Pelvic Organ Prolapse can occur after birth. Pelvic Organ Prolapse is when one or more of the pelvic organs has pushed into the vaginal wall, and are beginning to descend downwards through the vagina. This could include: the bladder; the uterus; and/or the rectum. There are different grades associated with how far the organ has descended, but symptoms can vary from person to person even if they have the same grade and type of prolapse!
Some common questions that we receive are: “how do I push with a prolapse?” or “should I have a c-section to prevent my prolapse from getting worse?”
Let’s break it down!
Prolapse can be a pressure management issue; there is too much pressure downward, the pelvic floor is weakened, and organs move down. After a vaginal delivery or prolonged push phase, the pelvic organs normally sit lower. Over a few weeks, they will begin to ascend upwards as the pelvic floor and tissues of the pelvis heal and recover from pregnancy and birth.
If we do too much shortly postpartum, we may find that these organs cannot return to their original resting points because we have not provided an opportunity to recover properly. Our general recommendation is at least two weeks off your feet as much as is realistic for you and your family.
Here are our tips to help manage prolapse during pregnancy and birth:
Pushing may not be causing prolapse, but rather not focusing on healing postpartum. Take the time to rest postpartum, you may find this helps with prolapse more than anything else.
See a pelvic floor physical therapist during pregnancy. Working with a PFPT can help reduce the severity and/or symptoms of prolapse! This is especially true during pregnancy. A pelvic floor PT can work with you on pressure management, break down pushing techniques, and help you relax your pelvic floor.
Relax the pelvic floor. A tight or tense pelvic floor may actually be what is causing your perceived prolapse symptoms. Learning to relax the pelvic floor is incredibly beneficial for birth and pushing, but it can also help alleviate discomfort and issues during pregnancy.
Pushing Considerations
Pushing is all pressure. We increase the pressure in our abdominal cavity to push baby out; the uterus contracts, decreasing the volume to push baby out. We can manage this pressure to make pushing less stressful on our system, and easier on prolapse with a few considerations.
Upright pushing uses gravity to support fetal descent and birth. These positions, such as kneeling, standing, squatting, or all fours, help decrease the effort required to push when compared to a supine position. The decreased effort would mean less pressure is required to push your baby out, which is ideal for prolapse management.
Open glottis pushing, or exhale as you push, can help to decrease the maximal pressure or force of the push. This method of breathing is still effective, and can actually decrease pushing time and tends to be less stressful on both mother and baby. It does not appear to be as effective, since it seems like less effort (it is less effort). This method of breathing also helps the pelvic floor relax more, which may also make pushing easier.
Fetal Ejection Reflex or Laboring Down allows the uterus to passively push your baby down and out with little effort on your part. This is a sign from your body that it is ready to push, and the passive pushing helps to decrease the active pushing phase (aka when all the pressure is generated).
We break down pushing techniques, and considerations for prolapse, in our childbirth education courses and every other month pushing webinar!