"Kegel, Kegel, Kegel"? Questioning the Status Quo

Monday, June 10, 2019

Each month I teach a small group of expecting parents about the labor and delivery process and each month I ask, who’s been told to “kegel?” [The majority of hands go up.] Then I say, “great! Can one of your explain how to do a kegel for those that might not know.” There is always one eager student who answers quickly: “squeeze like you’re trying to stop the flow of urine.”

Here’s the thing. The vagina and the surrounding muscles of the pelvic floor do not actively help push a baby out. I understand why you might have thought that. No one really learns about childbirth (before they come to class) but it’s not true. Vaginas don’t push babies out. Uterus’ push babies out. “Tight vaginas” can even cause some trouble when it comes to labor AND postnatal recovery.

Let me explain!

Check out this image of the pelvic floor.

There are 14 muscles that run from pubic bone to tail bone and from sitz bone to sitz bone. The pelvic floor is akin to having an artisanal woven basket between your legs, especially created to help you eliminate waste (from bowel and bladder), support internal organs and your general upright structure, and provide sexual pleasure! The pelvic floor has very important jobs to do.The muscles around the vaginal opening are, in general, tight on all of us. If you’re curious, I would highly recommend seeing a pelvic health specialist for a prenatal or postpartum evaluation! They are not always tight, just often. The reason I don’t want to you to super-kegel your way through labor-preparation is because tight muscles are more likely to tear under pressure!

That said, if you did want to kegel to “strengthen” the pelvic floor muscles, “squeezing like you’re trying to stop the flow of urine” wouldn’t be the way to go. If you look at the picture again, the muscles around the vagina are just part of the equation.

Excuse my language, but can you squeeze like you are stopping the flow of urine at the same time as you are holding in a fart? Let go and try again. There it is!? Now you have access to the front and back of the pelvic floor muscles! If you can do it one more time – stopping urine, holding in a fart, and pull your low belly in you're on your way.

WAIT WAIT WAIT! For labor preparation specifically, I really want you to focus on the release. When a baby passes through the vaginal canal, the muscles of the pelvic floor should be used to relaxing and releasing.

Let’s go the other way.

Can you try to push out a drop of urine? Let go. Can you try and push out a drop of urine at the same time as pushing out a fart? Again, excuse my language! Can you try and push out a drop of urine at the same time as pushing out a fart and see if you can let your belly go (presses out and away from you)? That’s it. That is your pelvic floor release. Some women will describe this as finding a bulging sensation. in their pelvic floor or between their legs. If you do it a few more times, you may really notice how and why this would be useful for labor preparation. We want our muscles and tissues to be comfortable spending time in their relaxed state so they are happy to do so when a baby passes through. BUT, we don’t want them to live here. Be mindful of checking in with your range of motion (contraction and release) but do not force your body in either direction, or over do the “exercise.”

Can you move through the full range of motion seamlessly? Imagining moving a dimmer as opposed to a light switch. Can you coordinate with breath? Exhale contract, inhale release. It’s a challenge! Reaching out to a pelvic floor specialist is always a good decision. They can help you assess your personal situation and give you a a targeted plan!

You can also look into Perineal Massage for labor preparation and if you have friends abroad think about getting your hands on an Epi-No.

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