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Physiotherapy in Labour and Delivery

By Miral Patel

A few weeks ago I had the pleasure of meeting Susan Steffes, a Registered Physiotherapist and Certified Birth Doula, who specializes in antepartum, intrapartum, and postpartum care – or, in other words, a physiotherapist who works with mothers to be!  Susan was in Toronto teaching eager physiotherapists (including myself) how our knowledge as physiotherapists can go a long way in assisting with labour and delivery.  For the first time in my life I can say I took a course that I did not, for a minute, lose interest or lose focus on!

Susan brought to mind simple concepts about movement and mobility that can make the labour and delivery process much smoother. Her treatment approaches were so practical and LOGICAL, I’m alarmed that they are not the NORM.  I’d like to take this opportunity to share with you how physiotherapy can help with your labour and delivery experience!

Let’s start with the stats: in Canada, 27% of births are cesarean deliveries. That means 1 in 4 births require MAJOR surgery for the mother. Almost half of the cesareans performed were due to “FAILURE TO PROGRESS.” In addition, 15% of births are instrument-assisted with vacuum or forceps. Instrument assisted births often increase the risk for tears or episiotomies.  A physiotherapist can help limit or minimize the risk of what some may call a “traumatic birth experience” with education and simple mobility and biomechanical strategies.

Prior to the birth of your baby, a pelvic floor physiotherapist can address musculo-skeletal imbalances in the pelvis. They can assess you internally and externally to identify areas of weakness or tightness. These muscle imbalances should be corrected to allow for optimal movement of the pelvis. If the pelvis is balanced and moves freely, the baby can pass through the birth canal more easily.

Now for the excitement!  DURING labour and delivery, a physiotherapist can assist by suggesting movements or positions that help the baby out of the body. They can use hands-on techniques to help provide pain relief and also to facilitate the opening of the pelvis.

Staying mobile for as long as possible is always encouraged!  If the mother is upright and moving around, she has gravity helping her to bring the baby down. Walking or standing may not always be the most comfortable for a labouring mother, but a physiotherapist can guide you and your partner through various supported positions that are still upright.  Furthermore, by suggesting different positions (eg. sticking your bum out, or tucking it in), you can influence the space in the pelvis from front to back. With side lunges you can open up the pelvis from side-to-side. Depending on where you are in your labour, a physiotherapist can help guide you through these positions to help open up the right areas of the pelvis at the right time.

In addition to guiding you through various positions, physiotherapists can use manual techniques to help provide comfort and pain relief. When a labouring mother experiences a great deal of back pain during contractions, a physiotherapist can provide hands-on pressure at various points along the pelvis to help ease the pain. Depending on where the pressure is applied, opening of the pelvis can also be facilitated.

Watch this quick video for a better understanding of pelvic mobility during labour and delivery:

https://www.youtube.com/watch?v=BopvfDznpVY

Now that you’ve seen the anatomy, I bet you’ll be alarmed to learn that in Canada 94% of women deliver on their backs.

Let’s work on changing this stat by getting one of our physiotherapists involved in your labour and delivery!

You might also like to read: 5 Reasons to See A Pelvic Floor Physiotherapist

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