The Role of Pelvic Health Therapy in Better Births

Discover how you can prepare clients for better births and what you can do to educate and empower your first-time moms, so they don’t wait to get pelvic health therapy only after challenges from a birth experience.

We can learn so much from our clients’ previous birth experiences, but wouldn’t it be great if we could help them prior to a challenging birth, so they could have a better outcome from the start? As pelvic health therapists, we still have much work to do in supporting moms throughout their birth journey. I look forward to the day when every pregnant person seeks our care before their first birth. Right now, about half my pregnant clients are first-time moms; the other half are returning after challenging first births, hoping for a better experience this time.

Client History

Recently, I saw “Abby” (name changed) at 30 weeks who was pregnant with her second baby. Her first birth involved an episiotomy and over two hours of pushing. She birthed on her back and reported that she felt like her baby was in danger during birth. After the birth she bled for a long time and has had continual urinary leakage since this birth. She said she uses 2-3 panty liners a day due to the leakage. In addition, Abby suspected she had postpartum depression, though it was never officially diagnosed.

Assessment & Treatment

Upon assessment, I discovered Abby’s pelvis was in an open birthing pattern: the sacrum sheered left, left ischium splayed. Her sacrum was also stuck in flexion, and she was experiencing considerable tension in her right uterine ligaments—with the baby also favoring that side. Much of this tension was likely present during her first pregnancy.

During treatment, I worked externally on her pelvic bones and uterine ligaments. It was fun to watch her surprised expressions as she felt the releases happening in her body. With internal work, I found increased tone on the left pelvic floor, with right-sided sphincter tension at 7 – 9:00. After releasing the pelvic floor muscles, using the Schulte Hold, she had pretty good muscle strength.

I checked how Abby pushed and found that she had a reciprocal breathing and contracting pattern. She tended to contract her pelvic floor on the inhale, which isn’t ideal for effective pushing. I knew I was going to see her the following month and since she was dealing with stress incontinence, I decided to have her work on her breathing and contraction of the pelvic floor on exhale to help her attune more to her pelvic floor. During the breathing practice together, she had some lengthening of the pelvic floor muscles, but it wasn’t great. I instructed her how to breathe in sit to stands and lifting on the exhale. I would reassess what needs to happen for pushing on her next visit.

At the end of the session, I taught her how to do an inversion, and when she came back up from the inversion, her baby was more centered in her belly. It was no longer hanging out on the right side. I encouraged her to continue doing daily inversions to help support the uterine ligaments.

Key Takeaways

What I want to highlight in this case is the potential impact the restrictions in her uterine ligaments may have created in the first birth. She remembered her first baby always being on the right side, too. She shared that her first baby’s head was slightly mis-shapen at birth, indicating a more crooked passageway through the pelvis. The need for an episiotomy for baby to come out could also be related to ineffective pushing mechanics and lengthening of the pelvic floor. Her story captures the importance of educating our pregnant clients about:

• What restrictions they are carrying and how they can impact their birth
• How baby’s position in the belly is so important for a smooth birth
• What their body’s aches and pains are really telling them

Let’s keep raising awareness and supporting pregnant people everywhere. Share your experiences and insights—together, we can help more families have better birth experiences!

About the Author: Lynn Schulte is a Pelvic Health Therapist and the founder of the Institute for Birth Healing, a pelvic health continuing education organization that specializes in prenatal and postpartum care. For more information, go to https://instituteforbirthhealing.com