Welcome to the MamasteFit Podcast! In this week’s episode, we will be discussing whether or not you should do key goals to prepare for birth with pelvic floor physical therapist, Hayley Kava.
Hayley Kava is a pelvic floor physical therapist based out of Minneapolis, Minnesota. She used to work at the MamasteFit gym as a PT, but as a military spouse, she moved to Minnesota. Currently, she is relocating to Kansas this summer and then hopefully back to us next summer.
Before we continue, let me ask you…
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Now let’s continue with our episode…
Hayley’s approach to therapy is non-traditional, going beyond clamshells and glute bridges, and she supports rehab as a full-body approach. In fact, she’s possibly the best physical therapist I know, and I credit her for the newer concepts we’ve developed here at MamasteFit. Thank you, Hayley, for being here!
Hayley: Thanks for having me for that amazing compliment. I think all pelvic floor physical therapists should be nontraditional and get outside of the box, and I’m excited to know you guys and be able to make this info even more accessible.
Gina: Yeah, I’m really excited to have you here with us to discuss this very hot topic: Kegels!
So many of us have been told to do kegels to essentially solve any pelvic floor issue that we have. Whether you’re leaking, if you have prolapse, if you have any sort of pain, or anything with a pelvic floor, the solution seems to be to do kegels.
But I’ve also seen birth professionals, including medical providers, recommending doing kegels as a part of birth preparation. And so I’m really excited to dive into this topic with you this week.
And so, I guess to start off with, the biggest question is, should we even be doing kegels to prepare for birth?
Hayley: No.
Gina: Podcast over. That was easy.
Should you do kegels to prep for birth? No.
if that task at hand is to allow those pelvic floor muscles to let a baby out and to be able to move our pelvis in a way that allows a baby out and lets our uterus sort of do the job, just contracting those pelvic floor muscles isn't it.
Hayley: That was tough. So just like a bicep curl is going to strengthen your bicep, if that’s the only strengthening thing you do, that’s not going to prepare you to reach up overhead and grab something off of the top shelf and bring it back to you.
And so, we want to train specifically for the task at hand.
And if that task at hand is to allow those pelvic floor muscles to let a baby out and to be able to move our pelvis in a way that allows a baby out and lets our uterus sort of do the job, just contracting those pelvic floor muscles isn’t it.
What is a kegel?
Roxanne: Can you describe what a kegel is? Because it’s definitely something that I’ve heard folks recommend to me personally when I was pregnant. But I think a lot of folks are confused on what even is a Kegel. Could you explain what that means?
Hayley: Yeah, Kegel was named after some male old OBGYN, I believe, and his last name was Kegel. And he thought that or taught people to contract the muscles that sort of stop our pee from flowing out or stop our poop from escaping our body and to squeeze and lift those muscles. And the thought was that that was going to strengthen the pelvic floor and improve its function.
And so, our pelvic floor muscles are capable of doing more than just a squeeze and lift. They also need to learn how to turn off and relax and expand. But that’s essentially what a kegel is, a contraction of the muscles that stop our pee and poop from leaving our body.
Gina: So, when we do pelvic floor activations, it’s more than just squeezing to lift up the pelvic floor because depending on how the pelvis is actually positioned, it can influence the type of activation we can have within the pelvic floor, including the type of release we can have in the pelvic floor. Correct?
Hayley: Yeah! So, while the muscles do sort of span from like our pubic bone in the front of our pelvis to our tailbone in the back, they also run from our sit bone to our sit bone on the side and they create this big bowl. And what I always say is that the pelvic floor is just sort of responding inside of the container that it’s in, which is the pelvis.
So yeah, the way we move our pelvis absolutely influences different areas of length or different areas of activation within that pelvic diaphragm as I like to call it.
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Birth Preparation: Preparing Your Pelvic Floor
Gina: What do you think should be like the ultimate pelvic floor prep for birth or rehabilitation exercise? If it’s not likely Kegels.
Hayley: I think we have to look at how do the muscles of the hip interact with the pelvis itself and then how responsive is that pelvic floor to the movements that we’re doing at our hip and at our pelvis.
So, an example I sometimes like to give is, and something that you guys post a lot is like outlet opening is we can open the outlet for birth for sort of that pushing phase with hip internal rotation and that helps facilitate outlet opening. What we want to be working on in pregnancy is does that hip, the muscles around the hip actually connect appropriately to the pelvis so that when we do that internal rotation, are we getting the length of the pelvic floor that we want or creating the space that we want in that outlet.
This course explore your pelvic floor anatomy, function, and how to prepare your pelvic floor for birth! This course includes educational videos, mobility exercises, relaxation drills, and how to relax your pelvic floor during labor tips.
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And so that might include actually strengthening inner thigh muscles, strengthening glute muscles so that we have that more solid relationship between hip pelvis and pelvic floor.
Gina: That makes sense to me because I think I’ve geeked out with you on this concept a lot, especially when you were in the gym with us.
Approaches to Pelvic Floor Birth Prep and Rehab
So kegels are obviously not the only answer and it’s likely not the answer for the majority of people. And the rehab or the type of movement that someone should be doing is going to probably vary significantly from client to client.
And so, seeing an in person or a virtual professional for your individual situation is probably incredibly beneficial but as a more generalized thing because not everyone who listens to this podcast will be able to work with you in person, unfortunately, what do you see as being more successful with approaching pelvic rehab, like after birth or the preparation for birth to be able to find that internal rotation to release that posterior pelvic floor?
if you can do nothing else, is learning how to get these two diaphragms talking to each other so that then when we're talking and we're breathing and we're moving, we're getting this automatic responsive reaction of our respiratory diaphragm and our pelvic diaphragm together.
Hayley: Yeah, so I’d like to call it the pelvic diaphragm because it is a sort of sheet of muscle just like our respiratory diaphragm in the bottom of our lungs is also a sheet of muscle. And that these two diaphragms really interact with one another as we breathe or they should interact with each other as we breathe.
And so I would say a humongous piece of advice if you can do nothing else, is learning how to get these two diaphragms talking to each other so that then when we’re talking and we’re breathing and we’re moving, we’re getting this automatic responsive reaction of our respiratory diaphragm and our pelvic diaphragm together.
Gina: What are some techniques that you use to help someone move those together or in coordination with one another?
Because I know that you do virtual consults, as well. So I guess what are some verbal cues that you would give someone to help them know that they’re moving their diaphragm and their pelvic floor in coordination with one another?
Hayley: One would be to feel your sitz bones down on your seat. So your pelvic floor are the muscles that are kind of where you would be if you were sitting on a bike seat. So being able to anchor down through those sit bones is an important part of sort of referencing that pelvic floor.
And then if you are at the steering wheel, you have your hands pressing into the steering wheel and we’re going to think about feeling your ribs move down as you exhale.
So when we exhale in our internal obliques or abdominals and our transverse abdominals engage. So abs that attach to those ribs move down. It actually helps our diaphragm to relax and move up. That exhalation phase of the diaphragm moving up helps support the pelvic floor.
Learning how to move up, we don’t necessarily have to actively think about that. But when we get that full and complete exhale, it helps that happen.
A lot of people during pregnancy and postpartum get into a reversal of that breathing pattern. And so lots of people will feel that when they breathe in, they feel their pelvic floor muscles tense up. And then when they blow out, they feel their pelvic floor muscles relax.
So now that the respiratory diaphragm and pelvic diaphragm are now not working together the way we’d like, you are thinking about, can I blow all that air out, feel those ribs move down? And then as I inhale, feeling my back body in my side body open up. And that helps that air maybe lengthen down into our back pockets or into our butt sometimes
I’ll say so that we know that we’re getting that length of the pelvic floor with the dropping of our diaphragm on that inhale and then reversing it again as we exhale.
But I often don’t bother queuing the squeeze and lift of the pelvic floor on the exhale because it should just be following along with that breath cycle.
Gina: So, when I see where folks will say inhale to relax, exhale to contract or to activate, which usually frustrates me because inhalations is a state of tension, as well. So, when we inhale, we’re feeling this increase in pressure.
Diaphragm is moving down, it’s stretching and lengthening the abdominal cavity. And then when we exhale, we’re having this recoil of all those muscles kind of springing back into their resting point. Or if we’re adding an activation to assist with stabilization with under demand or under load.
And so, it seems like the thoracic position and how the thoracic spine is moving can really influence how well we can release our pelvic floor, move our pelvic floor. And so you were talking about the side body releases and back expansion.
Is your pelvic floor relaxed??
Gina: If someone’s having a hard time feeling their pelvic floor moving like they’re listening and they try to go through all the cues, what would be some of the first things that you would recommend they do? If they’re like, “I don’t feel my pelvic floor move, or I don’t really know where my pelvic floor is.”
Hayley: Yeah, so sometimes we will add some extra reference centers for them. So we might have someone get into more of like a child’s pose position where their abdomen is supported a little bit more so they can feel some more of the movement of that diaphragm and then in turn, that pelvic floor. We also might try sitting on something that gives a little bit of feedback to those pelvic floor muscles. Maybe like a deflated ball or even like a big exercise ball so that we’re getting a little bit of that elasticity so we can sense the motion of that.
I’ve even had sometimes people sit on a foam roller. It’s a little bit harder, and it’s sometimes a little bit more tender on those pelvic floor muscles, but can give us that feedback that we need to see is our pelvic floor responding reflexively to our breath.
Does being an athlete mean c-section??
Gina: There’s sometimes a lot of misconception or myth that if you are really athletic, you will have a C section because your pelvic floor can’t relax. And that’s something that I’ve seen in different doula groups or birth working groups. They’re like, “oh my God, my client is really into CrossFit. Like I’m trying to make her stop, she’s going to have a C section.”
Is there any sort of trend that you notice with athletes or that does seem to be their pelvic floors are a lot tighter or is this something that’s like a little bit more generalized to the population?
I think there are absolutely ways that we can optimize those relationships of the muscles of the hip and the muscles of the pelvic floor and our breathing that are going to be more optimal for birth. But I wouldn't necessarily automatically say just because someone does CrossFit, they're going to have a harder time in labor birth. But there are maybe postural compensations that we see that sometimes can make that more difficult.
Hayley: Yeah, I mean, in the US. The C section rate is really pretty high and so I’m never going to discourage someone from doing something that’s helpful for their health and physical activity and strong bones and strong connective tissue, which is what lifting weights and being in sports is going to do.
I think there are absolutely ways that we can optimize those relationships of the muscles of the hip and the muscles of the pelvic floor and our breathing that are going to be more optimal for birth. But I wouldn’t necessarily automatically say just because someone does CrossFit, they’re going to have a harder time in labor birth. But there are maybe postural compensations that we see that sometimes can make that more difficult.
Gina: Are there certain sports that you see more pelvic floor tension that could inhibit labor, like our dancers or gymnasts or folks that really favor that extension and that arch position? Which I think is the postural position that you’re talking about, that could potentially result in labor stalls.
And if we've habitually been there, we're going to build muscle in those patterns. And so that posterior pelvic floor might run a little bit more tight, the anterior pelvic floor might have a little bit more tension.
Hayley: Yeah, when we’re in more of that extended position, like gymnastics or dancers are often in or other just sort of extension dominant sports. Yeah, that pelvic inlet is more open and the pelvic outlet is maybe a little bit more closed. And if we’ve habitually been there, we’re going to build muscle in those patterns. And so that posterior pelvic floor might run a little bit more tight, the anterior pelvic floor might have a little bit more tension, but we would really have to test to know for sure if that’s exactly what’s going on with someone. But yeah, I would say that we see that as a trend in those types of activities.
Roxanne: So just because maybe not everybody understands exactly what you mean by when you say extension position or extended position, can you describe what that exactly means? Is it more like externally rotated legs or more of extension in the spine, if you know what I mean?
Hayley: Yeah. So typically more like low back extension. So we think about how a gymnast would stand after they land. Their rib cage is sort of flared up in the front, so those ribs are kind of popped up, the back muscles are more active, and that pelvis is in more of like an anterior pelvic tilt. And so, when that pelvis goes into more of an anterior pelvic tilt yeah, typically the femurs will kind of follow out into a little bit more external rotation. So that might also look like turnout in dance. Right. So, toes are turned out, pelvis is a little bit more forward, those types of positions.
Gina: Would you call this a common postural tendency for most folks during pregnancy, or just like most folks in general also?
Hayley: Yeah, what I would typically see is that we come into pregnancy with our own patterns and compensations, and then pregnancy sometimes just exaggerates them a little bit more. And so as the belly grows, as the uterus changes shape, that’s going to add more pressure on the abdominals in the front.
And so lower back muscles that might pull you into more extension would maybe exaggerate that pattern a bit more.
Gina: Some of the prenatal and birth preparation type exercises that we incorporate within our Pelvic Floor Prep for Birth program and our prenatal fitness programs, include a lot of thoracic mobility, thanks to Hayley.
So we have a lot of back expansion exercises, lat releases because a lot of us are pulled into this extended position. So we’re like poking our butts out, like arching in our backs. And so our lats are just getting tighter and tighter and resulting in this more extended position as a common prenatal compensation.
And we see it with our gym clients as well. So a lot of them are very arched. And so we’re focusing a lot on finding this side body opening these lat releases, this back expansion to support the pelvic position.
Releasing Tension in the Pelvic Floor: Beyond the Squat and Butterfly Pose
Sometimes that's when we'll see difficulties with baby making their way through that pelvic floor or if there are underlying asymmetries that's sometimes when we'll see more asynclitic babies is because they get hung up more on one side of the pelvic floor versus the other.
Gina: And so we’ve kind of talked about the pelvic floor. There’s not one movement that’s going to stretch the entire pelvic floor. There’s not one movement that opens the entire pelvis. And so, when we favor these really extended positions, what parts of the pelvic floor are becoming more tense or tight that could potentially inhibit labor progress?
Hayley: Yeah, in those positions, generally, our posterior aspects of our pelvic floor tend to get a little tighter and shorter. A symptom of that would be constipation. Right. Name a pregnant person who doesn’t end up with a little bit more constipation.
Then, because it’s all a sort of diaphragm of muscle, if we shorten one area, the opposite area has to lengthen in order to sort of keep the structural integrity of those muscles. And so in general, then we see the anterior pelvic floor muscles are getting put on a little bit more stretch and lengthened out, which can feel like tightness also. And so that could look like painful intercourse or that could be urinary urgency or that could even eventually look like bladder leaking as well.
So, we tend to see posterior pelvic floor tightness and shortness and anterior pelvic floor muscle tension and length. And then we have our pelvic wall. So, our pelvic wall is our obturator internus and our Piriformis. And so if we’re dealing with sciatic pain or which is very common in pregnancy, our Piriformis sits more in that posterior pelvic outlet which is going to be tight and short in those more extended patterns.
And then our obturator internus which attaches to the hip also as we pull into those more externally rotated positions, tends to get tight and short also, which can cause pain.
And so when that pelvic wall is really restricted, I feel like, although I’m not in births like Gina, is that sometimes that’s when we’ll see difficulties with baby making their way through that pelvic floor or if there are underlying asymmetries that’s sometimes when we’ll see more asynclitic babies is because they get hung up more on one side of the pelvic floor versus the other.
Gina: Roxanne probably has the feedback for you on what she’s feeling during labor with what is happening within the pelvic floor when she’s doing vaginal exams for folks whose labors are stalling.
And it's funny because when we have babies coming down, this is a common thing providers will say when they're like, there is a ton of room in the back of their pelvis. So to me, it's like, oh, well, it's relaxed back there. But also there shouldn't be a ton of room in the back of the pelvis because that's where the baby should be. So that's also a sign that baby's in a bad position, usually, because the baby should be able to take up that whole area pretty easily.
Roxanne: Hayley, you have touched pelvic floors before, so you can kind of tell when there is some tension. And it’s interesting because when we do the vaginal exams for people, most of the time I’m not obviously feeling for tension, but I can tell when there is tension.
Because one, it’s more uncomfortable for them and they usually will tense up a little bit more because it is more uncomfortable when there is tension there as I’m trying to find their cervix.
But also I can feel almost there’s a difference between certain sections. So you can kind of feel it, and it’s hard to describe because some people it’s different in every person, I feel like. But it’s almost like bands. It’s like hard rubber bands, almost like within the vagina. And then it’s like again in certain spots.
And then sometimes when we feel that, we’ll offer for them to just do a little massage, where I’m literally all I’m doing is applying pressure against that tension and you can just feel it relax, which is super cool to feel, but I’m sure it doesn’t feel great.
I think 99% of the people that have ever done this have an epidural, so they don’t feel anything. But I’m sure it’s not super comfortable for people without an epidural.
Gina: Where are you feeling the tension normally? Normally towards the back?
Roxanne: So it’s normally towards the back. So it’s like you do like you can enter into the vagina and that portion is usually not uncomfortable. But until I have to reach further to actually get to the cervix, because obviously the cervix is not right there.
That’s where it’ll feel tighter and like a smaller sensation. Like, I have to feel like I have to kind of stretch it out a little bit just to get to the cervix sometimes. But yeah, I guess it is more at the back.
And it’s funny because when we have babies coming down, this is a common thing providers will say when they’re like, there is a ton of room in the back of their pelvis. So to me, it’s like, oh, well, it’s relaxed back there. But also there shouldn’t be a ton of room in the back of the pelvis because that’s where the baby should be. So that’s also a sign that baby’s in a bad position, usually, because the baby should be able to take up that whole area pretty easily.
That was just a side note when you said that. That’s what I thought of is providers will always be like, yeah, she’s got a ton of room back there. And I’m like, that’s an indicator of that issue. That means the baby is not in that room, so we should address this.
And so, what I think would be really interesting to do on like, a cervical check is what happens if you brought someone's knees into internal rotation, or what happens if you had them do a little bit of adduction. And what I feel during internal exams is that when we come into internal rotation, whether that's on their back or inside lying, is that those coccygeal bands melt away.
Hayley: Yeah, so our coccygeus really being one of those big muscles of the posterior pelvic floor that does tend to be a little bit tighter in more pelvic externally rotated positions and hip external rotation is going to pull us more into that.
And so, what I think would be really interesting to do on like, a cervical check is what happens if you brought someone’s knees into internal rotation, or what happens if you had them do a little bit of adduction. And what I feel during internal exams is that when we come into internal rotation, whether that’s on their back or inside lying, is that those coccygeal bands melt away.
Yeah, we can create a little bit more bony space so that those muscles can respond appropriately.
Roxanne: That is really interesting because most of the time when you’re getting a cervical exam, you’re in that butterfly position, which is super externally rotated.
Sometimes we have providers who will just have their feet, and so they’re in the neutral, almost internal position just because the patient preferred that position. And that’s the position the provider also preferred, because they’re like, yeah, why am I going to have them open their knees really wide?
That just makes it harder for me. I’m like, that makes a lot of sense. But why is it not normal, why is this not the norm amongst everyone?
Like, when you get a PAP smear, they don’t put you in that butterfly position. You just put your feet on the table and you’re in a neutral position or stirrups, but still, that’s like yeah.
Gina: So speaking of butterfly positions, I’ve seen you get a little spicy on Instagram with this, too. And I’ve also been feeling a little spicy because it’s frustrating me.
So, typically when I see these reels that are the top five pelvic floor relaxation exercises, every single exercise that’s recommended is external rotation. So deep squats, butterfly poses, pigeon, everything is with wide knees.
Do you think that those are really helpful for a lot of folks when it comes to preparing for birth to release their pelvic floor?
Do you think that should be a combination of different types of hip movements, or do you think it should be a lot more emphasis on releasing that posterior pelvic floor?
Which, spoiler alert, is not usually done with wide leg movements, as Roxanne kind of noted with her cervical exam experience.
This course explore your pelvic floor anatomy, function, and how to prepare your pelvic floor for birth! This course includes educational videos, mobility exercises, relaxation drills, and how to relax your pelvic floor during labor tips.
- 2+ hours of on-demand videos
- Immediate and lifetime of the course access
- Watch on Mobile Device
But the truth is that the hip external rotation range of motion might seem limited because they're already externally rotated.
Hayley: So from my standpoint, I’m never going to give an exercise without evaluating a patient. But we can generalize because of things that we know clinically and things that trends that we see with our clients and with our patients, is that in pregnancy, it sometimes seems like people lack hip external rotation.
But the truth is that the hip external rotation range of motion might seem limited because they’re already externally rotated.
So, you’re hanging out in that real kind of back arched, hips out, pregnancy posture waddling along like that, and then your PT or whoever assesses your hip external rotation and it hits a hard point like, oh, that’s really restricted, that’s really stiff.
Let’s go in and let’s just stretch that. But the issue is it feels tight because you’re already there. So that’s like taking your elbow, straightening it all the way out and going, my elbow is tight. So, if you keep stretching your elbow and try to get it straighter and straighter and straighter, we’re probably going to create some hypermobility at your elbow, which isn’t good for your elbow. So just like, if we’re already at the end of external rotation of the hip and then we stretch it into more and more and more external rotation, of course it’s going to feel tight. Of course, we’re going to feel tension and stretch, but not in the areas we want and not really to the end that we would like.
Right. So, we might even feel looser when we come out of that stretch because now we sort of we’re taking that tension off and it’s sort of slackening those tissues. But no, I wouldn’t say that that’s a good long-term strategy for preparing for birth or for supporting your healing in that postpartum period either, because we don’t want to create over tissue lengthening through that anterior pelvic floor, which is going to cause other problems down the road.
Gina: Yeah, I think I sent you a reel about somebody who was leaking whenever they squatted but was only with squats, which is a wider legged movement.
When we have that more external rotation, the anterior portion of the pelvic floor is in more lengthened state. The pelvic floor has a harder time potentially contracting and working to maintain continence.
If we’re always doing these really wide legged positions as we prepare for birth, then we are potentially not creating the release in portions of our pelvic floor that we need, which is usually the back half of the pelvic floor.
In our birth class, we have folks do a lot of hip-shifted exercises in different positions and side-lying all fours, a standing position, just to help them feel more of that, like, internal rotation.
And what I find is a lot of folks will find that their right side, when they move into the hip shift, feels like it’s stretching more when for most of us, the left posterior portion is tighter.
I think this really relates to what you were saying, where if something is already stretched and then we stretch it more, it feels potentially more intense than the side that maybe needed it more.
Gina: And that was kind of my experience through my pregnancy as well, was whenever I was trying to stretch more of my right posterior pelvic floor, it felt way more intense than when I did the left side.
But knowing my own body’s postural tendencies, I understood that my left posterior side was my tighter side. And so it’s an interesting sensation to feel that this side feels like it needs it more when really it’s already too lengthened.
Hayley: And so I think that’s where in my line of work is that I am going to have tests that I do with my clients to know where we are and to kind of confirm or deny our pelvic floor hypothesis.
But again, yeah, we all have, asymmetry that’s known, our right diaphragm is bigger than our left diaphragm, and it attaches further down our spine on the right than the left.
So there are these built-in humans that exist for everyone that are going to influence those relationships also in our pelvic diaphragm. And so being even aware that that’s a thing is a huge shift for a lot of traditional programs and a lot of traditional therapists.
Gina: Yeah, I definitely found that understanding, like the rib cages position relates into the pelvis and how it can influence how the pelvic floor can function, how it can release, was like a huge light bulb for me when I thought about pelvic mechanics and how the pelvis was moving during labor and what position should we be doing to help kind of release that tension and to help with baby’s position.
Because the pelvic floor plays a large role in your baby’s head positioning as well. So as baby descends into the pelvis, they’re pushing against the pelvic floor. And depending on the tension within it, which for a lot of us is probably asymmetrical, it can cause baby to tilt their head sideways, which presents a larger diameter to the cervical opening, which is obviously not what we want.
Or it can even cause baby to extend their head or they’re like looking up, which could also be problematic because it’s a very large circumference of baby’s head. And what we want is that chin tucked position, which the pelvic floor can assist with. And so, we don’t necessarily want a super loose and a super tense and tight pelvic floor as well.
There’s this big common misconception that the pelvic floor needs to be really strong to push your baby out, but really we just need it to release and just get out of the way as the uterus pushes the baby out.
There's this big common misconception that the pelvic floor needs to be really strong to push your baby out, but really we just need it to release and just get out of the way as the uterus pushes the baby out.
And I’m thinking of our reel where I like, shove Roxanne out of the way. Roxanne is usually abused in our funny reels. I think I have a few coming up where I’m the one who is being assaulted, but I’ve seen it a lot where folks are like, oh, you just need to do kegels so you can push your baby out.
And then when I’m like, your pelvic floor just needs to move out of the way. And they’re like, oh, well, I mean, you need to do kegels so that your pelvic floor is strong after birth. And I’m like, I don’t think that you and I have the same meaning of strong.
Gina: So this concept of releasing and relaxing the pelvic floor can be really hard because we could probably have an entire episode on societal expectations of women or females and how our bodies should look and how it should be as small as possible.
And so, a lot of us are like clenching and sucking in and being as small as we can to where we’re just kind of living in this state of tension.
What are some ways to help someone feel or know that their pelvic floor is released or it’s relaxing, which I’m sure is hard to do, but that’s definitely something that we have a lot of folks that are like, well, how do I know that I’m doing it? How do I know that it’s happening without seeing a professional? Which could obviously be probably the most, the easiest way to do it.
If you're going through your pregnancy and you are doing all the activities you want to do, you're not leaking gas, you're not leaking poop, you're not leaking pee, you're not having painful sex, and you're not having si joint pain or pubic pain or back pain. Chances are your pelvic floor is doing just fine.
Hayley: If our pelvic floor is functioning well, we don’t have to think about it.
And something that I always tell my clients is that our end goal of rehab is not that every single time you lift something, you also lift your pelvic floor.
And so if you’re going through your pregnancy and you are doing all the activities you want to do, you’re not leaking gas, you’re not leaking poop, you’re not leaking pee, you’re not having painful sex, and you’re not having si joint pain or pubic pain or back pain. Chances are your pelvic floor is doing just fine.
And so we don’t necessarily need to go searching for problems in there if things are doing okay. And even if you don’t have a sense of how that pelvic floor moves, but you’re not having any issues, I wouldn’t overthink it, I wouldn’t stress about it.
At 35-ish weeks, you can begin perineal stretching, which sometimes gives people a sense of how those tissues move with their breath, or if there are any areas in that pelvic floor that feel particularly tense or tight.
But again, as a way to learn how to just yield those pelvic floor muscles in the presence of some pressure or stretch or tension.
So generally, if I have a client who’s feeling really good, pelvic floor is doing what they want to do, they’re getting ready for birth, we’re working on how their body moves globally for that. We’re not doing anything specific for their pelvic floor, we’re just working on them as a whole human and that’s going to set their pelvic floor up for success.
If we have overall strong muscles in our body, our pelvic floor will also be strong. And that does help us after birth because we know birth is a planned injury to those pelvic floor muscles. They have to stretch to let the baby out. And if we’re starting from a point of good strength and coordination with the hip and our breath, then we’re going to be set up for success in that healing in the postpartum period.
But we can’t just like isolation tone our pelvic floor. That’s not a real thing, right? And so sitting there and putting a probe in and having like electric stem or having playing a game with the Kegel machine in our pelvic floor or sitting on a vibrating chair, those electric chairs, that’s very isolationist. Thinking of those pelvic floor muscles when we know both how our pelvic floor works and how birth is, is that it’s very integrated, right? This is a nervous system thing. This is a whole body thing. And so, if we’re thinking about it as just related to those pelvic floor muscles, we’re really missing out on what is really going on.
It becomes this very integrated system where there are so many different components that we're thinking about as we prepare for birth beyond just the pelvic floor. And I think for a lot of us, the pelvic floor is such a buzzword when it comes to the perinatal time frame. And I mean, it was a buzzword for me. I didn't even know what a pelvic floor was my first birth until I was pregnant.
Gina: Absolutely. So when we do our prepare for birth like work-up, it’s not just the pelvic floor musculature. So the pelvic floor is a part of this overall system that’s providing a lot of functions to our body.
And when it comes to birth preparation, the pelvic floor is not the only thing that can influence your labor, and influence your baby’s position. It plays a large role, but it’s just one piece of this overall system.
We need to look at how is the uterus set up, how the uterine ligaments attach to the pelvis, and the tension within the actual uterus and how that can influence the baby’s position. The surrounding musculature of the abdominal wall; that can influence whether or not it’s very pendulous, where the belly is really falling forward or it’s very tight, or it’s kind of constricting the belly. That can also play a role in our baby’s position.
Similar to how our thoracic spine is set up can influence the tension within our back and our lats and how we can position our pelvis and how we can release the pelvic floor.
And so it becomes this very integrated system where there are so many different components that we’re thinking about as we prepare for birth beyond just the pelvic floor. And I think for a lot of us, the pelvic floor is such a buzzword when it comes to the perinatal time frame. And I mean, it was a buzzword for me. I didn’t even know what a pelvic floor was my first birth until I was pregnant.
And I was like, what do you mean that there are muscles in my vagina? What do they look like? How do I work them?
But like you were saying, when we think about postpartum rehab, it’s not just can we make our pelvic floor strong again, it’s also how do your glute muscles work, how is your hamstring working, how’re your legs working, how is the rest of your abdominals working. And all of those are playing a big role in how our body is able to function.
But stacking the cards in our favor and optimizing our movement patterns in pregnancy and being knowledgeable about how to support ourselves in birth and having an amazing doula potentially to support us through that our partner to support us through that, really does set us up for success.
Hayley: Yeah, absolutely. I mean, my background before getting into public health was in sports medicine and orthopedic surgery. And you better believe if a professional athlete has an ACL surgery, we would never expect or we would never think that our rehabilitation of someone who had an ACL surgery would just be to sit on the table and squeeze their thigh muscle.
We know that that’s not going to do it. I know that that’s how you guys think, and I believe the same.
For first-time parents, I think that’s always really scary. It’s like all the things that could possibly go wrong with your pelvic floor is really frightening. But when you get informed about one sort of the anatomy of your body, the anatomy and physiology of birth and how it’s really designed for this and that it’s okay, and that you can do this and you will heal.
But stacking the cards in our favor and optimizing our movement patterns in pregnancy and being knowledgeable about how to support ourselves in birth and having an amazing doula potentially to support us through that our partner to support us through that, really does set us up for success.
And so I would say, largely clients that I’ve worked with, even on and off throughout their pregnancy, we really don’t need too much support postpartum right. Is that we can set that system up for success in pregnancy to have a really smooth postpartum journey. And I would love that I don’t have to see someone that much. Plus, you have all those have all those skills to really then get into a fitness program they want to get into or back into the activity that they love.
There’s a lot more to the pelvic floor than isolated movements that you can do similar to any other type of rehab. If you had ACL surgery, we would not do only quad exercises to strengthen your quad. It’s about how can we integrate it better into the overall system.
Our pelvic floor is set up by the way that our pelvis is positioned, which can be influenced by other structures within our body, such as our thoracic spine positioning. And so there’s a lot more to preparing for birth than just doing 500 kegels a day or doing tons of squats and butterfly poses to stretch, quote, unquote, your pelvic floor.