Whole body strength
That’s right ladies not only do we want you to think about your pelvic floor muscles and maintaining them, but also whole body strength is super important to help prevent those niggles that can sometimes come with pregnancy, birth and postnatal.
In pregnancy your body will go through normal physiological changes to accommodate a little one or two, or three..ekk! This extra weight gain can challenge the areas above and below bum. Therefore having whole body strength will help to spread the load when carrying out day to day activities and help prevent the onset of pelvic girdle pain/ low back pain. If you intend to stand, squat or be on all fours during birth, you may want to train in these positions, few say birth is a sprint and more of a marathon, ultramarathon!
Looking 9-10months ahead you will you will be carrying, lifting a mini you + pram and all the gadgets that come with babies, don’t even mention car capsules! Being strong for all these new activities will make life much easier and I would say less visits to the physio. The amount of ladies I see postnatal for back, neck, shoulder pain.... lets get you ladies one step ahead of the game and keep exercising in pregnancy or start some strengthening and cardio exercises. If you have a non complicated pregnancy you should be aiming to achieve 150mins of cardio (walking, swimming, cycling, running, cardio classes, Pilates) and 2 strength sessions a week (weights training, Pilates) Doing exercise you enjoy is the most important
As well as staying strong, mobility is something we as physio look for a well, think of gymnasts strong but mobile, now we don’t all need to be aiming for the splits! But ensuring you have good mobility through out the whole body will make strength training much easier and again prevent those niggle that can come from sitting or standing all day, we will all have a routine with our jobs so doing exercises is a great way to get the body moving in ways we don’t normal do throughout the day
Be physically prepared for pregnancy and motherhood
Pregnancy can be a uncertain time with the bowels. Some women find their bowels are more frequent and loose were others find 5 days will pass and nothing....finding it really difficult to pass a chocolate log.
Constipation is when you need to push, stain, manually assist, splint or are passing hard lumping little chocolate nuggets or bricks ouch! This can lead to weakening of the pelvic floor muscles, prolapse, haemorrhoids (piles) or anal fissures (paper cuts of the anus)
A few tips to help you on your way to good bowels in pregnancy
Pop a stool under the feet
2 kiwis a day or plums, pears, prunes can help keep stool soft
Drink up to 2L of fluids a day
Go on the urge!
If you have a prolapse or find it difficult to fully empty try using your hand to splint the perineum (skin part between vagina and anus) when passing a poo
Have rest breaks throughout the day (in the ideal world!) if you stand for long periods to reduce swelling or haemorrhoids
Speak to your G.P or midwife with regards to the best stool softener or laxative for you if you are pooing less than 2 a week
We touched on this last week, when @Drcampbell did a great post regarding the research around perineal massage.
It is definitely something all women should be aware off if preferencing a vaginal delivery and should know how to carry out it out. It is pretty straight forward the difficulty is more getting down to the vagina entrance the massage yourself. However I do find most partners are very entheustic at helping out, pregnant women maybe not so much!. If you are unable to do it yourself and your partner is a keen bean, but you would like to reign in the enthusiasm! book an appointment in with us and we can guide them through it!
In the research woman as early as 32 weeks would perform this daily, however the standard recommendations tends to be from 35 weeks plus x 3 times a week for 5-10 mins.
I has been shown to be helpful in first time pregnancy, but I also suggest if you have had a previous episiotomy or tear there is no harm in massaging this area prior your next vaginal birth.
A few wee tips to get your started
Warm bath / shower or warm compress on the vulva area prior
Lube of your choice
Lying in a reclined position, knees bent with pillows supporting legs either side (comfort first ladies)
When applying a downward pressure no more than 4/10 pain / discomfort
Speak to your midwife this can also be performed during birthing, and discuss using warm compress’s to support the perineum which has also been shown to reduce the incidence of 3rd and 4th degree tears.
Towards the end of your pregnancy it is a good idea to explore and try out different positions you imagine yourself potentially using for birth. You might go heck what was I thinking, when you try them out. Options are good, as birth rarely will go to plan or how the movies show it.
You may be limited on birthing positions due to baby or if a epidural is required. It is important to speak to your midwives about pain relief and how if that will impact your birthing positions. Also take what you need to keep your pain under control ladies. Being ginger I would say the research is right (funny that) that ginger people require more pain relief!... yup not good on the pain front at all!
The pelvic is like a U bend pipe; therefore finding positions that take advantage of this are
Standing leaning forward
On hands and knees
kneeling supported by bed / prop or partner
Gravity can help bring baby down and out. Upright positioning helps the uterus contract more strongly and efficiently and helps the baby get in a better position to pass through the pelvis, studies have shown the dimensions of the pelvic outlet become wider in the squatting and kneeling or hands-and-knees positions compared to lying on your back Research also shows upright birthing positions may increase maternal satisfaction and lead to more positive birth experiences
Side lying position with your top leg supported or held by you or partner/ midwife has been shown in the to be the most protective position with regards to reducing pelvic floor trauma.
What about water births
Birthing in water reduces the use of epidurals and spinals for pain relief and shortens the first stage of labour by an average of 32 minutes (I’d take that!). Research shows no difference in pelvic floor function at six months postpartum between 25 first-time mums who had waterbirths and 27 first-time mums who had land based births.
Pelvic floor exercises
These are exercises to strengthen your pelvic floor muscles. The pelvic floor muscles are like a hammock that go from the front of your pubic bone to the tail bone at the back and span side to side. the wrap around the 3 openings (urethra, vagina, rectum) and help to maintain continence.
Research shows strengthening your pelvic floor muscles in pregnancy will help to prevent or reduce you having urinary or bowel leaking during your pregnancy and postnatal....sign me up!
What the best program?
One that is individualized to YOU, that will challenge your pelvic floor muscles and is progressive.
You see many people citing 12 sec x 12 x 3 sets x 3 days - that's defiantly something to work towards, but you might find you get pooped after 3 x 12 sec holds and then start doing lots of weird and wonderful versions of a pelvic floor contraction because google said that's what I should be doing. Get your pelvic floors to a pelvic health physio and they will tell you what is the best program for you to start with and how to progress.
What doesn't count as a pelvic floor exercise is
clenching your butt
doing a bridge / lifting your butt in the air
holding in your stomach
holding your breath and squeezing your pelvic floor
clenching your legs together
in fairness you might get a squidge of a pelvic floor contraction from doing the above or heck you might end up doing the opposite and bearing down, not helpful!
This is why seeing a pelvic health physiotherapist is SOOO important to make sure you are contracting and relaxing the RIGHT muscles and have a sweet technique
I'm a big fan of using apps to help women to remember to do there exercises as compliance can be super low and pregnancy brain can kick in! I understand these muscles are 'hidden' inside and it's hard to know are you actually making changes, if you have no symptoms, they I'd say they are doing their job. Again, another reason why you should see a pelvic health physio, they will examine the pelvic floor muscles and explain give you a run down on your current pelvic floor muscle status; tone, strength, endurance, coordination and fast contractions, they are also a few devices you can use if you like numbers to help monitor your progress.
Learning how to do pelvic floor exercises is pregnancy or even prior pregnancy is super helpful, it's one less new skill to acquire postnatal! and if you are in the routine of doing your exercises in pregnancy it will be easy to pick up postnatal.
Seek help if you:
cannot feel your muscles hold or relax
feel a downward pressure on your pelvic floor during or after your exercises
feel you are not making any progress
see no improvement in your bladder or bowel leaking
have back or pelvic pain, as this can interfere with your pelvic floor function
notice your symptoms getting worse
basically, if you are pregnant or planning a pregnancy!
Are you doing your pelvic floor exercises ladies?