Issue link: https://www.massageandbodyworkdigital.com/i/1315831
58 m a s s a g e & b o d y wo r k j a n u a r y/ fe b r u a r y 2 0 2 1 postpartum massage, pelvic bone alignment, abdominal support girdles, or Mayan abdominal massage, and certainly nothing about internal pelvic floor fascial massage to release fascial adhesions that form during pregnancy and delivery. And so, my journey began. THE PELVIC FLOOR AND ITS IMPORTANCE The pelvic floor is made up of muscles, connective tissue, and ligaments that lie within the opening of the pelvis to form a diaphragmic sling. In women, it is responsible for three major actions: supporting and keeping our abdominal and pelvic organs (such as the bladder, uterus, bowel, and intestines) in place; acting as resistance against increased intra-abdominal pressure; and opening and closing of the levator hiatus, which is responsible for contracting the sphincter for the urethra, vagina, and anus. 6 This sling is also referred to as the second diaphragm because it not only supports our lower organs, but it moves caudally as the respiratory diaphragm contracts, allowing more room for lung expansion during inhalation and returning to its original resting place upon exhalation. 7 During pregnancy, as the baby grows and expands, pushing internal organs aside and stretching fascia to make room, the extra weight puts a lot of pressure on the perineal structure to support the pelvic floor muscles, as well as the blood vessels and nerves that supply the urinary tract. 8 During a vaginal delivery, the passage of the baby through the vaginal canal exerts tremendous pressure on the perineum and supporting tissues. This pressure can cause lasting damage to pelvic muscles, overstretch connective tissue and ligaments (resulting in scarring and adhesions causing future muscular imbalance), and cut off blood supply to the nerves that make up the pelvic floor. 9 Experts say that "compression and stretching of the pudendal nerve during childbirth appears to be a major risk factor associated with subsequent diminished levator muscle function . . . and for some it is likely to be the first step along a path leading to prolapse and/ or stress incontinence." 10 Research is proving this out. Pelvic Floor Research Highlights • A 2006 study used a cross-sectional National Health and Nutrition Examination survey (2005–2006) of 1,961 nonpregnant women to provide estimates of symptomatic pelvic floor disorders in US females. 11 The analysis determined the weighted prevalence (the sum THE BIRTH FACTOR Affecting both women and men, PFD can be attributed to five key pathologies: age, obesity, chronic pathological conditions that cause an increase in abdominal pressure, past surgical interventions in the pelvic area, and, for women, injuries while giving birth. 4 According to researchers, 5 the most prevalent cause of PFD by far, among women, is giving birth. When I was pregnant with my first child, I did my research on the safest options, created a birth plan, spoke endlessly with my doctor about the likelihood and risks of various outcomes, and considered myself fairly well educated on the entire process. I knew that C-sections were on the rise in the late 1990s and that there were a lot of complications that could arise from major surgery. I also knew that interventions such as inductions and epidurals were being cited as catalysts that could lead to emergency C-sections. Because of this information, I decided I wanted to deliver vaginally, without any interventions if possible—a natural birth. When the time came, I was able to deliver naturally and required only a couple of stitches in a hospital that was known for interventions and cesareans; I felt highly empowered by the process. The following day, all the new mothers in the ward were given a short "how to" lesson on caring for newborns and were sent home with advice to avoid strenuous physical activity, like vacuuming and heavy lifting, and a reminder to "do your Kegels." Not one person told me to avoid going up and down stairs due to the stitches, nor to stay home and rest for the first month due to the trauma that my pelvic floor and uterus had just undergone. I told myself I was a strong, independent, and perfectly capable woman who wasn't sick but had just performed the most natural of acts—something the female body is designed to do. A couple years later, I delivered my second child (again a natural birth) at a birth center with three midwives. As before, I required a few stitches but suffered no other complications or issues. The midwives had me wait for an hour to ensure everything was OK, and then sent me home. Unlike the hospital, though, I was given instructions to rest and avoid going up and down stairs so that the perineal tissue would have a chance to heal properly. I was also advised to avoid heavy lifting, but there was no mention of why it was necessary to rest and rebuild my core and pelvic floor. I knew nothing about