Hi friends! We often talk about seeing a pelvic floor physical therapist after birth to help with things like peeing when you laugh, painful cesarean section scars, pain with sex, and more. Did you know that seeing a pelvic floor PT DURING pregnancy can help prevent pelvic floor problems along with alleviating pregnancy-related pain? This week we will talk about the different things a pelvic floor physical therapist can help with prenatally.
Pelvic Floor Muscle Training
This is what pelvic floor physical therapists do best! While pelvic floor muscle training is often thought of as strengthening exercises, sometimes called Kegels, pelvic floor muscle training incorporates both learning how to contract the muscles and how to relax/lengthen them.
It’s important to be able to do know how to contract and relax during pregnancy and labor and delivery. During pregnancy, strong and coordinated pelvic floor muscles help to prevent issues like leaking pee. While laboring, if the pelvic floor muscles have good resting tone, this can help stimulate the baby to engage in the pelvic and help progress labor (Simkin, 2017). For a successful delivery of the baby, the pelvic floor muscles need to be able to stretch and lengthen to allow the baby to exit through.
Pregnancy Related Pain
It is common (but not normal), to have pain in the back, hips, and pelvis during pregnancy. Contrary to popular belief, just waiting until after delivery isn’t always the best plan. Many times, pain during pregnancy will persist after delivery if it is not treated. A physical therapist can evaluate you to help alleviate your pain while also helping you get stronger and move better throughout your pregnancy.
Perineal Massage
A physical therapist can teach you techniques for perineal massage. It is recommended to start perineal massage at 37 weeks. The goal of perineal massage is to decrease the risk of perineal tearing and postpartum pain with a vaginal delivery. To learn more about preventing perineal tears, check out our online self-paced workshop for only $24.99.
Birth Positions
Physical therapists are experts in the way our bodies move. They have special training to teach you different positions that will not only help in preventing a stalled labor, but that will make you most comfortable and avoid hurting yourself. (Even if you do have injuries form birth, like a nerve injury or perineal tearing, a pelvic floor physical therapist can help postpartum, too).
It’s ideal to meet with a physical therapist around 37 weeks to discuss different birth positions specific to you. For example, if you have knee pain getting on your hands and knees might not be the most comfortable position, so your therapist can give you alternatives. The can do this with many different conditions including pain in the back, hips, tailbone, and more.
In addition to your comfort during labor and delivery, your physical therapist can give you different positions to help the baby position itself in the pelvis while opening the pelvis to give the baby space to come out. You therapist will talk to you about different positions depending on what stage of labor you are in.
Education
Physical therapists are great teachers and can cover a variety of topics, including how to prevent conditions like incontinence and pelvic organ prolapse (Dietz, 2015). And let’s face it, you’re probably able to listen better before birth when you don’t have a newborn requiring all of your time and attention.
As a wise man once said, prevention is the best medicine. Take care of your pelvic floor before you have symptoms of pelvic floor dysfunction like leaking pee or poop, constipation, pelvic pressure, and pelvic pain.
To learn more about pregnancy and your pelvic floor muscles, check out these great resources:
Find a pelvic PT near you
Subscribe to access our video courses on demand at Pelvic Flicks
Take our course Labor and Birth: Preparing the Pelvic Floor with Melissa Dessaulles, PT
Watch our Pregnancy and Your Pelvic Floor YouTube playlist
Learn more about your pelvic floor on our Instagram
Visit our Amazon store for our favorite pelvic health products
Sign up for our email newsletter
For providers, check out our online courses to help your pregnant clients. Consider joining our Ambassador Program and most of our courses are included with your membership!
How to Help Prenatal Clients Prepare for Birth with Melissa Stendahl, PT, DPT
Contemporary Considerations for Management of Pelvic Girdle Pain: Pregnancy and Postpartum with Dr. Susan Clinton, PT, DScPT, OCS, WCS, FAAOMPT
Pacifying Pregnancy Pain with Dr. Caitlyn McCurdy-Robinson, PT, DPT
The Impact of Delivery on the Pelvic Floor with Dr. Sarah Boyles, MD, MPH, FACOG, FPMRS
How to Start an Acute Care OB PT Program Q&A with Dr. Ann Croghan, PT, DPT, CLC and Dr. Hanna Poe, PT, DPT
Pregnancy, Hormones, and the Pelvic Floor with Dr. Jill Krapf, MD, Med, FACOG
Written by Emily Reul, PT, DPT
References
Simkin P, Hanson L, Ancheta R. The labor progress handbook: early interventions to prevent and treat dystocia. 2017. John Wiley and Sons.
Dietz H. Pelvic organ prolapse—a review. Australian Family Physician. 2017;44(7):446-452.