The Pelvic Floor During Childbirth


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What Happens To The Pelvic Floor During Childbirth?

When you give birth vaginally, the muscles at the top of your uterus will contract, pushing your baby’s head toward your cervix. As the baby travels through the vagina, your bones and ligaments will stretch and move to make way. Your cervix will dilate so your baby can travel through it, after which, your uterus will continue to contract in order to deliver the placenta.

Naturally, all of this is traumatic for the muscles and tissue that you count on for normal bladder and bowel function, which is why it’s so common for women who give birth vaginally to experience the leaking of urine or stool during and after childbirth. A few of the areas of your body that may be affected include:

The perineum – This is the area between the vaginal and anal openings. It’s what is cut when the doctor performs an episiotomy, though it can also tear on its own. Either way, the end result can be vaginal “looseness” or bowel problems.

Levator muscles – These provide critical support for your pelvic organs, but muscle strength can be compromised by childbirth.

Pelvic nerves 
– Injuries to your pelvic nerves are particularly common after long or difficult deliveries, and these injuries have been associated with incontinence.

Connective tissue – This helps keep your pelvic organs in the proper position, and they can stretch, tear or weaken during childbirth.

Pelvic bones – Every woman’s bone shape and structure are unique, and your pelvic bones can influence how easy or difficult your birthing process is.

Women who give birth via caesarian section aren’t immune to pregnancy-related incontinence, either – the surgical procedures of a C-section can also contribute to pelvic floor issues, and there are specific strategies that women can follow to make their recovery easier. Click here for more information.

Birthing Strategies

If you’ve been doing your Kegels and other pelvic floor exercises throughout your pregnancy, you’ll have gone a long way towards helping make the delivery go smoothly. But once the contractions start, there are other things you can do to help minimize discomfort, enhance the birthing process, reduce the likelihood of postpartum complications and potentially reduce episodes of post-pregnancy incontinence.

Relaxation – Once the pain kicks in, it’s awfully hard to stay relaxed, but if you can manage it, you can significantly reduce the pain associated with delivery. Breathing exercises, meditation, and mindfulness can all help you manage the stress of childbirth.

Choosing a position – While lying on your back is the most common way that women in America give birth, alternatives include squatting, sitting, standing and lying on your side. Some positions can increase the risk of pelvic or perineal injury – for example, lying on your back with your legs strapped into stirrups. Check with your doctor or midwife to learn the pros and cons of each position, and be sure to practice it well in advance of your due date, so you can find the position that’s likely to be most comfortable to you.

Time your pushing – Recent studies have found that, by allowing the fetus to “passively” descend through the birth canal with gentle pushing, you can reduce your risk for a difficult delivery, the use of forceps and perineal injury. Also note that prolonged pushing may sometimes increase the risk of pelvic nerve injury, fecal incontinence and bladder dysfunction, so you should have a discussion with your doctor or midwife ahead of time about what your reasonable limits for pushing may be.

Be aware of your baby’s size – Big babies tend to be associated with more significant perineal, rectal and pudendal nerve injuries along with incontinence. If your baby is 9 pounds or more, check with your physician to understand the potential complications and how you can best address them.

Be aware of the process – Vaginal deliveries sometimes require a physician’s intervention – in some cases, a vaginal birth can be halted for an emergency c-section (particularly if there’s undue distress to the baby or mother), the doctor may perform an episiotomy, or in increasingly rare cases, birth may be facilitated with the use of forceps or a vacuum mechanism. None of these is done indiscriminately – your OBGYN will only perform these when its considered medically necessary – but be aware that each off these can contribute to pelvic floor issues.

What about C-sections?
Did you know that about one in three births in America is performed via caesarian section? With that many procedures taking place, it shouldn’t come as a surprise to anyone that today’s C-sections are far safer than at any time in the past – but that doesn’t mean that they’re risk-free. Learn more about what to consider with a C-section here.