Pelvic Floor Exercises Aren't The Best Way To Prepare Your Body For Childbirth 

Six years ago, one of my best friends and I were pregnant at the same time and throughout the day, we would text each other one word: "Kegels!" It was a reminder for us to get in those pelvic squeezes — 100 a day was a recommendation we both had heard — as a way to prepare our bodies for childbirth. Kegel exercises, the contraction and release of pelvic floor muscles, have reigned for decades as the go-to exercise to help make labour faster and easier.

Photo: www.cnsphotography.co.uk (Getty Images)

They're so easy to do! The government's Pregnancy, Birth and Baby website notes that you can do them anywhere. When you're stopped at a red light! While you're in the waiting room at the OB-GYN office! I often did them during my lunch break — I enjoyed knowing that while stuffing my face with pad Thai, I was discretely working out.

In the end, I'm not sure if my loyalty to these vaginal crunches helped me much — if you consider my five hours of intensely trying to push the kid out, I would venture to say maybe not. Since then, I've learned that while Kegels have their place, some childbirth experts believe there is an overemphasis on them, and it may be doing many pregnant women more harm than good.

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Lindsay McCoy, an exercise physiologist, birth doula and childbirth educator, explains the Kegel conundrum to me like this: "As a baby comes through, the pelvic floor has to yield. It has to open. So if we're having everyone just clench-clench-clench, it's the opposite of what we want." McCoy, who is the co-founder of the prenatal exercise program One Strong Mama, wants to spread the message that "tighter is not better — it's just tighter."

The pelvic floor muscles work like a hammock for the pelvic organs, including the uterus, bladder and rectum. A kegel, McCoy explains, is a concentric contraction, meaning it draws two ends of a muscle closer together. It's a fine movement, she says, but the problem is that a majority of women already have hypertonic, or too-tight pelvic floors. Sitting at a desk all day can cause tightening. So can stress.

And when you start with a muscles that are already too tight and then you add on concentric contractions, you're making those muscles less functional for childbirth, she says. (Picture another example of a concentric contraction: the raising of a weight during a bicep curl. If you did this constantly and never learned to let go, your arm would lose flexibility and become pretty useless.) Tension in the pelvic floor can cause other problems, too, like restrictions in your deep core muscles and pain during sex.

During childbirth, women need their pelvic floors to be able to "yield and stretch," McCoy says. And to be able to do so, she believes they can't simply squeeze their vaginas all day. "The pelvic floor is a whole body problem," she adds. "You can't fix a whole body issue with a spot treatment."

Instead of doing a ton of Kegels, McCoy recommends that pregnant women build a strong core and pelvic floor, which requires training and sometimes physical therapy. With those she coaches, McCoy uses all sorts of techniques to get them there — she helps them lengthen their muscles, shows them how to do a proper squat, works on their alignment and teaches them to breathe in a way that creates more movement in the ribs.

Kegels are part of the program, too, but McCoy has most women focus on "the release, not the squeeze."

"I wish I could just say 'Do these three exercises three times a day, or 20 times a day," McCoy says. "But it's this whole system and every part works together." The payoff for doing it right? A smoother labour and delivery, she says. When the baby comes, bodies that have been training know what to do. "If childbirth is going to be intense or painful, I at least want it to happen efficiently," she says. "Nobody wants to push for five hours."


Comments

    Some really good points, but there are some points that need to be clear:

    The main reason for doing pelvic floor exercises is to prevent pelvic floor problems after the birth, such as urinary incontinence, not to help with the birth itself. They are an important part of preparing your body to recover well from labour and childbirth.

    This said, studies on pelvic floor exercises during pregnancy found no negative impact on birth outcomes, including the length of labour or birth complications. In one study, women who did pelvic floor exercises during pregnancy actually had shorter length of second stage labour (the pushing stage) than the women that didn’t (although it wasn’t statistically significant) (Bo et al, 2011), and another study concluded that pelvic floor exercises may be effective at shortening both first and second stage of labour (Du et al, 2015). They should not make you have to push for five hours in childbirth. If this happens, it is likely that something else isn’t happening the way that it should.

    You definitely shouldn’t be doing hundreds of ‘kegels’ a day and, just like any other exercises, relaxation, rest and recovery are as important as muscle contraction. You wouldn’t go to the gym and do a hundred bicep curls 3 times a day and you don’t need to do this for your pelvic floor. Doing a smaller amount of good pelvic floor contractions with proper relaxation is much much better. Doing 8-12 contractions of 8-12 seconds repeated 1-3 times a day is recommended by the Continence Foundation of Australia (ww.continence.org.au).

    It’s absolutely true that some women have tight pelvic floor muscles, which can cause problems like pain with sex and constipation, but often this is not caused by doing pelvic floor exercises and many of these women have poor awareness of their pelvic floor muscles. If you think you might have pelvic floor tightness, or if you’re not sure if you’re doing your pelvic floor exercise correctly, go to a physiotherapist with specific training in pelvic floor physiotherapy and they can check and give you advice that is tailored to you.

    Bobbi B - Midwife and Physiotherapist with over 10 years experience in pelvic floor and continence physiotherapy.

    Last edited 29/05/18 8:52 am

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