“Manual therapy mobilizes the pelvic organs and increases blood flow to the uterus,” says McGurk, who recommends women see her three months before they get pregnant, if possible. “A uterus that is fully mobile before pregnancy will help reduce the risk of back and pelvic pain during pregnancy as well as potential birth injuries.” You can expect some manual external manipulation in the abdominal area and internal adjustments which move and lengthen the connective tissue between internal organs and surrounding structures and, frankly, feels like the most attentive vaginal exam you can ever hope to have. McGurk suggests being proactive and asking your doctor for a list of people they recommend. (You can find a pelvic floor therapist near you here.)
As it turned out, I did not actually know how to do them. All of my diligent squeezing and lifting was doing precisely nothing for my pelvic floor. I had to have my PT run through a list of alternative cues before finding one that worked for me. The winners: “Draw your sit bones together and your tailbone to your sit bones,” or “Visualize a cone inside of you and lift up to the tip of the cone”. And don’t forget to release; lengthening and relaxing the muscles of the pelvic floor is just as important as contracting, especially when preparing for childbirth.
Unless your physician warns you not to, work out regularly before and throughout pregnancy. “Preparing the deep core unit is one of the most critical elements for pregnant and post-partum women because it will reduce the aches and pains of typical compensations, such as waddling, prepare the body for the birthing process and help new moms recover quickly,” says Carolyn Appel, CSCS, a New York City-based trainer, mom, and author of the forthcoming book The Little Book for Big Bellies.
Squats are great for developing core, pelvic floor, and lower-body strength and they reinforce good alignment that you might rely on while laboring. Appel teaches a squat in which you inhale on the way down, releasing and lengthening the pelvic floor muscles, and exhale on the way up, drawing the pelvic floor in and up. Hip lifts are also good for spinal health and help bring awareness to your abdominal muscles in a three-dimesional way. You can check out her full pregnancy workout plan here. Additionally, she recommends thoracic breathing exercises; simply inhale and focus on expansion through the ribcage 360 degrees. An increase in ribcage expansion during breathing will ease the increasing pressure on the lower abdominal and pelvic floor muscles as the baby starts to grow.
“Every woman should be seen at six weeks postpartum for a pelvic floor evaluation. Therapists are trained to assess and treat prolapse while midwives and OB/GYNs officially diagnose the grade of the prolapse,” says McGurk. Some of the most common symptoms include the feeling of heaviness or a bulge in the pelvic region, urinary problems, painful intercourse, and low-back pain. I also had severe leg fatigue, a less common symptom.
I knew immediately after giving birth to my daughter, Aarya, that something was wrong with my bladder. It was December 2015 and I’d just capped off 20 hours of labor with three hours of pushing. I’d popped all of the blood vessels in my face under the strain (think: bride of Frankenstein). I’d (regretfully) had an epidural, Pitocin, and the requisite catheter that comes along with that cocktail of heavy drugs. Because of the way I was shaped, I was told, I had to keep the catheter in for the hours of pushing, as the baby wouldn’t be able to fit through the birth canal if there was even a drop of urine in my bladder. I knew instinctively this was causing trauma but in the overwhelming heat of the moment I didn’t have the strength to resist.
Over the next three days it became clear I had lost all control of my bladder. The doctors and nurses kept reassuring me that this was on the spectrum of normal, but I could see the worry creeping into their faces as the days wore on without improvement and I was ultimately diagnosed with a grade 3 bladder prolapse. At 35 years old, I wasn’t ready to embrace the idea of spending the rest of my life in diapers. It turns out that though childbirth is not the only cause, about 11 percent of women undergo surgery for urinary incontinence or prolapse in their lifetime according to a trial published in The Lancet.
I have a background as a yoga teacher and did everything “right” to prepare my body and mind for childbirth; I read stacks of books on natural birth, took childbirth education courses, meditated daily, and had a yoga practice. But, my long and continuing road to recovery revealed some gaping holes in my basic understanding of my pelvic floor and how to care for this precious and complicated network of organs and muscles that, well, keep your insides from falling out.
Six weeks after the birth I had the good fortune to find an excellent pelvic floor physical therapist, Brooklyn-based Michele McGurk, who was able to begin to address the imbalances caused by the birth-related trauma. After almost two years of admittedly inconsistent therapy, exercises, and invasive visits to the urologist, I’ve been able to find some stability and strength with the help of a pessary (a device similar to a diaphragm that supports the pelvic organs) and a lot of patience.