Bridgerton Birth Prep

Dearest gentle reader, it has come to this author’s attention that the women of the ton are unaware of exactly how their pelvic floor may affect how their baby is born. And as is typical of this author’s ways, she finds herself compelled to share this most curious of news with her readers.

Before we get down to how the pelvic floor may impact a vaginal delivery, let’s break down some commonly used birth terms:

Some anatomy … Or as Lady W would call it, “An appreciation of the arts.”

The cervix and uterus reside above the pelvic floor muscles and are attached to the top of the vagina.
The vagina, and indeed the bladder and bowel, are surrounded by 2x levels of pelvic floor muscles.
Layer 1 is the deep layer and is located around 4cm into the vagina. It surrounds the vagina, the rectum (bowel), and the urethra (tube which urine passes through). Once the baby begins to descend down and out of the uterus, this group of muscles are the first set which need to be passed through. They are required to stretch to ~3x their resting length to allow this to occur.1
Layer 2 is the superficial layer and is located around 1cm into the vagina. This level is most stretched when your baby is “crowning”.

Some terminology … Or, “An even rarer jewel.”

Stage 1: The longest part of labour is where the cervix is dilating to ~10cm wide.
Stage 2: (exceptional creativity in naming aside) Is when you begin to “push” and your baby moves down and through the vagina until they are born.
Stage 3: Completes labour and is where the placenta is delivered. Following the birth of your baby, your uterus will continue to contract to expel the placenta.

Now some physiology … Or, “The most remarkable coup of the season.”

The diaphragm is what creates the “pushing movement” – NOT your pelvic floor. The diaphragm creates a downward pressure throughout your abdomen and pelvis and is the same movement you use to open your bowels.
When the pelvic floor contracts it reduces the size of the opening where the vagina passes through. In the context of birth, it is more difficult for a baby to pass through a smaller, stiffer opening, than a wider more relaxed one.
If we put these points together, to have a good 2nd stage, we aim for a pelvic floor to be as relaxed as possible, and a push to be as efficient as possible.

From a pelvic floor physio’s perspective, what would the optimal pelvic floor look like going into a vaginal delivery? Well it would look like someone who was confident in both contracting and relaxing their pelvic floor; it would look like someone who could confidently push in many positions, with their pelvic floor relaxed the entire time; it would look like someone who was able to relax both their deep and superficial layers of their pelvic floor, as well as the muscles surrounding their pelvis; it would look like someone who was confident in their preparation of pain coping strategies, knowledge of hospital pain relief choices, and confident to adapt to speed bumps which inevitably occur throughout the course of birth.

As Lady W says Discoveries are everywhere, mother nature is sharing her secrets.

I look forward to seeing you in clinic soon!

Lara Bowyer … Pelvic Physio … Bridgerton tragic.

Lien, K. C., Mooney, B., DeLancey, J. O., & Ashton-Miller, J. A. (2004). Levator ani muscle stretch induced by simulated vaginal birth. Obstetrics and gynecology, 103(1), 31–40. https://doi.org/10.1097/01.AOG.0000109207.22354.65