Many pregnant people ask us how to prevent pelvic floor injuries during a vaginal delivery. This is a hard question to answer, because the birth experience is so unique to each person and each pregnancy. While there is no way to prevent injury, research does show that a couple of factors may reduce risk. Certain birthing positions and choosing how to push during labor are a good place to start!
No matter what happens, Agile pelvic PT has you covered with expert advice and guidance in managing the effects of a vaginal delivery. For helpful tips about early postpartum recovery, check out our guide.
- There is no “best position” for birthing. You can (and should) labor in different positions depending on what is helpful and comfortable. Your birth attendants can guide you when different birthing positions will help with baby’s positioning. You may also feel that you are drawn to different positions. If possible, follow your instincts!
- You have MANY birthing positions to choose from. We like the information on the Evidence Based Birth website. This is also a great resource for more in-depth discussion of the research cited in this article.
- Most people have some fetal monitoring devices on their body during labor. These devices, as well as an epidural, may limit some of your available positions.
- Even if you have an epidural, you do not have to be on your back in stirrups! Many people can move with some help into other positions.
While there are studies about birthing positions, they are of variable quality. Put together, they don’t give us much specific direction! However, we have more confidence about some conclusions:
- Upright positions (sitting, kneeling, squatting) appear to reduce risk of forceps or vacuum assistance and episiotomy.
- Lower risk of fetal heart rate abnormalities with upright positions.
- Increased risk of second-degree perineal tears with upright positions
- With epidurals:
- Changing positions about every 30min appears to be helpful in reducing risk of forceps/vacuum use, Cesarian, and episiotomy. Both groups in the study (those who moved frequently in labor and those who stayed supine the whole time) ended up birthing with feet in stirrups. This means that the position changes themselves seemed to be the important ingredient!
- Supine with stirrups (lithotomy) and squatting appeared to increase risk
- Generally, sidelying positioning appeared to be protective
HOW TO PUSH DURING LABOR
During the second stage of labor, you have options about how you breathe and push! You may use both of these strategies in different situations, or find yourself predominantly using one. Research suggests that “open glottis” versus Valsalva strategy is the lower risk way to push during labor.
- “Valsalva pushing” means holding your breath and not letting any air escape while you push downward. If you are being coached by labor attendants in the hospital, this is generally the technique that they teach.
- Can generate a higher degree of downward force when pushing needs to be faster
- May cause your pelvic floor muscles to automatically contract instead of release
- May have a larger negative impact on your blood pressure, baby’s heart rate and blood pressure
- Appears to have a larger negative impact on postpartum bladder function
Open glottis (“spontaneous”) pushing
- Exhaling and/or making sound as you bear down. Your glottis is the part of your trachea where your vocal cords are. It closes when you hold your breath, and opens when you’re breathing/making noise.
- When not being coached, most people push this way.
- Less impact on your blood pressure, your baby’s heart rate, and blood pressure, and may reduce the pressure on your pelvic floor muscles
- May increase total length of pushing phase
Ultimately, researchers conclude that “in the absence of strong evidence supporting a specific method or timing of pushing, the woman's preference and comfort and clinical context should guide decisions.”
The right decision for you is unique to your birthing experience! We believe in collaborating with your care team to choose the best option in each situation.