Okay... kegels AREN'T good now??

[candiland]

My friend, who is newly preggo, was telling me that a midwife she knows says that research is showing that kegels are actually BAD for birthing women. She said it gets the muscles too tense and muscular and greatly increases the risk of tearing and the like. This totally makes sense to me, but.... it is so CONTRARY to everything I've ever been told

[pamamidwife]

I haven't seen this at all. I wonder where she's getting this...

Sounds dubious...

There was some research to show that 10 sets of 10 kegels a day was all women needed to do to improve pelvic floor muscles.

Of course, with the thinking from most OBs, the higher rate of cesareans should "cure" all those cases of urinary incontinence and uterine prolapse.

Ugh.

Keep kegeling!

[julie128]

I have heard this. When you kegel, the muscles get TOO tense. You want your vaginal muscles relaxed when you give birth, not tight. It's important to kegel after the baby's born, though!

[kama'aina mama]

The problem may be that many people are doing them "wrong". As with most exercises there should be equal focus on the contraction of the muscle and then the total relaxation of the muscle. Most women just clench, clench, clench. Done properly Kegels not only increase the overall toneness of the puebo-coxyc (sp) muscles but the control over those muscles as well... which includes the ability to voluntarily relax them during labor.

[emmaline]

lets have the research! no one give up until you've read plenty of evidence!!

[morninglark]

My mw mentioned something about this the other day. According to her, kegels are what you need to do, but you can overdo it. She said you should only do 50-100/day and no more or you will become too tight, risk tearing, etc. I kind of thought of it as "toning the muscle" as opposed to "body building".

[pamamidwife]

I just don't see how having a strong pelvic floor can increase tearing. Women in cultures that squat alot and are not as sedentary as us in the Western world have strong pelvic floor muscles.

Kegels are not the only way to strengthen your pelvic floor - just the way that most of us do it because we do not live in a culture where we squat or are physically active for work everyday.

Then again, IMHO, we set women up for tearing and deep lacerations with poor positioning, providers putting their fingers up inside and stretching out the vagina during second stage (talk about something that will make your pelvic muscles contract!), and cheerleader pushing.

[stafl]

I will look for links to back me up on this... but I don't think having strong pelvic floor muscles is the same as having tense, tight pelvic floor muscles. What makes you tense and tighten up is being afraid. Ina May calls it the "sphincter law" - I am convinced this is the reason my labor never progressed, and actually stopped dead in its tracks as soon as I got to the hospital.
So do your kegels, everyone! And find a care provider, and birthing place which makes you feel comfortable rather than puts you on edge.

Interesting about the squats - I do them all the time with this pregnancy, its the only way I can pick toys up off the floor, or get down there to play with DD. And, this time I don't leak when I sneeze! At this point in my last pregnancy, I had to wear maxi pads to keep from wetting my pants. And I was doing kegels just as often, if not more with that pregnancy!

[tinyshoes]

balony

The more well-toned the pc muscles are, the easier it is to control them, and whatever the muscles are doing will be more effective--whether it's holding pelvic muscles in place, or pushing out a baby.

This logic is discussed in Susan McCucheon's Natural Childbirth the Bradley Way. I don't own the book, but borrowed it from the library over a year ago--

--and the part of the book that was SO VIVID for me and memorable was the idea that the stronger the pc muscle is, the EASIER it is to control it and use it to push the baby out. Slack, lazy, pathetic muscles will not make it 'easier' to push out the baby, rather, they could be an impedement. Pc muscles are there to be used, not to atrophy. You got it right, kama'aina mama, but I wonder if doing them 'wrong' is really detremental--I would think it'd just be lame or a waste of time, vs. truly harmful.

Honestly, let's think for two minutes about how retarded it is to suggest that a stregthened muscle = an overly tense muscle...do marathon runners have trouble walking 'cause their leg muscles are so strong that their legs are too tense to bend?

I don't know....I know how 'someone said their midwife/OB said Fact X' can carry weight, and I'm glad we're talking about it here, because I really hate it when crapola advice or foolish ideas about birth are perpetuated--we have ENOUGH of that going on in our culture, IMHO.

[Quirky]

I ended up with an episiotomy after 2.5 hours of pushing because my vaginal entrance/perineum was not stretching at all, and my baby's heart started to decel. I was more than a little upset, given that avoiding an episiotomy was my most important goal after having a healthy baby.

At my 1 week followup checkup, my midwife was super-apologetic, and told me I was maybe the 10th epi she'd cut in 20 years of delivering babies. She asked whether I'd been a runner or a dancer, my muscles were so tight. (If you knew me you'd know what a joke that is!) She said I had the tightest muscles she'd ever seen.

Now, I'm not a Kegel-maniac or anything, and I also know my mother was born with vaginal strictures and had epis with all three of us girls (although lithotomy position could have had a lot to do with it as well). So maybe I'm just naturally tight. But I had done a fair number of Kegels (up and down elevators) as per my prenatal yoga class. Maybe I did them "wrong," I don't know.

In any event, it seemed like tight/toned/taut muscles didn't do a whole lot for me. I wish I knew what to do for next time - the episiotomy, stitches, and healing process sucked rocks.

[tinyshoes]

Interesting...

Is it possible for a woman to have an anatomically smaller introitus (opening to the vagina; the episiotomy is a cut to enlarge this)? My guess is yes.

Does this introitus, this opening, have much to do with the muscles of the pelvic floor which suspend the various pelvic organs and give the vagina its brawn and might? I don't know.....

If you think of the mouth on your face as an introitus, the muscles of the cheeks are more like the pc muscles we're talking about, right? They're connected and work together, but if you just have a small mouth opening, you just have a small mouth opening. (Do OBs snip the corners of their own mouths to get Big Macs in there, so that their jaws don't get slack, or so that the Big Mac doesn't get squished? I don't know.)

Just some ideas, hoping others can add their $0.02 to see if we can better evaluate this unusual bit of 'advice' to quit Kegeling, esp. since we don't have a reference cited yet.

[candiland]

If you think of the mouth on your face as an introitus, the muscles of the cheeks are more like the pc muscles we're talking about, right? They're connected and work together, but if you just have a small mouth opening, you just have a small mouth opening. (Do OBs snip the corners of their own mouths to get Big Macs in there, so that their jaws don't get slack, or so that the Big Mac doesn't get squished? I don't know.)

Well.... Ina May had a great anology about how we don't expect the penis to have difficulty becoming erect. You look at this rather small hunk of flesh, and it doesn't look like it's capable to get that large. But when the man is aroused, it gets very big and very hard. Yet, for some reason, we think that our anatomy is somehow flawed.

Did tons of women tear way back when, when they birthed in huts and fields? According the anthropological research, most did not. They were physically active women, who bent and squatted and carried and worked all day, every day. And they also use(d) totally upright positions for birth. I'm assuming that this, along with a mindset and culture that truly believed birth was a totally normal, safe experience, is what kept these women's perineums intact.

BUT - I don't think any women in the history of childbirth up 'til now did anything like kegel exercises. So I can see how some true natural childbirth advocates question it.

[Plady]

"Slack, lazy, pathetic muscles"

Too funny, I feel like Hans and Franz are here to coach our kegeling

[Mallory]

I came across this scary thing and thought of this thread!!!!Gyneflex!

[pamamidwife]

Originally posted by candiland
BUT - I don't think any women in the history of childbirth up 'til now did anything like kegel exercises. So I can see how some true natural childbirth advocates question it.

Yeah, I agree, but women now more than ever are sedentary. We didn't used to be.


My PC muscles are really the only fit part of my body. I could be in the PC muscle olympics!

I remember in the 70's authors called it the "LOVE MUSCLE". LOL!

[mamaley]

T Pamamidwife I love that quote!

[ferdinandthebull]

kama'aina mama is right on.
I just finished a great book called The Female Pelvis by Blandine Calais-Germain.
The Female Pelvis explains in detail, with clear drawings, the bony and muscular structures and how they function and move during normal physiological processes like urination, sex, childirth, etc. Then, the book describes a variety of excercises to promote body awareness, muscle tone, oxygenation and elasticity. It goes well beyond Kegels.

It is true that exercise can create muscle tone that inhibits muscular elasticity. Weight lifters are often "muscle bound" and marathon runners can easily get shortened ilio-tibial tratcs, glutes and hamstrings that can lead to tears, tendonitis, etc.
Calais-Germain stresses the importance of complete relaxation, usually for twice as long as the muscular contraction, between each contraction. Skipping the relaxation will lead to tight, shortened muscles. Relaxation alternating with contractions will lead to strong, flexible, elastic and well-oxygenated tissues.
HTH

[tinyshoes]

ferdinandthebull, thanx for the book recommendation! I see it's for sale @ Amazon... it looks good, just the kind of thing I've been looking for!

[normajean]

My vagina is very tight. My doctors always comment about it when they do my annual pap because its hard to get the speculum in, or their hand for the pelvic.

However, I had no problem delivering my 9lb 9oz son with only a TINY episiotomy (2 stitches) which the doctor did because I had started to tear by my Clitoris. (I would MUCH rather have an epis than lose my Clitoris!!! lol)

I do kegels all the time now, because they feel good, and help with some stress incontenence. I doubt it will cause any problems for me, because I can relax very easily.

Get this--while my friend was having her epis repaired, her DH jokingly asked the doctor to put in an extra stitch or two. The doctor said that at least 8 in 10 guys ask the doctor for extra stitches to make the vagina tighter for them!!! MEN!

[Quirky]

Originally posted by normajean
Get this--while my friend was having her epis repaired, her DH jokingly asked the doctor to put in an extra stitch or two. The doctor said that at least 8 in 10 guys ask the doctor for extra stitches to make the vagina tighter for them!!! MEN!

Which just goes to show how ignorant and inconsiderate men and doctors can be.....it hurt like hell healing from my episiotomy and the scar/site is JUST NOW beginning not to be uncomfortable during sex, almost 15 months after my ds was born. My dh would much rather me not have had the episiotomy, because he wasn't getting any for months and months, I was so uncomfortable!

I'm definitely going to get that book on the female pelvis!