If you have a current pelvic organ prolapse diagnosis, you may have heard or been told to schedule a c-section to prevent your prolapse from getting worse. Cesarean birth is birth and a valid way to give birth, and there are many reasons that a c-section is the best option for you and your baby. But a prolapse diagnosis is NOT a reason to have a c-section.
It is important to understand that the mode of delivery (vaginal or cesarean birth) is not a strong of an indication of the severity of pelvic organ prolapse (or worsening of a current prolapse) nor does it decrease symptoms associated with prolapse.
Rather, your breathing and movement mechanics play a MUCH larger role in pelvic organ prolapse!
3 reasons why a prolapse diagnosis does NOT mean schedule a c-section.
Pelvic Organ Prolapse (POP) is when the pelvic organs (bladder, uterus, and/or rectum) push into the vaginal wall.
The grade (or severity) is determined by how low into the vaginal wall one of the organs falls into the vaginal canal. Grade 1 is the least severe, while grade 4 is considered the most.
Prolapse severity does NOT always equate to symptoms experienced. You could have a grade 1 pelvic organ prolapse and experience tons of symptoms (heaviness, bladder issues, etc.) while someone else has a grade 4 and experiences no symptoms at all.
Learn more about prolapse in our webinar with Hayley Kava, pelvic floor physical therapist.
There is an increased prevalence of prolapse with a vaginal birth BUT there is not necessarily an increased occurrence of symptoms associated with prolapse.
And there is not necessarily an increased worsening of prolapse after subsequent vaginal births. Prolapse may just be a normal part of postpartum if there are no increase symptoms or discomfort associated with the prolapse.
I would almost compare prolapse to looser skin postpartum. Our bodies are different after we go through pregnancy and birth, but it does not necessarily mean there is any decrease in function or an issue.
Our mode of delivery may not determine if we experience symptoms associated with prolapse, but the following things do play a much larger role:
- Breathing Mechanics
- Movement Mechanics
- Muscular Coordination
Let’s explore each of these so we can better understand how to approach managing prolapse during pregnancy and postpartum!
1. Prolapse is a Pressure Management Issue
The pelvic floor is a big player in our pressure management system.
As we inhale, the diaphragm flattens and moves downwards. This increases pressure DOWN into the abdominal cavity and the abdominal wall, back, and pelvic floor all lengthening in response to this increased pressure and tension.
Then depending on the demand (or lack thereof), we exhale to lift UP and IN to activate the pelvic floor and core canister. Or we exhale to relax.
Exhalations add muscular force to COUNTER the increased pressure under exertion or increased demand. This helps protect our pelvic floor from the increased pressure as we pick things up or move our bodies.
In general, inhales are DOWN and OUT, and exhales are UP and IN.
How we breathe can influence the pressure against our pelvic floor. If we breathe BACKWARD or inhale UP and exhale DOWN (or bearing down), we could be causing more issues.
Watch the video below for an explanation of diaphragmatic breathing and pressure management!
How we coordinate that breath to movement also plays a large role in managing prolapse!
We want to match our movement to our breath cycle:
- Inhales are eccentric (lengthening), so we want to match the inhalation to either before or during the eccentric portion of our movement. Ex/ inhale to lower in the squat.
- Exhales are concentric (shortening), so we want to match the exhalation to the concentric portion of the lift. Ex/ exhale to stand up from the squat.
Common Issues with Breathing Mechanics
Coordinating our breath to movement can support prolapse and overall function!
Issue 1: A common issue is that we exhale DOWN with the concentric or exertion portion of the movement, which can increase pressure down onto the pelvic floor and potentially worsen prolapse.
If you are lifting AGAINST gravity, you should feel the pelvic floor lift UP. If you feel an increased pressure DOWN as you lift against gravity (picking up a weight from the floor), then you are likely exhaling DOWN or bearing down onto the pelvic floor which can be problematic.
Solution: Focus on an exhale UP and IN as you move weight against gravity.
Issue 2: Another common issue is to NOT lengthen at all with inhalation in fear that an increased pressure downward with inhalations will worsen prolapse. But we need to lengthen the pelvic floor with our inhalation to generate power!
Solution: Focus on inhaling DOWN to feel increased pressure on the pelvic floor. If you feel nervous about this, try practicing inhalations in restorative positions such as supine or seated. You can also focus more on the rib cage expansion than the pelvic floor lengthening!
Watch the breathing drill below to learn a restorative breathing drill.
Want to learn more ways to connect with your pelvic floor as you prepare for birth? Check out our prepare your pelvic floor for birth course!
2. Movement Patterns & Muscular Coordination
Next, how we move plays a large role in pressure management of the pelvic floor!
Our spines are meant to move, and we are NOT promoting maintaining a rigid neutral spine position.
But we may find issues if we are ALWAYS favoring one posture or one position ALL the time.
This may contribute towards an uneven distribution of pressure against the pelvic floor and a muscular imbalance (particularly of the hip musculature and pelvic floor).
It is important that we can find neutral, and move in all directions comfortably with our spine and pelvis!
One way that we can promote this is with fitness training!
We tend to favor positions that make it easier for us to collapse into (such as tucking the butt under or arching in the low back).
But if we incorporate strength training, it makes it easier for us to find neutral and move in any direction!
Our prenatal and postnatal fitness programs support a strong pregnancy, preparation for birth, and recovery postpartum! Our programs are offered via the teambuildr app or on-demand with a video you follow along as you workout at the same time!
3. Prolapse does NOT mean decreased function!
Prolapse does NOT always mean decreased function or symptomatic! Many folks who have prolapse do not experience any symptoms of heaviness or symptoms associated with prolapse. Having prolapse does not mean that you have a pelvic floor issue or are dysfunctional.
For me personally, I have had a grade 1 cystocele pelvic organ prolapse (my bladder pushes into my vaginal wall), but there are no symptoms associated with it. It has not worsened throughout three pregnancies and births, and it has not affected my function AT ALL. So, having a prolapse does NOT mean that there is necessarily an issue.
I would compare prolapse to looser skin postpartum: our bodies are different after we give birth, but this does NOT mean that there is a decrease in function or capability!
The pelvic organs may sit lower after birth due to a number of factors, such as increased mass and loading during pregnancy, postural and movement habits during pregnancy, breathing mechanics, and the actual birth. But this does not mean that our function is decreased.
If you are experiencing a symptomatic prolapse, working with a professional can help tremendously! Pelvic floor physical therapist and a urogynecologist are two examples of professionals that can support managing AND improving any prolapse symptoms!
Pelvic floor physical therapy could improve prolapse severity and symptoms. Remember that the severity of prolapse does not always equate to symptoms experienced!
Working with a urogynecologist for an assessment and pessary can be helpful with managing symptoms, as well!
Prolapse is not a reason for having a cesarean birth!
Cesarean birth is still birth and a great birth option for many who may have a complication with a vaginal delivery. But having prolapse is not one of those reasons.
C-section birth will not necessarily prevent prolapse or stop the worsening of a prolapse, since there are a number of factors that could contribute to pelvic organ prolapse.
How we move and breathe throughout our pregnancy and postpartum seems to have more of a say in if we have prolapse, the severity of it, and if we experience any symptoms that interfere with our function.
In general, most of us don’t even know we have a pelvic organ prolapse, and it does not mean there is decreased function or an issue to even be concerned with!
Want to learn more about prolapse? Check our out webinar with Hayley Kava, pelvic floor physical therpaist!