Redefining Pregnancy Prep: A Tale of Fruits and The Pelvic Floor
During pregnancy, our attention often fixates on baby-related matters, but it's high time we shine a spotlight on the essential aspect of pelvic floor health while pregnant.
When you're expecting, many women sign up to receive texts and emails that compare the growing little person to a particular fruit. I remember getting them and thinking, “Oh man, Kiwis are so little! I feel like I shouldn’t be so tired if all I have done is grow a Kiwi.”
When you're pregnant, all the focus is on the baby - how big the baby is, what super fancy stroller you must have, how to baby-proof your home, what to feed the baby, what amazing toy will make your baby able to do fractions by six months, and so on. Honestly, the list is endless. But what gets exactly zero time in the planning and preparing for a new little one are your pelvic floor muscles. It is literally what your baby passes through to enter the world (well, unless you have a c-section, but still, then it is important). It's high time they pelvic floor muscles get their moment in the spotlight.
Throughout your pregnancy, the pelvic floor plays the role of a hammock, trying to support that growing papaya with all its might. The pelvic floor can start showing signs of weakness during the pregnancy, especially if you are pregnant with baby two or three. Incontinence can be part of this weakness, as can pelvic organ prolapse. Now, here's the kicker: most women only seek help when these issues have reached a level that's as sustainable and effective as a screen door on a submarine. This is because the little pomegranate's needs are all we think about and all other people talk about. You will soon be a mother for the first time or again, and while that is an important, unpaid, and dirty job involving a lot of human fluids, you also need to take care of yourself. It will not get easier to make time for yourself so lets’s talk about how to find it now and what to do with it to help you prepare.
What To Expect For Your Pelvic Floor
Pregnancy and postpartum are like the ultimate body makeover, but most people only chat about the “bodybuilding” —the baby you are building up into an eventual small gourd. What also needs to be focused on is what to expect when your pelvic floor just held a cantaloupe for a month, and your stomach looks like a deflated balloon with a two-finger gap in the middle (diastasis recti).
*photo credit Visible Body Software
Your pelvic floor should be on your radar during pregnancy, just like tracking what fruit your baby's supposed to resemble at week 8. But guess what? No one told you, so it is no wonder that you aren’t sure what to do.
To make matters worse, most women just assume that pelvic pain and incontinence are part of the 'mom package,' like sleepless nights and baby spit-up. Some of us are too shy to ask for help. Some of us just get tired of trying to keep up with the day after having a baby and don’t ask until pelvic floor problems are causing them to adjust their activities.
Women's health often gets the silent treatment, especially when it comes to our 'intimate lady parts' until things are so bad we are willing to try surgery to make life better, even though surgeries that address pelvic floor issues like slings and mesh are only a temporary fix.
In the world of healthcare, we call a lack of understanding about your health poor health literacy. Women's health is generally under-studied and WAY under-discussed, especially when it comes to our more intimate lady parts. We seem to tiptoe around discussing women's health issues as we age, treating it as if it's a dirty conversation akin to a mother's last-minute “what to expect” chat with her daughter right before her wedding night.
Here is the big picture of what pregnancy preparation should include: pelvic floor strengthening, stretching, understanding diastasis recti, and prolapse. This is the information I would give to my patients if they came to the clinic wanting to prepare for birth. I highly recommend seeing a women’s health physical therapist if you want specific recommendations and medical advice tailored to your body. However, if you live in a place that doesn’t have those professionals around to help, the rest of this article will give you a good place to start.
Pelvic Floor Strengthening
The pelvic floor picture from above is supposed to help you see that the muscles that make up the pelvic floor really do look like a hammock or basket. The ability of these muscles to hold your bladder up along with your uterus while you are growing your baby is impressive. It is also easy to see that if we put a watermelon in your basket, that definitely puts that muscle's strength and endurance to the test.
As the muscle gets stretched, it will be harder for the pelvic floor to contract unless you train it. The farther along you are in your pregnancy, the more help you might need to give it. If you sense a sneeze coming, contract your pelvic floor before you sneeze.
Setting aside as little as 5 minutes of your time a day to strengthen will make postpartum recovery easier. The first part of any muscle training program is your body growing extra nerves into the muscle so you can get more of the muscle contracting at once. Start that growth early by just doing some Kegels, as I show here, during natural gaps in your day that I call the in-between times.
The in-between time gaps could occur while waiting for the microwave to finish, for the eggs to cook in the morning, or while brushing your teeth. If your doctor’s office is like any other doctor's office, you are going to wait for a while. Get in some extra Kegels. You don’t need to set aside 30 minutes—in fact, please don’t. Most people never start because they can’t find that 30 minutes. Steal the time you might be using to scroll social media and take it back for the good of your pelvic floor.
Preparation for the Pelvic Floor Big Stretch- Third Trimester
Throughout pregnancy, it would be great if we all worked on strengthening the pelvic floor, but during the third trimester, it is important to focus on lengthening and softening to help with preventing tearing. Your pelvic floor does not push your baby out in a normal birth. But your baby has to pass through the pelvic floor, so we want it to be able to stretch so it can get out of the way so it does not tear.
There are a few ways to stretch the pelvic floor to make it easier to get flexible in preparation for birth a vaginal birth. One is perineal massage. The perineum is the tissue that runs between your vaginal opening (the baby hole) to the anal opening (the poop hole). There is a lot of great information on how to do perineal massage, so I will not go into detail here.
The best position for relaxing your pelvic floor is a deep squat, so the stretches that I recommend will look like a squat done while lying on your side or while sitting. These stretches are great for you even if you are having a c-section. Your pelvic floor should be able to contract and relax into a stretch. Check out these ideas for stretches.
Diastasis Recti
Diastasis recti is when the tissues in the 6 pack abdominal muscles separate so that you can grow a watermelon in your belly. It is very common, and there are things we want to do so that we don’t make it worse and harder for you to get back to normal after you deliver.
No holding your breath when you lift a heavy bag or box, or another child just hit their head on the dog, the counter, a plastic toy, or your elbow…they do a great job of hurting themselves, so holding young children is a way of life. Instead of holding your breath, exhale when lifting and pulling those abs up, ideally with your pelvic floor.
One of the other things I recommend is rolling to your side as you get out of bed and pushing up with your arms instead of sitting up like you would for a crunch exercise. As your growing baby gets larger, your 6 pack abdominal muscles get more and more stretched out. We want to strengthen in a way that will allow for good control of these muscles and not stress the tissues between the 6 pack muscles. Doing a sit-up to get out of bed will be hard on those tissues between the muscles the farther you get in your pregnancy.
Why? Crunches and sit-ups are not the abdominal strengthening exercises of choice during pregnancy because they add tension to the separating tissues. There are lots of other options for strengthening the core and pelvic floor during pregnancy. I will give you a couple here below.
Prolapse
There are different types of prolapse, which I will discuss in a different post. Prolapse is when your bladder, uterus, or rectum starts to collapse into your vaginal canal due to weakness of the pelvic floor (i.e., your muscle basket is caving). It's more common among the mature crowd, who haven’t strengthened for a long time, but it will also happen in younger lady parts owners.
A prolapse is typically found during a trip to the bathroom when they feel organs making guest appearances at the vaginal opening – not the kind of bathroom surprise you want to get ever. I don’t really know what a good bathroom surprise would be, but it would probably involve a bubble bath instead of finding an organ collapsing out of your lady parts. The organ will not fall out because you are just feeling the lining of the vagina with the organ on the other side—but we do need to get that pelvic floor in shape so that stops happening.
Managing prolapse during pregnancy will involve strengthening but should also include avoiding straining like you would if you are constipated and trying to push out poop. Often, I will have patients get a stool to put their feet on in the bathroom in order to decrease strain on the pelvic floor when using the bathroom. Placing a stool under your feet puts your pelvic floor in a relaxed, stretched position. There are other changes to your diet to help you decrease constipation to help decrease strain on your pelvic floor.
Remember, even if your organs have decided to make a guest appearance, you're in control and can get them back to where they belong with pelvic floor strengthening. Check out the videos above on how to start pelvic floor strengthening and subscribe so that you can get that upcoming post that focuses on prolapse treatment.
Wrapping Up
Amid the whirlwind of preparing for your bundle of joy, our attention tends to fixate on the baby – we're measuring their size and daydreaming about baby names. But guess who's stuck in the backseat of this grand adventure? Your trusty pelvic floor, both before and after the baby's grand entrance.
Just because incontinence, prolapse, or diastasis recti can be common as baby onesies at a baby shower doesn't mean it's your new normal.
So, here's the deal – find those precious gaps in your chaotic day to show some love to those pelvic floor muscles. They're as vital as your little kiwi. Let's ensure you're the kind of mom who doesn't need adult diapers as part of her golden years game plan. 🥝💪 #MomGoals
D.I.G. Deep
Get Deliberate
Set a timer on your phone or set your phone to lock you out of social media after 5 minutes to help you remember to get those pelvic muscles strong during your in-between time.
Get Inspired
What will you be able to do when your pelvic floor muscles are strong after delivery? Go to the trampoline park with your kids? This is the reason why you are taking those 5 minutes back a day. It is important to picture that future you and write it down. Don’t just think about it. Write it. Save it as an event on your Google calendar.
Get Going
Find some other current or future new moms or maybe even your own mom. Tell them about finding the in-between time and get them to find their own with you. Share this post with a pelvic strength accountability group you create. Together, you can kick pee pads to the curb postpartum.