Childbirth and the Pelvic Floor
Top Contributors - Jess Bell, Kim Jackson, Carin Hunter and Olajumoke Ogunleye
Introduction[edit | edit source]
The pelvic floor can be significantly impacted by birth[1] - so much so that pelvic floor dysfunction after birth is considered a major public health issue”.[2] However, it is also important to remember that the pelvic floor plays a key role in childbirth and how the birth itself progresses.[3]
NB: When discussing the “pelvic floor in birth”, we are referring not only to the pelvic floor muscles but to the entire pelvic floor, including the pelvic organs, ligaments, myofascia, muscles, nerves, etc. These structures all interact within the pelvic bowl (also known as the pelvic ring).
This page explores specific ways to help maintain pelvic health during childbirth and to enhance it after birth. In particular, it discusses the five key priorities identified by Ibukun Afolabi[3] for pelvic health in childbirth - the 5 “Ps”:
- Proactive prevention
- Pelvic biomechanics
- Position
- Pressure management
- Perineal preservers
Proactive prevention[edit | edit source]
As mentioned, childbirth, whether it be vaginal or via caesarean, can adversely impact pelvic health. However, Afolabi[3] asks the following questions:
- Is the problem giving birth itself?
- Is childbirth inherently problematic?
- Could the problem be something else?
Afolabi[3] argues that giving birth in itself is not the problem. Instead, the problem lies with how women are primed, expected and instructed to give birth. And she believes that this can be improved when current knowledge is applied to the birthing context.
Pelvic biomechanics[edit | edit source]
Pelvic movements are generally described as rotations about one of three cardinal axes. Each rotation acts to create motion in one plane:[4]
- Rotation about a mediolateral axis causes motion in the sagittal plane often called anterior or posterior tilt
- Rotation about an anteroposterior axis causes motion in the frontal plane - occurs when one side of the pelvis goes lower while the other goes high and is often called pelvic drop or hike
- Rotation about a vertical axis causes motion in the transverse plane, called forward and backward rotation or anterior and posterior rotation.
The following video explains the movements of the pelvis in detail.
Pelvic movements can have a positive impact on labour. Maternal movement of the pelvis during birth enables babies to navigate through the pelvic inlet to the pelvic outlet - and to avoid any barriers.
If barriers are encountered during the movement path of the baby (i.e. cardinal movements), and the baby is unable to navigate through the pelvic path, other structures begin to absorb the forces generated by the uterus. This can place the pelvic structures under greater strain and have a negative impact on the pelvic floor:[3]
- There can be increased compression of the pudendal nerve, which can heighten labour pain
- The pelvic floor muscles (and the body generally) may tense up and stiffen rather than remaining supple, elastic and dynamic
- Medical interventions might be escalated:
- For instance, a mother may be given more synthetic oxytocin to increase uterine contractions
- This has been shown to “interfere with the coordination of uterine and pelvic floor muscle contractions[8]
Moving and harnessing the power of pelvic kinetics can stop this downward spiral and, thus, prevent pelvic floor injury.[3] Various studies have explored the positive effect of movement on labour:
- A Cochrane review found that there is evidence to suggest that walking (and upright positions) during the first stage of labour can reduce the length of labour, the chance of a caesarean section and the likelihood of needing an epidural[9]
- Toberna and colleagues[10] discuss the role of “dance” in terms of encouraging upright positioning and movement during the first stage of labour
- NB the authors note that “dance” is not to be taken literally in this context, but rather used to represent a range of body movements (pelvic and rhythmic body movements, upright positions, and changes in position)[10]
References[edit | edit source]
- ↑ Van Geelen H, Ostergard D, Sand P. A review of the impact of pregnancy and childbirth on pelvic floor function as assessed by objective measurement techniques. Int Urogynecol J. 2018;29(3):327-38.
- ↑ Burkhart R, Couchman K, Crowell K, Jeffries S, Monvillers S, Vilensky J. Pelvic floor dysfunction after childbirth: occupational impact and awareness of available treatment. OTJR (Thorofare N J). 2021;41(2):108-15.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Afolabi I. Childbirth and the Pelvic Floor Course. Physioplus, 2022.
- ↑ Lewis CL, Laudicina NM, Khuu A, Loverro KL. The human pelvis: variation in structure and function during gait. Anat Rec (Hoboken). 2017;300(4):633-42.
- ↑ Dr. Jacob Goodin. Hip Joint & Pelvic Girdle Anatomy: Joint Movements. Available from: https://www.youtube.com/watch?v=n8iNhG4xJVc [last accessed 10/1/2022]
- ↑ About Medicine. What is the True Pelvis? - Pelvic Inlet & Outlet Anatomy. Available from: https://www.youtube.com/watch?v=NB0-8WCo9X4 [last accessed 10/1/2022]
- ↑ Kim Vopni - The Vagina Coach. Make childbirth easier. The pelvic inlet and pelvic outlet in birth positions. Available from: https://www.youtube.com/watch?v=_SnE79Q2rp8 [last accessed 10/1/2022]
- ↑ Karahan N, Arslan H, Çam Ç. The behaviour of pelvic floor muscles during uterine contractions in spontaneous and oxytocin-induced labour. J Obstet Gynaecol. 2018;38(5):629-34.
- ↑ Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev. 2013 Oct 9;(10):CD003934.
- ↑ 10.0 10.1 Toberna CP, Horter D, Heslin K, Forgie MM, Malloy E, Kram JJF. Dancing during labor: social media trend or future practice?. J Patient Cent Res Rev. 2020;7(2):213-217.
