Shanghai Mama

“The perineum and pelvis [….] form the lowermost portion of the abdomino-pelvic unit, support the weight of the abdominal and pelvic organs, and bear the full share of intra-abdominal pressure”
This group of muscles forms a diamond shape that joins the pubic bone to the sit bones and the tailbone.
Keeping these muscles in good tone is necessary as they bear the weight of the upper body, weakness in this area can affect posture and lead to back pain and misalignment.

During pregnancy this area of the body has to bear an even greater amount of weight, it is thus important to keep them “fit”. As the baby’s head and body emerge during delivery these muscles are also under a huge amount of pressure as they have to stretch to their maximum.
Toned healthy muscles not only are stronger but they also are able to stretch and return to their original shape.
So… in order to help avoid tearing during birth and to encourage the muscles to go back to their original shape after labour it is a good idea to do some preparation work.
Not only will your posture benefit from it, but your sex life will not suffer and the embarrassing problem of stress incontinence will be avoided.

I’m currently 35 weeks pregnant and I’m using a 3-way approach to prepare the pelvic floor for the big day, some more regularly than others, I guess I will probably start trying to use all 3 daily from next week.

STEP 1 – PELVIC FLOOR EXERCISES
These exercises are designed to improve tone and blood circulation to the pelvic floor, they also teach how to control the muscles knowing how to completely let go of the tension as you allow the baby’s descent during labour.
You can practice the following in a squatting position (if this is comfortable), or kneeling with you knees apart and head on your hands or any other relaxing upright position.

1. CONTRACTING AND RELEASING
Close your eyes and focus your awareness on your pelvic floor.
See if you can tighten your pelvic floor muscles by drawing them up towards your uterus. Just your pelvic floor muscles should be moving, not your buttocks or abdominal muscles.
Now breathe out and let them go and feel them release slowly.
Repeat several times- inhaling when you tighten and exhaling when you let go.
Now go one step further. Tighten the pelvic floor muscles when you breathe in, hold them tight while you exhale and inhale again, then let them go slowly on an exhalation.

2. UP IN STAGES
Using your imagination, contract your pelvic floor muscles in stages, like a lift going up four floors and pausing in between each floor.
This exercise takes a lot of concentration and it’s great to achieve greater control of the pelvic floor muscles. Each time you contract or release down you are doing so by going only ¼ of your maximum contraction or relaxation.

Take a couple of deep breath. With your next inhalation contract ¼ up, exhale and hold the contraction, inhale going up to 2/4, exhale hold, inhale 3/4, exhale hold, inhale all the rest of the way up, exhale hold, inhale hold. Now start the journey down on, as you exhale releasing ¼, inhale hold, exhale to 2/4, inhale hold, exhale ¾, inhale hold, exhale all the way down, take a couple of breaths making sure you are muscles are soft again.

The downward part of this exercise mimics the way your pelvic floor will release as your baby is being born. You can practice this downward part separately to get used to the idea of the baby’s head emerging. To make this most effective you can visualize the baby’s head being born with each exhalation until the baby’s body is fully emerged and lying on the ground facing you. This is a positive image that can help during labour.

3. BUTTERFLY LIFTS
As you sit relaxed and breathe normally, contract and release the muscles in quick succession. Repeat from 10 to 100 times and then relax. These can be done any time, anywhere during the day, while waiting for the bus, while brushing your teeth…

STEP 2- PERINEUM MASSAGE
To prepare the perineum and make it more elastic it is recommended by midwives that perineum massage should be practice during the last few weeks of pregnancy, starting with the 34th week. It is also useful to get used to the idea of the baby emerging for the baby canal and can help relax during labour. Some birth attendants and doctors don’t recognize the benefit of this preparation so it is also worth talking about it with your practitioner to find out what they think. Anyhow this is not a dangerous practice so it might be worth doing it just in case it helps on the day.

Very good instructions on how to perform this are found here

STEP 3- EPI-NO
A couple of months ago I was introduced to this rather odd sounding device by a friend. The EPI-NO is a pelvic floor muscle exerciser and can also be used for birth preparation. The website does a good job of explaining how it works. There have been studies which show that the use of the EPI-NO to prepare for birth not only has a good impact on the outcome of the perineum after birth, fewer cases of tearing and episiotomy, but also see the training as extremely useful for building confidence in women which become accustomed to the feelings of labour beforehand and will be able to enter the birthing room with more confidence.
I purchased one online and I’m waiting to start the training at week 37. I’ll keep you posted to let you know if it helped.