How Pregnant Women Can Care For Their Pelvic Floor

Like a tiny island in the Caribbean or your favorite underground band, the pelvic floor muscles are often unknown—but once discovered, turn out to be super cool.

Pregnancy is often the first time someone encounters the pelvic floor muscles as the body undergoes some major remodeling.

But what exactly does the pelvic floor do during pregnancy, how is it impacted during delivery, and what’s the best way to care for it afterwards?

We’ll go over all of this and more in this post.

The Pelvic Floor’s Role During Pregnancy, Labor, and Delivery

The pelvic floor is a group of muscles that connect the left and right halves of the pelvis and are important for continence, pelvic stability, and support for your abdominal organs. During pregnancy, the pelvic floor muscles undergo a low load, long duration stretch like a bowling ball in a hammock. This stretch increases with the increasing weight of the fetus.

During labor, the pelvic floor has one job and one job only—get the heck out of the way! Contrary to popular belief, the pelvic floor does not play a role in pushing the baby out.

During delivery, the pelvic floor muscles must stretch to the width of the ischial tuberosities (aka your sit bones), and the uterus is doing the majority of the work of pushing. Pelvic floor muscles need to have enough elasticity to endure this stretch, to help decrease the risk of perineal tearing, episiotomy, or levator ani avulsion.

Why is Pelvic Floor Coordination Important?

Your pelvic floor muscles are unique because they’re not clearly visible, like a biceps muscle is. Without vision, we have to rely on proprioception to know when these muscles are contracting and when they are relaxing.

What does it feel like when your pelvic floor is contracting? What does it feel like when your pelvic floor is relaxing? Prior to delivery, developing coordination of your pelvic floor muscles is an extremely valuable skill to master, and it will help you discover the answers to these questions.

This is particularly true if you have an epidural, which numbs structures below the waist. This is because it’s even harder to coordinate the action of these muscles when you can neither see them nor feel them.

How Can I Increase Pelvic Floor Coordination?

Here’s a great exercise to practice and start developing that coordination. Begin by sitting on a ball or a soft surface, like a pillow, and follow the steps below:

• Contracting the pelvic floor: imagine you are lifting your perineum off of the ball, towards your head. Visualize your pelvic floor as an elevator and you’re going up.
• Lengthening or relaxing the pelvic floor: imagine you are lengthening your perineum down towards the ball without holding your breath. Visualize your pelvic floor as an elevator and you’re going down.

Once you’ve gotten an idea about what these two motions feel like, try out different potential labor positions, such as all-fours, squatting, or laying on your back.

If you’re a c-section mama, whether by choice or not, I see you. You may have labored prior to having a c-section, and the pelvic floor is not spared from the effects of pregnancy. Building coordination, strength, and the ability to lengthen your pelvic floor are still beneficial skills to build during pregnancy and postpartum to prevent future pelvic floor dysfunction.

At-Home Technique: A Self-Mobilization of Your Pelvic Floor

If you notice difficulty while lengthening your pelvic floor muscles, some mobility work can be very helpful. Self-massage of the perineum, for instance, is simple to perform and requires no equipment…

• Find a comfortable position where you can reach your perineum. This can be on your bed with pillow support, or in the bathtub with warm water. Use a
• Water-based lubricant if not performing in the water.
• Insert both thumbs or two fingers into the vaginal opening and provide slow, steady pressure towards the back of the vagina (towards the rectum) in a U-shape.
• Breath slowly and steadily. Hold this stretch until you feel a slight pinch or
• Pull using the amount of pressure you’d use to check the ripeness of a tomato.
• Continue to breathe and slowly glide the thumbs/fingers into a U-shape.
• Repeat this maneuver for 5 minutes.

Note: A pelvic wand can also be a useful tool, and allows you to reach deeper layers of muscles than with your fingers alone.

To Strengthen or Not to Strengthen?

Ideally, getting assessed by a specialized physical therapist, rather than following a blanket recommendation, is the best way to determine if you need to strengthen your pelvic floor.

A specialized physical therapist can assess your pelvic floor muscles both externally and internally (beyond the first trimester, in the absence of complications) to determine your individual needs for strengthening.

Conclusion

Pelvic floor health is equally important as other aspects of our health, especially during pregnancy. A little intentional care can go a long way to prepare your pelvic floor for birth and postpartum.