When a woman becomes pregnant, it is an exciting, happy and joyful time for her and her partner, but it can also create stress and anxiety, especially if it’s her first pregnancy. Many new expectant mothers will also develop fears; such as a possible miscarriage, whether the baby will be healthy, or whether she is going to be a good mother. New mothers will experience similar emotions when her new baby comes into the world. There are many changes and challenges that affect the woman throughout her pregnancy and after childbirth. The changes can include emotional, mental, physical and hormonal changes to the body. The woman can have mood changes, that is unexplained teariness or become easily upset, increased tiredness, develop enlarged and tender breasts and frequent urination. This essay will briefly describe the location and function of the pelvic floor; discuss the importance of maintaining a strong pelvic floor during the antenatal and postnatal period in the treatment of urinary incontinence. And as a midwife, it is their role to provide education and support for the women they look after.
The pelvic floor consists of layers of muscles “stretching like a hammock from the pubic bone in the front, to the base of the spine” (O’Connell, Bennett & Jarvis, 2004). There are three openings that pass through the pelvic floor; the urethra from the bladder, the vagina from the uterus and the anus from the bowel (The Royal Women’s Hospital Fact Sheet, 2010). The pelvic floor muscles work to support the bladder, uterus and bowel (Hendy, 2006; The Royal Women’s Hospital Fact Sheet, 2010) and hold the organs in their correct position (O’Connell et al., 2004). A strong pelvic floor assists with improved bladder and bowel control because the muscles contribute to the closing mechanism of the sphincter of the urethra and anus (O’Connell et al., 2004). This helps to prevent problems like urine or faecal incontinence and prolapse of the bladder, uterus and bowel (The Royal Women’s Hospital Fact Sheet, 2010). It also plays a role in sexual activity and childbirth (Day & Goad, 2010). Some common causes of pelvic floor muscle weakness include pregnancy and childbirth, constipation, being overweight, changes in hormonal levels during menopause and ageing (The Royal Women’s Hospital Fact Sheet, 2010).
There are two factors that cause the pelvic floor muscles to be weakened and damaged during pregnancy and childbirth; hormonal change and mechanical trauma during vaginal delivery (Baessler & Schussler, 2008). During pregnancy, a hormone called relaxin is released by the body to help ligaments, soft tissues and the cervix to be more elastic to allow appropriate stretching to accommodate the foetus’ growth and prepare the woman’s body for birth. There is an increased pressure to the pelvic floor as it stretches to support the extra weight of the growing foetus (Baessler & Schussler, 2008; Day & Goad, 2010; Hendy, 2006). A mechanical trauma occurs in the second stage of labour where the foetus’ head starts to show through the vagina, this stretches the pelvic floor “up to 3.26 times its original length” (Baessler & Schussler, 2008). An assisted vaginal delivery, such as the use of forceps and Ventouse, has also been shown to weaken and damage the pelvic floor, leading to urinary incontinence (Chiarelli & Cockburn, 2002).
Urinary incontinence is defined as the involuntary leakage of urine (Joanna Briggs Institute, 2006). There are a few types of urinary incontinence, but the common types that affect women during their pregnancy and postpartum period can include stress and urge incontinence (Baessler & Schussler, 2008; Hay-Smith, Morkved, Fairbrother & Herbison, 2009). Stress incontinence is the involuntary urine leakage when there’s a physical exertion, for example coughing, sneezing or lifting; and urge incontinence is the involuntary urine leakage associated with a sudden need to void (Duggan, 2005;...
References: Chiarelli, P. & Cockburn, J. (2002). Promoting urinary continence in women after delivery: randomised controlled trial. British Medical Journal, 324(7348), 1241-1244
Day, J., & Goad, K
Dinc, A., Dizilkaya Beji, N. & Yalcin, O. (2009). Effect of pelvic floor muscle exercises in the treatment of urinary incontinence during pregnancy and the postpartum period. International Urogynecology Journal, 20(10), 1223-1231
Hamilton, H. (2007). The midiwfe’s role and responsibilities. In Hamilton, H. (Eds). Contemporary Midwifery Practice: Health Promotion: the role of the midwife (pp.13-19). Bundoora: the Faculty of Health, Medicine, Nursing and Behavioural Sciences.
Hendy, S. (2006). Maintaining the integrity of pelvic floor. In Pairman, S., Pincombe, J., Thorogood, C. & Tracy, S. (Eds). Midwifery: preparation for practice (pp.444-454). Australia: Elsevier
Joanna Briggs Institute (2006)
The Royal Women’s Hospital Fact Sheet (2010). Pelvic floor exercises. Retrieved 31st August, 2011 from: http://www.thewomens.org.au/pelvicfloorexercises
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