During the first part of the assessment we will have a chat to you to get an idea of what we might want to focus on in the physical examination. For example, we want to know if you are experiencing any musculoskeletal pain, or if you have experienced any bladder or bowel changes e.g. leakage, if you have history of painful periods, constipation, pain with sex, or a history with your bladder prior to pregnancy. All of this information could indicate some tension through the body that will need to be addressed.

We can discuss and ‘decode’ your previous birth stories, discuss anything that you’d like to change for next time, and help implement strategies and tools in your pregnancy, labour and birth.

We look at the pelvis, hip and thoracic position in specific positions or when performing functional activities e.g. squat. This can give us an idea on what structures to treat and manage that could be contributing to the pain or changes throughout your pregnancy.

We use some strategic measures in our assessments to give us an idea of the effectiveness of the pelvic floor and its ability to ‘move’ in preparation for labour and birth.

Pelvic Floor Assessment: We assess for pelvic floor tone, strength and coordination and particularly look at any trigger points or tension through the muscles inside the pelvis.

GH+PB: this is a measure taken from the mid urethra to the mid anus at rest and then on bearing down manoeuvre (pushing like you are opening your bowels) . It gives us an indication of the distensibility of the pelvic floor or how well the pelvic floor can move through its full range of motion.

Bearing Down Manoeuvre: We will also assess the bearing down manoeuvre to check how efficient your pushing is during the second stage labour (this is all important to know if you are planning a vaginal delivery and we need that baby to come down and through the pelvic floor).

1. Advice and education: we can talk to you about the normal birthing process, the cardinal movements, and what role the uterus, the pelvis and the baby all play in this process.

2. After identifying any findings during the physical assessment we can then treat through release techniques (both the external and internal pelvic muscles), verbal cueing to help you relax and open the pelvis, and provide home exercises and strategies you can use and practice before the big day.

3. We can give you some ideas of different birth positions in favour of opening the pelvis that are more ideal for different stages of your labour.

• We can discuss different birth skills and ways of dealing with labour pain ‘healthy pain’ using the following:

• Obstetric TENS - We hire these out for you to use during labour.

• Acupressure points - that you and your partner can use during labour.

• Perineal massage/advice on Epi-no to assist reducing your chances of tearing.

• Massage techniques to use during active stages of labour.

• Birth skills e.g. breathing techniques, visualisations, affirmations.

Ideally, we want you to be going into your birth feeling empowered, educated and with the most optimal pelvic floor! If you would like any more information please contact our friendly physiotherapy team who specialise in this area. We look forward to meeting you!