Preparing to Push!
Exercise your pelvic floor muscles to prepare for childbirth
The pelvic floor is a small group of muscles and connective tissue that run from the pubic bone to the tailbone that function to support the internal organs, ensure healthy urination and bowel movements and contribute to satisfying sex. Like any other muscle group, the pelvic floor muscles can become weak, get injured or become dysfunctional leading to pain and discomfort. Unfortunately for many women, they don’t know about these muscles until it is too late. By getting to know your pelvic floor prior to childbirth, you will be ready when it comes time to push your baby out and prevent unnecessary post partum pain and dysfunction.
The second stage of labour (the pushing) is often the most dreaded with tearing and episiotomy being common fears. As the head emerges, the area between the vagina and the anus, called the perineum, can tear or be surgically cut (episiotomy). By strengthening and stretching the muscles and tissue of the pelvic floor you can prevent this perineal trauma.
Tearing ranges in degrees from first to fourth degree. First degree tears are small and superficial and typically heal naturally. Second degree tears are deeper and affect the skin and muscles of the pelvic floor and need to be repaired with stitches. Third and fourth degree tears involve the skin and muscles extending down to the anal sphincter with fourth degree tears extending even further into the anal canal and rectum.
While tearing is certainly not ideal, it is better than an episiotomy. Women who have an episiotomy often lose more blood during delivery, report longer, more painful healing times and are more likely to have weak pelvic floor muscles after birth. They are also more prone to infection, decreased sexual satisfaction and are at a greater risk of suffering third and fourth degree tears during the birth when the incision itself tears. By preparing the pelvic floor for pushing, women will have strong, flexible and healthy muscles thereby reducing the likelihood of tearing or requiring an episiotomy.
Pelvic floor exercise is the best way to prepare to push and prevent perineal trauma. Strong, flexible muscles are able to support the weight of the growing baby, are able to relax to allow the passage of the baby’s head and are able to recover more quickly post partum. Women with a strong and functional pelvic floor will also be less likely to experience post partum incontinence, pelvic organ prolapse and pelvic pain. Pelvic floor exercise should involve a strengthening component – Kegel’s – that are done throughout the entire pregnancy – as well as a stretching component – perineal massage – that is done in the last few weeks of pregnancy. Like the cervix that dilates to allow the baby to pass into the birth canal, the vagina must also stretch to a ten cm diameter to allow the baby’s head to emerge. A flexible muscle will stretch without tearing and a strong muscle will recover better from the stretch.
Kegel’s are performed by contracting the pelvic floor muscles in two different ways. First, contract and hold for ten seconds while continuing to breathe then relax and repeat – do this up to 100 times. Next, contract and relax in short, quick bursts. The best part about Kegel’s is that they can be done anywhere and no one knows you’re doing them. If you are unsure if you are doing them correctly you can try inserting a clean finger into your vagina and then squeeze it, you can squeeze your partner’s penis or you can use a biofeedback device that will allow you to see your contractions and your strength improvements.
Perineal massage can be done alone or with a partner. Lubricate your fingers well with a non-petroleum based lubricant or oil and rub enough into the perineum to allow your thumbs to move smoothly over the tissue and lower vaginal wall. Put the thumbs well inside the vagina (up to the second knuckle) and move them upward along the sides of the vagina in a U-type movement. This will stretch the vaginal tissue, the muscles surrounding the vagina, and the skin of the perineum.
Perineal massage will be uncomfortable but should not be painful. Concentrate on relaxing your muscles as you apply pressure. As you become more comfortable, you may wish to increase the pressure just enough to experience a slight sting in your perineum. This will allow you to become familiar with the sensations you’ll feel during the birth. You should perform perineal massage for five to ten minutes daily from about the 35th week of pregnancy until labor.
Preparing your pelvic floor for pushing with these simple, proactive exercises will improve your pelvic floor wellness now and for the future.