When I get a question I don’t feel like I have the best answer for, I hit up pubmed for research and trusted colleagues for their insights and wisdom. Anita Lendach , pelvic health physical therapist,  is one of those colleagues. I posed a question to her that I had received. Specifically the inquirer wanted an opinion of a technique for pushing a baby out called “Pushing with a blocked inhalation”. The technique is described as: “The woman inhales, holds her breath, while contracting her abdominals into a push.” The inquirer and I were also hoping for better alternatives and any additional advice.

Here is Anita’s answer (printed with permission):

I understand that the diaphragm lowering during inhalation would create a downward force, but to push and hold the breath at the same time is scary to me.  And that is common practice, from what I know.  I have had multiple women tell me that their MD’s told them to hold their breath while they push. 

I think there are a few different ways to teach it; one can inhale and create a downward widening (of the pelvic floor and the perineum); hold the widening as you exhale and pull in the abs, directing the force toward the vagina. Or one can time the pushes with the contraction, focusing solely on the exhalation with abs coming in, back to the level of the uterus, and down thru the vagina. 

Having women understand the direction of forces, how the breath can help and where to direct the force are huge.  I help women distinguish between core for most daily activities, for facilitated bowel movements, and for delivery, all with their special coordination.

The generalized pushing and holding the breath is probably what causes so many problems (hemorrhoids, prolapse, etc.), even lung and head injuries women have reported after delivery.

And of course positioning is huge,- let gravity help and make sure the pelvic floor can expand in all directions (including the tailbone, where women get in trouble with the supine (elevated or not) position, because the tailbone has no where to go/expand.

Great information and insight! A trip to see a pelvic health practitioner, like Anita, can help you distinguish what a widened pelvic floor feels like, how things (organs, babies, and pelvic floors) can gently descend on inhale, how breath holding vs exhaling with a push can change what you feel in your lady bits, where the heck your tailbone is  and most important how to direct the force. Knowledge and practice ahead of time, will help you really know what to do at game time to optimize your own protection during and recovery post delivery.

In addition, a recent study from Miquelutti et al* found that a periodically supervised ‘birth preparation program’ that included education, and exercise reduced issues of incontinence throughout the pregnancy in the exercise group. The study did not show an improvement in lumbopelvic pain or anxiety in the birth preparation program group over controls. The study authors acknowledged, and I concur, that the lumbopelvic exercise program provided (two stretches, isolated TA engagement, and isolated PF engagement) may not have been enough and was chosen as the safest and easiest to perform independently at home. They concluded that lumbopelvic pain may require more supervised intervention and specific exercises for a better response. More reasons to seek out help to understand and guide you through the changes your body is experiencing while you are pregnant vs waiting until the baby is in your arms!

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*Miquelutti MA, Cecatti JG, Makuch MY. Evaluation of a birth preparation program on lumbopelvic pain, urinary incontinence, anxiety and exercise: a randomized controlled trial. BMC Pregnancy and Childbirth 2013, 13:154 http://www.biomedcentral.com/1471-2393/13/154