The Importance of Pelvic Floor Assessment During Pregnancy

The Importance of Pelvic Floor Assessment During Pregnancy: Reducing the Risk of Forceps Delivery and Prolonged Pushing Stages

Understanding and optimising your pelvic floor function during pregnancy can significantly impact your birth experience, potentially reducing the need for interventions like forceps delivery and minimising the duration of the pushing stage.

The Link Between Pelvic Floor Function and Pushing Effectiveness

During labor, the second stage involves pushing, where the baby navigates through the birth canal. Ideally, this process requires the pelvic floor muscles to relax and lengthen, creating an open pathway for the baby. However, some women unknowingly engage in pelvic floor co-activation while pushing—where they contract instead of relaxing the pelvic floor muscles.

This counterproductive effort can close the space the baby needs to pass through, resulting in a prolonged pushing stage. A 2019 study found that 18% of first-time mothers exhibited pelvic floor co-activation, leading to longer pushing times. Prolonged pushing is linked to a higher risk of pelvic floor dysfunction, including conditions such as prolapse, incontinence, and perineal trauma (Ghoreishi et al., 2019).

Risk Factors and the Role of Pelvic Floor Assessments

Several factors can contribute to pelvic floor dysfunction during childbirth, including:

• Pelvic floor hypertonicity: Tight, overactive pelvic floor muscles may not release effectively during pushing.
• Incorrect pushing techniques: Lack of awareness about how to engage the core and relax the pelvic floor.
• Baby and mother factors: certain things like maternal age, baby weight and birthing position can also impact pelvic floor outcomes

A pelvic floor assessment at 20 weeks and again at 34-36 weeks can help identify and address these risk factors. During these assessments, a trained physiotherapist can evaluate:

1. Muscle tone and relaxation ability: Are your pelvic floor muscles too tight, or can they relax effectively?
2. Pushing technique: Are you able to bear down without engaging the pelvic floor?
3. Body alignment and breathing: Is your posture and breathing pattern conducive to effective pushing?

How Early Assessment Helps Prevent Complications

Addressing these issues during pregnancy allows you to work on relaxation and pushing techniques well before labor begins. Some key benefits include:

• Reduced risk of forceps or vacuum delivery: By improving your ability to push effectively, you may reduce the likelihood of needing assisted delivery tools.
• Shortened pushing stage: Efficient pushing minimises the strain on both you and your baby, reducing the risk of complications.
• Lower risk of pelvic floor dysfunction: Preventing prolonged pushing helps protect against prolapse and incontinence post-birth.

Knowledge is Power

One of the most empowering aspects of pelvic floor assessment is gaining knowledge about your body and its unique needs during childbirth. Understanding how to work with your pelvic floor—not against it—can make a significant difference in your birth experience.

Practical Steps to Take

1. Schedule a pelvic floor assessment with a physiotherapist specialising in Pelvic Floor care at 20 and 36 weeks of pregnancy.
2. Practice relaxation techniques such as diaphragmatic breathing and using a pelvic floor wand to help release pelvic floor tension.
3. Learn proper pushing techniques through guided instruction and feedback from your physiotherapist.
4. Incorporate pelvic floor-strengthening and relaxation into your prenatal routine to maintain strength and flexibility.
5. Perineal Massage: from 36 weeks gestation start perineal massage with your partner or with the assistance of a pelvic floor wand

Preparing for childbirth goes beyond packing a hospital bag or attending a birthing class. Ensuring your pelvic floor is ready for labor is a proactive step that can improve your birth outcomes and protect your long-term pelvic health. With assessments and tailored guidance, you can feel confident in your ability to navigate labor and reduce the risk of interventions and complications.

References:

• Ghoreishi, F. S., Kordi, M., et al. (2019). Impact of pelvic floor dysfunction on the second stage of labor: A systematic review. Journal of Obstetrics and Gynecology Research.
• Dietz, H. P., et al. (2005). Pelvic floor trauma in childbirth – myth or reality? Australian and New Zealand Journal of Obstetrics and Gynaecology.

By taking these proactive steps, you can give yourself the best chance at a smoother, safer delivery. Your body and baby will thank you!