There has been a lot of discussion this week about press coverage given to a new study suggesting that epidurals may prevent trauma to the pelvic floor during delivery. Basically, the idea is that an epidural relaxes the muscles such that they don’t tear. I don’t know whether or not that is true. I haven’t read the study itself, only representations of the story in various places. I know that Amy Romano at Science and Sensibility is sceptical, and I think she is a pretty trustworthy source of information. It has been interesting to follow the discussion between her and the study’s authors in the comments section of her blog. (And ire-provoking to see the known ideologue Dr. Amy Tuteur’s $.02 popped in there, too—but I digress…) Whether or not the study’s conclusions have merit, the coverage of the study, particularly in the Globe and Mail, has been quite atrocious.
I’ve said it before and I’ll say it again: I don’t think there’s anything inherently wrong with epidurals. They have an appropriate time and place, and the only person who can really say for certain whether or not an epidural is indicated is the woman with the baby descending through her pelvis. I’ll trust her to be the judge of how she wants to manage those sensations. So, this is not an anti-epidural rant. Hell, I was practically desperate for one with my first baby—got to the hospital in transition and begged for one. I was too far gone, at 8 cm, to qualify—and in retrospect I’m glad that was the case, as it was a very cool experience to give birth without drugs—but at the time, if someone had tried to suggest that I was wrong to ask, I’m sure I would have wrung his or her neck with my own bare hands. That said, there are definitely risks involved with an epidural, just as there are risks with any invasive medical procedure. Risks v. benefits. That’s the name of the game.
So, there may be benefits to epidurals that we didn’t know about before. That’s awesome. It’s always good to learn new ways of preventing women from lasting harm to their bodies. Women want good options when it comes to health care. But a) this study isn’t saying epidurals prevent tears—it’s saying epidurals may play a role in preventing some kinds of pelvic floor damage; and b) the uncritical coverage of this study has not explained that there are also many other steps women can take to safeguard the health of their pelvic floors. The point is: there is nowhere near enough data to say that epidurals are necessarily the best approach, and they certainly aren’t the only one, either.
What else can women do? There are the often-cited birthing strategies that include not giving birth on one’s back, but instead choosing a position that is more in synch with physiological processes occurring and can benefit from gravity; avoiding fundal pressure; and pushing spontaneously, rather than following directions for pushing. But there are other things women can do as well, before they get to the moment when they are actually in labour—a moment when they may or may not want/be able to think about those strategies.
Women who perform simple pelvic floor exercises during pregnancy and after delivery can greatly reduce their chance of pelvic floor trauma and the speed of postpartum healing. The stronger the pelvic floor, the more flexible; the more flexible, the more likely those muscles will get up and out of the way and not tear while a baby passes through. A strong pelvic floor can also prevent/reduce the significance of other common pregnancy- and birth-related concerns, such as hemorrhoids, prolapse, and urinary incontinence. And as a bonus, contracting the pelvic floor automatically gets the transverse abdominus to co-contract, helping to tone the abdominal muscles. These are seriously awesome exercises that can be done anywhere, at any time of day, with no special equipment.
So, what do you do? Basically, you want to do a modified Kegel, which can then be performed in various series, at various speeds, and in various patterns. If you’ve never done a Kegel before, the idea is to draw the muscles of the pelvic floor (PF) up and into the body, as if you’re stopping yourself from going pee. Draw them in, breathe, hold for a few counts, breathe, relax. Once you get the hang of that, you can move on to combine PF work with other core strengthening exercises such as curls (unless you have diastasis recti), superwoman, and cat-cow. You can do them sitting on a chair or an exercise ball, standing, lying on your side, on your hands and knees, in child’s pose—there are many positions that work, all of which have a slightly different benefit.
The bottom line (pardon the pun) is: strengthen your pelvic floor. Pregnant or not, this is a good thing to do. But if you’re pregnant or contemplating giving birth at some point, strengthening your pelvic floor is a noninvasive, key step in minimizing the risk of tearing and other significant trauma to the perineal region.