How having a strong core can help childbirth
Sometimes, as the weight of the belly increases in the third trimester, weakness in the core can cause what is called a “pendulous belly” (hanging belly), this is when the belly sags forward unsupported by core muscles. Having Pendulous belly can contribute to less than ideal baby positions like asynclitic (baby’s head tipped to the side) which means the baby’s head is no longer in line with the birth canal, and may also contribute to prodromal labor (long labor, without a lot of progress), or “sticky” shoulders (shoulder dystocia) which is when the baby’s shoulders get stuck and cannot pass below the pubic symphysis without manipulation.
Having a strong and effective core should help support the belly and keep it in no less than a 60 degrees angle to the lower body.
So what’s a pregnant person do to strengthen the core and make sure the pregnant belly is well supported?
The first step is to find a solid prenatal core training program that teaches appropriate and safe core work during pregnancy. Obviously, we recommend our comprehensive program, Check out our different targeted programs for each stage of your journey into parenthood. Appropriate core training before and during pregnancy can help prevent a pendulous belly. DO NOT run out and do one million crunches or suck the belly in. Too much tension and pressure in the abdomen is not great for childbirth either.
2. Abdominal Support.
If you notice that you have a pendulous belly, try out a support belt! We want the belly to ideally be around 60 degrees. Not only will changing the angle of the belly help prepare for birthing, it can also relieve aches and pains associated with a pendulous belly. The belt we recommend is called the Baby Belly Belt by Cabea. We encourage moms to do their prenatal core training in addition to the belly support band. Use it as a tool, not a crutch.
3. Labor Support.
We teach a technique for birthing called the abdominal tuck and lift, popularized by Spinning Babies. Essentially, what this technique does is lift the belly angle up during a contraction. This can help with both speeding up the process, and helping baby to find an optimal position. Learn more about this technique in our program or at Spinning Babies. If you choose to use this technique, make sure you do it through 10 contractions in a row for full effect.
Change in Margot over 3 pregnancies
Here is Margot’s bellies from her 3 pregnancies. You can see how her belly angle is quite low in her 2nd pregnancy. She did have diastasis recti prior to conception and possibly she had weak lower core support. As you can see by the photo of her 3rd pregnancy, she learned a lot about core support during her 3rd pregnancy and with the help of proper pregnancy exercise training, her core is supporting her pregnancy more effectively. She is not exactly 60 degrees in the 3rd pregnancy, but much better angle than her 2nd pregnancy, no doubt from the work she has put in.
Try to relax.
Do your part with solid core support through exercise and belly band, if needed. Have the abdominal tuck and lift in your back pocket should you need it during birth. And then relax. We do what we can do, and then we let go and know that sometimes baby’s position or certain things that arise during birthing are outside of our control. We stack the cards in our favor, so to speak. And then we let go and enjoy our pregnancy as best as we can. Some people may need a combination of all 3. Prenatal core work, a belly band, and the technique during birth. Others may only need exercise and support. Still for others this does not appear to be a problem at all. Not everyone is going to have a pendulous belly and it won’t necessarily cause a problem for everyone. Learning about it is a tool. Not another thing to stress out about.
Are you in a Kegel all day long?
Many women I assess with pelvic floor issues have a pelvic floor that stays contracted/ tight / engaged throughout their day. It is so “normal” feeling that they are not even aware that they are pulling it up and holding tight until we begin to do our pelvic floor work and they become aware of the tension there.
There are many reasons why we might hold our pelvic floor chronically tight:
- Because we feel like otherwise stuff will fall out (organs, pee, a baby…. you know, stuff)
- Certain sports…. I tend to notice that athletes in certain sports tend to have the tendency to clench. Take Roller Derby for example- I can pretty much guarantee you that if I was about to be body slammed by someone named Soul Crusher, I would probably clench my pelvic floor.
- Chronic stress. We hold it somewhere and many people hold it in the pelvic floor.
- Acute stress. Someone you do not feel comfortable with walks into the room- what does your body do? Tense up.
- Trauma in our past. Considering that every 98 seconds (yes, seconds) someone is sexually assaulted in the United States(1). This one may be a big one for many people. If this is one of your reasons- please seek out professional support as you begin the release work.
What are some issues caused by tension in the pelvic floor?
A too tight pelvic floor can cause a lot of different types of dysfunction and pain. The one I see most regularly in my private practice is pain during penetration.
Not very yielding for childbirth.
The goal is not a super.tight.pelvic floor but rather a strong, functional and YIELDING pelvic floor. Imagine your bicep muscle… if it was too tight you wouldn’t be able to extend your arm all the way. Tighter isn’t better, it’s just tighter. Not great for childbirth. But not great for the rest of life either so if you’re done having kids or not planning kids, you still don’t want a too tight pelvic floor.
The deep core muscles not working as well.
The pelvic floor and the deep core, oversimplified, co-contract i.e. work together. Lifting the pelvic floor should ideally automatically cause the deepest core muscle, the Tranverse abdominus, to contract. But if the pelvic floor is lifted all the time?? Well of course that is going to jack up that whole coordination system.
Release with a ball:
- Be aware that if you are new to this you are going to want to find a really squishy one. Sit on the ball just to the inside of one of the sitz bones. You should be able to look like you are just sitting in the chair, but you may not be able to sink all the way back down- go slow and don’t force it.
- If you’re able to sit normally and it’s not too intense, add some movement. Circling the upper body, gentle rocking from one sitz bone to the other. Just explore. Again- this is genttttttttle. Do not force yourself through something that is uncomfortable. The goal is to be able to relax and release.
- Switch to the other side and do the same thing.
Learn how to move your body better.
Once you have done release work we need to add movement improvement. This is everything. Learning to exercise “smart” is key for your pelvic floor. That is why we have developed an entire program devoted to smart prenatal exercise. Body Ready Method® is incredible comprehensive and covers each one of the tools mentioned in this post and much much more. Check out our different targeted programs for each stage of your journey into parenthood.
- Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, National Crime Victimization Survey, 2010-2014 (2015).
- Postma, Riemke, et al. “Pelvic floor muscle problems mediate sexual problems in young adult rape victims.” The Journal of Sexual Medicine 10.8 (2013): 1978-1987.
- Madill, S. J. and McLean, L. (2006), Relationship between abdominal and pelvic floor muscle activation and intravaginal pressure during pelvic floor muscle contractions in healthy continent women. Neurourol. Urodyn., 25: 722–730. doi:10.1002/nau.20285
- Tajiri, Kimiko, Ming Huo, and Hitoshi Maruyama. “Effects of co-contraction of both transverse abdominal muscle and pelvic floor muscle exercises for stress urinary incontinence: a randomized controlled trial.” Journal of physical therapy science 26.8 (2014): 1161-1163.
Pelvic Opening During Pregnancy
Do you know how many births I’ve attended as a doula where the birthing person was told their pelvis was too small for the baby to pass through it and they did it anyway? A lot. CPD (cephalopelvic disproportion) or true narrow pelvis, happens but it’s very rare and usually associated with malformation of the pelvis – either from other medical diagnoses or causes. Yet, so many are told they have a small pelvis instead of really considering all the factors that were at play such as:
- baby’s position.
- birther’s position.
- other factors like medical interventions.
- And even still sometimes it’s a mystery.
Does this mean cesarean isn’t a valid option and necessary sometimes? Not at all. I am very grateful we have intervention. I was born by cesarean myself. I’m also grateful that families get to CHOOSE and I’ll never stop advocating for personal preference. BUT can we please stop blaming the pelvis size when there are many more factors at play? We can not tell what a pelvis will do during labor and delivery by assessing it when it’s not in labor and delivery.
Opening the Pelvis During Pregnancy
Start with finding a neutral pelvis (a block under the hips will help). Face the front leg and hinge forward. This is external rotation and opens the top of the pelvis. Hold and breathe – our body needs time to adapt – so 10 second stretches aren’t so helpful here. Next we are going to activate a way of tapping into the nervous system to help truly change range of motion, cool, right? Press your lower leg into the floor for 10 seconds.,then reverse and you’ll notice you can go deeper into the stretch! Because you’ve communicated safety to the nervous system. But especially during pregnancy, please be mindful and don’t force the stretch. Just go a tiny bit deeper. Hold for another minute.
Then switch to face the back leg. This is internal rotation, which opens the bottom of the pelvis. Note that internal rotation tends to be harder for most, so go easy.. This is the time where you allow yourself to be where you are rather than where you think you should be. Hold for 2 mins. Reverse – press into the ground for 10 secs. And then right back into the stretch. Deepen by a micro amount and hold for 1 min.
Do this routine at least 3x a week and you’ll be on your way to some super mobile hips!
Opening Up the Pelvis During Birth
The pelvis is broadly divided into three sections; the inlet, the midpelvis and the outlet. We need different movements to open up each part of the pelvis.
Opening the inlet of the pelvis
Opening the mid pelvis
Opening the outlet
When the baby is at the outlet we want to internally rotate the leg and untuck the pelvis. Internal rotation refers to bringing the knees together and the feet away from each other. Certain types of squats, kneeling, side lying and even lying down with knees together will facilitate this.
When we break it down this way, the birth position possibilities are much greater. Because you can squat (kneel, side lie…) in a way that opens the inlet and in a way that opens the outlet, so understanding the upper leg position and the pelvic position opens us up to create space for the baby through the whole process. Check out our different targeted programs for each stage of your journey into parenthood- with tips and movements to help prepare you for your birth!
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Squats vs Kegels
You’ve probably been hearing a lot of buzz about the squat. And many have been touting it as the go-to thing to do for pelvic floor health. The more squats you do, the stronger your pelvic floor, right? It used to be the kegel, and still is in many circles. You’re pregnant? Don’t forget your pelvic floor! 100 kegels a day for you! And you! And you!
Now it’s the squat. Squat a lot and you’ll have an easier birth and a stronger pelvic floor. That’s what they say. And I’m here to call BS.
But wait… Lindsay… I thought you loved the squat?
Oh, I do, I even have a shirt that says “I squats.”
I’m a squat lover FOR. SURE. But I think that it’s so easy for us to take a very small piece of the huge picture and boil it down to one thing: squats=strong pelvic floor. Have urinary incontinence? Squat more. Want to have an easier birth? Squat. Want to strengthen your pelvic floor for whatever reason? Squat.
People really *are* handing out the squat exercise prescription like it’s the new kegel.
And SQUATTING IS NOT THE NEW KEGEL. The kegel isn’t the new kegel either. Squatting is one part of a whole body movement program and a systematic re-learning of how to use your body in ways that optimize birthing space, functionality, well-being and minimize: pain and disease.
Squat vs Kegel? Is that a question?
“Squat vs Kegel” is NOT the question we should be asking. There is not one exercise that is going to be THE exercise that you need to do. It’s not about the kegel OR the squat. It is about how all the parts of our body work together to support our system. Our pelvic floor, core, diaphragm (how we breathe) are all pieces to the pelvic floor puzzle and that means there is not going to be one exercise that magically fixes/protects/strengthens the pelvic floor.
Getting your whole body to work together is not only going to help your pelvic floor, it’s going to also help your core, your back, maybe even your bum knee that you didn’t think was related (it probably is).. A whole body movement program is much more than just spot treating your pelvic floor, it is treating your pelvicfloor as an essential component to your inner core system and body. Squatting is one piece of the puzzle. Don’t get me wrong, it’s an important piece. But if you’ve ever done a puzzle, you have to build the edges first (at least that is what my grandma always taught me). If most of the time you are sitting. With a tucked pelvis. And thrusted ribs. Then I can promise you this: doing 50 squats a day isn’t going to do what you think it’s going to do. And you are not going to be able to do the squats like you think you are doing them.
Don’t get me wrong, I am all about doing something is better than doing nothing, but if you’re lazy like me (or really, I’m just efficient because I don’t want to do something unless it’s actually worth my time) and want the most bang for your buck, you might as well get the most out of every squat you do!
A squat is not about the squat, itself, but the strength and the range of motion/length of the muscles that we need to get into an aligned squat and the strength that holding this squat will build. Here are some pointers:
1. Prepare your body for squatting.
Join our Free Facebook Group for loads of free videos and discussion on squat preparation. When our bodies are prepared, they are able to squat more freely, naturally, and we are able to get the most out of our squats. It’s not as simple as ‘just start squatting.’ Check out our different targeted programs for each stage of your journey into parenthood.
2. Get a squatty potty
This is going to get you into a squat as often as you go to the bathroom. Use it for both #1 and #2 (I’ve had that question so feel the need to clarify). This is a great way for your body to find the range of motion of a squat while eliminating. This is how we are designed to eliminate. In my opinion, the porcelain throne is a huge contributor to the vast amount of people in our western society with pelvic floor issues. Statistically, we have a lot less babies, yet a lot more pelvic floor disorders. There are also so many people with pelvic issues that have not given birth.
3. Every time you get up from sitting, try to use vertical shins!
How many times a day do you have to get up? Probably a lot. Every time, see if you can engage your posterior leg muscles by not allowing your knees to go past your ankles. You have to get up anyway, right? So might as well get this added benefit, right?
4. If you are pregnant
Learn about your core, pregnant belly alignment, and your pelvic floor. And of course – make sure you do exercise classes that focus on pelvic floor and core for pregnant women. Your body will thank you during birth and beyond.
5. And squat, too.
I’m not anti-squat and I hope this post didn’t come off that way. I am just anti-ONLY squatting and not doing anything else.
Busting Pelvic Floor in Pregnancy Myths
The pelvic floor, though a very important part of the body, isn’t talked about much. Because of the mystery surrounding it, people often cannot make out the difference between facts and myths about the pelvic floor during pregnancy and birth. Let’s talk about a few of the top myths we’ve heard in our BRM community that we thought necessary to bust!
MYTH #1: Just do your Kegels
Too many kegels can result in a tight pelvic floor which we are NOT aiming for, in birth. Rather we want a pelvic floor that can hold in urine when we run, sneeze and laugh and also yield to allow a baby to pass through. Kegels have their place, but on their own are not the best preparation for birth.
MYTH #2: Peeing your pants is normal
MYTH #3: Cesarean will prevent pelvic floor dysfunction
Not true! Yes, a traumatic vaginal delivery can cause pelvic floor issues. But so can a cesarean birth. And no matter what type of birth you have, your body and pelvic floor still have to go through pregnancy. No matter the type of birth you plan/have, your pelvic floor health is important to be proactive with.
MYTH #4: Tighter is stronger
It’s just tighter! A tight pelvic floor that can not go through a full range of motion can be the cause of a lot of issues. From extended pushing stage to painful sex. Also, having a vaginal birth doesn’t “stretch you out” so that there’s no way your pelvic floor is tight. A ton of people I see have too tight pelvic floors after vaginal birth, so it just doesn’t work like that.
It’s worth being proactive about pregnancy rather than waiting until you already have an issue. It’s worth not settling for the fact that you’ll pee a little bit every time you sneeze for the rest of your life.
Check out our different targeted programs for each stage of your journey into parenthood- with tips and movements to help prepare you for your cesarean birth!
If it was an issue with your knee you wouldn’t feel ashamed. Yet, our culture has fed us shame about this our entire lives and this often makes it harder and more embarrassing to seek the help we need. But you’re worth it and you’ve got this.
Why Kegels Might Not Eliminate Urinary Incontinence
As a Pelvic Health PT, I’ve been at odds with the over-prescription of Kegels as a silver bullet ‘cure’ for all things wrong in the pelvis, specifically urinary incontinence (UI). This could be a much longer blog post, but I stuck to the top 3 reasons why I think Kegels are generally ineffective.
1. Urinary incontinence may come from weak pelvic muscles, but not all weak muscles need strengthened.
Weakness in the pelvic muscles can be complicated. But simply put, all muscle fibers in our body need to overlap the perfect amount to generate an optimal force. So, if a muscle is too long (over lengthened) then it will be weak. Now, if the muscle fibers overlap too much (ie the muscle is tight) this will also be weak. Tight does not equal strong, tight= tight=weak! Now hopefully you see why more Kegels (ie tightening) will be ineffective! It is common to assume that when something is not working well, it needs more tone, however with the pelvic floor, that is simply not the case.
We need to begin thinking less in terms of muscle tone and more in terms of function. Ideally, in pregnancy and beyond we train our pelvic floor and core to work optimally, to support us when needed, to not work so hard when not needed. The prenatal programs (like Body Ready Method®) Sign up for our prenatal program to get all the information you need for a pain-free pregnancy.
that emphasize ideal core and pelvic floor function as opposed to “kegel” 40 times a day are the ones I recommend.
And, if you’re a professional in the prenatal realm, the Body Ready Method®️ gives you access to easy techniques used to assess a client’s pelvic floor and gives you the safest exercises clients can do on their own to strengthen their core with something other than kegels.
2. Kegels don’t replicate function.
Pelvic muscles never work in isolation, so why train them that way? We are taught to do them in the car while at a stop light, possibly in less than optimal alignment. One thousand bicep curls doesn’t help you with running a half marathon. So an isolated contraction isn’t actually what is required when you bend to lift your toddler or when you perform jumping jacks at the gym. I know many women who can kegel all day long, but still leak pee and have urinary incontinence.
It again goes back to attempting to rid ourselves of the old paradigm: more muscle tone = better. It does not. That is not to say that there is not a time and place for a kegel. There is. But most people are doing them successively during the day under the assumption that it will and does increase pelvic floor function and reduce urinary incontinence. It does not.
3. Many factors contribute to IU.
It’s just a sign that something is off somewhere in our pressure system known as the core system. Excess pressure in our core and pelvic floor is one of the primary reasons behind UI and pelvic floor disorders and reducing that pressure must be the keystone of the treatment plan.
There are multiple things that lead to excess pressure in our core such as standing and sitting posture (alignment matters!). How about if someone has diastasis recti or a prolapse? How about someone who constantly grips their tummy muscles or who truly has a weak transversus abdominus? This list goes on and the bottom line is that we cannot spot treat our pelvic floor and just do kegels hoping that they will resolve it all. We need to look at the bigger picture and often when we do, the urinary incontinence begins to be resolved. Even if not one kegel was ever done.
Body Ready Method®️ is an online training for prenatal professionals offering a tool kit that aims to broaden the scope of professionals who wish to work proactively with pregnant people. Using the tools, techniques, exercises and assessments in BRM®️ you can help assess all the factors that contribute to UI specific to each body and treat each unique case with effective training.
All women’s bodies are unique. If you would like to talk about how the above relates to your specific condition, feel free to contact me on FB. If you’d like to read more, you can visit our blog here. Check out our different targeted programs for each stage of your journey into parenthood.
Author Bio: Jessica Dufault is a Pelvic Floor Physical Therapist in Madison, WI at Mindful Motion Physical Therapy.
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