A Coach unpacks her three-pronged program to bring balance to the pelvic floor during pregnancy and beyond.
Pregnancy places enormous demands on every part of the body, but the pelvis often becomes the center of attention. Rightfully so.
The pelvic floor plays a crucial role in supporting the parent and child before, during, and after labor. A healthy pelvic floor serves as a sling for the growing baby throughout the pregnancy, reduces tissue trauma and other complications during childbirth, and helps support recovery postpartum.
Historically, the medical community has emphasized strengthening the pelvic floor, to the extent that the term “doing Kegels” has been part of the American lexicon for decades.
And while many do benefit from strengthening their pelvic floors via Pelvic Floor Muscle Training (PFMT), like Kegel exercises, there’s a common misconception that it’s a one-size-fits-all prescription for expecting parents.
In reality, there’s much more nuance to pelvic floor health and training. If no two bodies are alike, no two pelvises are either.
Understanding the Pelvic Floor
To understand how best to support the pelvic floor, it’s essential to comprehend its function, particularly during pregnancy.
“The pelvic floor is a group of muscles and ligaments at the base of the pelvis that support organs like the bladder and the uterus, but during pregnancy, the pelvic floor [also] helps support the added weight of the growing uterus,” says Samantha Ward, a COACH X at Equinox Highland Park who specializes in pre- and postnatal training. “Pregnancy puts a lot of pressure on the pelvic floor, and a common misconception is that the answer is to train it in isolation, such as with Kegels.”
During labor, the pelvis must have sufficient strength to support contractions, but equally important, it must relax between contractions. For many, that proves to be the harder part of the equation.
Recent research has found that one in four women of reproductive age (pregnant or not) suffers from chronic pelvic pain, and that 60 to 90 percent of these cases are related to a hypertonic (read: overactive) pelvic floor — essentially, a pelvic floor that’s constantly contracted.
In life, a hypertonic pelvic floor can cause symptoms including pain in the pelvis, lower back, and hips, including pain when urinating or during sex. In pregnancy, researchers have found that higher vaginal resting pressure (a marker for hypertonicity) can lead to prolonged second stages of labor, though very few studies have been conducted on prenatal hypertonicity specifically. Some people also develop a hypertonic pelvis as a result of childbirth (though research is still limited on how many, due to proven underreporting on pelvic floor dysfunction, or PFD, after delivery).
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“A healthy muscle has the ability to turn off and on,” says Ward. “It also needs to know when to do so, and at what intensity, depending on the load it is under. The way a Kegel is often taught is focused on the contraction, but not the ability to relax. Women need their pelvic floor to work in conjunction with the rest of their body, which requires more nuance than that.”
In reality, Ward says, no part of the body works in isolation. Pelvic floor health 101 begins with understanding the relationship between the pelvis and the rest of the body.
“The most common issue I see is [people] not understanding how the pelvic floor is connected to the entire ‘core’ [the muscles throughout the torso, including the diaphragm, abdominals, erector spinae, and pelvic floor],” Ward says. “The whole core needs to work together. Moreover, our entire body has to work together, especially during pregnancy and postpartum, when we’re caring for a newborn. It’s important that women understand how the body works to support them, so they can train their entire body during this phase of their life — and strengthen the pelvic floor in the process.”
A 3-Part Pelvic Floor Program
Ward works with clients using a three-pronged training approach that focuses on the connection between the pelvic floor, core, and the rest of the body.
“It’s admittedly difficult to define that balance,” she says. “But what I look for (and train myself and clients for) is: first, the ability to connect the pelvic floor to the entire core and diaphragm; second, strong glutes and posterior chain (so the body is aligned to execute this connection); and finally, the connection to breath.”
What does that look like in terms of movement and functional training?
“I’m cueing my clients on how to connect the pelvic floor to the diaphragm and educating them on how to ‘connect’ the ribcage and the hips in all movements to support core stability,” she says. “I like to use an elevator analogy to start: As you breathe in, the diaphragm lowers (elevator goes down) and increases pressure, so the pelvic floor has to relax and lengthen to balance that pressure. When you breathe out, the elevator goes back up, and the pelvic floor contracts and lifts. Once a client gets the visual, I simplify it: Inhale, let the belly expand; exhale, ‘zip up’ to pull the hip bones to the ribcage.” Rather than zipping up, you can also think of “hugging the baby” on the exhale.
Ward also uses exercises that encourage proper breathing while executing the movement. “It could be something ground-based — like cat/cow, bird dog, or deadbug — or something standing like a squat, but the emphasis is on getting the entire core to work together,” she adds. “When we inhale, the pelvic floor should relax, and on the exhale, it rebounds up to support this entire system and create stability.”
Research also shows that Pilates supports pelvic floor health because it emphasizes both the inhale and exhale of every movement, which is why it’s often recommended by prenatal doctors and postpartum pelvic floor therapists as part of a balanced program.
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Finding Pelvic Floor Balance Postpartum
Finding, or re-finding, pelvic floor balance postpartum is a pivotal part of every pregnancy.
“Going back to common misconceptions, I have had clients think that because they had a C-section, they don’t have to worry about their pelvic floor recovering,” says Ward. “All women, regardless of type of birth, tearing, etc., need to focus on healing and training their pelvic floor postpartum.”
Once cleared by your healthcare provider, Ward advises that you slowly return to movement, focusing on connecting again to your breath and integrating your core in every exercise. “Everything stems from there,” she says, “so putting in the work from the start will allow you to safely progress to weight training, running, jumping, anything, over time.”
She also recommends working with a pelvic floor specialist. “In my opinion, pelvic floor therapy should be a requirement for every mama postpartum. Even if you ‘feel good’ or feel like things are healing well, it's something that can be hard to determine the status of. You also want a professional to assess the degree of your diastasis recti, as this is also connected to the core and pelvic floor.”
The pelvic floor is a complex and integral part of the pregnancy journey. The more you know, the more you can support your body exactly the way you need.
“Once a woman is postpartum, she is always postpartum,” says Ward. And that new, and lifelong, parent deserves to thrive.