3 things all pregnant women should know about their pelvic floor

Yeah, didn’t think so.

Don’t worry: you’re in good company! Dr. Alexis Elias-Spohn, a doula and physical therapist with a focus on pelvic health says, “Listen, most people don’t even know they have a pelvic floor, much less know what the pelvic floor does.”

That lack of knowledge is because pelvic floor health isn’t currently part of standard post-partum care. “I have a vision,” she says, “that when you’re in postpartum care and all those people come to your hospital room – OBs, doulas, lactation consultants--that a pelvic floor therapist will come in too and tell you how to rehab.”

One day, says Dr. Elias-Spohn, it will be standard care in the US, as it is in many other countries. Until then, Nurtured Nesters, here’s your primer!

First, the big picture: your pelvis is a bunch of bones in the middle of your body that support the spine and protect a bunch of organs. At the base of your pelvis is the thing we’re concerned with here – your pelvic floor.

The pelvic floor is a little bowl of muscles with a big job: it supports the GI tract, the urinary tract and the reproductive tract. All those systems go through (or the technical term, “pierce”) the pelvic floor. So not only is the pelvic floor a sort of central point for your body in literal, directional terms (it’s in the middle), but also it’s a center of health for lots of different body systems.

Men and women both have pelvic floors, but women are more likely to need pelvic floor physical therapy, because our pelvic floors get stretched out in pregnancy and childbirth.

Dr. Elias-Spohn puts it succinctly: “Your pelvic floor stabilizes you from the inside out.” When it comes to childbirth--especially if you’re hoping to attempt a VBAC (vaginal birth after a C-section)-- having a healthy, strong, flexible pelvic floor is key.

She recommends pelvic PT immediately after your first birth – whether you want another child or not. But if you’re considering another child and want to attempt a VBAC, pelvic PT can help assess the muscles in your pelvic floor to make sure they’re healthy and flexible. Clenched muscles, after all, can keep the baby from coming out! Not great for your chances of a successful VAC. 

“Giving birth,” reminds Dr. Elias-Spohn, “is a kind of trauma. Beautiful, natural trauma. But still--it’s a big deal for your body. So you need to rehab after it, and that includes your pelvic floor. PT can prepare your pelvic muscles for a vaginal birth and teach you to coordinate your breath with the pelvic floor, so you can relax and push that baby out.”

Pelvic floor PT looks different for every patient, depending on whether you’re facing specific pelvic floor-related problems (like pain in your hips, groin or vagina, incontinence, or constipation) or are doing preventative care or preparatory care for a VBAC.

In general, though, pelvic floor PT involves breath training, exercises to strengthen your glutes and core, and movement to support hip mobility. It might also include Kegels (though the efficacy of these is up for debate) and internal or external visceral massage. (Dr. Elias-Spohn describes this as “organ massage”).

Listen, pelvic floor PT might not be your favorite form of self-care. But is it a critical part of caring for a pregnant and postpartum body? Absolutely.

Here’s the final word from Dr. Elias-Spohn: “If you’re having discomfort during pregnancy, you don’t have to grin and bear it. If you’re hoping to attempt a VAC, you don’t have to leave it up to chance. Call a pelvic floor therapist and see what you can do to help your body work its best.”

She recommends calling your insurance to ask about in-network and out-of-network PT benefits.

Here’s a quick sum-up:

Onward, Nurtured Nesters!