Pelvic Floor Health

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Health, strength & happiness

Almost universally women worry about tearing during childbirth. The following are answers to our most frequently asked questions.

What can I do before I give birth?

Pick your parents … genetics plays the largest factor in tissue integrity
Eat healthy, drink lots of water – to make your tissue as strong & stretchy as possible
Get some movement in your life – increased blood flow strengthens tissues
Don’t smoke – toxic byproducts will weaken your tissues
Take essential fatty acid supplements – to make your skin soft & stretchy
Make pelvic floor exercises a habit (instructions below) – not only do strong muscles resist tearing, but you will also push your baby out faster
Do perineal massage (instructions below) – to learn how to relax your muscles when stretched
TRUST that even if you don’t do any Kegels, perineal massage, etc, this does NOT necessarily mean you will tear

What about during the birth?

The physiology of the vagina is such that it has numerous small folds and pleats. During birth these open like an accordion in front of the baby’s head. The hard work of labour, especially pushing, brings blood and heat to the whole pelvic area, which in turn increases the pliability of the tissue.

What you can do:

Know that you can and should push as hard as you can, except for the last few minutes when the baby’s head is crowning. Although the sensations may be very intense, you will not be in danger of tearing at this point. In fact, the faster this stage is over, the better for your tissue. This can be helped by using upright, gravity-positive positions.
As the head starts to stretch the tissues open, apply counterpressure with your own hand to the areas that feel the most intensity
In the last few minutes when the head starts to emerge, you will feel a burning sensation. At this point, it’s okay to slow your pushing efforts – as opposed to trying to push harder to get the intensity over with. Because it is hard to maintain control of a strong urge to push, your care provider will likely talk you through this part.
Apply warm (or cold if there is swelling) compresses to your perineum once the head is visible – for comfort and increased blood flow
During the last few minutes, have you use gravity-neutral positions to slow the crowning stage
Talk you through the last few minutes while the head is slowly emerging – to give your tissue time to stretch and open
Use frozen pads or apply ice to your perineum (like any injury – ice for the first 48 hours). It sounds uncomfortable now, but will feel great in the moment!
Wash your hands before (as well as after) using the toilet until your stitches are healed
Pee in the shower/bath if urination causes stinging
Use a peri bottle after using the toilet – add herbs/lavender/tea tree oil for their antibiotic and healing properties
Take Homeopathic Arnica 30C every 4 hours while awake (minimizes any swelling or bruising)
If you feel you need pain relief medication, ibuprofen or acetaminophen can be taken according to the recommendations on the bottle
Plan to not go outside for 7 days. Stay in bed and cuddle with your baby, minimizing activity as much as possible. Aim to only walk up/down stairs once or twice a day max.
Sit with your legs together, i.e. don’t sit cross legged.
Sitz bath twice a day – add herbs/lavender/tea tree oil.
Full bath x 10-20 minutes once a day (in addition or instead of sitz bath) – add 2 cups Epsom salts, perineal wash herbs – avoid bubble bath
Do NOT sit on a hemorrhoid or “donut” pillow which can cause stitches to tear out
Eat healthy, drink lots of water
It is normal to feel “heaviness” in your pelvis at the end of the day if you have had increased your activity. This is the pelvic floor muscles getting fatigued. Try to balance days of activity causing fatigue, with days of rest.
Prolonged use of maxi pads can be very drying – occasionally try sitting on a blue pad while nursing, or use cloth pads. After a sitz bath, dry out your perineum well, then sit on a blue pad or towel and let your perineum fully dry and breathe for 1-2hours.
You will not have the same strength when doing kegels. Be patient, it will return.
Inform your midwife if:
You have increasing amounts of pain in your perineum, not associated with increased activity or decreased use of painkillers
You have discharge that is abnormal in color or foul smelling
You continue to have serious urinary incontinence past the first few weeks
Use lots of lube when you have sex, as postpartum hormones cause dryness.
See a pelvic floor physiotherapist if you have any concerns or just want to improve your pelvic floor strength. You do not have to have serious incontinence before seeking physiotherapy. If your problem is assessed to need further medical intervention, they can provide a gynecological referral.
BC Women’s Continence Clinic 604-875-3137 (self-referral)
Various private physiotherapists specialize in the pelvic floor
Check out pomegranate-midwives.com/Resources under Health for further referrals

What your care provider may do:

How can I speed healing after the birth?

First days:

First week:

First month:

In the first year:

Pelvic Floor Toning aka Kegels

Have a strong pelvic floor in 3 months!

“Kegel” is the name used to describe a conscious contraction of the pelvic floor muscles. Because there are many muscles in the pelvic floor, it may take awhile to learn how to contract all of them equally; a common mistake is to only contract the external muscles. If you are unsure or want some biofeedback as to how you are doing, you can ask a partner, your midwife or yourself to feel for muscle contraction throughout your vagina while doing a Kegel.

Initial Training Program

Do 2-3 times a day, for 8-12 weeks

Hold’ems – 10 sets, 2½ minutes

Do a Kegel for 10 seconds. Relax for 5 seconds.

Repeat nine more times

Speed’ems – 30 sets, 1½ minutes

Do a Kegel for 1 second. Relax for 2 seconds.

Repeat 29 more times

Urge control

Do you have overactive bladder nerves?

You experience situational urgency, such as whenever you arrive home or whenever you hear water running
You experience urgency, but when you go to the toilet your bladder is not full [some of this is normal in pregnancy – use your judgment]

If so:

Aim to empty your bladder before it is full to avoid teaching your bladder nerves to overreact
Practice using calm thoughts to quiet your nerves before you go to the toilet

Stress situations

Do a Hold’em before you cough, sneeze, lift, jump or anytime you might leak urine. The more this becomes a habit, the more your muscles will eventually do it automatically.

Advanced Training

Do 2-3 times a day, for 4 weeks

Hold’ems & Speed’ems

Try using different positions to challenge your muscles: standing with feet apart, leg up on chair, squatting, etc

Crowns – 5 sets, 2½ minutes

Combination of Hold’ems and Speed’ems: start as if

doing a Speed’em but don’t fully relax your muscles

until you have done 8 peaks.

Repeat 4 more times.

Maintenance Program

Do once a day

10 Hold’ems, 30 Speed’ems and 5 Crowns.

Perineal Massage

What is the goal?

The ultimate goal is to learn how to use your mind to relax your muscles, NOT necessarily to increase the flexibility of your tissues, although this will happen too. The key to learning this mind-body connection is to go to the place where you feel your body start to tense up – then take deep, relaxing breaths until those muscles loosen, which may take a few minutes. Over the course of a few weeks, your muscles (and your brain) will learn to know and trust that they can stretch quite far without injury. In turn, this confidence will cause your tissues to relax and stretch even further.

Instructions

5-10 minutes daily from 34 weeks

If you are doing the massage on yourself, insert your thumbs as shown. If you have a partner doing it, they can use their index fingers. Sometimes it’s only possible to get one finger in until the area has learned to relax and stretch more. Partners: be sensitive to her body and what she is giving you as feedback on the amount of pressure to use.

Preparation

If you have time, take a bath – the wet heat will start the relaxation process, especially if you add some yummy bath salts, lavender, etc.
Wash your hands. Make sure your nails are not ragged.
Relax in semi-lying position. Bend your knees and let them relax to the side. Use lots of pillows for support behind your back and under your knees.
Apply some lubricant to your fingers and tissues.

Practice

Place your fingers about an inch inside the vagina. Press downward and to the sides at the same time. Gently and firmly keep stretching until you feel your muscles tense up – you will probably be feeling a slight burning, tingling or stinging sensation; you should not feel pain. Hold this stretch for about two minutes or until the intensity eases. With each exhale concentrate on relaxing your muscles a little further.
To help your brain identify the muscles it wants to relax, try doing a Kegel. Or do a reverse Kegel and bulge those muscles out.
If you/your partner can feel more tension in certain muscles than others, use slight finger pressure or massage on those muscles for biofeedback.
As you keep pressing with your fingers, very slowly and gently massage in a sling motion over the lower half of your vagina, working the lubricant into the tissues. Some women find the motion of the fingers going in opposite directions more comfortable; others prefer to go in one direction at a time. Avoid the urinary opening. Keep this up for two minutes.
If you’ve had a previous tear or episiotomy, pay special attention to the scar tissue, which is especially non-elastic. Gently massage this area to help break down the scar tissue and help blood circulate in the area.
Pull gently outward (and forward) on the lower part of the vagina with your fingers. This imitates the stretch to the muscles and skin during birth.

Cautions

Be careful to:

avoid massaging the urinary opening or you may cause enough irritation to start a bladder infection
avoid being overly vigorous or you may actually cause micro lesions which weaken your tissues: it should be intense but not painful
use only good quality lubes (try Womyn’s Ware womynsware.com for a great selection) or oils (almond, olive or vitamin E); avoid petroleum-based oils such as baby oil or mineral oil
use positive thinking about your body’s ability to open and stretch when it needs to – remind yourself about the hormones of birth, as well as intense blood flow during pushing, that will radically increase the pliability of your tissue

Don’t do perineal massage if:

you have any kind of infection, including yeast or BV
it makes your tissues irritated or raw
you have a herpes outbreak
it makes you anxious
you don’t want to