthier pregnancy, smoother birth and an empowered, stronger recovery.