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Perineal Tearing Reduced – Avoiding Coached Pushing During Labor

We have mentioned before about the predicament with completing ‘kegels’ (or the contraction phase of the kegel alone is what most end up doing). This has an inherent potential impact on labor and delivery.

Now there is new research out of the European Journal of Obstetrics & Gynecology and Reproductive Biology about the impact that there can be had when removing what is often referred to as ‘coached pushing’ during labor and delivery in addition to a few other key factors.

At Warman Physio we want to set women up for the best success possible during labor and delivery, and know that knowledge is power!

So let’s run through some of the background here.

The Facts From the Research

An article in Return to Now outlined the results from EJOG in a thought-provoking post. There is an 85% reduction in 3rd and 4th degree tears (the ‘worst’ of the available 1-4 scale) when women are not coached to push during labor. The amount of severe vaginal tearing was reduced from 7% to 1% within the study.

The researchers completed a review to determine what the main contributing factors were for third and fourth degree tears, and implemented a series of measures to try and reduce these risks.

Some of the risks include a larger than average baby, baby being born ‘face-up’, forceps use, previous perineal tear history, as well as maternal age and weight

This program is referred to as STOMP (Stop Traumatic OASIS Morbidity Project) and implemented within the hospital unit by the midwives and OB GYN teams over the following year. This program includes laboring in different positions to deliver the baby such as squatting, kneeling, and standing, as well as breathing through contractions instead of pushing and applying counter pressure to the perineum during delivery of the baby.

A total of 3902 vaginal deliveries occurred during the 1 year following the launch of full STOMP implementation, with the most significant and immediate results occurring in the first 5 months.

What Does This Mean?

We have seen before in a video demonstration how the uterus does it’s job to push a baby out, coached pushing is shown to lead to closure of the perineum on the descending baby. Allowing women to follow their instincts, without coached pushing, is proven to reduce severe perineal tearing. This will not eliminate all perineal tearing, but gives additional information into how we can best support mothers during labor and delivery.

Physiotherapists are uniquely positioned to assist with mothers during this phase of life, particularly pelvic floor physiotherapists.

Although seeing a pelvic health physiotherapist is not the standard of care here in Canada, there are many women choosing to see one prior to labor and delivery for a variety of reasons such as leaking, pelvic pain, pain with intercourse, and low back pain or sciatica among others. There is also a large trend to see women post-natally as well due to the same reasons in addition to injuries sustained during labor and delivery such as perineal tears.

 

How can Physiotherapy Help?

Pelvic floor physiotherapists, like those we have at Warman Physio, are able to provide prenatal evaluation of the pelvic floor muscles, coordination, and information on labor and delivery preparation activities. Many women will have been practicing kegels throughout their pregnancy since there still is a significant amount of mis-information regarding what is ‘best’… (remember, a tight pelvic floor isn’t really what we are going for, a functional pelvic floor is what we want!)

In Saskatchewan women are provided an immediate referral to physiotherapy if they have received a third or fourth degree tear (which is GREAT!), however, any woman who has been pregnant into the second trimester may benefit from seeing a pelvic floor therapist after delivering baby.

We have seen that in France, the standard of care is that every woman who has a baby is entitled to Pelvic Floor Physiotherapy appointments postpartum.

Reducing injuries during labor and delivery, and having research to support theoretical working knowledge is critical to advancing health and wellness for women of childbearing years.

Wonder if Physiotherapy can help you for labor and delivery? We recommend an appointment 32-34 weeks gestation. (For those with contraindications to a pelvic exam, we would complete various education and external assessment components).

 

Our Pelvic Health Therapists:

Kendra Usunier

Maja Stroh

Scott Golding

Haylie Lashta

 

 

 

 

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What is CranioSacral Therapy All About?

You may have seen that our Saskatoon location is now open for appointments. Signe Bone is providing some new treatment techniques for Warman Physio, and one of those treatments is CranioSacral Therapy. We thought our clients would like to know what CranioSacral Therapy (CST) is all about!

The Basics – Where it started

CST was pioneered and developed by John E Upledger, an osteopathic physician from 1975-1983 with extensive scientific studies at the Michigan State University. Upledger was a clinical researcher and Professor of Biomechanics at MSU.

 

What CST treatment involves

When coming in for an appointment you can expect to feel supported and cared for as the therapist will apply subtle movements on the spinal and cranial bones to bring the central nervous system into harmony. Signe will evaluate and address the movement of the cerebrospinal fluid (CSF), which can be restricted by trauma to the body (such as falls, accidents, infections and general nervous tension). By gently working with the spine, skull and sacrum, these restrictions for nerve passages are eased and movement of the CSF through the spinal cord can be optimized. A nervous system free of restrictions enables the body to return to its highest levels of performance. When attending an appointment for CST alone, the treatment can be provided with the client fully clothed. If CST is combined with more traditional massage techniques the client will dress-down appropriately for the treatment with instruction from the therapist. Treatments independently last on average 60 minutes.

What Types of issues can CranioSacral Therapy benefit?

There are a wide array of things that CST can be beneficial in treating including:

  • Migraines and headaches
  • Chronic pain
  • Central Nervous System Disorders (ie spasticity, seizures, hearing problems)
  • Trouble sleeping
  • Reflux
  • Anxiety
  • Orthopedic problems
  • Scoliosis
  • Chronic fatigue

Special continuing education in CST can be done in order to specifically work with infants and children in addition to the adult populations.

 

Want to book in with Signe? You can choose the type of treatment you will receive when you book online!

 

 Signe’s passion for understanding the human body began at a young age with her own sports and repetitive strain injuries from her former schooling as a musician. After seeing the healing benefits of movement, breath awareness, massage therapy and physio,  Signe was inspired to focus on her training in Visceral Manipulation and CranialSacral therapy. After learning and seeing how amazing and intricate the body is, and the impact these treatments can impart on the body, she has developed a treatment style that incorporates all these various techniques to provide the best treatment to each client based on their own unique needs.
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Family Focused – What does that MEAN?

We see many people talking about being family friendly, kid friendly, family centred, or family focused in their business. What does this truly mean at Warman Physio?

When looking to start the clinic, I had worked in several places that were “family friendly”, but didn’t have any change tables, toys, or ways to keep kids occupied. This puts the onus 100% on the parents to remember to bring things for the kids (who may unpack the bag before you leave), and check to make sure that everything is charged (as we sometimes discover that technology requiring a charge isn’t always charged when we want it…) and the snacks are the snacks that the kids will actually eat (and hopefully not make a a colossal mess). Which is a huge undertaking when you are a new mom, or just frazzled trying to get the kids out of the house!

What I wanted to achieve at the clinic is a family friendly environment for everyone. I want each person who comes to the clinic to feel like family, sort of like coming home. The goal is for everyone, regardless of what service, issue, or injury they may be coming in for to get this ‘vibe’. For me, it has been a critical focus that when adding new therapists and staff that we stick to this value – being warm, welcoming, and compassionate. (It is written right into the clinic vision and mission statements!)

At the clinic you will find toys, games, books, swings, chairs, wraps, and carriers all intended to help keep babies and older children happy and content during appointments (regardless of what mom remembers to bring!)

The clinic treats babies and children right up to older adults; we truly are able to help everyone across the lifespan!

Ensuring that everyone is treated like an extended family member is the environment you can expect at Warman Physio.

The biggest reason why I wanted this particular feel is because I often heard that people would avoid going for needed appointments because they were unable to afford childcare; or they didn’t have support around to help watch their children while they attended their treatments. Not because they couldn’t (or were told they couldn’t) bring their babies to appointments, but because the environment of acceptance that sometimes babies cry and appointments don’t go as planned made bringing their kids to appointments difficult and uncomfortable. Now don’t let me give you the wrong impression – the therapists want the kids and babies to come, but when it’s not the “norm” it can be a difficult distraction to overcome!

Seeing prenatal and postpartum women, infants and children at the clinic has been the clinic ‘niche’ from the beginning – we just do it a lot! So having that colicky baby that cries the whole time? We’ve got this. Having that baby that needs to lay on momma the whole time? No problem. Having the two big kids that for some reason just NEED to both be on the blue chair? We can figure that out too. Our therapists will hang onto babies, use the swings, and help older kids problem solve during appointments, and sometimes (when mom is comfortable), Laura will snag some of the babies and wander around with them so the mommas can focus on their appointments. It is wonderful to have the content babies and kids in at the clinic, but the kids that are more ‘challenging’ aren’t any less welcome. We enjoy seeing all the kids that come in and want them to feel welcome as well!

So if you have been waiting until you’re back at work, have been putting off coming because you can’t afford childcare, or simply just didn’t know what to do with the kids for your appointments, don’t hesitate to book in with us! We even have kids attend massage appointments with parents sometimes (but I get wanting to be able to get into fully relaxed mode!) 😉

We are here to welcome you into our Warman Physio family – wherever you may fit!

Haylie has been practicing pelvic health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. She now adds to this education and treatment, her knowledge and experience in pediatric pelvic health providing workshops and presentations in addition to assessment and treatment. Haylie has been advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms since she started practicing. This ultimately brought her to open her family-friendly clinic in 2014.  At Warman Physio clients are encouraged to bring their infants and children to treatment if they need. Haylie was recognized as YWCA Women of Distinction finalist for Health & Wellness in 2017, the ABEX Young Entrepreneur Award Recipient in 2018, and a finalist in the 2019 SABEX and WMBEXA Awards.
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Male Pelvic Health – Incontinence and Pelvic Pain

You’ve already read all about WHY pelvic health is also important for men, now let’s dive into a case study!

Case Study – Male Pelvic Health

CT is a 43 year old male seeking help because he is having problems with leaking urine whenever he does physical activity. He has also been experiencing consistent sharp/burning pains around his rectal area. In the beginning he was leaking only a few drops of urine and feeling slight discomfort in his pelvic floor… but after a few months CT is leaking his full bladder and his pain has greatly increased. He is afraid to participate in golf, fishing, and jogging because this is when he leaks the most urine.

During the pelvic assessment it is found that CT has a weak pelvic floor (2/5 strength), and a lot of tension/tightness of his pelvic floor muscles. He is educated that he needs to strengthen his pelvic muscles in order to close his urethra (tube which pee comes out), so that he does not leak before he is able to get to the bathroom, or when participating in golf, fishing, and jogging. CT also requires training in relaxation exercises, and stretches for his pelvic floor, which will decrease the tightness and therefore stop the pain that he has been experiencing.

After the assessment CT is sent home with a breathing exercise, several pelvic floor stretches, and a muscle strengthening exercise.

At the next session CT reports having decreased episodes of leaking and reduced pain in his pelvic area. During a follow up evaluation CT now has 3/5 pelvic strength and a decrease in muscle tension. The therapist manually releases his pelvic muscles and he is once again sent home with progressed pelvic floor strengthening exercises and stretches.

After a few more weeks and 2 or 3 more sessions CT is no longer leaking and feels no more pain and discomfort in his pelvic floor. He is educated to keep up with his exercise program occasionally to maintain strength and proper length of his pelvic floor.

 

Not all pelvic health issues will present the exact same, and as such there is no one-size fits all program that will work for everyone. Need help with your pelvic health complaint? Don’t hesitate to contact us or book an appointment. Not sure if your issues can be helped by a physiotherapist? Give us a call, or send a message, we are happy to help you sort through it.

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Pelvic Health for… Men?!

Pelvic floor dysfunction is not just a problem for women… after all, everyone has a pelvic floor!

A study by MacLennan et al, reported that 4.4% of men have self reported problems with urinary incontinence (inability to control urine) (1). If you take the population of Saskatoon, which in July of 2018 was reported at 278,500 and divide that in half you have approximately 139, 250 males (2). 4.4% of the Saskatoon population will give us 6, 127 men that have problems with leaking or controlling their bladder. Keep in mind that urinary incontinence is only one of many potential issues with the pelvic floor.

The crux of the issue is that pelvic floor health can be a big problem for both women and men.

  There has always been a stigma around men seeking help for any issue, let alone their leaking bladder, erectile dysfunction, and pelvic pain. Men need to understand that they do not need to live with these stressful and often embarrassing problems.

Pelvic Health Therapists are specifically trained to help men and women with a vast majority of their pelvic floor dysfunctions. The pelvic floor is a bowl of muscle that surrounds the external openings, in men that is the urethra (the tube you pee out of) and the rectum.

The muscles are the same as any others in the human body and therefore they are treated similarly.  In a good number of cases urinary incontinence is related to the lack of strength, coordination, and increased tension/tightness of the pelvic floor muscles that close the urethra. Then when the bladder is full, or someone has the urge to pee they cannot stop themselves. By simply teaching someone to relax, strengthen and coordinate their pelvic muscles, urinary incontinence problems can often be resolved.

If the pelvic muscles are too tense it may cause pain in the perineum, abdomen, low back or inner thigh. Relaxation exercises and manual therapy skills can be applied to achieve relief. Strengthening pelvic floor muscles and addressing other contributing factors can often lead to the resolution of erectile dysfunction and healthier sex lives (4). Men need to understand that the tools and resources are out there to help them with their pelvic floor dysfunction, part of which may be pelvic health physiotherapy assessment and treatments.

In short, we are asking that men take it upon themselves to seek out help for their pelvic floor dysfunction and in return understand that they will be treated with privacy, respect, and compassion. Waiting and suffering in silence doesn’t need to be the case; we are here to help you, help yourself.

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