2 Types of Squats for birth

September 7, 2016 in Childbirth, Pelvis, Pregnancy, Uncategorized

When I was pregnant for the first time 16 years ago I knew squatting was a good idea to help with birth.  Yet I didn’t know much about how to best squat for birth.  Years later having worked with pregnant and post partum women, I’ve learned a lot I wish I knew back then.  But my births went well so what I did must have helped.  Let me share with you what you really want to do to help open up your pelvis for birth.

Pelvic Motions for Birth

For your pelvis to birth your baby the top of the sacrum first needs to move backwards during the first part of labor

counternutation

and then forwards again during the later part of labor.

 

nutation 2

 

So to help your pelvis do these motions, you can do two different types of squats.

Squatting for Birth

To help open up the top part for the first part of labor squatting with your butt tucked under will help make this happen, like this;

squattingnotgoodcounternutation

Yet so many women sit too much in this posture with pressure on the sacrum so you don’t have to work too hard on this squat other than to strengthen your legs.

 

What you really need to work on is the second type of squat because your sacrum needs more help opening up to get your baby out.  This squat is where you stick your butt out as you bend down like this:

squattinggood

 

Keep working on this last squat for the majority of your pregnancy as your sacrum needs more help opening up like this!

When you start laboring you would benefit from you doing the first squat to help allow your baby into your pelvis. Lifting up on your belly while you do so can help too.  Once you hit the second stage of labor then you want to focus on the second squat as that will help your baby to come on out!

 

So there you have the two different types of squats and when they are most effective during pregnancy and birth!   Squat away!!!

 

3 Signs your Pelvis is Still Birthing after Childbirth

March 26, 2016 in Childbirth, Pelvis, Post Partum, Pregnancy, Uncategorized

3 Signs your Pelvis is Still Birthing

 

Your pelvis may still be trying to birth your baby!  In my women’s health physical therapy practice I have discovered a very common pattern that a woman’s pelvis goes into to give birth. I’ve seen it in most every woman I’ve worked on in the last year since I became aware of it.  Only a hand full of women have not presented with this pattern. There is a certain way the pelvis opens up to help the baby get out.

 

This pattern can get stuck in a women’s pelvis, sometimes for years.   I first discovered this in my aunt who had a very traumatic birth with her first son who was 47 at the time.   So for 47 years her pelvis has been in an open birthing position.  One would think that the bones of the pelvis just go right back into place after the baby comes out.  In some women it does.  In others, which I’m finding is more and more common, it doesn’t.  The one thing I know that is keeping the pelvis from going back to its normal position is trauma!

 

Trauma can keep the pelvis stuck in the birthing position.   Until the trauma is released and the body and pelvis knows it’s safe then the pelvis can come back together to its normal position.   Trauma can be experienced at any time during the birthing process but most typically is occurs during the pushing phase when the pelvis is already open and ready to let the baby out.

 

Anytime a woman gets to the point where she wants to quit, doesn’t feel she can go on, feels out of control, or maybe gets threatened with a c-section a trauma response can happen in the body.

 

A typical trauma response in the body is to fight or flight the situation but since a birthing woman can’t do those two it does the only thing left which is to freeze. This freezing happens while the pelvis is in an opened, birthing position. Until the trauma is released the body tends to hold onto this pattern.

 

I can see how a woman may not recognize this trauma or that her pelvic is still birthing. After opening up so wide to get the baby out, all sense of normalcy, what was felt like before birth, is gone. There is no ground zero in your body once it’s birthed a baby. Also seeing and holding your baby in your arms for the first time is enough to distract anyone from what they’ve just gone through.   The reward of being with your baby seems to outweigh or override any negative feelings felt during the birthing process.

 

But I do know that women can feel a difference in their body after the pelvis has been helped back into its pre-pregnancy state. You must address both the physical position of the pelvis along with releasing any held emotions and trauma in the tissues.

There are 3 signs that I’ve discovered that are clues that your pelvis is still birthing. Let’s see if you have any of them.

 

#1. Your Pelvis is Tilted

The first sign your pelvis is still in a birthing pattern is when you lay down on your back on a hard surface (a soft bed may not the best surface to check this out on) is to check out how level are your hip bones, those little bumps on either side of your pelvis. Are they even? Or do you notice that your right side ilium, or hip bone, is higher than the left?

The typical birthing pattern is the right side will be higher than the left. When lying down on your back the pelvis will be tilted to the left as seen in this picture.

 

Position of pelvis after childbirth

Position of pelvis after childbirth

The reason for this is the sacrum gets jammed up and over to the right during the birth process.

 

Here is a normal posterior view of a sacrum prior to birth.

 

Normal position of sacrum in pelvis

Normal position of sacrum in pelvis

This is how the sacrum shifts to the right for birth.

Sacrum shifted to right

Sacrum shifted to right

This shifting of the sacrum to the right is also why so many women have right-sided low back pain after childbirth.   The sacroiliac joint gets jammed and the sacrum can’t move as freely as it should which is why the pain is created. Getting the sacrum back into proper place alleviates the pain.

There is a two-step process I do to help mobilize the sacrum back into midline again. I haven’t figured out how to help women do this on their own yet! Stay tuned….

 

#2. Sitting Unevenly or Uncomfortably

For the baby to be able to come out of the pelvis the sits bones or ischiums need to splay out to the side. Ideally they splay out evenly.   But depending on the baby’s pathway through the pelvis or the birthing position used, one ischium may be more splayed out to the side. Birthing in a side lying position can limit the mobility of the lower sided pelvis (on the bed) and cause more movement in the upper side (ceiling side). Birthing on your back with two separate people holding your legs at different angles can also potentially cause an imbalance in your pelvis.

If the pelvis remains in this birthing position, sitting may seem different. It can feel uneven, or awkward.   This is not from swelling or tenderness in your perineum, as that can cause discomfort and or pain. If you don’t have pain but sitting still feels weird, it’s because your bones are in a different position than before your birth.

#3. Feeling Ungrounded or Discombobulated

One of the things I ask the moms that I find with birthing pelvis’ is “What are you feeling in your body and in your life?” The most common reply is “ungrounded, not myself or discombobulated”

When we realize the pelvis is our energetic foundation for our body and life, when it is open and unbalanced we don’t have a solid foundation. In one of my clients it felt like energetically she was walking around with her energy just flowing out full blast, like both faucets handles turned on and water spilling out with no container to hold it.  When you can’t hold and contain your energy within you, if can feel a little unsettling. Most new moms may attribute this to figuring out how to care for a newborn, not that she has no energetic container.

 

So if you find you have one, two or all of these signs you now know what’s going on. Your pelvis is stuck in a birthing position and needs help coming back together.

 

 

 

 

 

 

Is Your Pelvis still birthing?

October 8, 2015 in Childbirth, Pelvic Floor, Pelvis, Post Partum, Women's Sex Issues

Is Your Pelvis Still trying to Birth Your Baby?

Labor can be such an arduous task. Whether it’s really quick or lasts for days, the impact on the body is huge, especially for the pelvis. It doesn’t matter how long it takes to get the baby out, the pelvis can still be left in its open birthing position. It can remain this way for months to many years.

 

I first identified this issue in my aunt who had a very traumatic birth with her first son who was 47 years old at the time I found this. Her pelvis was still open from birthing. When I realized what was going on I started looking for it other women who came to see me and was surprised how often I found it.

 

How do I know if a pelvis is still birthing?

 

I’m able to feel what the energy of the bones and tissues want to do. I listen to the body and see what wants to happen. No matter what part of the body, an ankle sprain, I can tell you how you twisted your ankle, an injury to your shoulder, leg or pelvis, your body holds onto the energy of the injury. It’s in the tissues and remains there and your body has to work around it. It’s usually not a big deal except most of the time we keep reinjuring it, in the same way. That could because the energy of the injury remains in the tissues until we release it. It could also be why some injuries just never seem to fully heal.

 

Birthing Pattern in the Pelvis

Birthing Pelvis

Pelvic Motions during pushing phase of birth

It’s the same thing with birth and the pelvis. When the pelvis births a baby, the sacrum pivots and in the pushing phase the tailbone moves backwards and the sit bones, or ischiums splay out to the side to get wider.   Usually this is the position that most women get stuck in because they tend to have a trauma response in their body from the intensity of the labor.   Pushing too long or the baby coming through too quickly can create a shock effect in the tissues and they get stuck in this open birthing position.

 

I’ve been asking these women whose pelvis’ are still birthing what they are experiencing and the effects have been from severe to subtle.   The most common complaint was a sense of feeling ungrounded.   Some complained of not being able to sit comfortably or evenly on their buttock.   Others had more subtle complaints of feeling spacey, just not the same, or feeling weird when walking. One of the bigger issues women can have from this is painful intercourse and an inability to contract their pelvic floor muscles.

 

Since all of the pelvic floor muscles attach to the bones of the pelvis, having the bones widened puts a stretch on these muscles. A stretched out muscle doesn’t have the same contraction ability and will appear weak.   These lengthened muscles also don’t have the give or flexibility they need in order to allow penetration to happen with intercourse.   My aunt I mentioned earlier has very little to almost no contraction of her pelvic floor muscles. Another client I saw was still in a birthing pattern and she was having pain with penetration. After one session of bringing her ischiums back together, her pelvic floor muscles relaxed and she had no more pain!

 So what do I do?

It’s a shame that the main treatment for weakened pelvic floor muscles is to see a   women’s health physical therapists, yet most of them don’t know how to assess or treat a pelvis stuck in the birthing position. No amount of kegels or biofeedback is going to help you get a strained, traumatized muscle stronger until it gets some help. It’s amazing how instantaneously a muscle can respond and contract when it’s not being lengthened or in a state of shock from the birth.

 

Most chiropractors don’t know about this stuck birthing pelvis and your doctor will most likely look at you weird if you bring this to their attention.   They all are just dealing with the physical tissues that when you look at the tissues everything appears just fine.   They aren’t aware of and don’t know how to address the energetics, emotions or trauma that get so tied up into the tissues keeping them held in this birthing pattern. You have to address them all in order for the tissues to release and the pelvis to return to it’s normal pre-birth state.

 

I have found in working with women that we need to address ALL of the trauma or issues that occurred during the birth so the pelvis can return to it’s birthing position after a treatment.   The sooner after the birth one comes in the better.   It’s easier to release the birth pattern because it hasn’t been stuck in the body for a length of time for it to think it’s the new normal position to stay in. However no matter how long it’s been you can still release the bones and tissues so they can find their natural place. It’s just takes a bit longer.

 

 

 

 

 

Common Pelvic Pain Pattern after Birth

May 3, 2014 in Pelvis, Post Partum

We have some wrong ideas around our body and birth in this country.    We all assume after a birth that the body just goes right back to it’s pre-birth state.  What I have found in working with hundreds of post partum women is this is not necessarily the case!  At first I thought I was just seeing women whose births were a little more traumatic than “normal” births.  But what I’ve come to realize is even “normal” births still leave their mark on women’s pelvises and they tend to be affected forever.  Unless they get the energy of the birth released from their pelvis.

 

While I’ve already written about the trauma’s that occur in the pelvis from childbirth, see this article here, what I’ve come to find even more prevalent in post partum women is a common pelvic pattern that gets stuck in their body after birth.  In releasing these patterns woman have experienced profound relaxation and normalization of their body, they feel like themselves again!

 

What I find is the sacrum on the right hand side gets jammed superiorly and has decreased mobility when I try and move the sacrum in the sacroiliac joint.  The left side of the sacrum can move just fine but the right side has decreased mobility.

 

The sacrum a lot of the time is still in a nutated position with the tailbone more posteriorly than what is normal.  There is a jamming up of the sacrum into the ilia and vertebra and when I distract the sacrum and encourage the tailbone to move into a more forward or anterior position all the women give a huge sigh of relief.  Front of pelvis

 

There is also a decreased mobility or accessory play between the pubic bone and the sacrum.  While standing on the right side of a woman with my right hand underneath holding onto the lower part of the sacrum and my left hand on the pubic bone there is a decreased mobility of the pubic bone to be able to move to the right.  When I reverse this motion on the other side of the body the mobility is fine.

It’s like the lower aspect of the sacrum is shifted to the right in the body, decreasing the shearing like accessory play in the pelvis.

 

In the majority of these clients the mobility of the left side pubis symphysis and pubic rami are more restricted than the right.  The left ischium is more splayed out than the right like the baby’s head had more pressure against this side than the right.

 

Internally it is more common to find increased tension in the left side pelvic floor muscles and a shearing of the bladder tissue to the left.  When palpating the bladder tissues there is less space on the left side around the pubic bone internally than on the right side.  I’ll also feel a pulling to the left of the bladder near the bladder neck.  Most of these woman complain of bladder leakage and when the bladder is restored to it’s normal position their incontinence improves and goes away.

 

While I originally thought these patterns were associated with a more challenging birth, women whose birth would be considered normal or “easy” are still presenting with these findings.   It doesn’t matter how your birth goes, whether it was fast, easy, or hard, your body is affected by the process and remains imprinted with this pattern until released from the bones.

 

In palpating the bones you can feel a hardness in the pelvic ring where the bones have experienced more pressures than other areas.  Believe it or not our bones have a gentle give to them when compressed.  Where there has been excessive pressure or trauma the bones feel really hard and can’t give to compression.  Typically I find one side pubic rami, most commonly the left, has more hardness than the other and that side ischium tends to be more splayed out to the side when palpated.  Bringing the ischium back to midline and releasing the hardness in the bone allows for greater distribution of energy throughout the pelvic ring.

 

This is critical for women who are having symphysis pubis dysfunction in their second pregnancy when they didn’t have any in their first pregnancy.   It’s the birth trauma from the first birth that is causing the pain during the second pregnancy.  I find that when I release the hardness from the bone, the pressures around the pelvic ring are able to disperse easier and take the excessive pressure off the pubic symphysis.

 

The greatest help we can give post partum women is to make sure their ischiums have come back together into midline after birth.  So many women are walking around with one or both ischiums still in a splayed out birthing position.   By helping them come back into the center and balancing this new position with the iliums can help women find more balance in their pelvis, make it easier to feel grounded and simply relax their entire pelvic area.

 

While it’s important to work with releasing these patterns from the bone, the healing is not complete until you normalize the pelvic floor muscles internally.  It’s like an pancake you have to work both sides, outside and inside, to rebalance the pelvic structures.

 

Too many women are complaining of pelvic pain after birth.   It is my belief that many of them are walking around with this common post partum pelvic pattern or their pelvis is still in a birthing position.   Helping to release these patterns from their pelvis allows them to reclaim their body after birth!

 

 

Valuing Your Body and Instincts During Birth

January 10, 2014 in Childbirth, Pelvis, Pregnancy

 

Pregnancy can be an overwhelming time for you and your body.  So many changes occur to your body as it swells to unrecognizable shape and proportion.  Then comes the uncertainty of birth.  How is this baby supposed to get out?  Really?  You can read all the books, watch all the videos and attend all the childbirth classes you want to prepare yourself for the anticipated day of your babies arrival.  Yet nothing can really prepare you for what you are going to experience.  Because no one really knows what YOUR experience is going to be of how YOUR baby chooses to come out.

 

This may sound kind of gloomy but let me reassure you of one thing.  That baby will find it’s way out one way or another.  The more prepared you are for your birth of what you CAN expect will help you relax into the process of what needs to occur. Read all the books, watch all the videos and take all those classes.  Know what needs to happen in your body for birth and what you truly desire to happen for you and your baby.  Then let it all go!

 

Letting Go In Labor

 

That’s right, let it go.  Because birth is really about letting go.  Allowing the process to happen.  Your body is designed to get your baby out.  When we can really connect into that sacred space deep within us you will know exactly what you need to do to help get your baby out.  Many women would benefit from really finding this space of knowingness within so they can listen to it during labor.  Yet most modern day hospitals and OB’s aren’t designed/trained to help women find this inner wisdom.

 

 

Giving Up your Power During Birth

 

We give our power over to our doctor and disconnect from our inner knowingness.  So many women in my practice have shared how they had a cervical check and were only 6-7 cm dilated and shortly after needed to push but was told not to push because they couldn’t be at 10 already.  When we listen to the people around us and not to our body’s signal, because we don’t know any better, more of that disconnect occurs.  When you try to stop from pushing when your uterus is pushing your baby out it creates all kinds of energetic blocks in your pelvis.  Your baby gets the confusing message, come out, no don’t come out.  There is a holding energy that anchors in your pelvis.  You lose that trust of your body that you once had or maybe never really had.

 

It’s challenging for a first time mom to understand what is going on in her body during labor to really trust herself to know.  Yet the more you can connect into your inner knowingness the more you can question other peoples judgements of your situation.  Your body knows how to do this so if you feel like pushing listen to your body.  Value the wisdom that your body knows how to get this baby out.

 

I saw one mom you came in for a post partum session and I kept feeling the energetic pattern of the babies head going into her right hip while there was a twisting of her upper body to the left.  When I asked about this she reported her husband was holding her right hand up by her shoulder while she was pushing.  Instinctually she let go of his hand and reached over to the left side bedrail and pushed.  Then her baby shifted into the center of her pelvis to come out.  Yet there was fear when this happened and this pattern was stuck in her body.  Identify and releasing the fear allowed the pattern in her body to let go.  Twisting her upper body to the left put some torque into her pelvis to shift the baby over into the outlet to get the baby out.  When I explained to her why she did what she did, she was able to value her body’s instinctual knowingness better.  YOUR BODY KNOWS!

 

So how do you connect to your inner knowingness?

 

It starts with a practice of quieting yourself and really connecting into your body.  Connect into your pelvis.  Feel the baby down in your pelvis.  Feel any sensations you feel in your body.  Become still and quiet and just feel what you feel inside of you.  Where do you get drawn?  Bring your breathe down to your pelvis or wherever you get drawn in your body.  The more you can practice this now the easier you will do so during your birth. During labor clear all the distractions around you and connect inside of your body.  See and sense what your body wants to do and get into that position.

 

A colleague of mine was in labor with her second child and she was feeling like she was losing her hold on the contractions and not getting anywhere as her labor wasn’t progressing.  She kicked everyone out of her room and quieted herself and went down and connected into her pelvis.  She got up and knelt on her knees with her butt up in the air and head down and stayed there till she felt something change inside.  Then she was able to continue on with her labor and push her baby out.  She did not know of inversion before this but this is a great technique to rotate a baby whose head is coming into your pelvis in a more challenging way, (OP or occiput posterior).  She got this information from her body and knew what to do.

 

So whenever you are feeling stuck with anything in life, whether it be birth or anything else, connecting into your pelvis and womb space can offer you a creative answer or direction.  If you need any support in feeling this connection I’d love to help you out.  I am amazed at the significant changes in my life since I’ve really embraced and reconnected to my pelvis.  It’s a powerful area and worthy of our attention.

 

 

 

 

Pelvic Trauma in Childbirth

July 30, 2013 in Childbirth, Pelvis, Post Partum

Realizing how the body goes about getting a baby out of the body is an extremely amazing feat.   Seems downright impossible if you look at the size of a newborn baby and the size of the pelvis, especially the vaginal opening.   What does make it possible is the way both the baby’s head and the mom’s pelvis are able to shift their sizes to accommodate.  The fetus’ cranial bones overlap to make it smaller and the pelvic inlet and outlet are made larger by the movement of the pelvic bones as the baby passes through.

Most of the time in an uncomplicated birth this process goes about smoothly.  However if the pelvic bones aren’t able to move normally like they should then dysfunctions occur in the pelvis and the baby’s head gets greater than normal pressures on it as well.

The biggest issue I encounter in working with post partum women is the lasting effects of abnormal tensions in the ischial bones.   These bones are not commonly addressed in standard post partum care.   The lasting effects on women with ischial dysfunctions could be low back and hip pain, pelvic floor muscle weakness, prolapsing of pelvic organs and painful intercourse.

Let’s take a closer look at the anatomy of the pelvis to see what is happening.  pelvis

Our pelvis looks like one continuous ring of bone yet different parts of the pelvis have different names.  The pelvis is comprised of two big ilial bones that are the broad, elephant ears shaped bones that connect on either side of the sacrum in the back.  This area of connection, where you see little dimples in the low back area on some people is called the sacroiliac joint.  If you were to put your hands on your hips at your waist you have contact with the top portion of these ilial bones.  When you slide your hands down the outside edge of these bones towards the midline of your body, where your buttocks connect into your upper thigh this is the area that your ischiums are located.  When you sit down on a chair the pelvic bones in contact with the chair are your ischial bones.   In a picture of the pelvis the ischial bones are that part of the pelvis that have a hole in the middle.  The lower part of the ring of ischial bone goes forward to connect to your pubic bone that sits low in the front of your body, in the middle of your two groin areas.  The bone leading from the ischiums to your pubic bone is called your pubic rami.

Mechanics of childbirth

During the first stages of labor the upper part of the pelvis needs to widen to allow the baby’s head to enter into the pelvis.  To do this the top portion of the sacrum needs to move backwards while the lower part of the sacrum, the tailbone area moves forward.  This is called sacral counternutation.  In the later stages of labor the opposite sacral motion, nutation, needs to occur where the tailbone moves backwards.   While at the same time the ischial bones widen out to the side.  It is during the last part of labor as the baby is coming out that pressure may be exerted more on one side of the ischium than the other.

As a physical therapist I understand the mechanics of the joints and muscles and what needs to happen for childbirth.  Adding to that knowledge is a skill I have developed to be able to sense or feel what the tissues and bones have gone through during a birth or an injury.

As I have worked on postpartum women I have been able to sense how the baby has come out of the pelvis.  I have felt many pelvic floors where the tissues are still twisting a bit from the baby’s head rotating to come out.  The pelvis may be a bit twisted or rotated as well.  Many times the baby’s head has contacted more of one ischium than the other.   That side ischium is harder and most of the time is still splaying out to the side more than the other.  Sometimes both ischiums are still in that splaying out position and need help coming back into midline again.

I had one client that came to me for painful intercourse who had this very issue.  When assessing her pelvic floor muscles they were like a tightrope straight across her vaginal opening.  When palpating the muscle there was very little give.  Normal muscle is like a trampoline, bouncy with pressure.  This muscle was like a board, with little give.   With the ischiums splayed outward the pelvic floor muscles are stretched to the brink.  Just encouraging the ischiums to come back together relaxed the muscles to where there was a bounce again in the tissues.    She reported having no more problems with intercourse after one session.

Many other clients come to me complaining of one sided hip and/or low back pain.  I find that it is usually the side where the ischium has not come back to its normal midline position.  After correcting the boney alignment and working to relax the pelvic floor muscles internally the hip/back problem goes away.   In one day I saw three different post partum women all presenting with the same pelvic twisting to the left and right side ischium splayed out to the side.    Through my sense of touch I could feel the baby coming out more into that right ischium.   It had more of a traumatized feel and stayed in that opened, birthing position.

Some women with ischial dysfunction complain of significant core weakness.  They complain of not being able to fully contract their pelvic floor muscles.  Their strength just never seems to improve no matter how long they have been doing kegel’s.   They also feel very weak in their core and have little strength around the pelvic region.

With the pelvis being out of alignment the muscles have tensions placed on them that is not normal.  This increased tension or tone in the muscles diminishes its contractile ability sometimes to the point of not being able to contract at all.

No matter how many kegels they do they just don’t seem to gain any strength.

The ischiums coming back into their normal midline position helps to bring the pelvic floor muscles back to their normal resting place so they can activate more fully during a contraction.  They no longer have abnormal tensions on them so they can contract through their full range of motion.  After a session of realigning a woman’s pelvis she immediately notices an improved strength in her kegel ability.

It is my theory that when the ischiums remain in the splayed out position the pelvis is sensing that birthing is still in process.  I’ve also tuned into urethra’s, bladder’s and uterus’ that are still bearing down like they are pushing out a baby.  Once the ischiums come back together in their midline position then the organs can easily realize that pushing out is no longer needed.  After I get the ischiums in their normal position I check internally with the organs and if they are still energetically pushing out I have the woman tune into those organs and with intention tell them to stay on up and inside.  As soon as I start saying these instructions I can feel the organs energetically retracting back on up and in, like a turtles head going back into its shell.  This helps the organs to stay in their proper place easier.   Mobilizing the ischiums is only one of many other areas and issues that need to be addressed to help with organ prolapse.  Yet I feel it’s a very important part of it.

WHY DOES ALL THIS HAPPEN?

If the baby’s head fits through the opening in the middle of the pelvis how does the head come out putting more pressure on one ischium than the other?  If you were to look down on the pelvis you would think a baby could only come out in midline. However, once the baby’s head is through the pelvic inlet it’s up to the pelvic floor muscles, ischial bones and the tailbone to continue to guide the head through the pelvis.  If those three bones are in their normal positions and the muscles and tissues attached to them in a normal state as well, the baby does come on out midline.

If you look at the pelvis from the underneath side you can see how the tailbone and the ischial bones are the three boney landmarks the baby’s head needs to pass through.  What if the pelvic floor muscles on one side had more tone in them and are tighter than the other?  The pelvic floor muscles attach on either side of the tailbone and lower part of the sacrum.  If one side has more tone than the other side then the sacrum is not going to be able to move backwards symmetrically.  If the sacrum is anchored on one side this may guide the baby’s head more into the opposite side ischium.

The women that I worked with that had right-sided trauma in their ischiums also had increased tone in the right side pelvic floor muscles.  Since I didn’t see them prior to childbirth I can’t say that this increased muscle tone caused the imbalance in the ischiums.  Plus this increased pelvic floor muscle tone noted after childbirth could be a side effect of the trauma and not the cause.   I am just not sure how one sided increased muscle tone influences the baby’s head out of the pelvis, whether it causes more tension on the same or opposite side ischium, but I’ve felt enough pelvis’ to know that it does.

How does the effect of increased tone in the pelvic floor muscles potentially influence or guide the baby’s head out of the pelvis?   Increased tone on one side of the pelvic floor muscles may cause the baby’s head to be pushing or guided more into the opposite side ischium.  Or is it the muscle tightness prevents opening of the ischium and nutation of the sacrum on that side causing the baby’s head to shift towards the tight side?  Either way whether tension in one side pelvic floor causes trauma on the same side as the tightness or the opposite side, the ischiums are still getting uneven tensions placed upon them leading to increased trauma and dysfunction in the bones and pelvic floor tissues.

Another player in this mechanic could be the sacroiliac joint.  If the sacrum is unable to nutate on one side because the sacrum is not sitting in the joint properly this can prevent it from opening up and possibly cause a shifting of the baby’s head toward one ischium more than the other.

I highly recommend any pregnant woman get their pelvis and sacroiliac joints assessed for normal mobility prior to going into labor.    A Webster trained chiropractor or a Women’s Health physical therapist can help you determine if your sacrum has the ability to move as it should prior to going into labor.   It could help you have a faster delivery.

One of my clients who had right sided ischial trauma presented with a cervix that was pulled off to the right side.  Instead of the cervix being in midline, it was positioned more to the right and pointing right into the right ischium.  Is that the reason her baby came out more into her right ischium than her left?

These are just a few theories I have come up with to help explain the imbalance I am finding in pressures and trauma on one ischium more than the other during childbirth.

WHAT CAN WE DO TO PREVENT THIS?

It’s hard to say if we can prevent this uneven pressure on the ischiums.  My guess is if women had their sacroiliac joints assessed for mobility and their pelvic floor muscles assessed for relaxation ability prior to childbirth then maybe we could help the baby find a more midline approach out of the pelvis.   While it is easy to assess sacroiliac joint mobility, it is not common practice for any women’s health physical therapist to do any internal work during pregnancy.    I have worked internally for pain and mobility issues in some pregnant moms but it is not common practice to do so.  I’m wondering if routine checking of woman’s pelvic floor muscle tension in the third trimester, and treating increased tone issues, might be helpful for mom’s and baby’s to have an easier birth experience.

The other key factor to address is baby’s positioning in the moms belly prior to the start of labor.  The more midline the baby’s head is down in the pelvis the better chance the baby has of making its way evenly into the pelvis.  Any restrictions in the abdominal fascia or uterosacral ligaments can restrict uterine mobility and prevent baby’s head and body from getting into the optimal position to come out.  Gentle release work of this fascial restriction can free up the mobility in that area and help the baby get into a better position.

For health care practitioners understanding the mechanics of the pelvis and pelvic floor muscles is imperative in helping moms have as easy of a birth as possible.  For pregnant moms any dysfunctions or problems in your low back or pelvis need to be addressed prior to going into labor.   Then your baby can have a smoother, hopefully easier transition through your pelvis.  I am a huge proponent of making sure the pelvis and pelvic floor muscles are in good working order prior to labor beginning.  If we can help make the passageway work more smoothly then both mother and baby will experience fewer traumas.  And don’t we all want that!

 

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