Weighing up the options

Keeping your pelvic floor in good shape during pregnancy, and taking into account all the possible childbirth scenarios, can help avoid problems later.

Pelvic floor health is often the last thing on a woman’s mind when she discovers she is pregnant. More pressing matters such as weight gain, stretch marks and returning to pre-baby shape seem to occupy a large portion of their minds.

However, the rude shock of incontinence or prolapse after childbirth has many wishing they’d focused more on their pelvic floor - that unseen but vital group of muscles and connective tissue that holds up the uterus, bladder and bowel, and helps shut off the urinary and anal sphincters.

The facts are startling; one in three women who have ever had a baby will be affected by urinary incontinence. When these women reach the age of 50, they have a one in two chance of incontinence, often due to prolapse.

As many as one in four women have anal incontinence in late pregnancy (Johannessen, et al, 2013), with up to one in five still suffering from anal incontinence one year after birth.

The pelvic floor takes much more than its fair share of stress during pregnancy and childbirth, making it more vulnerable than other parts of the body during this period. This is because:

• The hormone relaxin is released, softening the body’s  tissues and ligaments so they expand to accommodate the growing baby. This, along with the increasing weight of baby and uterus, puts pressure on the pelvic floor, which, if not strong enough, may stretch and lose its elasticity, much like overstretched elastic. Daily pelvic floor strengthening exercises are recommended to keep the pelvic floor strong

• Constipation is common during pregnancy, and straining on the toilet can place further stress on the pelvic floor. Added to this, a full, impacted bowel restricts the bladder’s holding capacity, risking leakage. Avoid constipation with a high-fibre diet, good hydration, sensible exercise and learning pelvic floor-friendly toilet habits from a women’s health physiotherapist
• Inappropriate high-impact or weight-training exercises can further strain the pregnant pelvic floor. These can be replaced with low-impact exercises, controlled moves and lighter weights with increased repetitions
• Childbirth itself places an enormous strain on the pelvic floor, particularly if the pushing stage is protracted. Less than half of first-time mothers have unassisted deliveries, with 27.1 per cent undergoing a caesarean section and 23.3 per cent an instrumental vaginal birth

Lisa Westlake, physiotherapist, fitness professional and author, said that, instead of women making a rigid plan about how they want their labour to progress, it might be helpful if they kept an open mind about possible labour scenarios.

'Rather than setting themselves up for potential disappointment, I suggest women do all they can to prepare themselves mentally and physically for labour, including sensible exercise, a positive mind set, and being educated about the different possibilities by appropriate, unbiased health professionals.'

'Talk to your doctor prior to delivery, and stay informed during your labour as to your progress and options' Westlake said.

She also recommended the Continence Foundation of Australia’s free Pregnancy Pelvic Floor Plan app (downloadable from Google Play or the App Store), which has customised, pelvic floor-safe workouts for pregnant and postnatal women.

She also encouraged women to seek out a women’s health and continence physiotherapist during pregnancy.

'A women’s health and continence physio will help you understand your pelvic floor, ensure you are exercising it correctly, and help you safely and effectively regain your pelvic floor function after delivery'

She recommended the free Pregnancy Guide booklet, downloadable from the Continence Foundation website, and encouraged women to visit the pelvic floor first website, which has a section devoted to exercises  during pregnancy.

Rachael Thompson’s story Vagina Diaries writer and director Rachael Thompson was acutely aware of the importance of her pelvic floor when she first became pregnant four years ago. She did her pelvic floor exercises religiously while pregnant.

'My main concerns were to maintain my pelvic floor to avoid long-term damage, and avoid an episiotomy by doing perineal massage and stretching,' Rachael said.

She did all she could to bring on a natural birth without need for induction – walking, expressing colostrum, acupuncture and drinking raspberry leaf tea while pregnant.

However, when labour hadn’t started two weeks after her due date, Rachael was induced – twice. Her labour required an episiotomy, forceps and an epidural. 

'It was a difficult birth, and he had a pretty big head,' she said.

After the birth, Rachael had little control over her bladder.

'For the first couple of weeks I couldn’t do things like go into the shops because I was scared I would suddenly lose complete control of my bladder and wet myself,' she said.

Her incontinence, she now realises, was further exacerbated by her excessive water intake. 'Even though everyone says to drink more when breastfeeding, I overdid it!' she said.

A referral to a continence physiotherapist by her concerned midwife, and the resumption of pelvic floor exercises, saw a dramatic improvement in Rachel’s incontinence within a six-month period.

Rachael attributes her relatively swift recovery to the excellent condition of her pelvic floor, the legacy of the strengthening work she’d done while pregnant.

'Without the pelvic floor exercises during pregnancy, my problems would have been much more severe,' Rachel said.