A mindset of prevention before, during and after childbirth can help you to avoid pelvic floor problems, or keep existing symptoms in control.  These areas of your body, and aspects of your comfort and control, deserve a place in your health planning. 

  * Tone Up Your Pelvic Floor.  A regular pelvic floor exercise (‘Kegel’) routine can prevent symptoms before, during, and after childbirth.

  * Try Perineal Massage, Starting During Pregnancy.  It’s ‘right at your fingertips’, and just might reduce your risk of perineal injury during childbirth.

  * Episiotomies Only When Necessary.  Several research studies have indicated that this procedure is best to avoid whenever possible – in terms of preserving pelvic floor muscle strength, preventing severe lacerations into the rectum, and safeguarding sexual function. According to The American College of Obstetricians and Gynecologists, routine episiotomy should not be regarded as part of current practice. Keep in mind, however, that ‘selective’ episiotomy remains an important obstetrical tool – and in many cases represents the best care for baby and mom.

  * Understand Other Obstetrical Factors, Important to Your Pelvic Floor.  Important links exist between pelvic floor function and forceps delivery, prolonged labor, macrosomia (large fetus), pelvic shape, and various labor and delivery ‘styles’. As you plan for childbirth and face decisions, keep these factors in mind – and remember that childbirth should not be viewed as an inevitable physical sacrifice.

  * Optimize Your Postpartum Healing.  Promoting optimal recovery for the pelvic floor after childbirth is a frequently neglected aspect of women’s healthcare. Paying attention to your postpartum healing and rehabilitation may reduce the likelihood of problems.

  * Communicate.  Whether you see a doctor or midwife, prenatal counseling should include discussion of laboring and pushing styles, perineal massage, forceps and episiotomies, cesareans and other aspects of childbirth that may influence pelvic floor function. Keep in mind that regardless of ‘pre-labor planning, your provider may still need to rely upon an unexpected strategy or procedure at the time of delivery.

When Should I Consider Seeing a Urogynecologist?

Incontinence and pelvic floor symptoms are common after childbirth.  If they are not bothering you significantly, there is little risk in waiting to seek care.  Unfortunately, countless women who are bothered by symptoms wait years before seeking care, unaware that help can be found.  Numerous treatment options exist today in urogynecology – including medications, physical therapy, non-surgical devices, office procedures and minimally invasive surgical options.  If incontinence or pelvic floor symptoms continue to trouble you beyond the postpartum period (6 weeks-3 months), seeing a urogynecologist represents the next step in understanding your condition, and finding relief.  Severe pain or problems any kind are never normal after coming home with your new baby.  Always contact your obstetric care providers with any concerns or questions.

Adapted From:  “Ever Since I Had My Baby: Understanding, Treating and Preventing the Most Common Physical Aftereffects of Pregnancy and Childbirth”, by Roger P. Goldberg, MD MPH