How Big Will My Baby Be?

Are you pregnant and concerned about your ability to birth a "big baby?"

In late pregnancy, ultrasound and other methods are used to try to estimate a baby's size at birth. We hear a lot of our pregnant clients worrying about their ability to birth their baby vaginally, especially those who have been told that their baby may be on the larger end of the spectrum. 

But how accurate are these estimates, and how does the information affect choices surrounding birth?

The medical community generally defines a large baby as over 8lb 13oz. Statistically speaking, fewer than 8% of babies born in the US meet this definition. 

A new study surveying 1,960 new moms found that four out of five of the mothers who were warned that they might have a big baby did not, in fact, give birth to a large infant. However, those mothers were almost twice as likely to have medical interventions such as labor induction, and almost twice as likely to have a planned cesarian birth.

A 2012 study showed that simply being told the estimated birth weight of a baby caused a significant increase in the percentage of cesarian births when all other variables were controlled. 

The American College of Obstetricians and Gynecologists (ACOG) has published guidelines stating that suspecting a large baby is only "rarely" an indication for a planned cesarian birth. These guidelines say that doctors should only offer a cesarian to women with a baby predicted to weigh over 11 lbs at birth.

As we learn more about the role of womens' past experience, fears, and preconceptions on the processes of labor and birth, it's important to recognize the effect of the large volume of information that women receive during pregnancy. While technological advances and the ability to collect more data can be helpful, anxiety regarding a baby's size may influence how an expecting mother approaches vaginal birth or considers elective cesarian birth. 

Psychotherapy for Irritable Bowel Syndrome

A recently published systematic review and meta-analysis showed that cognitive therapy, hypnotherapy, mindfulness, behavioral therapy and dynamic psychotherapy all showed benefits against the symptoms of Irritable Bowel Syndrome (IBS). This high-quality study showed that these therapies were significantly effective when added to standard care, with the benefits remaining at 6 and 12 months. See the full text article here. 

This study is an important reminder to physical therapists, doctors and patients that the management of abdominal and pelvic dysfunction is often most effective with more than one provider. If you are suffering from IBS, talk to a provider you trust about a multidisciplinary approach to manage the aspects of your symptoms beyond the gastrointestinal and musculoskeletal systems!

Pregnancy and Pelvic Floor Exercise

In our daily work with expecting mamas, we are constantly reminded that pregnancy is a time of information overload. Advice comes from all directions - family, friends, doctors, midwives, doulas, class instructors, books, magazines and the internet - and many women and their partners simply don't know how to make sense of it all.

As pelvic floor physical therapists, we frequently discuss concerns brought to us by our pregnant patients about the safety and efficacy of pelvic floor muscle exercise during pregnancy. With the volume and diversity of information available on this topic, it's easy to see why a lot of women are paralyzed by fear of doing the "wrong" thing.

So what's a mama to do? Our answer, ultimately, is the same that we would provide to any woman who comes to us with signs of pelvic floor dysfunction. It depends. 

Generalizing exercise prescription for any population of people, pregnant or not, will never completely address the needs of any one of those individuals, and may prevent many from getting relief from their symptoms. The state of pregnancy creates common features among many women, but each enters her pregnancy with a unique physical, gynecological and psychosocial history that must be determined by a thorough history and physical examination before any conclusions about the most appropriate type of pelvic floor exercise can be made. 

The most important "rule" about pelvic floor muscle exercise is that it should work to cultivate a strong, flexible and coordinated muscle group. Our best physical function occurs when our pelvic floor muscles can achieve a full range of motion during voluntary contractions and relaxations, respond appropriately to postural demands as a component of the deep core, provide stability and force closure to the pelvic girdle and lumbar spine, and adequately support pelvic organs against intra-abdominal pressure.

During pregnancy, it is very important to practice relaxing into the sensation of pressure and stretch felt at the perineum (see our home page video about perineal massage!). But it's also important that pelvic floor muscles can contract strongly and with good endurance to provide needed stability for the pelvic bones and give support to a growing uterus and pelvic organs (including the bladder). As with all things in life, moderation of all of these factors is the key.

The path to to get to this ideal state depends entirely on where our muscles begin - some individuals will need to work primarily on motor control and coordination, some will need to practice voluntary contractions, and others will need to focus on voluntary relaxation. The reason that our jobs stay so interesting is that every body is unique - so let's treat them that way! 

Don't Blush, Share a Flush!

California is struggling with a historic drought, and even in San Francisco we are feeling the effects! A major source of water use is from toilets, especially old and inefficient ones. As physical therapists who talk about toileting all day, we want to do our part to find ways to reduce water waste. 

But is peeing in the shower the best way to combat water waste? The body is quick to associate the urge to urinate with certain activities and environments. Those of you who have already tried going in the shower may have noticed that after doing it voluntarily a few times, the reaction of your pelvic floor muscles and bladder to getting into the shower is more automatic. The next time, when you don't necessarily want to release your muscles, it might be very challenging or impossible to hold back! The same sort of situation occurs when you train yourself to pee "just in case" every time you leave the house, or rush into the house after your evening commute and go straight to the bathroom. Urinary urge (the need to pee) may eventually become disconnected from your bladder being full, and connected instead to a certain time of day or situation. Habits are easy to build and harder to break, so it's important to prevent problems from the beginning. Ideally, you should be using the toilet only when you have a physiological need.

Our conclusion? If it's yellow, let it mellow! Don't blush, share a flush! 

But maybe think twice before peeing in the shower.

What is a Kegel, Anyway?

The "Kegel" was first described in 1948 by Arnold Kegel, an Assistant Professor of Gynecology at University of Southern California. In his quest to treat "genital relaxation," he realized that the strength of the pelvic floor muscles was an important component. He developed a "perineometer" to measure pelvic floor strength, and coined the term "Kegel" to describe the voluntary contraction of the pelvic floor muscles. 

So really, a Kegel is one man's attempt to describe the "concentric" (shortening) action of the pelvic floor muscles to achieve the goal of lifting and supporting the pelvic organs. He certainly blazed some important trails for the description and measurement of muscle strength, and his discoveries laid a foundation for the successful conservative treatment of many pelvic conditions.

HOWEVER. Kegel is not the last word on pelvic floor muscle activity! Ideas have evolved and the body of evidence-based practice has deepened and widened significantly since the mid-century. A Kegel is no longer the only tool we have in our toolbox, and we understand that this type of exercise may actually not be helpful for many types of pelvic floor dysfunction. A physical therapist trained in the specific evaluation of the pelvic floor muscles will not only evaluate how the muscle can squeeze and hold (a Kegel), but how well it can relax. A Kegel is only half the story, if even that much! What's more, if you would benefit from Kegels, you may need to be doing them in a different position than in sitting or standing! Depending on your strength and endurance, your PT may prescribe pelvic floor exercise that will be more efficient and give better results. 

Kegel AH. "The nonsurgical treatment of genital relaxation; use of the perineometer as an aid in restoring anatomic and functional structure". Ann West Med Surg. 2 (5): 213–6.