Too Tight To Deliver…

to tight to deliver

We have all heard or experienced stories of lengthy labours where babies had difficulty descending, usually resulting in an instrument delivery or emergency c-section to deliver baby.

But what is the cause of this?

Is it just your genetics or could something physical like the condition of your pelvic floor, one of the most important groups of muscles that come under great stress and strain during pregnancy and childbirth be a leading contributing cause.

So what is the pelvic floor?

Well the pelvic floor consists of three layers of muscle as well as ligaments and connective tissue, which lines the bottom of the pelvis acting as a hammock/floor. It stretches from the pubic bone in the front, to the sacrum and coccyx at the back. The main muscle of the pelvic floor, the pubococcygeus lies in a figure of eight around the openings of the urethra, the vagina, and the rectum and provides sphincter (& urine) control. A woman’s pelvic floor muscles also support her bladder, uterus and bowel (colon).

When a pelvic floor is dysfunctional it can lead to symptoms like:
• Urinary & Faecal Incontinence
• Prolapse
• Back, Pelvic & Hip Pain
• Painful Intercourse
• Constipation or Bowel Strains

So how does this affect delivery?

During the delivery of your baby the pelvic floor should relax and stretch up to 3 times its size and thin out to allow your baby to pass through. So, whilst strengthening the pelvic floor throughout pregnancy is important, the ability to release these muscles is just as important, especially during the pushing stage of birth. A tense pelvic floor (Hypertonic PF) can slow down the birth of your baby and in some cases require an instrument assisted delivery (forceps/vacuum), increase need for episiotomy or emergency caesarean section. This can lead to further trauma to mother’s pelvic floors and increased risk of prolapse.

So how do you know if your pelvic floor is to strong or weak?

A women’s health physiotherapist is who you want to see and they are the experts in this area. They will perform an internal examination of the pelvic floor and advise you on its condition. After this assessment they are then able to recommend whether your pelvic floor needs strengthening (for a weak pelvic floor) or if you need to learn to relax it (hypertonic/overactive pelvic floor). Pelvic health throughout pregnancy is vital and there are many studies which support the benefits of maintaining a functional pelvic floor throughout pregnancy. I recommend seeing a women’s health physiotherapist around 26-30 weeks to be assessed and implement a plan for your pelvic floor leading up to your delivery. Seeking help sooner if you are unsure how to correctly activate and engage your pelvic floor and release it is also strongly recommended. It is also important to be checked again at 6 weeks and 12 weeks postpartum to again assess the condition of your pelvic floor after birth. Early detection and treatment is the key in your pelvic health.

There are a variety of causes for a hypertonic pelvic floor, birth trauma and scar tissue from previous pregnancies can be a cause of tightness in the pelvic floor muscles. Studies have shown women who experience perineal tearing or vaginal tearing may be at a higher risk, as the pain and scarring can cause the pelvic floor muscles to tighten protectively. One-sided pelvic floor tears can cause the opposite side of the pelvic floor to tighten due to overactivity.

As the symptoms of a weak pelvic floor are very similar to those of a hypertonic pelvic floor, performing pelvic floor exercises with a hypertonic pelvic floor can make the situation worse. For this reason, we highly recommend seeking out a women’s health physiotherapist and getting assessed. This can also lead to more educated conversations with your obstetrician regarding your birth plan for the delivery of your baby.


Written By Tara Thompson

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