Positive Health Online

My belly is like a balloon, bursting to pop, there doesn’t seem to be any more room left, I am eight months pregnant, my baby isn’t due for another month. Each time I climb a stair, I find myself having to stop to catch my breath, yet I can’t seem to take any deep breaths. I am forever breathless.

When I eat I get indigestion, it feels as though food sticks in my throat.

I can just about see my feet, to check there isn’t any swelling, yet trying to put my underwear on is a struggle. When I walk I wobble, hitching my hips up to swing my legs round, there no fluidity in my movements any more. I feel enormous, ungainly and tired. I find myself either itching my belly or rubbing my lower back to ease the constant dull ache at the base of my spine, neither help ease my discomfort.  I constantly feel the need to pee, yet when I go, there is only a dribble. It’s an incredible journey my body is taking, supporting, nourishing and nurturing my growing baby, yet the only obvious evidence to the outside world  is my growing belly.

Fit to burst my belly at full term pregnancy with my third daughter

My uterus which nestles in my pelvis has changed from being a pear shaped sac resting just behind the bladder to increasing about five times its normal size to accommodate my foetus, placenta and amniotic fluid. Weighing 15 times its normal weight, (and that’s not including the baby!) and reaching 500 times its original capacity, my uterus has grown at an astonishing rate, so it is any wonder I am experiencing some degree of discomfort during pregnancy.

The muscles at the base of my pelvis, known as the pelvic floor muscles, are supporting my uterus and these are becoming compromised due to added weight, so it’s no wonder my back aches and the frequent need to go to the toilet. These muscles of the pelvic floor stretch across the bottom of the pelvis. A tapestry of muscles, fibres and ligaments, they extend from the pubic bone at the front of the pelvis to the coccyx, at the base of the spine, leaving gaps for the vagina, anus and urethra to pass through.

The pelvic muscles are mainly comprised of the superficial group, a group of muscles at the entrance to the vagina which are mainly concerned with sexual function and bladder control, the urogenital muscle group which surround the urinary and genital muscles, and are involved with the function of your bladder and the deep pelvic floor muscle group, which includes the levator ani inside the vagina. This muscle extends from the pubic bone at the front through to the coccyx at the back and the side walls of the pelvis towards the hips. This muscular hammock acts to support your pelvic organs namely your uterus, bladder and bowel and keep them in place and is the main support for the pelvic floor.

Normally this hammock like structure would support about 20lbs of weight of our pelvic organs, however this increases substantially during pregnancy due to the growing uterus and baby, which inadvertently puts extra strain, stretching and weakening these muscles. In addition to this; hormones which are released during pregnancy, namely Relaxin, relax and soften the ligaments to help the body accommodate the growing baby and prepare it for the birth. Consequently the ligaments, fibres and muscles forming the pelvic floor loosen which unduly impairs their effectiveness, which may result in occasional leaks of urine when laughing or sneezing, commonly known as stress incontinence. 

During a vaginal birth the pelvic floor muscles get tested to their limit, as they have to stretch to allow the baby’s head to pass through the birth canal; this can leave us feeling tender, sore and bruised. Evidently these muscles are also prone to being over stretched with a difficult birth, a forceps delivery or if the baby is considered big and in some instance can leave nerve damage to this area. A caesarean birth doesn’t escape post pelvic floor problems, since they have also been stretched and weakened during pregnancy.

Being familiar with our pelvic floor muscles is not only significant in terms of toning and strengthening them for post-birth care, it is also important we learn to relate to their ability to release and relax, so that we can use this action during the birth process to support us to have an easier and more comfortable experience whilst giving birth. Therefore it is important we become familiar with the muscular actions of the pelvic floor. Pelvic floor exercises, also known as Kegel exercises can help use become familiar with the actions of the pelvic floor muscles. Although they focus on strengthening and toning these muscles, to help prevent post-birth pelvic complications, they can also be used be adapted for pre-birth pelvic muscle awareness. Named after the Californian gynaecologist, Dr. Arnold Kegel, these exercises are safe to perform during pregnancy and after birth.

Pre-Birth Pelvic Floor Awareness and Releasing Exercises

Puppy Dog Pose

To help you locate your pelvic floor find a suitable position, which takes any downward pressure off your pelvic floor muscles for example puppy dog pose. Come to all fours with your knees wider than your hips and rest your head, by making two fists with your hands to support your head you can use cushions or support your head on the seat of a chair. Be aware you are not over arching your lower spine, a natural tendency in later pregnancy, to counteract this you can tuck the base of your spine under to help ensure you keep your spine straight.

Now imagine you are peeing and want to stop the flow of urine, this action will help you locate your pelvic floor muscles and become familiar with their actions. Now contract and release your pelvic floor muscles quickly and in succession, as you inhale contract, lifting the pelvic floor in and up, as you exhale release your pelvic floor, directing your energy down. Do this for the count of thirty and gradually increase the number daily by five until you reach a hundred.

On your last count part your lips slightly and exhale through your mouth, directing your breath and energy down to your pelvic floor muscles and out through your vagina, imagine the path in which your baby will take as it pass through the birth canal.

Take a moment to relax and connect with your breath before you begin the next set of exercises.

Imagine your pelvic floor is divided into four different levels. Locate the outer levels first and then the more deep layers of muscles, so there is more of a lift than a squeeze. As you imagine moving up each level notice how the squeeze intensifies. At the top stay here for five breaths, with each inhalation lift the pelvic floor a little more and slowly release back down, stopping at each level and contracting for the count of 5. At the bottom relax the pelvic floor and feel the muscles widening as you exhale through your mouth and direct your exhalation down your body. Visualize your birth canal widening, expanding and opening.

There is a direct relationship between the jaw and the pelvic floor muscles. When the jaw is tense the pelvic floor muscles automatically contract. Take a moment to explore this clench your teeth and jaw and feel how this impacts on your pelvic floor muscles. Exhaling through deep vowels sounds ‘’aaahhh’ ‘ooohhh’ can help relax the pelvic floor muscles and therefore are a useful tool during labour.

Post-Birth Toning and Strengthening Pelvic Floor Exercises

Post Birth Recuperation Pose

Lie on your back with your feet hip width apart, knees bent and touching. Take a moment to connect with your breath, following the natural flow of your inhalations and exhalations.

Bring your awareness to your belly, focussing on your exhalations, notice the soft hollowing of your belly and your lower back ease into the floor. Let your exhalation bring you deeper into this connection, allowing each inhalation to flow softly and naturally into your body.

On your next exhalation have a sense of your vagina drawing inwards and upwards, activating this action if need be. Keeping this engagement with your inhalation, with each exhalation activate the muscles a little more, contracting a little tighter. Feel the muscles being draw in and up high up on the inside of your belly.

On your next inhalation relax the muscles and take three natural breath cycles before repeating this exercise two more times. The pelvic floor not only supports the gems of our pelvic organs, it also contributes to spinal support, stabilising the core and posture. The pelvic floor muscles work in sync with the transverse abdominal muscles, which wrap around the sides of the belly and the mutlifidus spinae muscles which run up the groove on either side of the vertebrae processes from the cervical spine to the sacrum.

During pregnancy the musculoskeletal system naturally softens in response to the release of the hormone relaxin, which gives rise to increased flexibility in the joints affecting posture and stability. Naturally the spinal curves become more pronounced in pregnancy as the body learns to compensate for the enlarging uterus and altered centre of gravity. Stretching, weakness and separation of the abdominal muscles further affects posture and greater strains the spine, another reason why Kegel exercises are so important.

Pelvic tilts also help to ease discomfort in the lower back whilst strengthening the abdominal muscles. You can do these standing or on all fours.

Pelvic Tilts - Standing

Standing with your feet outer hip width distance apart, bring your hands on to your hips and soften your knees. Tilt your pelvis forward and back. Feel how the base of your spine scoops under when you tilt your pelvis forward and your lower back arch as you tilt it back. Let the movements be fluid and sensual.

Cat and cow – Pelvic Tilts on-all-Fours

Neutral spine                                                     Cat pose

Begin by coming into a neutral spine on all fours. Ensure there is enough room for baby, by widening your knees towards the outside edges of your mat. Stay here for a moment and connect with your breath and guide your breath down to baby. On your next exhalation round your spine, tuck your chin in and look towards baby, pressing the earth away from you through your hands. Flowing with your breath, inhale come back into a neutral spine, exhaling rounding into cat.  Repeat this five times.

The pre-birth pelvic floor awareness exercises and both pelvic tilts are suitable for all stages of pregnancy. They help to bring awareness to the pelvic floor muscles, tone the abdominals and take care of the spine. The post-birth pelvic floor exercises are suitable following birth; however medical advice is required if you have any abdominal splitting. The post-birth pelvic floor exercises help to bring blood, nutrients and oxygen to the site of the pelvic floor, which can help with the healing process post-birth.

During our pregnancy it is important we listen to our bodies and let out body and baby be our guide. If something doesn’t feel right, we need to listen to that and act to alleviate the discomfort. Over the nine months of gestation we become more in tune and sensitive to our babies, tenderly touching and stroking our belly in response to their movements.

Having a baby is a beautiful gift, yet we need to remind ourselves too, that we are gifted with an incredible body which we also need to take care of.