Why is Prenatal Pelvic Physical Therapy Important?

by Keeli Gailes PT, DPT, ATC

Prenatal pelvic physical therapy is important because it will help you be proactive in preventing future pelvic floor and other physical dysfunction. 

“An ounce of prevention is worth a pound of cure”

~Benjamin Franklin

You may think that there is no need to go to pelvic physical therapy while you are pregnant because you are feeling fine or only dealing with “normal” pregnancy changes such as: low back pain, increased urinary frequency, your feet swelling/growing and becoming out of breath more easily. These things will all just go away when the baby comes right? Unfortunately the answer is “sometimes” but even if they do, you will often experience the long-term effects of changes that occurred in your body during pregnancy 20-30 years later when you reach Menopause and your hormones are not as protective as they were in your youth.

Pregnancy Hormones – What, How, and Who?

There are a number of “pregnancy hormones” in your body during and following pregnancy. Among these hormones is relaxin, which does what it sounds like.

Relaxin is responsible for helping the ligaments in the body lengthen to allow the pubic symphysis to gently widen during delivery and facilitate a vaginal birth. Unfortunately, this hormone does not stay concentrated right at the pubic symphysis and it has effects from head to toe during your pregnancy. These effects, however, can be reduced by giving your body the support it needs during and after your pregnancy. 

The physical effects of relaxin allowing for ligament lengthening, along with the postural changes that occur as the center of balance shifts with the growing baby over the course of 10 months, are significant even if everything goes smoothly. This combination can lead to flattening of arches, swaying of the back, diastasis recti (abdominal split), hyperextension of the knees, and a forward head position. There is no evidence that suggests relaxin is responsible for pain, however.

Sometimes these effects cause symptoms during a first pregnancy, but more often they will compound over multiple pregnancies or when postural changes that are not corrected continue and compound over time until you start to see an increase in “common” issues like low back pain with prolonged standing or mild leakage.

Supporting your Body During Pregnancy

Some ways that you can support your body during pregnancy include:

• Engage in a balanced and targeted strengthening program (can be yoga-based)
• Wear supportive clothing or belly-bands such as the Maternity FIT splint. 
• Choose shoes with good arch support or add supportive insoles to help prevent the collapse of your arches.
• Learn how to use good posture and move in a pregnant body safely. Get on the waitlist for our upcoming Prenatal Workshop!

Why it is Not Best to “Just Take it Easy” While Pregnant

Historically, there has been a lot of unnecessary fear mongering among fitness and medical professionals around physical activity during pregnancy. This is, in part, because we have historically excluded pregnant women from most studies in the name of “doing no harm”. It is also a result of many fitness and medical professionals not being up-to date on the scientific evidence that actually supports regular activity in pregnant individuals.⁵

This has led to higher instances of women becoming sedentary during their pregnancy. Less activity can lead to higher risk of gestational diabetes,² as well as postural weakness and muscle imbalances which can lead to pain. Furthermore, those who do start to have pain or discomfort during their pregnancy are often told that it is “normal” and are not referred to prenatal pelvic physical therapy, so their symptoms continue and may even become progressively worse over the course of their pregnancy.

Posture, Pelvic Floor, and Pregnancy

Beyond the changes already discussed, the pelvic floor is also commonly affected far before delivery occurs. This is often due to the relationship between the pelvic floor and the muscles that surround the pelvis. When the pelvis takes on an anterior tilt, there is often compression of the nerve roots exiting the mid and low back. These are the same nerves that are responsible for telling the pelvic floor what to do and, if compressed, that message can become unclear. With altered nerve information, the pelvic floor often trends toward having either too much or too little tone. 

This tilt may be a very gradual process and the effects may not be obvious until late in the pregnancy or even in the postpartum period, but they can look like; urinary incontinence, frequency or urgency, as well as pain with bowel movements, intercourse, or positional changes. By learning how to effectively connect with and strengthen/support your pelvic floor and deep-core throughout your pregnancy you can help prevent or minimize these short and long-term effects. Furthermore, a healthy, strong, and supple pelvic floor may allow for a smoother delivery as it facilitates the baby navigating the birth canal in an optimal way. This is supported by the fact that the Spinning Babies method addresses imbalances in pelvic floor tension before and during delivery and has led to lower rates of c-sections when implemented.⁴

Benefits of Yoga During Pregnancy

Along with physical changes, mental health is often highly impacted by hormonal changes that occur during and after pregnancy. Here’s what the evidence says:

•  A systematic review in 2015 described the prevalence of depression in pregnancy as “7.4%, 12.8%, and 12.0% for the first, second, and third trimesters, respectively.³“ This demonstrates that “postpartum blues” do not always wait until postpartum. 
• Another systematic review done in Japan described a study on a group of women who were depressed during their pregnancy and demonstrated that the effects of yoga practice on this population were that “depression, anxiety levels, anger levels, leg pain, and back pain significantly improved”.¹ 
• The same review described 4 studies that showed that the effects of prenatal yoga for healthy women were “significant improvement in pain and pleasure at delivery, duration of delivery, perceived stress levels during pregnancy, anxiety levels, depression, pregnancy-related experiences, quality of life, and interpersonal relationships”.¹ 

How We Can Help!

At Garner Pelvic Health we use Medical Therapeutic Yoga (MTY) to integrate age-old yogic wisdom with current medical evidence in a way that will give you confidence that you are practicing safe and effective movement that will support your body’s changing needs.

While group yoga classes are helpful, individualized prenatal pelvic physical therapy will allow for instruction based on the unique intricacies of your body and help you get the most out of all of your movement.

We also practice Functional, Integrative, and Lifestyle Medicine (FILM) that allows us to help you recognize what other parts of your lifestyle you can optimize (nutrition, sleep, mental health, spiritual health etc.) to give you and your baby the best possible outcome.

You can join us in our upcoming prenatal physical therapy Workshop or Book a Free Consult to decide whether you would benefit from one-on-one care with one of our staff physical therapists. 

Get on the waitlist for our
NEW Prenatal Workshop coming soon!

Meet the Author

Sources

1. Kawanishi Y, Hanley SJB, Tabata K, et al. [Effects of prenatal yoga: a systematic review of randomized controlled trials]. Nihon Koshu Eisei Zasshi. 2015;62(5):221-231. doi:10.11236/jph.62.5_221

2. do Nascimento GR, Borges M do C, Figueiroa JN, Alves LV, Alves JG. Physical activity pattern in early pregnancy and gestational diabetes mellitus risk among low-income women: A prospective cross-sectional study. SAGE Open Med. 2019;7:2050312119875922. doi:10.1177/2050312119875922

3. Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR. Prevalence of Depression During Pregnancy: Systematic Review. Obstetrics & Gynecology. 2004;103(4):698. doi:10.1097/01.AOG.0000116689.75396.5f

4. Acosta LM. Spinning Babies® a Professional Development Program for Birth Workers to Reduce C-Section Rates.

5. Piercy KL, Troiano RP, Ballard RM, et al. The Physical Activity Guidelines for Americans. JAMA. 2018;320(19):2020-2028. doi:10.1001/jama.2018.14854