From celebrity bump watches to high-end maternity collections (like our own), we live in a world where pregnancy is seen as stylish and sexy. But we’re not gonna lie—after delivery, your vagina will have gone through a lot. And much like the rest of our bodies, the pelvic floor changes during pregnancy, losing strength and elasticity as the strain of supporting a developing baby significantly increases the workload of our muscles. Allison Oswald is a mother, wife, Pilates instructor and Doctor of Physical Therapy who works with women to align, strengthen, and restore their bodies before, during, and after pregnancy. We asked Allison to walk us through some of the common problems associated with pelvic health, the solutions and how to embrace our bodies during the process.
HATCH: What are some of the most common problems associated with pelvic health and pregnancy?
AO: Many women are able to experience a pregnancy that feels good and is pain free. But for some, they may also experience pain and discomfort. Some of the problems that I commonly see are sacroiliac joint dysfunction, incontinence, pubic symphysis dysfunction and diastasis recti also known as DRA.
All of the above mentioned dysfunctions could cause back pain, hip pain and even difficulty walking. Incontinence, or the uncontrolled loss of urine, can cause women much embarrassment and shame, I’ve had patients tell me about this issue postpartum, alluding to the thought that they did not feel anything could be done during pregnancy. This is a common but frustrating thing for me to hear, because I know that a lot can be done during pregnancy to address all of the above-mentioned issues and more. However for some reason women often believe that during pregnancy they just need to “suck it up” so to speak.
HATCH: How can actively taking care of your body and strengthening help during labor and childbirth?
AO: When a woman can connect to her pelvic floor, meaning she understands where it is, what it is, and how it functions, she is more empowered and has a strong sense of her own abilities during labor and delivery. The pelvic floor is the passage in which your baby will come into this world, so being able to visualize and utilize those muscles properly is essential during labor. Clinically I have seen women have more efficient and less traumatic deliveries with this preparation.
HATCH: What can we do during and after pregnancy on a daily, weekly, or monthly basis to better the health of our pelvic floor, and our business down there in general?
AO: Whether it is during pregnancy or not, the key to better the health of our pelvic floor is alignment and breath. In order for our core system (pelvic floor, diaphragm, abs and back) to function properly, these components need to be stacked properly. This is very individual, but is basically aligning the diaphragm (breathing muscle)/rib cage over the pelvic floor. This would leave a small natural curve in the low back.
The next step is to learn to breath properly with your diaphragm. Upon an inhale the ribcage should expand 360 degrees aground (not breathing just into your belly and definitely not up into your neck and shoulders), as this happens the pelvic floor lengthens down. Upon the exhale the ribcage comes back together, the diaphragm comes back up and the pelvic floor recoils up and in.
When this coordination is not working, I tend to see shoulder breathers or women who suck their stomachs in all day, and they are the ones with pelvic floor dysfunction.
A few quick tips are:
- Stack your ribs over your pelvis
- Breath through your ribcage/diaphragm
- Don’t suck in your stomach
- Don’t tuck your butt underneath you
- Don’t sit all day, especially without proper alignment
- If something doesn’t feel right, seek out a pelvic floor physical therapist, it is never too late
HATCH: What steps can women take to solve the “pee issue”? During pregnancy, but especially after?
AO: A “pee issue” is a pelvic floor dysfunction, which means that your pelvic floor is not able to do what it is supposed to do. It does not necessarily mean that your pelvic floor is weak; it just means that it is not functioning at its best, and could actually mean that it is not able to fully relax/lengthen. Your pelvic floor needs to be able to counteract the pressure that is created in the abdomen (ie.full bladder, cough, lifting, etc.…), which is also known as your intra-abdominal pressure.
During pregnancy, you should focus on your posture, alignment, breath and body mechanics so that you are not putting undue stress or strain on your pelvic floor. Unless you are having symptoms like peeing in your pants, then you do not have to actively do pelvic floor exercises such as kegels. This is a common misconception.
Post pregnancy, the same thing applies. Posture, alignment and breathe, movement patterns are all important to make sure that you are creating a situation in which your muscles can work as they should. If you are tested internally by a pelvic floor Physical Therapist, you will receive a program that is specific to you. Whether that is to contract or lengthen your pelvic floor or possibly release trigger points to improve function. But most importantly to “solve the pee issue” means you need to get a proper evaluation to treat your symptoms, and know that it is never too late!