The pelvic floor is one of those body parts that most of us know very little about. It wasn’t until I became a birth doula that I learned about how important our pelvic floor is when it comes to sexual pleasure, our ability to carry and birth a child and even holding our organs in place within our body. In my experience most medical professions don’t talk about the pelvic floor with their clients until they are experiencing issues like incontinence. When I started asking around for the best pelvic floor therapist in LA to recommend to my clients, it didn’t take long for me to find Allison Oswald. She is everyone’s go-to for pelvic floor heath. Her clinic offers massage, lymphatic treatment and pilates, all of which benefit pelvic floor health through preconception, pregnancy, postpartum and beyond.
C: What exactly is the pelvic floor?
A: Anatomically the pelvic floor is the group of muscles and connective tissue located at the base of the pelvis. This hammock like group of muscles support the organs above it and are a part of the core muscles which stabilize the spine. They also play an important role in our continence, our sexual function and our lymphatic health. Energetically and emotionally, our pelvic floor is a major part of our connection to ourselves and our ability to be grounded, feel secure and experience pleasure.
C: Is it true that in other developed countries mothers must see a pelvic floor specialist before leaving the hospital after birth? Why do you think the US doesn’t have the same standards when it comes to maternal pelvic health?
A: I'm not sure that it is required in these other countries, but it is definitely part of their standard of care, and how awesome is that?! But why this not a part of the US standards of practice is a big question and needs a big change. I think that the support for women in the postpartum period is not as valued as it should be here in the states. We see it in everything from length of hospital stay after delivery, lack of covered care providers and services, limitations on maternity leave and so much more. I know that we are starting to see a shift, and grateful for the many people working to make those changes, but we still have a ways to go.
C: How does prenatal pelvic floor work help prepare the body for childbirth?
A: Prenatal pelvic floor work is all about developing a deeper connection to the inner core. Personally, I always start off with lots of visuals and analogies to make this area of the body seem less elusive. Very often this is the first time women have seen a model of the pelvic floor muscles, and they can actually start to understand what they do, where they are, and how they can use them in their own bodies. With loads of more education and lots of practice, women learn how to use their pelvic floors effectively during pregnancy on a day to day basis. This will help make pregnancy more comfortable, teach women to work out more effectively and prepare for labor and delivery. When a woman learns to tap into her pelvic floor she is able to make that connection during labor which will only help the process. And if a woman is having a vaginal delivery she will be more equipped to relax and lengthen the pelvic floor muscles for birth. Which in some research has been shown to lessen intervention and risk for tearing. And on the postpartum side of things, women who have a good connection with their pelvic floor can reconnect more easily to allow for quicker healing.
C: You have a Pilates studio called Plumb Line in Los Angeles. So many of my clients swear by it! Tell me a bit about your approach to Pilates. Not all Pilates is created equal when it comes to pregnancy, right?
A: I love Pilates for so many reasons. But a few of the main reasons I think it's so effective during pregnancy, are because the movement is intentional, it's focused on breath and alignment, and it integrates the mind/body connection. Therefore, my sessions are not just about feeling the burn, but rather finding a deeper connection to the entire body. I focus hugely on breath and often ask for feedback from my clients. Hearing their feedback is helpful to me, but the goal is actually so they can start to interpret that feedback in their own bodies. As women begin to make these deeper connections, they start to appreciate the movement more and become more empowered in their own body awareness. This is when I see the lightbulb moments, when women start to realize their own strength, connect more deeply with themselves, their baby, and understand how incredible their bodies are. And yes, there are many other types of Pilates approaches out there, more focused on the cardio, or the flow, or not adapted at all for pregnancy. And for some women this might be appealing and feel good too, but in my practice it's always about the intention and the quality.
C: What are a few things women can do to promote optimal pelvic health throughout pregnancy or even before conception?
I like to teach the A, B, C’s to all of my clients.
A: Alignment…Standing or sitting, try to keep your ribcage over your pelvis comfortably without overarching your low back or rounding. This is not a rigid stance, but a good rule of thumb is to feel like your weight of your body is evenly distributed between your both feet, as well as the balls and heels of the feet.
B: Breathing…All women will benefit from understanding how to breath properly in connection with the pelvic floor. We call this diaphragmatic breathing. If you can imagine your diaphragm at the base of your rib cage being the top of your core, and the pelvic floor being the bottom of the core, you want to start with sitting where those two are parallel. Then inhale feeling your ribcage expand 360 degrees (not up into your shoulders or neck). As this is happening, the diaphragm is expanding down, and the pelvic floor is too. As you exhale, the diaphragm recoils up and the pelvic floor moves up. This breath practice improves pelvic floor function, along with so many other benefits such as calming your nervous system, aiding in digestion, improving blood flow (great for fertility) and coordinating the deepest core.
C: Connection…As you learned in breathing, the pelvic floor moves up (contracts) with the exhale. So now, you can begin to use the exhale during activities/movements when you need more support. Because when you exhale you are activating your pelvic floor a bit. And other daily tips would be to always relax vs. strain to use the bathroom (I love the squatty potty), move your body at least 20 minutes every day, drink plenty of water and to not accept any pelvic floor symptoms as “normal” just because they are “common”.
C: Are there exercises you don't recommend?
A: Not generally...I feel there is so much fear out there about what you shouldn't do during pregnancy or postpartum. And often times these blanket statements are false. Each woman's body is different. Which brings me back to the point of if a woman is well connected with her own body, she will be better equipped to know what she can or can't handle with exercises.
C: How can prenatal pelvic floor work benefit the body after birth?
A: It's all about muscle memory and the body being able to reconnect more quickly, if there was a connection there in the first place then the pelvic floor and deep core can heal more quickly and appropriately. Women will also know a bit more about what to expect, and seek support more proactively.
C: There is a common misconception that with a cesarean you won’t have to worry about the pelvic floor becoming compromised. Can you expand on this?
A: Yes, unfortunately I hear this one all the time, but sadly it's not true. The pelvic floor is working hard throughout the pregnancy, so has plenty of time to become compromised before the actual birth. And the scar tissue that develops from the cesarean can also have an effect on the pelvic floor muscle function and connective tissue. Pelvic floor connection postpartum is really key for any woman that has been pregnant.
C: What’s your take on kegels?
A: Not all kegels are the same, and they are also not for everyone! If there is ever a pelvic floor issue, there tends to be an overarching belief that you must need to do kegels. And this is absolutely not correct. Oftentimes women actually need to learn to lengthen/relax their pelvic floor muscles. This is why I do what I do. I always recommend getting a pelvic floor exam first to determine exactly what it is you need. This will allow you to know what is right for you, but also make sure that you're doing kegels properly if in fact that is what you need.
C: Do you recommend perineal massage before birth? If so can you tell us a bit more about when and how this can be done at home?
A: I absolutely do! For a low risk pregnancy, I recommend women begin perineal massage at home daily around 34-35 weeks gestation. I believe that it is an excellent way to prepare the perineum for vaginal delivery, along with building a mind/body connection to this area of the body so women can more easily stretch for delivery. For my patients that feel comfortable doing this on their own, I typically have them do it in the shower. Using lubrication, I have them put one foot up on a stool or ledge. Using the thumb just barely into the vaginal opening, I have them apply a firm pressure down (6 o'clock) and then move between 3 o'clock and 9 o'clock swiping in a horseshoe shape.