Pelvic PT Leads To Successful VBAC Births
Women that have C-sections don’t get the rehab and recovery that they should. Often times they will have subsequent cesareans. Some women will not have a choice and some will choose to attempt a VBAC, a vaginal birth after cesarean and they really want to have a vaginal delivery. Maybe they are dying to just have that experience, maybe it was taken away from them in the first place, maybe they’re having another baby and they just want to experience that natural delivery. I want to talk a little bit about why it’s so important to not just hope for a VBAC, but to train your body, optimize your body, and really prepare for what you want to happen.It’s not just physical. There’s a mental component in this. For that mental piece it’s important to talk with a mental health professional and really, if you’re having a hard time, with birth anxiety or just coping with the stresses and changes in relationship dynamics, we really advocate for getting support from a professional counselor. For the physical VBAC preparation we have this pioneering program called the Prenatal Tune-Up package and it’s a lot of hands-on work in the pelvic floor along the external pelvis, a lot of stuff on the back, neck. It’s really all inclusive, but we’ve had a 100% success rate, so we’re pretty stoked about that. We believe that everyone should have this experience to help optimize what they want to have happen.
So let’s talk a little bit about why it’s so important to help prepare your body to have a VBAC. After a cesarean, you have scar tissue and that scar tissue is also in the uterus. It’s not just scar tissue in the belly that you can see on your skin, that scar tissue goes many layers deep.You want your organs moving really good. It’s really ideal to get that scar tissue worked out before pregnancy. But there’s definitely work you can do during pregnancy to help improve that scar tissue. When you decrease the scar tissue, decrease the adhesion’s, you improve the muscles’ ability to contract and relax. Looking at the belly is definitely an important piece of what’s happening and what we do to help prepare for a vaginal delivery after a cesarean. We also work a lot on breathing patterns and where that breath is going. When you take a deep breath, you need to be able to pull that all the way down into your pelvic floor. When you go to have a vaginal delivery, you have to have your pelvic floor which is three layers and all of the layers need to be able to contract, relax, and bulge. As you know, some people will look at that externally and say, “Okay. Yeah. You can contract, you can relax, you can bulge.” But really, the best way to holistically feel all the muscles, know exactly what they’re doing, and what needs work is to manually assess them.
As far as VBACs are concerned, a lot of what we do is help prepare the pelvic floor for that experience. Most people that have cesareans that I see, when I really start to question them about their sex life, sex never really returned to being as awesome as it used to be.There’s just not a ton of movement in the pelvic floor. So if you touch a muscle, you want it to be like a pillow, you can feel the muscle there, you can poke it, it doesn’t hurt, it feels really good, you know, you might get a massage and you’re like, “Oh, yeah. That feels good. I feel like you’re loosening up my muscles. Cool.” But muscles that aren’t working effectively become rigid. These muscles that no one ever talks about, no one ever touches, no one ever explores, are the pelvic floor muscles.
The pelvic floor is not just one muscle. One way I like to describe pelvic floors often in really, really tight, unhealthy pelvic floors, it almost ends up feeling like beef jerky. So when we’re talking about this beef jerky, this is a sign that the muscles are just totally dehydrated, unhealthy, and not moving. These pelvic floor muscles, are so important in not just preparing for a vaginal delivery, but really preparing for life. If you don’t know how your pelvic floor works, it’s really hard to be confident going into a VBAC. So there are little red flags, little signs that maybe your pelvic floor isn’t working as perfectly as you think.”Oh, I might pee a little bit here and there,” or “Yeah. When we’re really deep thrusting in intercourse, I do have some discomfort or it just doesn’t feel right.” Maybe there’s some stuff that can be worked out in order to help you have that amazing sex or to not pee even just a little bit. Those are little things that are a lot of times happening after cesarean too even though they’re not spoken about much.
I really would advocate that every single person that’s trying to have a VBAC, have a pelvic floor examination maybe your pelvic floor is top notch and you can contract it, and relax it, and you can bulge, and bear down. But most of the time, people find out, and a lot of times it’s not until you’re in delivery, that they don’t even know how to push and that’s scary. You want to know how to push before you go into delivery. I’m sharing this information today because I want every person that’s attempting to have a VBAC to realize the importance of having a pelvic floor examination and not just a pelvic floor examination, but really having someone look at your whole body, make sure that your whole body is optimized. I don’t know if it’s going to work every time for every single person. Obviously, there are things that happen, but I do know that we’ve had amazing, amazing success, and there’s just no reason why, if you’re really truly hoping for this, I would just say don’t hope for it.
Find out everything that you possibly can about how to have a successful VBAC and really part of that conversation has to be how is your pelvic floor working, how was it working before, like, what’s happening now, what are you experiencing? I would say just get an evaluation, know what’s happening in your pelvic floor so you can have confidence going into a VBAC. I guarantee you this, even if it doesn’t work out in your favor and you do end up with a cesarean, you will have a much, much better recovery because your pelvic floor will be working.
VBAC Success Story
A mom of a three year old showed up in hopes that we could help her have a vaginal delivery after her first birth was an emergency cesarean. Her amazing doula knows how important her pelvic floor function is and knows that it has a huge part in the moms ability to push. She came for a consult with us and discussed how important it was for her to have a vaginal birth. She said she felt like she was robbed of the natural birth experience and so desperately wanted to experience it. When describing what the session would look like and what would be evaluated the patient was able to express her fear of a pelvic floor evaluation.
She said she knew it was important but she had a long history of guilt and shame associated with “down there.” She was working with a counselor to also help with getting to a place where she could have a pelvic floor exam. She decided in the end that, that was what she needed in order to make peace with her vulva. After initially assessing her pelvic floor, I was highly concerned that she was going to have a very hard time pushing a baby out. She couldn’t move the muscles and the muscles were rock hard and dehydrated. The best we could do was optimize her body, pelvis and mind in order to prepare for what she wanted. After the first few sessions when things started to change and soften and she started to be able to control her pelvic floor, I knew there was hope. Hope that she could at least have a functional pelvic floor and with that hopefully have the dream delivery she desired. The patient went on to have a vaginal delivery on her due date and had no tearing at all.
She was so thrilled with her results and being able to achieve her vaginal delivery. That was the outcome she had wanted but what she said prior to her delivery was, “I should have had help after my c-section. I should have had help before my last pregnancy. If I knew how my vulva and pelvic floor worked I may have not been in the situation to have a c-section in the first place” She also made note that sex felt so much better for her and her husband even said it was better for him. He no longer felt like he was hurting her and there was more cushion according to him. The thrill of helping women achieve their dream delivery doesn’t get old but what I can say, is all we can control is how well we optimize our bodies. There are medical complications that can opt you out of vaginal deliveries that are out of our control.