10 tips; What Every Woman Should Know About Her Pelvic Floor Prior to Giving Birth

Okay, so this is a quick post. I have a few minutes to write before I drive my daughter off to her summer camp! Yikes!

I just read another blog post on core rehabilitation, written by a fitness specialist, in which it mentions vaginal child birth and inevitable, irreversible damage to the pelvic floor. Ugh...another. To those perpetuating this topic, please stop, it is fear mongering and not at all evidence based. To those (fitness specialists, health care providers, child birth educators, nurses, doulas and all)  preparing women for birth and core rehabilitation post birth, with accurate information, keep going! -you rightfully deserve a proper applause and standing ovation.

Long term, particularly post menopause, woman who have a C-section are just as vulnerable to pelvic floor dysfunction  (and possibly more due to the scar tissue). Furthermore sometimes the health industry undermines the need for women to heal when recovering from a C-section. In no way do I intend to dismiss C-section,  and a C-sections relevance, in particular situations, as a necessary measure to preserving not only the health of the pelvic floor, but also Mom & Baby. Speaking as a Child Birth Educator, there are exceptions, but these are exceptions and not the norm. Keep in mind, a C-section is major surgery, and Mother's recuperating from C-section may need to ease themselves into a modified, proper fitness routine. The same should be stated for women healing from a vaginal birth. Never make assumptions and generalize and be weary of articles that do.

Instead, let's discuss some preventative measures to maintaining a healthy pelvic floor:

1. Consider perineal massage, with your health care providers approval, 6 weeks prior to your expected due date. Here is a great article: http://www.midwife.org/ACNM/files/ccLibraryFiles/Filename/000000000656/Perineal%20Massage%20in%20Pregnancy.pdf As you are massaging you will begin to notice your vaginal area softening in preparation for birth. In the beginning your vagina may feel like the top of your ear, as you soften, the nose and finally the bottom of your ear (where ears are pierced).
2. Soak your vagina during labor. With your health care providers approval. Sitting in a tub will help you relax through the surges / contractions. It will also help soften your vagina in preparation for the delivery.  If a tub is not available, consider a sitz bath.
3. Prior to labor and delivery, ask if your health care provider routinely massages the perineum and applies pressure to the baby's head when she / he is crowning -most care providers at the Cleveland Clinic, and in general Midwives overall, have additional training on this technique.
4. In labor and delivery, request a nurse who will stretch the perineum and apply oil to the vagina during the last active phase of pushing.
5. If having a precipitous birth (quick birth under three hours) and a sudden urge to push, consider positioning yourself in the all fours position to reduce stress and strain against the vagina.  
6. Ensure you have a health care provider who does not routinely practice episiotomies (most do not). Ensure you have a health care provider who does not routinely use forceps and / or vacuums for labor and delivery (most do not).
7. Practice kegels correctly! In preparation for labor and birth, focus on the relaxing and opening phase of a kegel. Place an additional focus on relaxing the area between the vagina and the annus / rectum. Focus on this relaxing and opening when having a bowel movement and urinating.
8. During labor and birth, relax and focus on releasing as much tension from your body. Your uterus / fundus becomes the strongest muscle in your body and creates powerful contractions. Women during my Grandmothers generation, were semi-conscious during birth. Despite these women not being alert the uterus had an amazing ability to contract and allow baby to be pushed out. However, the interventions and medications used to sedate mom during birth,  created more complications and are rarely (if ever) used.  Nonetheless, relaxing will help the muscles of the vagina release and open.  
9.  When pushing consider slightly arching your back to pull the pubic bone away from the tailbone, this will open the pelvic outlet and naturally stretch the pelvic floor. If squatting ensure your pelvis is not curled or tucked under, instead tilt your body weight forward (against a squat bar, against the back of a water tub or against the back of a raised bed or headboard).
10. Consider aligning yourself with a physical therapist who specializes in pelvic floor health. Postpartum, whether you have had a C-section or Vaginal Birth, I strongly encourage women to have their pelvic floors examined by a physical therapist with a specialty in women's health and well-being.  Contact the child birth education department in your area for a list of recommended physical therapists.