Hello Thrivers,

Over the course of my time at Thrive, I’ve written a number of blogs about how physical therapy can help people recover and return to function after having a baby. We’ve also talked about physical therapy’s role reducing pain and maintaining function during pregnancy. We know, as validated by studies, that pelvic floor muscle education prior to childbirth reduces the likelihood that people will experience incontinence after birth¹.  However, it recently occurred to me that our Thrive clientele might benefit from further understanding how physical therapy can improve the actual birthing experience.

physical therapy and child birthThe genesis for this blog occurred after I attended a birthing preparation course taught by Ashley Brichter at Birth Smarter. This organization has virtual and in person childbirth education classes for expectant parents and professionals.  Despite being 5 years removed from having children myself, I found the educational review helpful for my professional practice.  It reminded me that understanding the anatomy of a vaginal childbirth can gift the expectant parent with tools to improve the birthing experience.  In the spirit of that education, let’s talk a bit about the pelvic floor muscle mechanics during childbirth.

It’s intuitive and correct to say that pelvic floor muscles stretch during vaginal delivery. It also understates the truth…these muscles grow between 1.5 and 3 times their original length². This can seem really scary to an expectant parent, but ultimately these muscles are designed to move! In normal, daily life, they get shorter and longer in response to given tasks.  When they function to maintain continence, they gently tighten so that we don’t urinate or have a bowel movement when we don’t want to.  Alternately, when we go to the bathroom, they relax and get longer to allow the passage of fluids.  I tell you this to illuminate the point that pelvic floor muscles are designed to change shape and length.  It’s just the magnitude of the change that’s specific to childbirth.

One can learn to increase muscle awareness and improve the ability to relax and lengthen the pelvic floor for birthing. This is exciting, and is where physical therapy comes in! By partnering prior to birth with a skilled PT, one can:

-Improve pelvic floor muscle awareness
-Engage in mindfulness techniques to enhance the relaxation and lengthening of the musculature
-Understand and practice laboring positions that more easily allow the pelvic floor to lengthen and the bony anatomy to open
-Learn what pushing positions and strategies are best for one’s body
-Increase tactile stimulation and stretch tolerance to the pelvic floor tissues via perineal massage (a technique which is proven to reduce incidence of episiotomies)³.

These skills give the birthing parent more agency over the experience. One becomes more prepared, more flexible, and more able to access available tools so that the pelvic floor can do its job!  I would love to tell you that the birthing experience will then be perfect.  The messy truth is that there is no such thing!  That said, it does create the potential for a more informed and empowered experience.   In the best case scenario, physical therapy is prescribed both before baby’s arrival and after.  At Thrive, we are passionate about partnering with birthing parents and their partners to enable a more empowered delivery and aide in the recovery that follows.

If you are curious is this type of rehabilitation would be good for you, schedule an appointment and speak with your physical therapist. For appointments please call (212) 254-7750 or email and ask for Elizabeth.

¹ S Woodley, R Boyle, J Cody, S Morkved, E Hay-Smith. Pelvic floor muscle training for prevention and treatment of urinary and fecal incontinence in antenatal and postnatal women, Cochrane Database Syst Rev (2017; 12).
² G CAllewart, M Albersen, K Janssen, MS Damaser, T Van Mieghem, CH Van Der Vaart, J Deprest. The impact of vaginal delivery on pelvic floor function – delivery as a time point for secondary prevention. BJOG: An International ³ Journal of Obstetrics and Gynaecology (2016: Volume 123; Issue 5), pages 678-681.
³ MM Beckmann, OM Stock. Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev (2006; 1).

Elizabeth D'Annunzio Shah Physical Therapist New York CityElizabeth D’Annunzio Shah, PT, DPT, OCS, MTC works with patients of all ages and abilities including recreational athletes, professional dancers and performing artists. She has a special interest in vestibular and balance disorders, movement theory and creative solutions for both neurologically and musculoskeletally impaired persons. Elizabeth is passionate about exercise as a means to maintain health, manage stress and enjoy life! She practices yoga in the Iyengar tradition, is an avid surfer, and participates in distance running events whenever possible. (more)