Which Stages of Childbirth Affect the Pelvic Floor?

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It is rarely appreciated that labor and delivery are among the most important physical events in a woman’s lifetime.  But the fact is, whether childbirth is easy or difficult, long or short, one fact remains constant: your body will never be exactly the same after pregnancy, labor and delivery, as it was beforehand.

All stages of pregnancy and childbirth have implications for the pelvic floor, to some degree.  For instance, when the widest part of the fetal head secures itself within the pelvic cavity, the fetus is said to have become ‘engaged’.  Some women may suddenly feel they’ve begun to ‘carry lower’.  When engagement occurs in a first pregnancy, it’s considered by some practitioners to be a sign that a ‘good fit’ exists between mother and baby – perhaps reflecting an easier labor and delivery ahead.  What if, though, you’re past the due date of your first pregnancy and the baby’s head is still unengaged?  According to some obstetricians, this may represent an early warning that your pelvic shape and your baby’s head aren’t an ideal fit, and that you might be at a higher risk for a long or difficult labor, or one that fails to progress to successful vaginal delivery.

Labor’s ‘first stage’ begins when uterine contractions become painful and frequent and the cervix begins to open.  When the cervix is fully opened you’ve entered the ‘second stage’ of labor, which ends with delivery of your infant.  At that point, most women are instructed to start pushing, encompassing the most physically stressful part of labor for both baby and mom.  This involves a tremendous amount of stretching and compression throughout the most important pelvic areas: vagina, bladder, urethra, muscles and nerves.

Do ‘Childbearing Hips’ Matter?
Most women know very little about this aspect of their body, or its potential importance during childbirth.  But in fact, the shape of your pelvic bones may have important effects not only on how fast labor progresses, but also on the physical ease or difficulty you might encounter with childbirth, and the types and extent of pelvic injury that might occur, and lead to symptoms afterwards.  Your doctor can determine your ‘pelvic shape’ by taking a series of measurements during a pelvic examination called ‘pelvimetry’.  Except for extreme cases, however, the ability to predict difficult labors based on pelvimetry is limited.

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

(Crown Publishers, Random House, NY 2003)

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