Reasons to See a Pelvic Floor Physio During Pregnancy
Reasons to see a pelvic floor physio during pregnancy
At The Pelvic Studio we are experts is assessing and treating your unique pregnant body. We strongly believe in Pelvic Physiotherapy being a ‘standard’ part of antenatal care. In other words, we believe all women who are pregnant should have a pelvic assessment at some point in their pregnancy irrespective of whether you experience any issues or dysfunction. This assessment is to prevent the common issues that occur during and after pregnancy and also treat these common issue should they arise.
Here are 5 reasons to see a Pelvic Floor Physiotherapist during pregnancy:
1. Learn to correctly use your pelvic floor muscles
WHEN: We recommend you book your first physiotherapy appointment around 12-14 weeks (though of course it's never too late!)
WHY: The pelvic floor muscles play an important role during pregnancy – they must be strong enough to support a lot of additional weight (usually around 11-16kg once you count the placenta, amniotic fluid and extra blood volume). The pelvic floor muscles also play an important role during labour – they must be able to relax so your baby's head can descend through the pelvis. Did you know that the pelvic floor muscles can stretch up to 3x their normal resting length during the 2nd stage of labour? No other muscle in the body can do this!
Research shows that women who do pelvic floor muscle exercises during pregnancy are less likely to develop bladder leakage, both during pregnancy and in the postnatal period. Pelvic floor muscle training is most effective when supervised by a physiotherapist, as everyone's pelvic floor is different and will need to focus on different areas (eg strength vs endurance vs relaxation). Additionally, many women who are given verbal or written instructions on PFMT will actually not be engaging their PFMs correctly.
HOW: Our physiotherapists have many ways to assess your pelvic floor muscle function. The gold standard (ie the way that gives the most useful information) is an internal vaginal examination. This means you take everything off from the waist down and lye down on a bed with a towel to cover you. The physiotherapist starts by looking from the outside, then uses one lubricated gloved finger inside your vagina to assess the strength, coordination, endurance, and relaxation of your pelvic floor muscles. If you do not feel comfortable to have an internal examination, or, you have been instructed to avoid anything inside the vagina, other ways of assessing the pelvic floor muscles include observing from the outside, or using an ultrasound machine over your lower abdomen.
2. Check Effective pushing technique
WHEN: We recommend booking this appointment for soon after your 20 week scan.
WHY: Recent evidence suggests that as many as 1 in 3 women may actually contract their pelvic floor muscles when bearing down (as if pushing out a baby). This is counterproductive, as the pelvic floor muscles need to relax so that the baby can descend through the pelvis.
HOW: The best way of assessing pushing technique is by observing and taking measurements of your vulva. Your physiotherapist can then provide individualised prompts and coaching to optimise your pushing technique.
3. Perineal Massage
WHEN: We recommend you book this appointment for 34-36 weeks. It can be really helpful for your partner to attend too, as they can help you do perineal massage at home. See our blog on labour preparation for more information.
WHY: There is high level evidence that doing perineal massage twice/week from 34 weeks onwards is linked to:
64% decreased risk of 3rd and 4th degree tears
21% decreased risk of episiotomy
70% risk of postpartum anal incontinence
Significantly reduced duration of 2nd stage labour
Significantly reduced postpartum perineal pain
HOW: Perineal massage helps you prepare for labour in two ways – one is by preparing the tissues around your perineum (the area between your vulva and anus). These tissues must undergo a lot of stretching when you birth your baby, so a bit of prep work goes a long way.
The other, perhaps more important, way that perineal massage helps you prepare for labour is by preparing your mind for the sensations you might experience during labour. Think of it as a dress rehearsal before the big show! While of course we can never fully replicate labour, doing perineal massage leading up to giving birth gives you an opportunity to practice some of the techniques you might use during labour (visualisation, breathing etc).
4. pregnancy safe exercise
WHEN: Our classes are safe at all stages of pregnancy. We’ve even had women at 40+ weeks!
WHY: There is so much conflicting information out there on what exercise pregnant women should or shouldn’t do. However, there is no evidence that being active during an uncomplicated pregnancy is harmful for mum or bub. On the flip side, there are lots of reasons why exercise is beneficial and recommended, including:
Prevention and management of gestational diabetes
Prevention of pre-eclampsia
Improved mood
Improved sleep
HOW: The recommendations from the Royal Australian and New Zealand College of Obsterician and Gynaecologist include: Aim to accumulate 150-300 minutes of moderate intensity aerobic exercise each week and aim to do muscle strengthening exercise at least 2 days per week (on non-consecutive days)
Our small group pregnancy exercise classes are the perfect environment for getting your strength training and some cardio into your week. Our classes are run by experienced physiotherapists, and include:
a) Functional group exercise using our cable machines and weights to gently improve strength and endurance
b) Pilates-inspired exercises using our reformer machines and mats to improve stability
c) Stretching to optimise mobility and reduce muscular tension
See our ‘Exercise during Pregnancy’ blog for more information.
5. Management of Pregnancy related pelvic girdle pain
WHEN: While you’re pregnant! PRPGP is a common complaint (up to 50-84% of pregnant women) which is often written off as one of those things you have to put up with during pregnancy, but this is not true! The good news is that most people see their symptoms disappear after the baby is born, but please don’t wait till then to get relief.
WHY: Pregnancy-related pelvic girdle pain (or PRPGP) is an umbrella term for pain around the pelvis/hips at any stage during pregnancy. Physiotherapists play a vital role in managing PRPGP, through assessing and addressing muscular tightness/weakness, prescribing pelvic support belts or garments and giving advice on appropriate exercise. See our blog on PRPGP for more information.