PELVIC FLOOR & INTERVENTIONS

Sometimes birthing interventions are used for the safety and wellbeing of both mother and baby, but interventions should not be used routinely.

Schedule time to discuss policies about interventions with your caregivers or birthing facility as some have their own policies and birth procedures. During pregnancy, discuss with caregivers how you would like to birth to determine their level of support and sort out fears and misinterpretations.

Research shows the pelvic floor can be adversely affected by routine interventions.

  • Epidural (spinal anaesthetic) is an effective pain control strategy and may be used to progress contractions if established labour slows due to pain, fear or exhaustion. The benefits must be balanced against a wide range of side effects: it increases the likelihood of having an episiotomy, forceps, vacuum extraction or caesarean section. As there is little feedback from the pelvic floor it is difficult to know where to push, or less likely a posterior facing baby will turn. Research shows many women receiving an epidural had a longer 2nd stage of labour and contractions needed to be stimulated.
  • Monitoring (CTG or cardiotocogram) is used to keep track of baby’s heartbeat and the mother’s contractions. While it benefits a high-risk birth, CTG can limit a woman’s ability to move, use the shower or bath and increases the likelihood of having a caesarean birth. Some hospitals now use telemetry, which allows the mother to carry a radio-controlled device and stay free to move around. CTG is difficult to avoid in hospitals where its use is policy with syntocinon or epidural injection. Unless syntocinon is used, CTG should only be used initially for 20 to 30 minutes and not left on through the entire labour.
  • Episiotomy cuts through the perineal muscles to widen the vaginal opening and may be used during an emergency requiring immediate birth. The use of episiotomy is an important issue to discuss with your birth attendants prior to birth. Research shows there are few reasons to perform an episiotomy, as it does not reduce the risk of tearing.
  • The choice of birthing position has a significant impact on the pelvic floor. Lying on the back and raising the head to push during a contraction (always shown this way on TV) tightens the pelvic floor, which risks muscle tearing and/or an episiotomy.
  • Artificial membrane rupture breaks the watery membrane around baby. This procedure is used (often with a syntocinon drip) to start or speed up a labour, to attach a monitor to baby’s scalp or check for merconium (baby poo). When labour is prolonged or stops after membrane rupture, the risk of infection and time limits may prompt caregivers to intervene further. Many hospitals have time restrictions on birth and when labour slows or extends beyond 8 to 10 hours, further interventions are started.
  • Assisted vaginal birth involves the use of either forceps or a vacuum assisted suction (ventouse) to quickly birth baby. Both interventions cause higher rates of damage to the pelvic floor and internal supports. There is greater risk of vaginal and perineal pain, bowel and urinary incontinence, and infection in stitches following an instrument assisted birth.
  • Prolonged forceful pushing is when the mother is directed to bear down for long periods. This action can tear the vagina and pelvic floor and strain internal supports. Spontaneous pushing is urge-driven by the mother, is less tiring and reduces the risk of tearing.

Following an instrument assisted birth, tearing or stitches, ask to see a woman’s health physiotherapist to ensure an effective pelvic floor recovery.

Hold It Mama has chapters on self-assessment for pelvic floor muscle damage, prolpase and techniques to stretch scars and prevent adhesions following both vaginal and caesarean birth.