Pregnancy & The Pelvic Floor
Pregnancy, your pelvic floor, and how your naturopathic doctor can support you through conception to postpartum
Written by Dr. Fiona Callender, ND
Pregnancy is a time of enormous change - physically, but also mentally and emotionally. Our patients often have a number of questions and are seeking support in order to prepare for a birth that they feel both educated and empowered in. As a naturopathic doctor with a focus in perinatal care, it is my role to help prepare you for what to expect, help you grow a healthy baby, manage symptoms along the way, and be a support for any questions or concerns. With additional training in pelvic floor therapy, we can incorporate this into our plan in preparation for birth and postpartum.
From a naturopathic perspective, we address trimester specific concerns as well as concerns that are unique to you and your health history. Your fertility journey, your life stressors, your diet, exercise, symptoms, risk factors etc. are all relevant. We come up with a plan to optimize how you feel and support your birth aspirations as well as postpartum experience.
Pelvic floor therapy can be a useful tool in preparing for that postpartum experience. We want to understand and support the changes that occur during pregnancy and birth in order to prevent dysfunction of the pelvic floor and core in the long-term.
How often do pelvic floor concerns come up in pregnancy?
Disorders of the pelvic floor are experienced by as many as 1 in 4 women! Symptoms might include prolapse of pelvic organs, urinary incontinence - especially when sneezing, coughing or exercising - and impaired sexual function. There are some statistics that report up to 60% of adult women experience some degree of urinary incontinence - you aren’t alone if this is you! Many women experience this before pregnancy - especially in those that are highly active.
Demands on the pelvic floor: the why
Symptoms of pelvic floor dysfunction often come from a mismatch between the strength and integrity of the pelvic floor and the severity of demands that are placed on it. This may be individualized, not everyone will experience the same kind of demands on the pelvic floor muscles in their day-to-day life - or have the same resilience to these demands.
Challenges to the pelvic floor might range from mild stress in a healthy but sedentary person, to intense demands on the pelvic floor in someone with a chronic cough or someone who competes in powerlifting.
How Pregnancy changes the demands
The pelvic floor provides support to our organs (and a growing baby). The muscles and ligaments of the pelvic floor must resist downward force - both by the weight of the growing baby and by constantly changing forces that come from us moving normally, and anything else that increases in pressure in our abdomen (think, coughing or sneezing or landing in a jump). If we have injury to either the muscles or the supportive ligaments/tendons, the others muscles or ligaments may have increased demands placed on them. If both are injured or can’t support the load, we start to see symptoms.
These may include:
Pelvic floor injury
Prolapse
Urinary incontinence (leaking pee)
Pain
Pain with sex
How Birth Impacts
Vaginal birth is the most important risk factor for developing pelvic floor dysfunction. When a vaginal birth is followed by regular repair and healing, the pelvic floor recovers normally and no symptoms tend to pop up. Many people experience this and are able to return to normal activities with out rehab or support.
If we have any issues with repair, or we don’t recover well, we may start to see symptoms creep in. These symptoms might take years to appear (20-30 years later!). Addressing any issues early can be helpful, but it’s never too late!
Preparing for birth
In preparation for birth, the third trimester comes with changes in the the pelvic floor tissues. Perhaps the most remarkable of those changes involves the increased “stretchiness” of the muscles. They may allow for 300% increase in stretch!
This is important because we don’t actually “push” a baby into the world with our pelvic floor muscles. These muscles actually have to be coordinated enough to get out of the way! Relaxing our muscles is often the more challenging (and frustrating) side of pelvic floor training.
We can work together to develop this coordination as well as prepare you with relaxation techniques, positions for birth that reduce risk of dysfunction/tearing, breathing through birth etc.
POSTPARTUM
Working with a naturopathic doctor with pelvic floor training can also support your postpartum journey. We will discuss what to expect postpartum - from symptoms to watch for, lactation/milk supply, ensuring you have enough support for you and your families needs, monitoring your mood, and assessing your return to activity when you are ready.
Depending on the type of activity you do, and whether it has high demands on the pelvic floor and core (think, running, crossfit etc), it can be especially helpful to meet with a practitioner for assessment and education to ensure we aren’t returning before we are ready.
How can we help?
Although it is not possible to completely eliminate the risk of pelvic floor injury, there are ways we can minimize the risks.
Training your pelvic floor, through guided activities, examination feed back, and exercise homework can help prepare your whatever stage of pregnancy you are in.
Throughout your pregnancy (and before!) we can build strength and endurance in the pelvic floor muscles to be able to support the weight of a growing baby and maintain a strong core.
Closer to labour and birth we will also focus on learning how to relax the muscles of the pelvic floor. We know that a contracted muscle is more at risk of injury than a relaxed muscle. The mental side of “yielding” and “allowing” becomes part of birth-prep and reducing risk of injury/tearing. Through practice, training and building your body-brain connection, we can support you in feeling confident going in to birth.
Another aspect of my care includes working together to address your birth aspirations so you can advocate for yourself, being prepared for a variety of outcomes, and reduce fear.
We will talk about birth positions and strategies to help you feel prepared for whatever kind of birth is necessary or desired for you. We will create a plan for your postpartum experience and guide you through your return to activities. Working alongside your other practitioners, we will ensure you have support that makes sense for you, your values and aspirations, and your life.
Curious about how this might look? Book a meet & greet appointment with Dr. Fiona