How to Prevent Pelvic Floor Injury During Childbirth

As Pregnancy Specialist Physical Therapists, the #1 Question We are Asked is How Can I Prevent a Pelvic Floor Injury When I Give Birth

Did you also know that 19% of women experience pelvic floor injury due to vaginal birth?   And that these injuries are associated with urinary incontinence and bladder dysfunction, fecal or flatulence incontinence, pelvic organ prolapse, pelvic pain and other associated weaknesses of the pelvis/hips/low back. Fortunately, there is a lot you can do to prepare your body and help prevent pelvic floor injury during childbirth.

If you are interested in learning more about our specialist PTs, receiving care in our holistic model so you can prevent pelvic floor injury with your childbirth, reach out to us by calling (616) 516-4334 or contact us here with your questions. 

Our pregnancy specialist PTs have devoted our careers to providing our patients one-on-one, personalized and holisitic care during their pregnancy to help prepare for birth.  Our Push & Birth Prep care is personalized to your body and your needs.

Here is one patient’s words to us after giving birth.   Our goal is to prevent pelvic floor injury during childbirth and empower women to have the birth experience of their dreams.  Mission accomplished here:

I want to thank all of you for the prep work you did for me. It all made such a difference! I am so thankful for Purple Mountain and all the beautiful ways I’ve been blessed by you and by your team through the years ❤️My birth went beautifully. I had a near first degree perineal tear and I feel amazing!! It was the most beautiful and sacred birth and I am still in awe of God’s goodness and mercy in it all.

Have You Considered Birth Prep with Our Pregnancy Specialist PTs?

In our pregnancy physical therapy to help prevent pelvic floor injury with birth, our PTs include push prep and personalized treatments teaching you what to do to reduce your risk of a perineal & pelvic floor injury.  Your Birth Preparation Program is personalized to you Birth Plan, needs and abilities, pelvic floor tension or strength, hip and spine mobility, ability to breathe and core strength.  In our Push Prep we encourage and work closely with you to prepare your Mind, Body and Spirit.  Many patients tell us they feel more relaxed after appointments, better connected to their baby and more confident in their ability to have an empowered labor and delivery.

Push Prep is Just One Portion of Our Birth Prep Personalize Program, Yet it is so Important

Knowing how to push a baby out, what you should be doing and avoiding is a skill.  Many of us really have no idea how to do this well.  Most of us have a visual in our mind, from television or movies, of a woman bearing down, lying on her back, lifting her head and grunting, screaming or holding her breath as she births her baby.   The reality is much more nuanced and can be more gentle on your body.

Our PTs teach you how to push and will guide you through pushing using a variety of positions and techniques to foster competence and confidence in doing this.  One wonderful and unique offering we have here at Purple Mountain PT, that no one else is providing is the use of real time ultrasound imaging to show you your muscles, while you push, while you engage your core, while you perform pelvic floor muscle training.  This is so helpful for our soon-to-be moms, because the visual image paired with our physical therapist coaching you and practicing the optimal techniques with you, provides you mastery of pushing.   Together, with your PT, we determine what your best options & techniques are with regard to the Push Phase of Labor.  Each woman is different, the techniques, positions and options that work best for you need to be personalized and our PTs do this with you.

Learning to control your breath, engage your abdominals, lengthen your pelvic floor, position your hips and other important pushing techniques is our specialty.   Let us give you the confidence to learn what to do!   To work with our pregnancy and postpartum specialist PTs, give us a call at (616) 516- 4334 or contact us here with your questions and we will be in touch.

In Addition to Push Prep, Our Birth Preparation Personalized Program Includes Labor Prep.

Labor is an experience during which your body and your baby are moving towards the birth.  It is an important time for you to be moving to encourage your baby to progress into your pelvis, onto your cervix.   Managing labor pains and having the know-how of movements, positions, breathing and things you can do to relax your body, to move your body and to prepare your body are invaluable.

Our PTs take you through these, reflecting on evidence based methods that are known to help you and your baby.   As with everything we do, our licensed physical therapist will never leave your side during your appointments.  We are with you every moment of your treatment, ensuring you gain the skills needed to prepare for your labor. We even include methods your partner can use to help support you during labor.

Patients tell us working with our PTs for Birth Preparation helps them have less fear of labor and confidence in their preparedness.   To learn more about getting started with our PTs, call us at (616) 516-4334 or contact us here.   Our schedules do get very booked, so even if you are early in your pregnancy and are interested in working with us, we encourage you to call us well in advance.

Our Birth Prep Program also includes Gentle Manual Therapies, Myofascial Release, Massage and Pelvic, Spine and Hip Alignment Treatments to Ensure You Feel Great and Your Body is Providing Your Baby The Space it Needs to Be Positioned Optimally.

If you are pregnant, we understand that you may be uncertain about how to protect your pelvic floor.  You also may be experiencing myriad symptoms from your neck to your toes, as your body changes.   Our holistic approach accounts all of this and aims to help your body manage the demands of the growing baby and prepare for a wonderful birth. To learn more about working with our PTs, reach out to (616) 516-4334 or contact us here.   We are located in Grand Rapids, Michigan and serve patients who come to us from all over the US.   We love this work and consider it a privilege to help you.

At Purple Mountain Physical Therapy, Your Pregnancy Treatments & Birth Preparation Are Personalized and Designed to Help You Feel Fantastic, Address Your Pelvic Floor Health, Improve Your Diastasis Recti Abdominis and Reduce Pelvic Floor Injury During Childbirth Include:

• Push prep and birth preparation exercises and practice, customized to what your body needs. 
• Breathing:  This is crucial and something many of our patients are unfamiliar with how to optimize.   We do not want anyone engaging in “purple pushing”, which is slang for holding your breath to push your baby out. This is not great for your pelvic floor.  We will guide you through breathing, positional changes, activating your abdominals, lengthening your pelvic floor and safety for your hips, pelvic foor and body.
• Rehabilitative ultrasound imaging to allow you to see your abdominal muscles and pelvic floor muscles while you breathe, while you push, while you contract and relax them.
• Pelvic floor muscle training:  Very often women learn that instead of relaxing their pelvic floor muscles, they are tightening them.  This is a problem that we have unravel, by teaching you how to properly and effectively move, breathe, lengthen your pelvic floor and push so that you can prevent pelvic floor injury during childbirth.
• Abdominal muscle and abdominal wall support: Pregnancy treatment will address your diastasis recti abdominis, teach you to support your abdominals without straining this area and work to strengthen your abdominals.
• Low back, pelvic, pubic and hip alignment:  Throughout your pregnancy our PTs want to help foster optimal alignment from neck to toes.  At every appointment we including manual therapies, myofascial mobilization and joint mobilization to balance your pelvis, lumbar spine, ribs and thoracic spine. This is because these areas need to be optimal so the baby has the space to get into position, head down around week 30 of pregnancy. This is also crucial that your pelvic and back are optimal, so you feel great and do not experience pubic pain, hip pain, back pain, pelvic pain.
• Perineal Massage: We teach you how and when to begin perineal massage, helping you understand its purpose.   Perineal massage can be very helpful to reduce tearing and prevent pelvic floor injury during childbirth.  Did you know some of your pelvic floor muscles are in the perineum?
• Third Trimester Exercises:  These are exercises designed to help you feel good and to help your body give the baby the space it needs to get positioned optimally for a vaginal delivery.  We also provide you specific labor exercises, to be completed at home, in the days before labor and once labor has begun.
• Partner involvement: From being your cheerleader to your right-hand person during labor, we educate you on movements and birth prep you can do together to promote the baby settling into the optimal position to allow the cervix to dilate and efface.  This also ensures safety for your hips, your baby, your bladder, your body.
• Labor and Birth education and recommendations:  Our PTs have much knowledge to share that women find invaluable to helping prevent pelvic floor injury during childbirth.

Are You Like Many of the Women that our Pregnancy & Postpartum Rehabilitation Specialist PTs have helped?  In addition to helping women prevent pelvic floor injury during childbirth, we also help them prepare for a successful VBAC. Here’s one former patients happy email to us:

I had a successful VBAC!!! Thank you for all of your help the past few months. Truly such a joy and has made my pregnancy so much more comfortable.  I will see you postpartum because I definitely need some help!

Did you know that your greatest risk for pelvic floor injury during childbirth occurs with your first pregnancy?

Many women first come to us following a traumatic birth that injured their pelvic floor, bladder, pubic bones or abdomen.  We help them through their postpartum recovery. These women find their strength again, yet it takes time and discipline and courage.   They express regret that they didn’t do Pregnancy Pelvic PT the first time they were pregnant.   Often they decide to go forth and have more children and they continue care with us through their pregnancy and find themselves on the other side of a birth that did not involve pelvic floor injury.   Many, many of these women tell us a similar story:

We often meet women after they have had pelvic floor injury during childbirth, when they first seek care for postpartum rehabilitation.  Women tell us they were woefully unprepared for their first labor and birth. A lot of them had hip, pelvic or back pain during pregnancy.   Some of them felt great during pregnancy.   Many of these women told us that to prepare for their first birth, they just “winged” it.   They might have read a book. Maybe they went to a chiropractor.   They might have talked to their doctor about their “birth plan”, but other than that they had no preparation for how to birth their baby.   They did not care for their pelvic floor.  They did not do perineal massage.  They were not aware of which positions are better for them to be in when they push their baby out.  They did not know about pregnancy PT, or if they did, they did not think they needed it.  Or maybe they thought it could be a good idea, but they just never took action to do pregnancy physical therapy.   Then they had their baby and suffered pelvic floor injury and experienced ongoing issues after their baby was born. They often tell us their birth was traumatizing.

If you are pregnant, please put your birth preparation and body preparation highest on your priority list, so you can reduce your risk of pelvic floor injury.

Our holistic approach, guided in years of experience and with trauma-informed methods provides you a safe place to prepare for birth.  To learn more about working with our PTs, reach out to (616) 516-4334 or contact us here.   We are located in Grand Rapids, Michigan.  We love this work and consider it a privilege to help you.

Please know that if you are reading this and you already sustained a birth injury, we are here for you!  Our clinic was founded on a mission to reduce birth injury and also to support women through postpartum rehabilitation.  This means that our specialist postpartum PTs have experience in treating the most catastrophic birth injuries that women experience, including OASI injuries, severe bladder injuries, severe pelvic organ prolapse, Hip injuries, nerve injuries and perineal tearing with pelvic floor muscle injury.   We know you are suffereing and you need and deserve the care we offer.  We have helped countless women just like you. We offer you hope and a path to restoration and healing.  To learn more about working with us for postpartum rehabilitation, call us at (616) 516-4334 to speak with a knowledgable team member or ask us a question here and we will be in touch.  These women often find us themselves online or have heard of us from their friends or recommendations on various social media pages.   Rest assured, we know how to help you.

The women who have sustained traumatic birth injuries arrive to us in fear, frustrated, depleted.  They experienced pelvic floor injury during childbirth and are worried about their recovery.  They are in pain or having pelvic organ prolapse or bladder or bowel problems or a combination of several things.   They wonder if things could have gone better for them if they had worked with us during their pregnancy.  And, so, in the understanding presence of our pregnancy and postpartum PTs, their healing can begin.  Yes, we can help these women.  Yes, we can bring forth healing.  Yes, we can help you process your birth story by integrating your somatic being with your experience.   And, yes, when they become pregnant with baby #2, they always immediately prioritize pregnancy PT.    They know that working with our PTs helps prevent pelvic floor injury during childbirth.  And, it does so much more than that.  It helps you feel empowered.  It helps reduce your trauma.  It eases your mental strain.  It helps you connect with your baby, your breath, your pelvic floor, your power.  It helps you be the strong mother you were born to be.   Together, let’s do this!

To learn more about our Birth Preparation Physical Therapy and working with our Specialist Pregnancy and Postpartum PTs, reach out to us by calling (616) 516-4334 or contact us here with your questions. 

Are you wanting to prevent pelvic floor injury during childbirth and don’t know what you should be doing?   Working one-on-one with our pregnancy specialist physical therapists will give you the tools, knowledge and confidence to head into your birth with a solid plan and know-how.  Women tell us that working with our PTs has given them peace of mind.  They tell us that they think every woman should be working with us. They tell us that they can hear our voice and our counsel during their labor, guiding them through their baby’s birth.  They tell us that their birth was so much better and less traumatic than prior births they had without our help.

Thankful for your supporting during my pregnancy!! We had a beautiful baby at home!  It was a very quick labor – praising everything was lined up and working together with baby (intense contractions started and baby delivered after 11 minutes of “pushing”.  I am so thankful for all the work we did leading up until this. I am feeling a lot better after this labor than I did my first as well

Here are additional tips to consider to help prevent pelvic floor injury during childbirth:

1. Prepare your Mind, Body & Spirit: Birth is an exceptional experience and it is important to be ready for this.  Feeling fear, anxiety or unprepared for what to do is not an effective plan.  There are many resources today to help you prepare.  We advise against listening to our hearing fear-filled birth stories.  Friends may want to share their story, which may not be good for you to hear.  Lean into your own strength, your source for peace, your trust in your body.   Journal, read, plan, exercise to include movements that help with labor and delivery.
2. Complete Perineal Massage: This has been found to reduce risk for perineal and superficial pelvic floor muscle injury.
3. Use warm compresses during labor: This has been found to bring blood flow and stretchability to the perineum during crowning of the baby, potentially preventing pelvic floor injury during childbirth.
4. Move during pregnancy: Unless this is not advised by your physician for medical reasons, we know that exercise, movement and strength training during pregnancy benefit the mother’s health and can help prepare for the marathon of labor and delivery.  Resistance training, in particular, has been found to reduce hypertension when pregnant.   Movement helps keep the pelvic floor toned and responsive.  Exercise and pelvic opening can prepare the body for labor and delivery.   Exercise and movement can also reduce issues with gestational diabetes and help the baby’s positioning.
5. Avoid lounging and slouched positions when pregnant:  Especially in the third trimester, we want to optimize your low back and pelvic alignment.   Lounging on a couch, for example, when you are somewhat reclined or sitting in a slouched position, can both allow the baby to settle into your low back and may impede the baby from getting into the optimal position so they are head down and placing their head on your cervix.
6. Pelvic Floor Muscle Training during Pregnancy:  Women assume this means to do kegels and get these muscles stronger.   However, this is a misconception.  We want the muscles both strong and flexible.   The pelvic floor muscle training must include efforts to get these muscles in shape, both strength-wise and flexibility-wise.
7. Manual rotation of the baby, if occiput posterior:  this would be during labor, if the baby’s head is occiput posterior.   Unfortunately, the occiput posterior head has a wider diameter trying to get through your pelvis.  Thus, it is recommended that your birth provider help manually rotate the baby and this can help prevent pelvic floor injury during childbirth.
8. Slow, controlled second stage pushing with pelvic floor lengthening and relaxation:   So often, we want to be champions and be able to exclaim “I pushed this baby out in two pushes!”.  Well, we have evidence that a baby coming through the pelvic floor too rapidly can lead to more pelvic floor injury during childbirth.   Instead, with the guidance of your OB or midwife, we recommend slow, controlled second stage pushing.   Too fast is a problem and too slow is a problem. Thus, our hope is that your baby and you are navigating this push stage very well, with progressive descent of the head and controlled pushing as the baby comes through the pelvic floor.
9. Avoid using forceps or vacuum, when possible:  Forceps are especially associated with high rates of pelvic floor injury during childbirth. Vacuum has a lower rate of pelvic floor injury during childbirth. However, it is best to avoid operative delivery (this means avoid both vacuum and forceps), when possible.  Thus, knowing different positions that can increase your pelvic outlet is very important.   Knowing how to optimize your pushing strategy to get the right forces on the baby to allow for birth is very important.  Knowing how to relax your pelvic floor, so it can stretch and open up to all for the birth of the baby is very important.  Our PTs teach every one of our patients these crucial skills.
10. Early Postpartum Physical Therapy:  Beginning postpartum PT early, rather than waiting six months, helps accelerate your recovery and takes advantage of this precious immediate-postpartum time that your body is in.  In the immediate post-partum months, your body is wanting and able to massively change.  Our PTs take advantage of these changes to help promote collagen healing, pelvic floor muscle healing, abdominal wall healing, diastasis recti abdominis recovery and more.

One Woman We Treated For her First Postpartum Recovery and then Again During Her Second Pregnancy & Postpartum Recovery May Have Said it Best

I tell all of my friends. All of them.  And everyone at work.  I tell everyone:  go to Pelvic PT when you are pregnant!!   If there’s anything, anything you’re going to invest it, make it pelvic PT.   And some of them tell me “I don’t need that”.   And I tell them, you don’t think you need that.  But, I was just like you.  I didn’t think I needed it and I really regret not getting it during my first pregnancy.  It made all the difference in my second pregnancy and labor.  Things were so much better.  And I’m healing better!

We are a specialty pregnancy and postpartum pelvic health PT clinic.  We have worked with countless women over more than 25 years of doing this.  What do our patients tell us?  They tell us their labor and delivery were much better.  They tell us they had a successful VBAC.  They tell us that they hardly tore.  They tell us that they used the positions and methods they learned with our PT.  They share their joy with us, just like this mom:

I went into labor when my water broke (!!!) in the middle of the night…My labor and delivery was sooo much better! I only had to push 9 times total! Efficient!

Purple Mountain Physical Therapy is the only dedicated, speciality pelvic health, spine, TMJ and pregnancy and postpartum clinic in West Michigan.   Our PTs live and breathe this work, because our patients are life-giving to us.   We love getting to know our patients.   And we are on a mission to reduce birth trauma and birth injury.   All of our patients receive private, one-on-one appointments with our PTs and tell us that working with us was an integral reason why their pregnancy, labor, delivery and postpartum recovery went so well.   It is an honor to do this work.  If you would like to learn more, call  us at (616) 516-4334 or contact us here. 

Peace,

Dr. Maureen O’Keefe, DPT  specializing in pelvic health physical therapy for over 2 decades.

A bit about my interest in preventing pelvic floor injury during childbirth.   Early in my career I worked in general orthopedics and completed post-graduate training in two separate areas: Spine and Pelvic Health.   I completed the Spine subspecialty training first, which meant I was treating very complex chronic neck and back pain, including failed back surgeries, herniated discs, osteoporotic fractures, headaches and more.   Next I began my pelvic speciality, with a one year program in what was called women’s health at the time.  The plan was I would focus my spine speciality on helping women who had low back pain when pregnant, obviously very common.   I loved doing that and this remains a cornerstone at our Purple Mountain PT clinic. However, these women with back pain also had pelvic floor problems and were often experiencing very difficult labor and delivery.   So, I turned my attention towards not only alleviating their back in pregnancy, but helping them prepare their body for an empowered birth.  This required thinking outside of the “typical” physical therapy box, widening my perspective and scope and treatments.  I employed a holistic, head-to-toe framework and began rigorously working towards helping women & their baby get into good positions for each other.   My doctoral capstone project, completed in 2003, was Physical Therapy Indications During Pregnancy.   I selected this due to a deep desire to further my knowledge and skills of how physical therapy can help someone when pregnant.  In 2004 I began to work closely with internationally recognized urogynecologic surgeons.  These surgeons perform surgery for pelvic organ prolapse, a common thing that can develop for a number of reasons and one of them is birth injuries disrupting support of the organs.   Working closely with these surgeons, over many years, while also continuing my private physical therapy practice and serving people who had pelvic floor dysfunction, chronic pelvic pain, pregnancy and postpartum needs, urinary incontinence, fecal incontinence and more broadened by desire to reduce birth injury.   There are actionable things we all can do, when pregnant, to help reduce our risk for pelvic floor injury.   This is included in every pregnant patient’s care plan here at Purple Mountain PT.

If you are interested in learning more about our specialist PTs, receiving care in our holistic model so you can prevent pelvic floor injury with your childbirth, reach out to us by calling (616) 516-4334 or contact us here with your questions. 

Helping women with pregnancy and postpartum recovery has been a cornerstone of my career and the reason why Purple Mountain Physical Therapy and all of our incredible specialist physical therapists provide exceptional pregnancy and postpartum care.   Every PT comes to us with advanced skills in pelvic health, spine, TMJ, pregnancy & postpartum rehabiliation. And each PT is carefully mentored and trained in the unique methods we deliver here at Purple Mountain PT.   Patients tell us this is life-changing for them and we are delighted to receive their trust.  We provide trauma informed care, meeting you and your body exactly where you need to be, to usher in healing and safety and feeling good!

If you would like to learn more about working with our specialist PTs, give us a call at 616-56-4334 or contact us here and we will be in touch!  Best wishes to you during your pregnancy!

You may be interested in these other articles:

Exercise in Pregnancy: A Physical Therapists Perspective

Tips to Prevent Pelvic Floor Injury During Childbirth

Postpartum Abdominal Help in Grand Rapids, MI

Can Pelvic Floor Therapy Fix Prolapse?

Oh no, I am having stress incontinence! What natural treatments can I do?

Dr. Danielle Campbell

Karen Munger, PT, PRPC, Cert MDT

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