5 Pregnancy Tips from a Pregnant Pelvic Floor Physiotherapist

by Anita Vandenberg (PT)

The number 1 statement I hear from my postpartum clients is "Why did no one tell me this when I was pregnant?" As a pelvic floor physiotherapist I feel privileged to work with women during pregnancy and postpartum stages of life on a daily basis. Some women come in due to issues they are currently experiencing such as incontinence, pelvic pain, prolapse or diastasis (abdominal separation) while others come in to prevent these conditions. I also educate expecting mamas and partners about childbirth including preparing your pelvic floor muscles, positions for labour/delivery to decrease stress on your pelvic floor and how to restore these muscles after childbirth.

I am excited to now be going on this journey personally as my husband and I are thrilled to be expecting our first baby in 2016. I assure all my clients that I practice what I preach by carrying out all of the recommendations I give to them, during my own pregnancy.

Below are my top 5 tips for pregnancy so you can be informed before childbirth and share this information with other expecting mamas:

1)    See a pelvic floor physiotherapist:

A pelvic floor physiotherapist has completed post graduate certification in assessing and treating your pelvic floor muscles which are a part of your Core 4 (pelvic floor, diaphragm, transversus abdominis, multifidus). The gold standard for knowing how your pelvic floor is working is with an internal assessment since these muscles exist inside your pelvis. Your pelvic floor is the exactly what it sounds like - the floor of your pelvis which has many key jobs- stopping you from leaking urine (common but NOT normal before, during or after pregnancy) and stool/gas, supporting your tailbone, pelvis, low back, pelvic organs and baby, sexual functions and lymphatic flow in your pelvic region...what other set of muscle are THIS IMPORTANT? Finding out if these muscles are tight/weak or loose/weak are key in guiding you through pregnancy, childbirth and beyond. Many women assume these muscles are loose BUT they can actually be tight just like any other muscle in our body. If this is the case it is important to release these muscles through manual release, breathing techniques and stretches since when childbirth time comes, if these muscles are still tight this can contribute to vaginal tearing plus you can still continue or begin to have incontinence or pelvic organ prolapse.

We also educate about perineal massage and recommend a device called the Epi-no which helps to stretch and prepare your pelvic floor muscles during the final stages of pregnancy.

Pelvic floor physiotherapists also check if you have a diastasis (abdominal separation) which happens by the end of pregnancy for most women if it is your first child but if it is a subsequent pregnancy you may be entering pregnancy with already having a diastasis. I recommend abdominal wrapping such as the AB tank to all of my pregnant clients for the first 8 weeks postpartum along with doing gentle deep core exercises since this is when you have some spontaneous healing of this abdominal tissue. If your diastasis isn't addressed early on, it can linger for years after childbirth and may lead to incontinence, pelvic organ prolapse and low back pain since you lack support in the front of your abdomen with a diastasis.

2)    Find a primary health care provider who matches your thoughts and expectations about childbirth:

In Ontario we have the options of an obstetrician, family doctor or midwife as a primary health care provider which are all covered by OHIP (not all family doctors provide obstetric care so it is best to ask your physician). An obstetrician or family physician provides the option of hospital to have your birth while a midwife can offer hospital, birth center or home birth as options although this does depend on your medical status as there are times where only a hospital will be recommended.

For decisions such as purchasing a home or car, most people shop around and speak to various agents and dealerships. Why do we not do this for such an important life changing event such as childbirth? Having a trusting and supportive relationship with your primary care provider will allow you to relax, experience less tension, feel more informed and empowered during pregnancy and the birth process. I recommend making a list of questions to ask your care provider before your first appointment and at every visit. These may include questions about the care provider's opinions/protocols about; induction, birth positions, epidural, cesarean section as well as the likelihood that they will personally be at your birth as opposed to a backup or on call provider.

Remember you have the right to change providers at any time during your pregnancy if you don't feel you are being heard or supported but by taking these steps at the start you can set yourself and your baby up for a positive pregnancy and childbirth experience.

3)    Seek out information regarding the various location options for childbirth:

In Ontario most women have two options – hospital or home birth - but in some community’s birth centers are a third birth option. Location is also dependent on any medical concerns that arise during pregnancy or pre conception where a hospital birth may be the best option offered.

Are you wondering why birth location may play a role in your birth experience? Tension and fear have a direct relationship to the discomfort you can feel during childbirth and so by minimizing these by creating a relaxing and supportive environment, this can help increase your positive experience. Only you will know where you feel most at ease. If you have options, take the time to research each location and have tours of each facility. If you had preferred a location outside the hospital but due to medical reasons you do not have another option, it is worth researching what options within the hospital are available to you to create a relaxing and supportive environment such as a birth tub, birth ball and doula (see tip #4). Creating a list of preferences to create a calming environment can help make your decision on location as well as an ideal topic to discuss with your care provider.

4)    Consider having a doula:

A doula is a support person for you and your partner during pregnancy and through childbirth. They can help reduce the need for interventions such as epidural, forceps/vacuum, episiotomy if these are events you wish to avoid. A doula cannot make decisions or speak on your behalf but can advocate and guide you how to ask for information about pros and cons of various recommendations so you can make informed choices in your birth process. Doulas offer prenatal visits to get to know you and your partner but also provide education about pregnancy and options during childbirth that are not provided in prenatal classes. Doulas are not covered by OHIP but are a great investment for this life changing event. I recommend interviewing a few doulas until you find one who fits your preferences for childbirth.

5)    Exercise:

The amount of exercise you decide to participate in is dependent on many factors including your pre pregnancy level of exercise, energy level and medical status. If you are having morning sickness and/or decreased energy levels, just getting through the day may be the only exercise that your body can handle. It is key to listen to your body and baby each step of the way. Finding out how your core muscles and joints are working (see tip #1) you will then have guidance of what exercises are most efficient for you to work on during pregnancy and postpartum. I recommend along with seeing a pelvic physiotherapist is seeing a fitness instructor who provides one-on-one or group class options that has taken the Bellies Inc fitness trainer course. It is important to work with a trainer who has up to date education about core conditions including diastasis and how to safely/efficiently exercise to avoid causing or aggravating conditions during pregnancy. The Bellies Inc certification is available across Canada.

Why push your body until it tells you it's not happy? Why not prevent conditions such as prolapse, incontinence, low back/pelvic pain and prepare your body for recovery postpartum ahead of time?

Exercises I recommend avoiding during pregnancy are: 

- Sit ups/crunches (these increase pressure in your abdomen which can put pressure on your pelvic organs, pelvic floor and low back).

- Plank/4point kneel positions (these increase pressure on your abdomen which can cause or aggravate a diastasis).

- High impact exercise such as running or jumping (the combination of relaxin in your body which loosens your ligaments/joints, the increasing size of your uterus and baby and having a diastasis, increases the work load of your pelvic floor which can lead to incontinence, prolapse or pelvic/low back pain).

Every woman's pregnancy experience is an individual journey. Creating a positive birth experience doesn't necessarily mean all plans are carried out as anticipated but that you felt informed and supported along the way even if unexpected twists and turns occur in your journey. Knowledge is power and I wish for every woman to increase her knowledge during the life changing events of pregnancy and childbirth to feel empowered in the process.

To get started today with tip #1 book an appointment with a pelvic floor physiotherapist. Don't live near us? Try our directory for a pelvic floor physiotherapist near you.

By: Anita Vandenberg(PT), MSc(PT), BKin(Hons)

Registered Physiotherapist- Pelvic Floor and Orthopaedic

Certified Pilates Instructor, Certified in Acupuncture/dry needling

Birth Doula

Twitter: @Holistic_physio

Facebook: Anita Vandenberg – Registered Physiotherapist

www.physioexcellence.ca