exercise

Preparing your Pelvic Floor for Labor Through Movement

Congratulations, you found out you are pregnant and are now planning all of the things - what will the baby’s room look like, what’s the best carseat, bottle, carrier, etc. You’ve probably planned it all...but have you thought about what positions you want to move in while in labor? We’ve all seen the TV show and movie where a woman is on her back, feet up in stirrups (the lithotomy position) and pushing as hard as she can, but did you know the position you give birth in can affect your rate of perineal trauma and tearing? In fact, giving birth in this position “may have been adopted to make it more convenient” for providers without looking at the effect it has on mothers. So let’s take a look at some of the common birthing positions that may be helpful for the mother during labor.

Walking, Standing and Leaning in Labor

Upright positions, whether it is walking, standing or leaning have been shown to decrease the second stage of labor or the pushing stage. The upright position has also been associated with a reduction in assisted deliveries and episiotomies. This is important because a long second stage of labor and assisted deliveries have both been associated with greater risk of third and fourth degree perineal tears.

How to prepare during pregnancy: WALK! Spinning Babies recommends walking daily and building up to 3 miles a day at a pace where you can still hold a conversation. Don’t let that number scare you, if walking hasn’t really been your exercise of choice in the past, that’s ok. Smart small and work up to three miles!


Kneeling, or All-Fours (Hands-and-Knees) While in Labor

The all-fours position has been associated with less pressure on the perineum (cough, cough, that means less likely to produce tearing, avulsions and prolapse), and gives the provider a good visualization of what’s happening. (1) An added bonus is that it has significantly higher rates of intact perineums, first-degree tears (lower rates of 2nd, 3rd and 4th degree tears) and lower rates of episiotomy. 

How to prepare during pregnancy: There are a few positions that are great that mimic this. First, just breathing in quadruped (all-fours), you can also do bird dogs, lunges, quadruped with your arms resting on an exercise ball and tripod movements. All of these will help you build strength and endurance in your arms and can help you feel more confident while in labor.


Sitting and Squatting While in Labor

If you’ve taken a childbirth education course, you’ve probably learned about how the toilet can be your best friend in labor. Not just because you have diarrhea (which fyi, is pretty common in early labor) or because emptying your bladder gives more room for the baby to descend (it does, so make sure you use the loo while in labor), but because the position helps open up the pelvic floor muscles to allow the baby to descend if (s)he is already engaged. In a relaxed position, the deep squat may decrease pain, labor time and decrease the need for cesarean by utilizing gravity to help the baby descend. One important thing to know is that squatting during the second stage of labor has been associated with increased risk of 2nd degree tears (and lower rates of 3rd and 4th degree tears) and blood loss. If squatting is your movement of choice, you can sit squat, use a squatting bar (available at some hospitals), utilize your partner to do a supported squat, or sit on a birthing stool. 

How to prepare during pregnancy: Squat. Squat to the pot, squat to pick your kid up, squat to do laundry, squat when you drop something on the floor, squat to your chair, squat, squat, and squat. Ina May recommends 300 squats a day but I understand that isn't possible for everyone. Instead, everytime you go to sit down practice your squats and if you have a little extra time, add 5-10 squats every time you sit down or stand up. When squatting, try to keep your toes straight or slightly turned inward to help open the pelvic floor and relax the booty. If you feel tension in your hips, doing a little squat therapy may help ease that tension.


Side-lying While in Labor

Lying on your left side has been shown to “reduce perineal trauma, avoid performing an episiotomy and achieve an intact perineum” even in first vaginal deliveries. (1) There are a couple of options to lying on your side- you can lie with a peanut ball or support between your knees, or you can put pillows under your feet to help your knees come together and your feet to go outward. This move actually opens the pelvic floor allowing more space in the pelvic outlet for the baby to descend and make its way to the outside. Many women note this position is beneficial because it allows her to labor in a more relaxed state and conserve energy in those marathon labors. 

How to prepare during pregnancy: Rest smart. This is another fabulous recommendation from Spinning Babies because how you rest matters too. Are you using your pregnancy pillow to basically practice your kung fu moves in your sleep? If so, changing up how your rest in a chair, car and even on a couch or bed can ease the tension on the ligaments in your belly. This can help with baby's position and help you mentally prepare for laboring in a relaxed position. So go ahead, use this as an excuse to take a 20 minute nap and practice your labor position.


Moving in Labor with an Epidural

An epidural can take out some of these movements (like walking) but with a few modifications, even a mama with an epidural can benefit from different laboring positions. One thing to note is the strength of your epidural. If your epidural is strong, you may want to ask your provider to turn it down so you can have more control over the position you are in.  

One movement you can do with an epidural during labor is lying on your left side. The amazing Penny Simkin came up with the Roll-over Technique  which helps the mama and baby get into a better position to labor. If you can still move with an epidural, it's possible that with a little help you could get into throne's position, supported squat or  even to a birthing stool. For some mamas, if the epidural is light enough they are able to get on hands-and-knees to birth the baby. More often than not, you can also utilize the peanut ball to help open the pelvic floor.

How to prepare during pregnancy: When was the last time you just sat and were present in your body? Maybe you like to multi-task or avoid checking in with how you are feeling. If that sounds like you, practice sitting or lying on your side. Notice how you feel, if you have any aches or pains, notice your breathing. Preparing for this one by preparing the two things you have more control over in labor: your breath and your mindset. 

What If I Labor on My Back?

Whether you have an epidural or not, if you find yourself laboring on your back there are small things you can do to help relieve pressure/tension on your pelvic floor.

  1. Place towel rolls under your ischial tuberosities (the bony parts under your butt) or off the sides of your sacrum. This will allow better posterior sacral movement during delivery and can relieve pressure on the pubic symphysis.

  2. Place a small pillow under your low back to help keep your back in extension and open the pelvic floor.

  3. You can limit the lithotomy position (think knees to your chest) by pushing with your feet still flat on the table. This is especially helpful if you are experiencing lightning crotch during pregnancy or delivery.

Are These Positions Safe for Mama and Baby?

In comparison to lying on your back, all of these upright positions have been shown to have fewer abnormal fetal heart rate patterns and no clear difference in admittance of babies into the NICU. That means that in general laboring and giving birth in one of these positions is equally safe for the baby as the mama on her back. It may even be more beneficial for the mother to reduce the risk of perineal tears and prolapse to give birth in an alternative position. One thing that can help is to try to move frequently, every 30ish minutes during labor to help the baby descend. 

If you are wondering what the best position to give birth in, it’s the one that your body chooses. Sometimes our minds and our bodies try to compete because we think we “should” labor in one position. Listen to your body, trust your body and most importantly, trust that your mama instinct is already on point. 



References:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6511367/#ref14

  2. DOI: 10.1002/14651858.CD002006.pub4.

Pubis Pain aka “Lightning Crotch” or Pelvic Pain During Pregnancy: Part 2

Part 2 - Managing pubic symphysis dysfunction through exercise

Not sure what pubic symphysis dysfunction is or the causes? Check out Part 1 for more information!

The most important thing to know is that each mama is unique in her needs. For that reason, it is important to see a chiropractor or physical therapist with additional training in pregnancy and postpartum to find out what your specific needs are. With that being said, there are some general guidelines. Y’all know by now that I love mamas to stay active during pregnancy but there are some exercises that are best modified or temporarily taken out when you have SPD.

The ‘Don’ts’ of exercising with pubic symphysis pain (exercises to avoid with lightning crotch):

  • Don’t over-stretch

    • Yes, it is possible to over-stretch, especially during pregnancy when relaxin and progesterone are helping muscles and ligaments relax in order to prepare for birth. If you are doing yoga or pilates, it’s a great idea to not push mobility at the end of any pose as this can increase your risk fo stretching too much and destabilizing the pelvis

  • Limit single leg movements for a few weeks (2-3 weeks) and slowly add them back in your routine to see if you can manage the load. If not, that’s OK…you can take them back out. If they do not increase or cause pain, it’s a great idea to add them back!

    • This includes taking out lunges, bulgarian split squats, pistol squats, warrior pose, assault bike, and step ups as all of these exercises are one-leg dominant and can increase shearing on the pelvis.

    • Here’s the catch…some mamas actually benefit from single leg movements with a little modification. If you notice that deep lunges cause pain, you can modify it! First, try to change the position of your feet by bringing them closer together. You may notice that by bringing your feet closer together decreases your pain but still lets you use those muscles. This is great! You can strengthen this area and then try to increase the distance between your feet as you get more comfortable. The next thing you can change is the depth or how far down you go into the lunge. If a full lunge causes pain, try to lunge at half depth or a quarter of the depth. If you are able to do these without pain, that’s great - you should continue to do them! Our goal is never to exclude the movements you love but to work with them to see what can work with your body at this time.

  • Use caution with traditional “core” exercises 

  • Traditional core exercises like sit-ups and crunches focus on activating one or two muscles independently of the core system (diaphragm, pelvic floor and all abdominal and back musculature). Working these muscles can actually pull on the pubic rami and increase pain. Core exercises like the plank are advanced and require full pelvic/core stability and joint centration (the pelvic floor and diaphragm should be aligned). It is common for mamas to compensate during this movement as their natural gravity shifts and this compensation can lead to increased pelvic and low back instability.

  • Watch deep squats or sumo squats

    • I love deep squats because the bottom of a squat is when the pelvic floor is most relaxed (hello benefits in labor) BUT that stretch can be too much with pelvic pain. If you notice pain with deep squats OR after deep squats, it’s okay to take them out.

  • Adductor stretch or adductor machines 

    • The adductors are connected to both the inner thigh and the pelvis and can definitely play a role in pelvic pain. Like most everything, it is best to figure out if the adductors need relaxed or strengthened. If you are constantly stretching and they don’t feel better, they may actually need strengthened! Vice versa, if you’ve been working hard to strengthen the adductors but they continue to be sore, you may need to calm the signal from the brain to down regulate this pain. The best way to know this is to see a professional who can guide you in what your body currently needs.

  • Fast/explosive movements 

    • We want to continue moving during pregnancy but fast and explosive movements require the musculature around the pelvis to respond quickly and when there is pain this reaction is often slower. It is easier to compensate and not utilize the appropriate muscles to create the force to stabilize.

Exercises that may improve pubic symphysis pain

  • Focus on posture and pelvic alignment

    • As you stand and walk your diaphragm should be aligned with your pelvic floor — this is a neutral spine. If you drop into too much anterior or posterior pelvic tilt this can increase pain/pressure on the pubic region. So one easy exercise to stand in front of a mirror and focus on finding that neutral spine.

  • BREATHE

    • As we inhale, our pelvic floor gently descends and relaxes and as we exhale it gently lifts and contracts. This is a normal progression with diaphragmatic breathing that naturally helps to activate the deep abdominal muscles and stabilize the pelvic region with the breath

  • Balance strength and mobility

    • All movements should be slow and intentional to start to focus on maintaining task-specific pressure (that’s the amount of support/brace/natural tension you need to create to stabilize the body). This intention trickles down to balancing strength and mobility so we aren’t over-stretching or strengthening a muscle that does not have its full range of motion.

  • Work the glutes and adductors in synergy through movement

    • Banded monster walks

    • Glute bridges with band around knees and yoga ball or block in-between knees

    • High Bear or low bear: with bands around knees and yoga ball or block in-between knees —> if you are able to do this and looking to advance the movement without doing a bear crawl, you can simply lift and hold one arm or one leg at a time

    • Hip Hinge or banded good mornings

    • 90/90 or Shin box flow: this is a movement where slow and intentional movements are best

  • Work all of the core together

    • Box squats: i mentioned earlier that deep squats may not be beneficial but shortening the range of motion to the point before there is pain can be extremely helpful in pelvic pain and keeping pelvic mobility with core stability

    • Side bridge

    • Bird dog with pelvic floor focus and focus on breathing and elongating spine

    • Dead bug with focus on crossover

Part 3: Labor and Delivery considerations for pubic pain

Mama, if you are struggling with pubic symphysis pain or any pelvic pain, I understand the frustration, anger and fear that comes along with it. I believe that no woman should have to suffer through pregnancy or postpartum in pain. Call 331-307-7110 to schedule an appointment today or book online. Not ready yet? That’s OK, schedule a free 15-Minute Healthy Mama strategy session today to discuss your options.