If you are pregnant. Invest in your health now, in your body now and in your future self. It is well worth it. And it may be easier to manage to do it now and take the time, then when you have a newborn to get the recovery care that is required postpartum (and yes, everyone needs recovery care even if you feel amazing). That's a topic for another day or you can read my book “Restore Your body After Kids: The Secret To Avoiding Peeing Your Pants And Achy Joints As You Age”
Many things that I absolutely want people to know as tis the importance of pelvic floor therapy in pregnancy. Once I started to establish a very strong treatment method for helping open up the pelvis and pelvic floor to prepare for birth. People are starting to get referrals from their medical providers to go see a pelvic physical therapist during pregnancy but most Pelvic PT's don’t do internal releases and spend the time it takes to really open up the pelvis. This stems from the physical therapy education and associations that have always operated from a “cya” perspective cover your own ass. Well when you operate like this and prescribe to this philosophy, I will tell you, you will NOT make changes in society, you won’t know how to buck the system and make real and lasting change.
When I started Body Motion in 2017, I was one of those PT's that wasn’t doing internal mobilization and soft tissue stretching and releasing inside the pelvis during pregnancy.
It was ingrained in me that you just don’t do this. All my amazing mentors subscribed to this philosophy and all professional education prescribed to this philosophy as well. I didn’t start asking WHY until after my first baby in 2015. In 2015, I was working as a pelvic PT for 3 years at that point. I was extremely fit. I played college hockey and then continued lifting heavy weights and got more and more into fitness once I had graduated. To very unhealthy addictive places at times. But I was in tip top shape going into my first pregnancy. I was in tip top shape through my entire pregnancy. I worked out no less than 4 days per week, doing very high intensity workouts and continued lifting heavy weights. The plus side was I didn’t have a lot of aches and pains. But the draw back, my body was tight. I had tight hips, everything was very tight. When someone like this shows up to our practice today we know this pattern and most of the time their pelvis is very glued together for lack of a better term and their pelvic floor extremely extremely tight. Anyways, after I delivered my first, the doctor told my mom in the lobby, there is no way, I thought this was going to end in a vaginal delivery. I absolutely thought Allison was going to have a c-section.
This doctor had that thought and most the time, the doctors thoughts end up being the care that you receive, so by some grace of god or the universe and my grit and determination (yes I am giving myself some credit here) I got that baby through my vagina. (With damage of course) So Why don’t pelvic PTs do internal during pregnancy? This was haunting me a bit because I started to reflect on all my past patients. Some with vaginal births some with cesarean births. I would do all these manual pelvic opening techniques on them through pregnancy, I would walk them through the best positions to deliver for their bodies based on their pelvic floor control in certain positions, I gave them all the good exercises to help maintain their strength and stability and work on their flexibility, I taught them body mechanics to help prevent injuries (including how to use their abs to prevent a diastasis recti). I can tell you I worked on my own pelvic floor control and coordination throughout my 1 pregnancy and did all these things listed above.
But why wasn’t this enough?
I could already tell this was going to be game changing. I started to see that the exact tightness and tone that I would manually release outside the pelvis via the gluteal muscles, long dorsal ligaments, sacrotuberous ligaments to help open up the pelvis, the same tightness and tone was happening in the pelvic floor muscles. The reason this was happening was most likely due to the Relaxin, Progesterone and Estrogen increasing the laxity of the pelvic joints, which means they were “looser” which starts happening at 6 weeks pregnant. Because of that looseness, the pelvic floor muscles and the gluteal muscles start to contract and tighten down. They do this to protectively “hold the pelvis together.” This is what I see clinically in every single pregnant person. The text books all tell you that when you're pregnant the pelvic floor elongates to open up for the baby to come through. However, whoever published that idea into the medical world was guaranteed not to be clinically touching and examining these muscles internally. Because I have never met a pregnant person's pelvic floor and thought it was elongated. So the beauty of this revelation was that stretching and obtaining new lengths through manual internal techniques was a game changed. I got emails, upon texts and more emails, right after people would deliver about how easy it was to push, how they weren’t frightened by any of the experience even the ring of fire because they knew what to expect with all the pelvic therapy. It had given them a baseline of exactly what a stretch feels like inside their pelvis, It had stretched to new lengths ect. The difference in changing my clinical approach was paying off. Some of those above clients I mentioned before have gone on to have successful vaginal births (vbac’s). It is a combination of all of our treatments but I think most importantly it's the preparation of the entire pelvis internally and externally. I want to note that many pelvic pts will do biofeedback to see how the tone of the muscle is and if the muscle can contract, relax and bare down, but unless someone is assessing all three layers of the pelvic floor and really seeing what is happening and what the muscle length is like and what the quality is like, it is impossible to assess without doing that manually. And that my friends is where the magic happens. Perineal stretching (just stretching the first layer/ the opening of the vagina) is quite simply not enough to prepare for delivery. However taking the approach that we have now coined and teach to other pelvic expert PTs here at Body Motion Physical Therapy our status for vaginal deliveries are amazing. Not to mention the reduction in perineal tears. And Doing this type of treatment prenatally significantly decreases the amount of healing needed postpartum. The clients that go through our prenatal preparation program, protocols and treatment approaches end up needing 1/3 of the time that it takes others who have a vaginal delivery.
Author: Allison Feldt
"We Help Women Through Pregnancy And Beyond So They Can Live Active, Confident And Healthy Lives To Prevent Surgery And The Need For Medications."