In the journey of motherhood, everyone wishes for a smooth and safe childbirth. However, various elements can add to the intricacies and complications of the birthing process. One of the pivotal and often overlooked factors is the anatomy of a mother’s pelvis. According to experts, the ease of labor can be influenced by the size and structure of the pelvis. It also has a say in the need for interventions such as cesarean sections.
How does pelvic anatomy affect the process of delivery?
A baby’s head moves down towards the pelvic canal between the 37th and 40th weeks of pregnancy as the mother’s body prepares for delivery. This is a sign that the baby is getting into position for delivery. Doctors keep an eye out for this change and after examining the mother, confirm that the journey has begun. If the baby’s head is low and well-positioned, there are higher chances of a normal delivery.
“X-rays and MRI scans are used to see how big the baby’s head is, its circumference, the girth of the mom’s pelvis, etc., and compare the measurements to get a rough idea about whether the pelvis structure will be apt for a smoother delivery,” says Dr Sujata Dutta, senior resident, obstetrics and gynecology, Fortis Hospital, Kolkata. “For example, if the shape of the mother’s pelvis is very narrow, shaped like a heart, resembling the male pelvis, it is called an android pelvis. Here, the pelvic brim [crucial anatomical boundary that the baby’s head must pass through during childbirth] is smaller,” explains Dr Dutta. “This makes it difficult for the baby to make it through the pelvis.”
While the mother’s pelvic anatomy impacts the delivery process, other factors including the baby’s size and positioning can also influence whether their head gets ‘engaged’ (when the baby’s head’s largest diameter passes through the pelvic brim).To foresee and handle any delivery-related challenges, doctors evaluate an expecting mother’s pelvic anatomy while providing prenatal care. By examining the pelvis, they can ascertain its size and shape, which can provide insights into whether a vaginal delivery is feasible. Factors such as the mother’s health, her past labor experience, and the baby’s size as determined by scanning are also considered before making a precise decision about the mode of delivery. “However, delivery is a dynamic process in which maternal contractions play a crucial role. Regardless of the number of tests done, a smooth delivery is based on what happens when the patient goes into labor. You cannot make a precise diagnosis beforehand,” adds Dr Dutta.
Why is pelvic floor exercise important?
From strengthening the pelvic floor muscles that support the developing uterus to the prevention of incontinence during pregnancy, pelvic floor exercises provide many benefits.
Dr Nutan Pakhare, a Mumbai-based Ayurveda physician specializing in Garbhasanskar (a traditional Indian concept that involves prenatal practices and rituals) and prenatal yoga, prescribes pelvic floor exercise or Kegel exercise (known as Ashwini Mudra and Moola Bandha in Ayurveda practice). These exercises involve contracting and relaxing the pelvic floor muscles, which support the bladder, uterus, and bowel.
How to perform pelvic floor exercises?
The first step in performing Kegel exercises is to identify the pelvic floor muscles and understand how and when they are activated. This is done by tightening the pelvis region — this can feel like you are trying to stop the flow of urine midway, or tightening to prevent flatulence. The muscles activated during these activities are pelvic floor muscles. “Once the muscles are identified, contract and hold the pelvic floor muscles for a few seconds, then release. Perform the process for a series of repetitions,” says Dr Pakhare, author of The Ultimate Guide to Garbhasanskar.
Dr Dutta recommends performing Kegel exercises 10 times in the morning, afternoon, and evening for better results.
“You can do quick twitches, which involve contracting the muscles and releasing them instantly. Longer ones, where you hold the contraction for 10 seconds and then release it, can also be done,” adds Dr Dutta.
Benefits of pelvic floor exercises
Helps prevent urinary incontinence
During pregnancy, the growing baby can put pressure on the pelvic floor and the urinary bladder, which leads to the weakening of the pelvic floor muscles. “As a result, even the slightest movements like coughing or getting up from a sitting position can lead to urinary leakage,” explains Dr Dutta. “Muscle tears during childbirth also potentially weaken pelvic floor muscles, contributing to post-pregnancy urinary incontinence.”
Strengthening the pelvic floor muscles through exercises can help minimize the risk of urinary incontinence during and after pregnancy.
Facilitates delivery
“Pelvic floor exercises strengthen the target muscle, giving pregnant women the ability to easily contract and release the muscles during the birthing process,” says Dr Pakhare.
Dr Pakhare believes breathing practices can also help in easing the labor process. “Through controlled inhalation and exhalation, breathing exercises strengthen the diaphragm muscle. It helps in the labor process throughout the pushing phase by supporting the contraction of the abdominal muscles and facilitating effective pushing efforts,” she elaborates.
Minimizes chances of uterine prolapse
Uterine prolapse, a condition in which the uterus descends or slips into the vaginal canal, happens due to weakened pelvic floor muscles and ligaments. “It is quite common after menopause as the estrogen supply comes down. Having weakened muscles after going through active labor increases the chances of uterine prolapse,” explains Dr Dutta. Pelvic floor exercises strengthen the pelvic floor muscles, thus reducing the risk of uterine prolapse.
Postpartum recovery
After active labor, the muscles become strained and weak. Exercise facilitates the restoration of muscle tone and strength, as well as speeds up the recovery process following childbirth.
Takeaways
- When the mother has a very narrow pelvis (known as android pelvis), with a smaller pelvic brim, it becomes challenging for the baby to pass through during delivery.
- Factors like the baby’s size and positioning can also influence whether the biggest diameter of the baby’s head goes through the pelvis.
- Practicing pelvic floor exercises helps to strengthen the pelvic floor muscles and aids in the prevention of urinary incontinence, facilitation of delivery, minimizing chances of uterine prolapse, and postpartum recovery.
