How a 'Birth Plan' Can Help Protect Your Pelvic Floor

How A Birth Plan Can Help Protect Your Pelvic Floor

The relationship between urinary incontinence (UI), pelvic floor disorders, and vaginal birth is a hot topic. Popular magazines and some scientific journals claim that vaginal birth is a cause of urinary incontinence, which has fueled the debate about another equally hot topic: cesarean delivery by maternal request! The presumed logic is this: if vaginal birth leads to UI, then cesarean delivery should be done to prevent it. In fact, questions surrounding causes and prevention of UI, as it relates to vaginal birth, are far more complex. Scientific studies done to date have shown no conclusive evidence that vaginal birth causes UI or pelvic floor disorders. Until we have more answers, cesarean deliveries done to protect the pelvic floor are unwarranted.

What is a “Birth Plan”?

It is never too early to learn what you can do during childbearing years to protect your pelvic floor and bladder health. A Birth Plan is a paper document you develop that serves as a communication tool between you and your healthcare provider. It describes how you would like to be cared for during your pregnancy, labor, and birth.  A Birth Plan helps you and your provider focus on practices and procedures you believe are important to include or avoid. Everyone wants a healthy mother and baby – that is a given. However, there are many pathways to achieving a safe, normal vaginal birth, a healthy infant and a healthy, satisfied mother and family. A Birth Plan simply places these thoughts in writing. During the course of your prenatal visits, a Birth Plan encourages conversation with your provider about the processes and procedures that occur in the hospital during labor and birth that may affect your bladder and pelvic floor.

Tips For Determining a Birth Plan

During your pregnancy, ask your provider to teach you the correct method for doing Kegel exercises. When done correctly, Kegels help strengthen your pelvic floor during pregnancy and after birth.

The obesity epidemic in the United States has led to changes in recommendations about weight gain in pregnancy. Ask your provider about the optimal weight gain for you. The old adage, “eating for two” no longer applies. Obese mothers who give birth to excessively large infants are more likely to experience postpartum bladder troubles whether having a vaginal or operative birth.

Pregnancy provides the ideal time for women to quit smoking. Cigarette smoking is a risk factor for urinary incontinence. Your healthcare provider has many suggestions to help you quit once and for all.

Once in labor, being upright allows gravity to assist with your baby’s descent instead of working against it while lying on your back.

New evidence shows that “gentle pushing” or delayed, non-directed pushing techniques can minimize pelvic trauma and are more protective than “forced pushing.”

To protect pelvic floor muscles, nerves, and connective tissue, express your desire to avoid the use of episiotomy, forceps and/or vacuum extraction. There is more than a decade of research that an episiotomy need not be performed unless there are indications for such intervention (e.g., fetal distress). Episiotomy, especially midline, has been shown to increase a woman’s risk of anal sphincter injury and not to reduce the risk of other pelvic floor disorders. Patients should discuss whether or not to have an episiotomy and be certain that their doctor will not use one, other than in extreme situations. Sometimes however, these maneuvers may be necessary for you or your baby’s health.

For help in writing a Birth Plan that works for you, consult your library, pregnancy resources, your healthcare  provider, and the Internet. Your healthcare provider can guide you about trusted web sites.

What No One Told You About The 4th Trimester

what to expect after you've had the baby

When you were pregnant, everyone joined you in counting down the days, weeks, and months until your baby would be born. Now that your little one is here, the countdown is over. But that doesn’t mean the woes of pregnancy are over.

The fourth trimester, or the recovery period and adjustment period of your body after birth, is a very formative time period. This month is filled with changes in your body, your household, and your baby’s body. Now that your little one is out of the safe cocoon of your womb, they’re learning to latch on to you for feedings and lay near you for warmth and comfort. All the while, your organs are resituating themselves and your hormone levels are skyrocketing to fuel these shifts.

Although everyone knows about the exterior changes that come after having a baby, many women are still surprised to feel so out of control with their bowels and bladder.

Childbirth—cesarean or vaginal—does a number on your organs. The trauma of childbirth weakens your pelvic floor muscles, often leaving them feeling like they had their own personal cross fit session.

Understand the level of work your body has done for you and react appropriately. The fourth trimester is a period of rest and recuperation. To treat yourself like anything else will only put you at risk for less than ideal symptoms in the long run.

Take time to map out a recovery plan for your bowels and bladder so you can ease your way back to a pre-baby stage. If you are experiencing urinary or bowel leakage, or a frequent urge to go often, start with a bladder and bowel diary. Fill it out and take note of what your body is responding to and then bring it to your doctor in your next postpartum appointment. 

Pessaries And Non-Surgical Options For Prolapse Treatment

Pessaries and Non-surgical options for prolapse treatment

I always wanted a large family.  After giving birth to and raising 4 children, I think I’ve pretty much fulfilled that dream.  My family is everything that I expected it would be.  What I never expected, however, was to have a prolapsed bladder.

I discovered it when I turned 63.  I had a feeling of heaviness “down there” for a while, but didn’t really think anything of it. I experienced a few accidents in the months before my birthday but thought they were just that – accidents. I was wrong. I went to the doctor for my usual check up, tried to explain what I was experiencing, and he told me I may have a prolapse. Prolapse is when the muscles supporting your bladder, rectum and uterus weaken. This weakening can cause your organs to fall into or through the opening of the vagina. This can happen to any woman with or without vaginal childbirth, but women who have had strain on their vaginal muscles (ahem, birthing 4 children) are at greater risk. After an examination, my doctor diagnosed me with a cystocele, or a prolapsed bladder.

At first I was horrified – the thought of an organ protruding, even slightly, sounded appalling.  What would this mean?  How would it affect my day-to-day life? Would things progress to a level greater than what I was already experiencing? ? 

Luckily for me, my prolapse is mild.  My doctor told me that as long as my symptoms were not causing me much harm, surgery was likely not necessary.  Some pelvic organ prolapse (POP) will improve on its own through watchful waiting, although my doctor said it is not possible to identify whose POP will improve with time. A common treatment option for those who do not want or need surgery is a pessary.

Pessaries are silicon devices that come in a variety of shapes and sizes and are placed in the vagina to provide support to the pelvic organs. Because each woman is different, the pessaries need to be fitted to the individual.  I decided to give it a try and was fitted three different times before the final size was decided.  I’ve had it in for 3 months so far and it is comfortable and seems to be treating the feeling of heaviness I had been experiencing very well.  It does require some upkeep and needs to be removed and cleaned on a regular basis, however this is easy to do and even if you have trouble, you can have the pessary removed and regularly cleaned by your provider. 

In addition to my pessary, my doctor also prescribed a vaginal estrogen.  This helps lubricate the area and reduce the risk of irritation or ulceration.  It also reduces the risk of getting a urinary tract infection.

Never in a million years did I think this would happen to me – I didn’t even really know it was possible to be honest. But thanks to my pessary, I’m able to easily manage my symptoms and live my life the way I want to.