During our prenatal care series we have covered a lot of things related to changes throughout the body during pregnancy. The aches and pains have been explained and the importance of exercise has been highlighted. It’s now time to consider the actual labour and delivery of the baby. So what can we do to prepare for the body for this amazing experience?
Preparing the pelvic floor:
Before, during and after pregnancy it’s important to ensure you have a strong pelvic floor, but it’s just as important to ensure you are able to relax it and let go (the opposite of a pelvic floor contraction). In previous blogs we have discussed the importance of pelvic floor strength in relation to our deeper core and reducing the risk of incontinence and prolapse, but in terms of giving birth your pelvic floor requires stretch and mobility in order to allow the baby through smoothly while reducing the risk of tearing. Training the coordination between contraction and relaxation will also allow you to identify how to relax during the pushing phase of labour.
To achieve this:
1. Training pelvic floor muscle relaxation. This can be done with verbal cueing or a feedback device with the help of your Women’s health physio.
Example of a verbal cue we use to help with the relaxation/OFF phase is the pebble analogy.
Picture a pebble falling into the centre of a still pond. Imagine the ripples spreading outwards to the edges of the pond. This is your pelvic floor relaxing, dropping down, and opening around your passages. Give this a go and focus on breathing mindfully as you do it.
2. Perineal massage/stretching: This is a method of preparing the outlet of the birth passage, particularly the perineum. It can help to reduce the incidence of tear and episiotomy but doesn’t reduce the grade of a tear. It can commence in the last 4-6 weeks of pregnancy only, and 1-2 x per week. Using massage oil hold each stretch for about 2 minutes before moving along to the next tight area to stretch.
3. EpiNo: This is device used to train pelvic floor contractions throughout pregnancy and also promote stretching in the last few weeks. You can begin this from 38 weeks using every night for 5-10 minutes. It is a device that pumps up like a balloon to mimic the baby passing through the birth canal. It helps to reduce tearing of the perineum.
Obstetric TENS during labour:
TENS has been shown to assist in pain reduction during labour, especially in the early stages. It also helps reduce the use of pain analgesics during labour. It is safe to use at home, as soon as you start your contractions. We have two machines to hire out to our clients - contact us for details.
Optimal positioning during labour:
Keep your spine long (avoid slumping), lean forward slightly & anteriorly tilt your pelvis. Active birth, or moving around and changing positions, is one of the most important things you can do to manage the pain of labour and birth. If you stay upright, gravity will also help your baby to move down through your pelvis.
Positions include squatting, leaning forward on a chair/wall or partner, 4 point kneeling on the floor or on an exercise ball, or even side-lying with your top leg supported. Have your hands and upper limbs supported, i.e. holding on to or leaning into something helps your pelvis and hips open and relax. Most importantly make sure you’re comfortable and supported.
Other advice during labour:
- Plenty of water to keep hydration up
- Warm heat pack or shower during labour
- Listen to music
- Have a support partner give you a massage
- Relax between the contractions and focus on visualisations and breathing
- Water birth during labour
We have attached an "Active Birth" Pamphlet from The Royal Women's Hospital in Victoria for more information.
Lastly, prepare with exercise for optimal strength during the birth and after. Labour can last a long time for some women and can involve some awkward and prolonged positions, therefore good physical strength and mobility will allow you to move and push more effectively.