Women are not expecting to come home from the hospital with a new baby and a broken body. Sure they may be a bit worried about what their body will be like after the baby is born but usually these thoughts center around the tummy – ‘Will I have stretch marks’? ‘Will I always look pregnant’? ‘Will my tummy ever be flat again’? Not many women are thinking ‘Will my bladder leak’? ‘Will my uterus fall out’? ‘Will I still be able to hold a tampon in’? Not many women know the intricacies of the pelvic floor and how to best support it in pregnancy and birth to help avoid postpartum pelvic floor dysfunction. Not many women know because nobody talks about it! If women had access to this information before or during their pregnancy, they could take steps to prepare their body, including the pelvic floor, for birth and know how to minimize the impact of pregnancy and birth on their bodies. Instead women are left with lingering issues after birth and are left saying ‘why didn’t anyone tell me this could happen?’.
The pelvic floor is part of the core – it is the foundation – and it plays a vital role in our everyday movement yet it doesn’t receive a lot of attention mainly because we can’t see it and also because it is a ‘taboo’ area of the body for many. The pelvic floor is a network of muscles, ligaments, and connective tissue that supports the spine and pelvis, maintains continence, plays a role in sexual function and helps keep our internal organs up in place. When a woman is pregnant the pelvic floor faces an ever-increasing load from the growing uterus, posture changes, and hormonal influences that impact the mobility of the joints and ligaments. During a vaginal birth the muscles and nerves of the pelvic floor will be stretched, feel intense pressure and may become injured. During a c-section birth the connective tissue involved in the network of the pelvic floor will be cut and surgically repaired leaving scar tissue. Any of these reasons can impact the function of the pelvic floor after baby is born and the mom may then face an uphill battle as she tries to restore and rebuild her core.
Critical information is missing from many prenatal resources that could help educate women and allow them to make informed choices in their pregnancy, birth and as a new mom. Information on birth positions, prenatal and postpartum perineal care, pelvic floor physiotherapy, posture checks and preventive and restorative exercise are all important topics for women in general, but especially pregnant women. They need to know that staying as upright as possible during labour and keeping the pelvic outlet open and unrestricted can assist the baby in moving into the pelvis and through the birth canal. They need to know that the side lying position for birth is one of the best positions in terms of preserving the perineum and that even if there is no tearing the perineum still needs to heal. Women need to know that at 6 weeks postpartum, even if they get a green light from their doctor or midwife, they should not sign up for a mommy bootcamp but instead make an appointment with a pelvic floor physiotherapist to get a thorough assessment of the pelvic floor so they can prevent the development of postpartum incontinence and pelvic organ prolapse.
When the pelvic floor loses its ability to support the spine and pelvis, maintain continence and hold the pelvic organs in place it is known as pelvic floor dysfunction that can present as back pain, stress urinary incontinence (leaking with you laugh or jump), urge incontinence (feeling like you can’t make it to the bathroom), pelvic pain, sexual dysfunction, and pelvic organ prolapse (when the bladder, the uterus and/or the rectum shift downwards and eventually out of the vagina). With the right knowledge and preparation, much of this type of dysfunction can be avoided or minimized. Learning about the conditions as a new mom and having to work at restoring function while learning how to care for a newborn is obviously not ideal and presents an uphill battle that many moms are not prepared for. It is much easier to prepare than repair.