The female pelvis goes through some pretty big and amazing changes during pregnancy and childbirth.
As the uterus grows and the baby becomes larger, the pelvic floor supports them, along with other pelvic organs.
You might also notice as your pregnancy progresses, many of your joints and muscles feel differently.
You may even end up with a ‘waddle' as you walk.
Hormonal changes begin long before labour to help your body prepare for birth.
It’s commonly believed that vaginal birth causes damage to the pelvic floor, and this is one reason why some women choose an elective c-section.
If you’re pregnant with your first baby, you might be wondering if a woman can give birth vaginally without damaging the pelvic floor temporarily or even permanently.
We know our bodies are designed to give birth vaginally, but does that design include pelvic floor damage?
What Is The Pelvic Floor?
We all know we have one, but where is and what exactly is the pelvic floor?
The pelvic floor is made up of muscles, nerves, blood vessels and connective tissues. It's found at the base of the bony pelvis and can’t be seen from the outside.
Sometimes the term ‘pelvic floor’ is used interchangeably with ‘pelvic floor muscles’ yet they aren’t exactly the same.
The pelvic floor muscles sling across the area where you sit, similar to a hammock. Pelvic floor muscles run from the pubic bone at the front, to the lower part of the tail bone at the back, and side to side from one sitting bone to the other.
What Does The Pelvic Floor Do?
The pelvic floor supports or holds up your organs, including uterus, bladder and bowel. There are also circular muscles that contract and release when your bladder or bowel needs to empty waste (sphincters). The muscles in the pelvic floor also work with the abdominal and back muscles to support and align the spine.
During pregnancy, the pelvic floor supports the growing uterus and baby. Your weight distribution changes, increasing the load on your pelvic floor muscles as they work to maintain pelvic and spine stability.
Hormonal changes cause your tissues and muscles to soften and become stretchy, in order to accommodate your growing baby and to prepare for birth. Stress incontinence (leaking urine) when you cough or sneeze is not uncommon in late pregnancy due the pressure and hormones.
What Are Pelvic Floor Problems?
Pelvic floor problems can occur when the pelvic floor muscles are stretched, weakened or too tight. Some women have weak pelvic floor muscles from an early age, and others experience problems related to the pelvic floor at different reproductive times during their lives.
Also referred to as pelvic floor dysfunction (PFD), these problems may include:
- Sexual dissatisfaction
- Urinary incontinence
- Leaking wind or bowel incontinence
- Skin and muscle tears
- Pelvic organ prolapse
Does Birth Cause Pelvic Floor Dysfunction?
There is a great deal of conflicting and confusing information about the causes of PFD. It's very common for health professionals to tell women that vaginal birth damages the pelvic floor. However, studies that look at the effects of vaginal birth on the pelvic floor include practices known to cause trauma to the pelvic floor.
These practices include:
- Epidural analgesia, which increases the likelihood of having an episiotomy and an assisted birth (with vacuum extraction or forceps).
- Use of forceps requires an episiotomy, and is likely to result in damage to the pelvic floor.
- Continuous fetal monitoring (CFM), which forces women to remain lying down or semi reclining. This restricts the opening of the pelvis, and forces the woman to push her baby against gravity. Women who have continuous fetal monitoring are more likely to have vacuum extraction or forceps births.
- Coached or ‘purple pushing', which is when the mother is told to take a breath, and then push hard for as long as she can. This can be very detrimental to the pelvic floor. The tissues need to gradually fan and stretch to accommodate the baby’s head. Forced pushing increases the chances of serious tears.
- Fundal pressure being applied, forcing the baby out before the pelvic floor has stretched naturally.
- Enlarging the opening of the vagina by cutting it during birth (episiotomy) can also cause trauma to the pelvic floor. Midline episiotomy (straight cut) common to North America is known to increase the risk for tears into the anal muscle. Mediolateral episiotomy (cut to the side) doesn’t seem to cause anal tears but it does go through muscle fibres. Healing is much longer and more painful and the scar can be uneven, pulling to one side.
How Can I Avoid Pelvic Floor Dysfunction?
Women who have elective c-sections can also go on to develop incontinence in the postpartum period. Having a c-section to avoid damage to the pelvic floor is a little like never eating apples in case you choke on a seed. The increased risks associated with c-sections are not worth the possibility of avoiding incontinence for the first year after birth.
Most women who develop incontinence after birth find the symptoms disappear within a few months – regardless of how they gave birth. It’s important to remember that damage to the pelvic floor can be minimised or avoided. Good nutrition (low sugar and grains, with plenty of protein, good fats, nuts, seeds, veggies and leafy greens), exercise and avoiding things like smoking are important things to consider when becoming pregnant.
Keeping your pelvic floor in good shape during pregnancy and after childbirth is a positive step you can take towards preventing long-term pelvic floor problems. Strengthening your pelvic floor muscles will help you to actively support your bladder, bowel and uterus.
Your pelvic floor muscles can be consciously contracted and released. Like other muscles in your body, you can train and strengthen your pelvic floor. If you aren’t sure what sort of exercises to do, see a specialist women’s health physiotherapist or osteopath. They can help you to understand the importance and correct way to do pelvic floor exercises.
Avoid practices and procedures during labour that can contribute to damage to your pelvic floor. Your care provider should be supportive of the process of natural birth and how to protect your pelvic floor without use of instruments or interventions. Hospitals tend to have routine procedures in place that you should be aware of before labour begins. Being informed and aware before the birth helps you avoid being placed in situations that can hinder your body’s ability to birth naturally and cause damage.
Choosing to have continuous supportive care during labour can go a long way to helping you avoid practices that may contribute to pelvic floor damage. Research shows that women who have a doula or experienced labour support person are less likely to have an assisted vaginal birth (vacuum or forceps), epidural or c-section.