5 Things I WOULD Do as a Pelvic Floor Therapist

Updated: Aug 18

Tips for pregnancy, birth planning, and postpartum

by Sarah Coombs, MOT, OTR/L, RYT

There is a social media trend at the moment along the lines of “5 Things I would NEVER do as a _____”. I’m not a fan of “never” doing something, so here is my spin: 5 Things I WOULD do as pelvic floor therapist, knowing what I know now.


My birth & postpartum experience with my daughter is what set me off on my journey into the world of pelvic health, and given what I know now, I would do some things very differently (and did in fact do them differently with my second pregnancy.)


1. I would adjust my yoga practice and workout routine to better support my body in pregnancy.

Yes, it’s true, you can keep doing many of the things you were doing pre-pregnancy! And despite the outdated notion that you should never start anything new in pregnancy, you can do that, too. There are phenomenal athletes who continue lifting, running, and doing all sorts of things with perfectly healthy pregnancies. But the question is: at what point are you doing something just to continue doing it versus choosing an activity to support your changing body in pregnancy?


For me, it was vinyasa yoga of the Astanga & power yoga lineage that I was quite frankly hellbent on doing until the very end. In fact, I distinctly remember doing a modified vinyasa practice when I was past the 40 week mark.


And yes, while there's nothing necessarily wrong with modifying & continuing a vinyasa practice in pregnancy, the way I continued to practice wasn’t actually serving me. (And this my friends is a lesson in aparigraha, or non-attachment.)


In hindsight, I would have done a hell of a lot more prenatal yoga & allowed myself to slow down and really connect with my body that last trimester. In doing so I probably would have also connected with other pregnant folks along the way.


2. I would take a birth class with an emphasis on physiological birth rather than my hospital’s birthing class.

A hospital birthing class will teach you the stages of labor, sure. Maybe a few tricks for comfort measures. But let’s be real, it’s mainly going to teach you about the hospital policies you will be told that you have to follow & the interventions they commonly use.


Don’t get me wrong, there are times where birth does truly warrant medical intervention. If you're birthing at a hospital it’s also incredibly important to learn about different interventions that could be presented as an option well before you’re going into labor. But if you're hope is for less intervention, then take a class on what happens in birth without interventions. This is not how our medical system views birth.


(Now, if you’re the kind of person who’s like: “I want that damn epidural the second I can!” or, "I'm okay with whatever my doctor decides", there's no shame in that, and a hospital birthing class might be a perfectly fine option for you.)


3. I would push the way body wants instead of coached “purple pushing”.

What is “purple pushing” you ask? It’s that pushing you see in the movies where the person holds their breath and then bears down with all their might. And for a long time it’s been coached by hospital staff because it quite frankly can be an effective way to get a baby out in a shorter amount of time, especially if you're also being told to lay on your back. However, this is most certainly not the only way to push & unless your body: 1. automatically wants to push that way OR 2. the way you’ve been pushing for quite some time has not been effective and you need to change it up, I wouldn’t suggest this as your go-to strategy.


Why? Well, holding your breath and bearing down with all your might is a great way to do some… err, damage. Ideally your uterus is doing its thing with contractions and pushes the baby out on its own without you needing to add anything extra (hello fetal ejection reflex!) If you do need to add in some extra effort to help baby along, you can do this with an open mouth & open glottis, which can still help with downward movement without also sending the absolute maximum amount force onto your pelvic floor & organs.


In my case, I automatically wanted to push with an open mouth during my daughter’s birth, and the L&D nurse told me I was pushing “wrong” and I had to do it her way, ie “purple pushing”. I then proceeded to only push that way for... over 5 hours. Hello, pelvic organ prolapse.


At the time, I didn’t know any better, but if I could go back in time I would quite frankly tell her to leave me alone & let me push however my body damn well pleased.


4. Forget the nursery, I would start a registry fund for a birth & postpartum doula.

Like many who have come before me, I spent all my time researching all the baby things. Towards the end of pregnancy I was in full-on nesting mode, preparing my daughter’s nursery that she actually didn’t spend any time in until she was about 3 months old.


I get it, if you have the privilege & means to have a registry, looking at baby stuff is super exciting & fun! And I also think it’s natural to go into nesting mode at the end of pregnancy. But it turns out I didn't need an animal themed nursery. I really needed an experienced birth doula to help with 2 & 3 from above and the most important thing of all: POSTPARTUM HELP.


Friends, we were not meant to take care of newborn babies all alone, and in many other parts of the world there are still structures in place around postpartum care where a new mother would never, EVER be left alone to recover & care for a newborn by herself. This is a recipe for poor maternal health outcomes, isolation, & things like PPD/PPA.


After an unplanned cesarean birth & a challenging initiation into breastfeeding, I was left alone since my partner was back to work after 2 weeks. My mom flew back home. I also thought I was supposed to be able to figure it out on my own. It was pretty terrible & I definitely ended up with PPA. I needed help. I needed someone to be there to support me through the learning process that is becoming a mom and to hold my baby so I could rest & have a break.


5. I would have an appointment with a pelvic floor therapist lined up for postpartum.

I remember asking my midwife at my 6-week postpartum visit what I should do now that I was “cleared” for exercise- to which she said, “well just don’t go crazy!” No referral to pelvic floor therapy/ postpartum rehab or even a recommendation of where the hell to start. And so I did what you do: I tried to jump right back into a vinyasa yoga practice 6 weeks after a major abdominal surgery. (I don't recommend this.)


Like many others, I didn’t know any better, and shame on the medical system for abandoning us all like this. After ending up up with all kinds of hip and pelvic pain, I thought: there must be a better way! What am I missing? And thus began the start of my new career path.


I will say this over and over and over: 6 weeks is the beginning of recovery, not the end and there IS in fact a better way.


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