What I Didn’t Know About My Pelvic Floor

Posted by Margot Hodes

How many of you can say you got to know your pelvis in a whole new way this weekend?  Well if you came to the CEA/MNY Pelvic Floor Workshop then you probably can.  Since the workshop description said there would be an “experiential approach”, I wondered, how experiential are we talking?  Do I need to shave?  I settled on just wearing comfortable leggings.  Lara Kohn Thompson, a certified yoga instructor and teacher trainer and expert in pelvic floor health, led this workshop for professionals who work with women during pregnancy, birth and postpartum.  Here are some of the highlights of the workshop.  After Lara spent some time reviewing the anatomy and physiology of the pelvis, she described how the state of our pelvis has a symbiotic relationship with our core, posture, breathing and our overall health.  In particular how we carry our body – the position we stand, sit, and walk can either support or put strain on our pelvic floor muscles.

Since we were all interested in the impact that pregnancy and birth has on our pelvic floor, there was much discussion around these issues.  Lara conveyed that many women are concerned that after pregnancy and birth they will have a weak pelvic floor and consequently problems with sexual satisfaction and incontinence.  An important point she made was that our pelvic floor should neither be strong and tight or loose and relaxed – rather, it needs to be efficient like a trampoline.  It needs to be able to stretch and move when needed and respond to pressure.  I thought this was a very powerful concept to carry forward with us.  Women don’t need to strive for a tight pre-pubescent vagina because a tight vagina isn’t efficient.  An efficient vagina will accommodate whomever or whatever makes a woman and her partner feel good; an efficient pelvic floor will provide enough elasticity to make sex satisfying and pleasurable.

Because so often there is little to no attention paid to the health of a birthing woman’s pelvic floor, many women do experience damage to their pelvic floor muscles post-partum.  This post-partum period can however be an optimal time to re-map or re-build the pelvic floor and to work on our postural habits.  Lara had us practice some exercises that allowed us to feel the difference between the superficial and the inner layers of pelvic floor muscles.  These exercises are recommended for women who have strained, torn or damaged pelvic floor muscles.  The superficial layer is the layer we feel when we do a traditional Keegel exercise, in the same way we contract our muscles when we are trying to hold back from urinating, defecating or passing gas (or as my sons like to say #1, #2 and #3 – farts now have their own number).  The inner layer is a deeper layer within the superficial layer.  Picture a bowl (this is the superficial layer) and a triangle inside the bowl (this is the inner layer).  As we lay on our backs and took some deep breaths while we contracted our muscles, many of us could not feel our inner layer.   Then we partnered up and tightly bound a scarf each other’s pelvis (the scarf was tied parallel with our ilium and sacrum).  With our partner keeping our scarf tightly in place this time, we tried to contract our muscles while lying on our backs and most of us could feel a big difference.  Firstly, it felt really good to have our pelvis compressed.  Lara noted that women love the way this feels post-partum and that it really helps them to reconnect with the feeling in their pelvic floor.  This makes sense because having my pelvis squeezed in my not post-partum body, I could access sensation in my inner pelvic floor muscles that I ordinarily would not feel.  If it can help a body that’s not post-partum feel more connected I can only imagine the benefits of this technique on a mom who has just been through pregnancy and birth.

Finally, Lara demonstrated how certain positions that we might consider optimal for pushing can actually put enormous pressure on our pelvic floor muscles.  Picture a woman sitting upright curled forward with her legs spread open and up toward her chest.  Yes, she has gravity working for her, but the pressure on her pelvic floor is like a champagne cork popping.  In an emergency situation when it’s critical to get that baby out fast then this can work to mom and baby’s advantage, but in a normal, uncomplicated birth it’s actually beneficial to let the pushing stage unfold in a more gentle way.  Instead of the mom leaning forward, she can be on an incline and her feet and knees can be raised and propped up against a wall or someone’s body, but not tucked in toward her chest.  This provides an efficient descent of the baby but puts less intense pressure on the mom’s pelvic floor.  It was really eye opening to learn how subtle differences in posture and position can affect our pelvic floor health during labor and birth.  For those of you who would like to learn more about the role of the pelvis in pregnancy and birth as well as ways to help increase pelvic flexibility and coordination, Lara recommended reading, “The Female Pelvis – Anatomy and Exercises” by Blandine Calais-Geramain.


Margot Hodes teaches childbirth education and breastfeeding preparation for Tribeca Pediatrics.  She is finishing her certification as a childbirth educator with CEA/MNY and for the past several years has taught as an Adjunct Assistant Professor for Teachers College, Columbia University, where she also received her Ed.D. in Health Education.  Margot is also a Certified Lactation Counselor and has a Master’s in Counseling from New York University.  She lives on the Lower East Side with her husband and two sons.