If you’ve read anything else on this blog you’ll know I am a massive advocate for pelvic floor/pelvic health/women’s health physiotherapy (or physical therapy as it’s called in the US). I believe ANY woman who has given birth, or is going to give birth can benefit from it, even if it is just a one-time assessment.
So obviously, I am not the exception to this recommendation. I’ve talked about my previous experience with PFPT as a postpartum woman and when dealing with my prolapse, but this is the first time I have seen one as a pregnant woman. I wasn’t quite sure what to expect, or even sure if I needed to go! I had seen some posts on Instagram from women I follow about seeing PFPT in their pregnancies (Brianna Battles & Michelle Coels of One Tough Mama) and wondered what their trigger was to actually book an appointment to see them. Then I finally got my head out of my own ass, and realized I am legitimately having symptoms that I would be telling my clients to go to physio for. I was having some minor leaks and heaviness, which in and of itself is enough to warrant physio, so I just got down of high horse, and booked an appointment.
I was a bit nervous. Was she going to think I was wasting her time? Was she going to just tell me everything I am feeling is normal and look at me like I’m an idiot? I know, irrational, but those were my fears. Luckily, the physio I saw was one of the nicest women I have ever met, and let’s be honest, I’ve never met a physio I didn’t like! She heard and validated my concerns, assured me that what I was feeling was common, but definitely not normal, and then we jumped right into an assessment.
She was so thorough, it made my nerd heart happy! She had me stand and felt my abs and glutes, she had me squat, then single leg squat on each leg, and me do side bends each way, then had me lay down and contract my TA and then coordinate that with movement. She assessed my diastasis and we discussed how to monitor that moving forward. She examined my PF muscles, and had me do some contractions and assessed where I was feeling pain, how my prolapse was doing and gave me some exercises to work on.
We discussed strategies to deal with my symptoms. One of which was some leaking, or stress urinary incontinence, which I had never experienced before I got pregnant the this time around. Even when I was full term with Bruce, I never leaked, nor did I postpartum. She mentioned bladder irritants, which I had heard of and discussed with the physician at the Pelvic Floor Clinic when I was diagnosed with prolapse. I knew they could contribute to frequency, but what I didn’t know is that they can also contribute to incontinence! The way she put it is, if your bladder is already irritated by certain foods, then when you add a cough or sneeze on top of it, you’re more prone to leaking! This totally made sense to me, because otherwise I could not find any sort of pattern or correlation to my leaking. It was so infrequent, and didn’t seem to relate to my activity level or even the fullness of my bladder when I put any pressure on it, but I hadn’t taken my diet into consideration! And after chatting with a few friends, they all corroborated these thoughts anecdotally.
We also discussed the strength of my muscles. She rated my PF muscle strength a 3+ out of 5, whereas previously I’d been a 4 out of 5. So I mean, considering I am 23 weeks pregnant, those tissues are so swollen and loosened because of relaxin, I’m pretty happy with a 3+! I mean, obviously, I’d love to be 5/5, but I gotta take what I can get! She gave me a few things to work on, and we found while the front half of my muscles were weaker, the back half was actually quite tight.
The we discussed preparation for labor & birth. She had some suggestions on positioning, like don’t lay flat on your back, which I mean, is kind of common knowledge these days, I think? Isn’t it? Or maybe that’s just for birth & pelvic health junkies like me! She suggested I try to squat or be on all 4s as much as possible and also encouraged me to avoid pushing using a crunching motion, which a lot of women get sucked into. She suggested I focus on keeping my arms up, at least shoulder height if not overhead with something to hold on to. She said this stops the crunching motion and allows the TA to aide pushing better. We discussed things like perineal massage and EPI-NO, but not in depth. Overall we both agreed that I am in a much better place going into this labour because I actually know how to relax my PF muscles, and that was probably what made my pushing experience so drawn out the first time. I remember feeling SO vulnerable when I actually did relax those muscles, and not feeling encouraged or well coached by my midwife when I did.
This is the #1 reason I suggest all first time moms (or any pregnant woman who hasn’t delivered vaginally, but wants to) see a PFPT in pregnancy! They will help you learn how to connect with those muscles and how to know what it feels like when you both contract AND relax those muscles, because relaxing them is key when it comes time to allow baby to pass through them.