Something I love doing is speaking to group prenatals. One question I often get asked about pushing during childbirth is: Are there any pelvic floor friendly pushing techniques I would recommend? Being the pelvic floor nerd that I am, of course there are! But first, let’s talk about why the pelvic floor is a concern during birth.
What Is The Pelvic Floor?
Your pelvic floor is the bottom of your bottom. The muscles of the pelvic floor span pubic bone to tailbone and hip to hip. Like any other muscles, the muscles contract and relax to aid in waste elimination, support the pelvic organs, and have sexual functions, among other things. During pregnancy, the weight of the uterus + fluid + baby puts a lot of pressure on the pelvic floor. This is something our bodies are designed to do, so don’t freak out. It’s just something we want to be aware of when we’re talking exercise and healing in the postpartum period… and of course PUSHING! Because ultimately the pelvic floor muscles have to relax and stretch to let a baby out of there, right?
So now that you know a little more about the pelvic floor, let’s talk pelvic floor friendly pushing!
How To Relax The Pelvic Floor
Sure, we know what it feels like to tighten the pelvic floor or kegel. But, do you know what it feels like to relax the pelvic floor? How can you even do this? When we focus so much on the tightening piece of the puzzle, it can be hard to know what it feels like to relax. Just like your shoulders and neck, your pelvic floor can hold tension. The problem is we can’t see it and often can’t feel it when it’s holding lots of tension. An automatic response of muscles put under pressure is to tense up or tighten. So, during pregnancy when the pelvic floor is under lots of pressure you actually may be holding tension in your pelvic floor.
So, how do you learn to relax the pelvic floor? The pelvic floor actually lengthens (relaxes) and contracts on each breath, or it SHOULD. When you inhale, the belly expands and the pelvic floor lengthens (relaxes). When you exhale, the belly and pelvic floor contract, moving pressure out of the system. However, pregnancy can also change our breathing patterns in some pretty significant ways. It can be hard to get a full breath in, thus not allowing for the pelvic floor to complete its full range of motion. One breathing strategy I teach to all of my clients is the core and pelvic floor connection breath. This is just reconnecting you to breathing and focusing on feeling how the two respond to each other.
I hear from so many women that they can’t really feel what’s going on here. It can definitely be tough if you haven’t learned how to tune in before.
So, what if you can’t feel anything? That’s when I teach the pelvic floor drop. This is the same concept as the core and floor connection breath, but with a little help to really feel the pelvic floor “drop” or relax.
Another thing that can be helpful pre-birth to prepare the pelvic floor for pushing is perineal stretching and massage. The perineum, the space between the vagina and anus, is the part that needs to stretch so much during birth. Stretching/massaging can prepare the tissues for that to happen. Perineal massage can be done with massage oil and just 5 minutes of manual stretching and manipulation, moving the perineum and gently stretching and massaging them. Perineal stretching can be done in several different positions and does not require a hands-on approach.
The Flower Bloom Breath
The flower bloom breath is a breathing strategy you can use during pushing that allows for more opening and relaxation of the pelvic floor. It isn’t as forceful as coached pushing, which is the general way practitioners will tell you to push during childbirth. Coached pushing can put a lot of pressure on the pelvic floor, unnecessarily, while you’re bearing down for a count of 10. This method of pushing can be incredibly useful, especially when combined with using more upright or gravity-assisted pushing positions.
Positions for Pushing
Many providers won’t give you other options for pushing aside from lying on your back with legs in stirrups. Not only are you using gravity AGAINST you, but baby has to travel up and over the tailbone in this position. This can make your pushing phase harder, longer, or force you to revert to more bearing-down type pushing strategies.
With an epidural: If you have the assistance of a doula, nurse, and/or support person (and your provider supports this), they can help you flip into a hands and knees position for pushing. The only issue here is that without feeling in your legs, they can feel like they are going to slide right out from under you. If this is a position you’d like to be in, ask for people to put pressure on your legs so they stay in place and roll gently as to not disturb the epidural. You can also push in a side-lying position or ask your nurse/provider to incline the bed in a seated position for pushing. This allows gravity to work for you.
Without an epidural: You can try any position you are comfortable in, given you have provider support. Some are very traditional and do not like or aren’t familiar with catching babies when the birthing person is in other positions. Many people find standing, squatting holding onto a bar or the bed, hands and knees, or seated to be the most comfortable positions.
Whatever you decide, allowing your body to labor down and tell you WHEN to push (feeling pressure, etc.) is super important. This means YOU aren’t working as hard and your body is ready to allow for stretching of the cervix, muscles, and vagina.