damaged pelvic floor through pushing?

[smurray]

Hi,

I have a question that someone might know about.

Since I had DD, 20 months ago, my pelvic floor muscles have been very weak. I am currently seeing a physiotherapist who has set me an exercise program and is testing the strength. She is fairly certain it will improve. Anyway.

My question is about how the damage happened. I had very strong pelvic floor muscles before the birth. The birth was mostly natural, but my pushing stage took a long time, and even though I was pushing with all my strength (so much so that I had blisters from clutching the birth stool) , it took 2 hrs plus. Eventually I had an episiotomy. It all worked out and I am very happy generally with the birth experience.

I am wondering if its possible I was pushing with the wrong muscles ? No one told how or what to push. So I think I was just straining the pelvic floor. I am now wondering if it would have been better to have pushed my stomach muscles out, and relaxed my pelvic floor as much as possible?

[Dorasmum]

Just trying to think back now to "how" I pushed. Isn't it like you're trying to push a poop out? the same feeling? I don't remember having that much control over it though, that I could concentrate on how I pushed. My pelvic floor isn't great atm, but not too bad, negligible difference after the second birth. DD2 came out in 3 minutes so maybe yes less time pushing made a difference? I would have thought that any damage done to mine was done with DD1- 1 hour pushing.

2 hours is a long time to be straining and since you noticed a big difference I would be more inclined to think it was that, not how you pushed. But someone may know something otherwise, I'm just guessing by what I feel with myself

Em

[kadownie]

don't know the answer to this... but after I had DS2 (a vb) I could see how pelvic damage could be done- I also had a longer 2nd stage- about 2 hours- however I refused to push as I wanted my body to do it in it's own time.. but having him sit on my pelvic floor for that long- (he was right down in there) I imagine could have (didn't though) done some nerve damage.. I have found it hard to 'feel' how to do kegels since his birth.. though I don't have any problems (yet). I imagine with the guidance of the physio- she will be making sure you are doing them correctly and they will strengthen up..

For me the correct way to push was not to push- I think relaxing is good- but I don't think pushing out your stomach muscles would have helped.. though not certain.

[Bronnie]

I didn't push with my last two, at all, and my floor is still a tad lacking. Still need heaps more work to keep it all where it should be.

[smurray]

Thanks for the replies!

I am thinking that maybe the reason my second stage took so long was because of the way I was pushing? That I was actually tightening the pelvic floor rather than relaxing, and making it more difficult?

Bronnie, I see that damage can happen anyway and maybe my pelvic floor might have been affected even if I hadn't pushed. Still, I think if I ever have another, I'll just try and relax and not so consciously push.

I do 3 sets of exercises a day, fast ones and slow ones. The physio is quite reassurring. I need the incentive of knowing I told her that I would do the program in order to make me take it seriously. When I tried to do it by myself, I just did it whenever I remembered... which wasn't every day. Luckily, its free on medicare because its considered a "chronic" condition if it lasts longer than 6 months.

[Dorasmum]

Let us know how it goes.. maybe some more of us need a boost to go see someone...I know I need to at least remember to do some kiegels a little more often.

Em

[timestwo]

I truly believe that my weaker PF is due to pushing for too hard too long (I also pushed for 2+ hrs as well)
Also I think the squatting position that I was in didn't really lend itself to letting the pushing just happen looking back it just kind of made me strain more.
I did feel that I was a bit under a time constraint in the hospitial so I think I was pushing hard to try and make it happen rather than just let it happen.
But this time round it's all going to be different.... (cross fingers)

[hanabi]

Were you directed to push, or were you pushing with your natural urges? Directed pushing is a significant cause of pelvic floor damage and the fact that you had an episiotomy could go some way to explaining why you have not fully recovered from your vaginal birth. When you are left to push with your natural urges, it's pretty hard to push incorrectly. Still, some women, especially in their first births, don't experience that overwhelming urge to bear down. I didn't, and I do remember being directed to push, how to push, what position to push in.

[Dorasmum]

That's so true, I didn't feel that with my first, I was directed to push and I couldn't even feel the contractions by then, I only knew by feeling my tummy tense up, basically i didn't really know what I was doing and it took an hour. With the second I was in the bath until I felt the urge got out, announced it was time to push her out and did within a few minutes. So why do some not get that urge? Is it too early? Fully dilated so they say to push but if we waited a bit longer the urge would come?

Em

[hanabi]

Personally, I think we're told to push too early, even though we may be fully dilated. The urge to bear down *will* come eventually if bub is in the right position to descend. We forget that bub is as much a participant in the birth event as mum is.