I keep hearing about the pelvic floor. What am I supposed to be doing or not doing? #askingforafriend

Dear Pelvic Floor-ishing,

The pelvic floor is a glorious support system that holds us up, holds us in and allows us to maintain digestive and sexual function. It energetically anchors us while also acting as a thoroughfare, allowing waste out and sexual health in.  We use the pelvic floor everyday, all day and it deserves some praise! Unfortunately, historically in the US medical system, we only start to talk about the pelvic floor when it becomes attached to the word dysfunction. In good midwifery fashion, let’s take a moment to talk about how to honor this muscle system, promote it’s healing, and also prevent dysfunction down the road.

Philosophies around the Pelvic Floor During Pregnancy

Some of the best ways to support your pelvic floor in pregnancy are also the simplest! I recommend focusing on nourishment and movement. Yes, these things have multitudes of benefits for your pregnancy, but let’s check in on how they effect your pelvic floor system.

Pregnancy Nourishment and the Pelvic Floor

Good nutrition and hydration is always going to support your muscle function. Make sure you are eating a colorful whole foods diet. This means: bell peppers, salad, tomatoes, squash, berries, fish… you get the idea, eat the rainbow! Stick to organic if you can and aim for diversity. Your pelvic floor muscles will thank you for keeping them in good shape with all those nutrients. While the body tends to absorb things best through food, speak to your provider about what supplements might be added to your routine. This should be individualized to match your own nutrition habits and/or dietary restrictions. You should have a thorough nutritional assessment in pregnancy to fine-tune optimizing your and your baby’s health.

Pregnancy Movement and the Pelvic Floor

Move your body! Most of us just don’t move enough these days; due to jobs, social structures, and even pandemic protocols. Take good effort to aim for 30 minutes a day of some activity that increases your heart rate. Remember that pregnancy has brought in a whole bunch of Relaxin hormones into your system. These awesome hormones allow your body to stretch and grow, but can also loosen things up and make you a bit injury-prone. Be sure to speak to your provider about what types of body movement best suits you during this pregnancy. Do you already have some symptoms of pelvic floor dysfunction (constipation, incontinence, pain with intercourse, history of painful periods)? An in-depth health review with your provider will allow for an individually tailored movement plan to suit your life, your body, and of course, your pelvic floor!

Breathwork and the Pelvic Floor

No, no, no, I’m not talking about Lamaze here! Integrating some form of breathwork will serve you and your pelvic floor greatly! Often people think they need to strength-train their pelvic floor to prepare pushing a baby out, but it’s actually quite the opposite. Birth is all about surrender, release and letting your body (and pelvic floor) take over and do the work. Through forms of meditation and following your natural breathing patterns, you can train your mind to cue in with involuntary muscle function. Try guided mediation apps like Hynobirthing or Expectful. These work best when regularly integrated throughout your pregnancy. 

Working with Your Pelvic Floor In Labor

It’s still all about nourishment and movement!

Nourishing Your Pelvic Floor in Labor

Labors can be long and likened to a marathon for some. Be sure to hydrate with electrolytes and have small energy-dense snacks throughout labor. Your pelvic floor is made up of muscles and we want them feeling nourished and ready for all the work they are about to do. While most people lose their appetite in the deep throws of labor, even the smallest bite of a banana can fuel you and your muscles. Make sure you have a supportive birth team prepared to remind you to drink water and have small bites. 

Movement to Benefit Your Pelvic Floor in Labor

Continue to move your body throughout labor. No, we don’t want you going for a hike or anything like that, but continue to switch up positions as your contractions flow. Follow your body and your intuition. Each subtle movement shift will aid in your baby’s descent. Choose a team of birth workers familiar with positions that can support you throughout labor, if you’re ever feeling “stuck.”

Pushing and the Pelvic Floor

This is the time for your pelvic floor to shine! When pushing a baby out, it is so important to let your body and your pelvic floor signal you with that insatiable urge to push. (Things are different if you’ve got an epidural on board… ;) ) You just did all this work to dilate to 10cm (crazy right?!) and sometimes your body needs a little bit of time to integrate the next phase of labor. Pushing too soon can put undue strain on your glorious pelvic floor. Once the sensation to push builds, work with your contractions and your breath to move that baby down. Choose a provider that can steer you towards birthing positions that support your individual pelvic floor, as well. Most people don’t need to be lying on an exam table with stirrups (a gravity-negative 

position) for pushing. Try gravity-neutral positions like hands and knees or being in water. There are also gravity-positive positions like a deep squat. Work with a team of birth attendants who can recommend the best plan for you and supporting your pelvic floor. 

Immediate Postpartum and Your Pelvic Floor

A human being just came out of your body! Recognize this crazy and wild thing you and pelvic floor just did! In this sweet time frame, focus on nourishment and recovery.

Postpartum Nourishment and Your Pelvic Floor

Calories are your friend! Aim for fiber-rich and nutrient-dense foods. You’ll want warming and easy to digest foods, as all our organs are readjusting to find their comfortable places above your pelvic floor again. Now that you’ve got a newborn at home, you’re also entering the territory of broken and limited sleep. You don’t get the same kind of cell-regeneration with these sleep patterns, so compensate with nourishing your system through food. And don’t forget to hydrate! All of your fluids are rebalancing after you have a baby and it takes quite a lot to regulate your system. Drink up!

Rest and Recovery for Your Pelvic Floor

The first 6-8 weeks after you have a baby are so important. Your pelvic floor just opened up for an entire being to come out of your body. It’s going to take some time for it to come back to its non-pregnant state. The most powerful thing you can do in this time frame, is not put extra strain on your pelvic floor muscles, especially in the first 2 weeks. Aim for the first 5 days in the bed, the next 5 days on the bed, and the next 5 days hanging out around the bed. Make your only duties eating, sleeping, going to the bathroom, and showering. Even just standing up an extended amount of time can put strain on your pelvic floor by mere gravity. You might notice increased bleeding in response. Use these cues and continue to give your body rest. 

Find a provider who will come to you for postpartum and well baby care. Most hospital based providers only offer one pediatric visit at 2 weeks and one gynecological visit for you at 6 weeks. This is not enough! Regular check-ins are how you prevent injury and promote rapid healing. Facilitate a postpartum care plan including meal prep, systems for ease with house chores, talk about roles with your partner, and consider getting a postpartum doula. Speak with your provider about when the timing is right to begin no-impact movement like walking. Remember the fastest way to recovery is healing first, and taking small steps into activity. Ask your provider for a pelvic floor assessment around 6 weeks postpartum. And make a plan to transition into care with a pelvic floor specialist around the same time. They’re amazing!