Pelvic health physiotherapists treat a wide spectrum of age and conditions in women, men and children. From incontinence to pain, menopause, post-surgical care and more recently a role for physiotherapists is emerging to help support women during labour and delivery.
The national cesarean section rate has increased from 17% of all births in 1995 to nearly 27% in 2010. In Ontario, nearly 29% of births in 2011/12 were by C-section. As these rates rise across Canada, a pelvic physiotherapist’s skill set and expertise in anatomy, physiology and biomechanics of the pelvis makes them well positioned to positively impact the labour and delivery process. This area of practice for pelvic physiotherapists seems to be a natural extension within our professional scope and our training in optimizing mobility and function.
Here are a few ways pelvic health physiotherapists can help moms prenatally and during labour and delivery:
1) Maintaining pelvic alignment and symmetry during pregnancy and delivery:
During pregnancy, maintaining symmetry within the bony pelvis can assist with form closure of the sacro-iliac joints and minimize shearing forces and mal-alignment of the pubic symphysis. This can help avoid or decrease symptoms of pregnancy related pelvic girdle pain. Proper pelvic alignment and muscular support during pregnancy, can help a woman with day to day activities such as walking, climbing stairs and rolling in bed without pain. As pregnancy progresses, these activities can become more and more difficult so by correcting mechanical dysfunctions early on, it can make for a much more comfortable labour and delivery.
2) Perineal care:
Although the evidence on the use of perineal massage and stretching is mixed, it has been found to be helpful for women in preparation for their first delivery. Perineal stretching can help prepare the vaginal connective tissue and pelvic floor muscles for delivery in order to prevent tearing. By practicing perineal stretching from 36 weeks of gestation onward, mom-to-be can also become accustomed to the pulling, numbing and burning sensations often associated with this tissue stretch. Feeling more comfortable with perineal stretching will allow her to be less stressed and anxious about these sensations during delivery and thus keep her mind, body and pelvic floor muscles more relaxed.
3) Strengthening vs lengthening of the pelvic floor:
Maintaining supportive pelvic floor muscle strength during pregnancy is important for continence, mobility and minimizing pain. During labour, priority shifts to appropriate breathing and lengthening of the pelvic floor. Being able to coordinate breath with pushing may not be as easy as it sounds. Pelvic health physiotherapists can ensure that mom-to-be is able to connect to and coordinate her breath with muscle relaxation. By palpating the pelvic floor muscles during breathing exercises, mom-to-be can learn how to push properly and safely prior to delivery. This will help reduce strain to the pelvic floor and excessive pressure to the abdomino-pelvic organs.
4) Optimizing birthing positions as baby makes its way through the birth canal:
It is important to ensure that the most space is available as baby descends into the pelvic cavity. Appropriate choice of positions can help improve the pelvic inlet and pelvic outlet opening thus biomechanically advantaging mom and baby. Understanding baby’s position during the different stages of labour and fetal stations can help a physiotherapist assist a woman with timing a variety of labour positions and modifications as required. The use of ‘hands on’ labour techniques can also be very effective for pain relief during uterine contractions and help facilitate proper feto-pelvic alignment.
5) Minimizing pain for existing musculo-skeletal conditions
Physiotherapists are experts in the assessment and treatment of musculo-skeletal dysfunction and can help alleviate symptoms for women with a history of injury or pain. Conditions such as hip labral injury, mechanical low back pain, diastasis recti abdominus, SI joint or pubic symphysis dysfunction should not be ignored during the delivery process. Attention should be given to modifying or adapting positions so as to avoid or limit exacerbation of pain.
6) Consideration to Biopsychosocial factors
Last but definitely not least, we must not undermine the importance of other factors outside of mechanics and physical tissues that can affect a woman’s birthing experience. Our brain and nervous system can significantly drive one’s overall perception of pain. Educating our moms-to-be about pain and discussing their fears, concerns and goals of labour can help settle anxieties and stress. Acknowledging the importance of a calm birthing environment, a woman’s cultural beliefs, expectations and religious factors can allow for a personalized birth plan that puts her at ease.
I hope these points help bring to light how physiotherapists with training in labour and delivery support can truly aid a woman’s birth experience. Yes, it is still an emerging role, which is why collaboration with midwives, obstetricians and GP’s is critical. There is also much work to be done to align birthing centre and hospital policies when it comes to having a physiotherapist present during this time.
In conclusion, it is clear that by guiding a woman safely through positions, breathing, alignment and other biomechanical and psychosocial considerations, a woman can feel empowered, more at ease and confident that her body can perform this emotional and physical feat. Scientific literature supports that continuous labour support is effective and really should be the norm. Pelvic health physiotherapists are very well suited for this role and perhaps sooner than later, we will see more PT’s assisting women during this beautiful life-changing event.
Eason, E., Labrecque, M., Wells, G., Feldman, P. Preventing perineal trauma during childbirth: a systematic review. Obstetrics and Gynaecology. 2000 Mar; 95 (3): 464-71.
Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub4.
Pulling back the curtain on Canada’s rising C-section rate http://healthydebate.ca/2014/05/topic/quality/c-section-variation
Rost, Cecile. Relieving pelvic pain during and after pregnancy. Alameda CA: Hunter House Inc., 2007. Print.
Steffes, Susan. The physical therapist in labour and delivery course manual. Section on Women’s Health of the American Physical Therapy Association 2014.