At Mend, we work with highly active women in Boulder County during pregnancy in our Boulder and Lafayette sports medicine and pelvic health physical therapy practice. This includes elite marathoners, CrossFit enthusiasts, triathletes, group fitness junkies and more.
As pelvic health specialists we often hear concerns from these active women about “being too tight” in their pelvic floor to deliver a baby without difficulty or sustaining an injury. Many of these women avoid doing evidence-supported pelvic floor muscle exercises (ie: Kegels) during pregnancy out of fear that this may increase pelvic floor muscle tightness and delivery outcomes.
A 2013 study by Bo et al “Too Tight to Give Birth” assessed pelvic floor muscle function and delivery outcomes in 277 women pregnant for the first time. The authors determined that pelvic floor muscle strength and endurance was not associated with operative or instrument assisted delivery or perineal tears. Strong pelvic floor muscles are not disadvantageous for delivery. Women with higher vaginal resting pressure did have a prolonged second stage of labor (full cervical dilation to delivery of baby) but did not sustain injury or undergo assisted/operative delivery at higher rates.
It is important to note that high quality systematic reviews (Woodley et al 2017, Morkved at al 2014) report benefits of pelvic floor muscle strengthening to reduce incontinence in late prenatal and early postnatal periods and did not exclude study participants based on vaginal resting pressure (pelvic pain was also not a reported outcome, which can relate to pelvic floor muscle tension). As is often the case with clinical trials, we cannot make broad generalizations about the appropriateness of particular interventions for all women. In this case, avoidance of an evidence-proven prenatal exercise program including pelvic floor muscle training due to fear may result in increased incidence of postpartum incontinence (prevalence 32-64%) and postnatal quality of life.
This uncertainty highlights the importance of working with a pelvic health physical therapist to provide individualized assessment of your body and concerns during pregnancy.