I see a lot of post-partum parents. Pregnancy definitely impacts the pelvic floor, and people often seem shocked when they’ve had a C section and still have incontinence, weakness, prolapse, or pain with sex.
Pregnancy is an exciting thing for many people, and brings new life into the world, yay! And, it can have impacts on the bodies of the individuals carrying those tiny humans. This blog is talking about how delivering a child can impact the body, and why.
Throughout this blog post, I will be using the term “pelvic delivery.” In many humans, this is described as a “Vaginal birth,” but not every human who gives birth is a woman, or identifies parts of their body as a “vagina.” Most people identify with the term pelvis, so that’s what I’m going with here.
Many of my clients when I ask them about their births are kind of curious, and I explain that there is a difference between a direct pelvic birth, and a Cesarean, or “C-section” birth.
So let’s dive into those differences.
Let’s talk about a pelvic delivery. Around 68% of births in the US are through the pelvis. This requires a widening of the bones of the pelvis to allow passage of the fetus’s head (as the head is the widest portion of the body at this age). Typically, the cervix must efface or “thin” and dilate, like a door that thins and opens to allow passage of the fetus out of what is commonly called the uterus.
The muscle of the pelvic floor (PF) must lengthen to allow the fetus to pass from the interior of the pelvis into the pelvic canal, and exit the parent’s body. There can be extensive stretch of these pelvic floor muscles. The amount of stretch varies, depending on the muscle. Some muscles can stretch of up 3.26 their original length, while others stretch closer to around 2.0, or “double” their original length. This also varies by the diameter of the baby’s head, so yes indeed, the size of that big old head might have an impact on your pelvic floor.
If the muscles of your pelvic floor aren’t on board, and aren’t able to lengthen, then that becomes a problem. A certain amount of lengthening has to happen, and if it doesn’t, the option is tearing, or the infant can’t leave the canal. It’s in this circumstance that a C section is typically recommended.
Even if you’ve had a C section, I hope it’s clear as to why the pelvic floor can be involved. It’s not always possible to tell before labor if the pelvic floor will lengthen. So many individuals will labor, and then have a C section.
Post C section, I’ll often hear “I didn’t even push,” or “I didn’t even push for that long,” but that still means your pelvic floor was put under stress. That means that if you labored and had a C section, congratulations, you’ve actually had double the impact.
This pelvic delivery + C section combo is the one I most often see with more long term complications, because the combination of factors. This is not to say that one is more intense, bad, or worse than the other; births really vary from person to person, but this combination has extra strain across the board. So, that’s why, even if you’ve had a C section, the pelvic floor can still be injured.
Now, let’s talk about why a C section compromises the core as well.
I often use the analogy of a can to describe the core. If you think of an intact soda can and you attempt to compress it, it has some nice resistance to it, and can maintain its pressure. If you cut a slit in the side (horizontal or vertical), and then try to compress it, it’s way easier. The can might even collapse. With the c section and your core, it’s the same thing.
With a C section, the scar is 360, which means it is extending internally, through every layer of muscle, and that scar compromises the integrity of the muscle, and the ability of the muscle to contract. You can think of it this way; when a body is injured, it sticks a bandaid (scar tissue) over the area, largely because it can’t lay down new muscle overnight. This scar tissue is like glue, and doesn't like to move, and so when a muscle tries to contract, it’s actually getting held in place by the scar tissue.
Post C section, it’s really important to start working this scar tissue once it’s healed. After 6 weeks, I recommend most parents start working scar tissue mobilization to help get things moving again. You can think of it like a clock, where you gently stretch and work the scar to make sure it moves in all directions. Over time, the scar tissue will get more elastic and the remaining muscle will grow and strengthen around it.
Regardless of your delivery, working on strengthening your core and your pelvic floor after pregnancy is key to returning to sport. If you're pregnant, or post delivery, and feel like your body isn't recovering the way you want to, contact us so we can support you in reaching your goals!
We’ll talk next time about some of the most important muscles you can strengthen during and after pregnancy!