Physical Therapy During Pregnancy
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What could you possibly be forgetting? What about getting YOURSELF prepared?
Likely from the moment you found out you were pregnant you have been focused on the tiny human growing inside of you. While prenatal vitamins, nursery preparations, and choosing the perfect name are all very important parts of preparing for the birth of your baby, so is preparing YOUR body to birth this baby!
Hopefully in the midst of your nesting you have decided to create a birth plan. As you consider what positions you want to labor and deliver in and what interventions you feel comfortable with during your birth experience, I would challenge you to consider what you are doing to achieve those goals. Hiring a doula and recruiting a rockstar support person is a great place to start, BUT there is more!
Research has shown that the percentage of first time moms that experience perineal tearing during delivery is somewhere between 80-90%. Research also shows that 66% of women that deliver their babies in sidelying have NO perineal trauma and 61% of women that deliver on hands and knees have the same TRAUMA-FREE experience. (Simarro 2017, Walker 2012, Soong 2005, Shorten 2002) Instead of crossing your fingers and hoping for the best when it comes to your perineum, what would it look like to practice different delivery positions with your partner BEFORE you go into labor? What about the evidence that says perineal massage 1-2x per week starting at week 35 can DECREASE your risk for tearing and episiotomies? Have you been taught how to perform this technique and are you taking the time to do it? (Seehusen & Raleigh, 2014) With my first son, I totally missed the boat on perineal massage. I ended up with a nasty episiotomy. You better believe I’ll be making perineal massage a priority this time around!
Our bodies become a temporary home for our babies during pregnancy. Our mama bear instincts have already kicked in, and we want to make sure we are creating a healthy and happy environment for our babies to grow within. Exercise and intentional movement is a great way to foster this type of environment for our little ones. Did you know that exercise helps prevent or manage gestational diabetes, high blood pressure and preeclampsia? Exercise also helps us sleep better, reduce our stress levels, and minimize back pain. If your pregnancy is non-complicated and you do not have activity restrictions, you should be exercising! The American College of Obstetricians and Gynecologists recommend exercising at a moderate intensity 3-5x per week. Sometimes we become paralyzed when we’re not sure where to start and what’s safe. Trainers, instructors, and Physical Therapists with certifications and experience working with women during pregnancy are great resources for mamas hoping to create safe exercise habits.
Let’s not forget about investing in our pregnant bodies to make life easier for ourselves in the postpartum. During your pregnancy your belly is doubling or even tripling in size. As we gain 25+ pounds, we expect our pelvic floor to step up to the challenge and make sure we don’t pee our pants when we sneeze at the grocery store. There are two studies that give us good reason to keep our pelvic floors strong during pregnancy. The research found that women experienced less urinary incontinence at 35 weeks gestation, 6 weeks postpartum and 6 months postpartum when they did pelvic floor exercises DURING their pregnancy compared to women that DID NOT do pelvic floor exercises. (Boyle et al., 2012, Price et al., 2010) Sidenote: sometimes the phrase “pelvic floor exercises” is confusing. Does that mean kegels? Yes and no. Clear as mud I know! Kegels are pelvic floor exercise where we lift and squeeze our pelvic floor muscles, but it’s also important for our pelvic floors to have the ability to relax and lengthen. Sometimes women experience pelvic pain and incontinence because of overactive pelvic floors (need help relaxing) and sometimes it’s because they have underactive pelvic floors (need more strengthening). Even if you have excellent pelvic floor strength and no concerns about incontinence, it’s still helpful to create a mind-body connection with your pelvic floor. During labor and delivery the goal is to relax and open your pelvic floor while pushing so that your pelvic floor remains healthy even after childbirth. Bonus points if you practice your breathing and pelvic floor relaxation while pregnant in the positions you hope to deliver your baby in.
I’ve been a mom in your shoes, running around with my To-Do list trying to check off all the boxes before my baby arrived. As you prioritize your list and consider your baby budget, remember that your body IS this baby’s home. The way that you prepare your body WILL make a difference on the day that your baby decides to make its grand entrance. Exercise, pelvic floor awareness, perineal massage, and labor positions are all important pieces of the pregnancy puzzle. It’s tempting to become intimidated or overwhelmed at this point because you’re just not sure where to start. Start by consulting a Women’s Health Physical Therapist. Now that you know what your goals are, you have some great questions to ask them! Physical Therapists should be another member of your prenatal team, and we want to help you make your planned Birth Story a reality.
My practice is Mamas & Misses, LLC and we offer In-Home Physical Therapy sessions for women local to West Michigan as well as phone or video consults for those who live further away. One of our missions is to provide knowledge to mamas that will empower you during your pregnancy and postpartum experience; therefore, we have lots of FREE info on our YouTube channel as well as our Instagram account @mamasandmisses_pt.
Dr. Nicole Bringer, DPT
Owner of Mamas & Misses LLC
Phone: (616) 466-4889
Boyle, R., Hay‐Smith, E. J., Cody, J. D., & Mørkved, S. (2012). Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews, 10, CD007471. doi: 10.1002/14651858.CD007471.pub2
Price, N., Dawood, R., & Jackson, S. R. (2010). Pelvic floor exercise for urinary incontinence: A systematic literature review. Maturitas, 67(4), 309-315. doi: 10.1016/j.maturitas.2010.08.004
Seehusen, D. A., & Raleigh, M. (2014). Antenatal perineal massage to prevent birth trauma. American Family Physician, 89(5), 335-336.
Shorten A, Donsante J, Shorten B. Birth Position, Accoucher, and Perineal Outcomes: Informing Women about Choices for Vaginal Birth. Birth. 2002;29(1):18-27.
Simarro M, Espinosa JA, Salinas C, Ricardo O, Salavadores P, Walker C, Schneider J. A prospective randomized trial of postural changes vs passive supine lying during the second stage of labor under epidural anesthesia. Med. Sci. 2017, 5, 5. doi:10.3390/medsci5010005
Soong B, Barnes M. Maternal position at midwife-attended birth and perineal trauma: is there an association? Birth. 2005;32(3):164-169.
Walker, C., Rodríguez, T., Herranz, A. et al. Int Urogynecol J (2012) 23: 1249. https://doi.org/10.1007/s00192-012-1675-5