Ashley came to see Dr. Gretchen Price in the third trimester of her pregnancy. She had pubic bone pain during pregnancy which limited her movements daily. With her first labor and delivery, she experienced perineal tearing and had an intense epidural that caused her to not feel anything at all, limiting her ability to move around during the labor. This time, she wanted a natural, medication free delivery.
She previously tried childbirth education classes in Wexford, PA but felt like she would benefit from more one-on-one training specific to preparation for labor and delivery including specifics on how to do perineal massage to prevent perineal tearing.
Dr. Gretchen Price completed an evaluation first to determine what specifically Ashley needed to reach her goals of a medication free birth and preventing perineal tearing.
The evaluation revealed decreased pelvic stability and pain reported while standing on one leg. Pelvic positioning was not symmetrical and her glute strength was decreased. Pelvic floor strength was okay but pushing techniques were poor. She required proper coordination and instruction to perform pushing correctly. Pelvic floor assessment also showed slight perineal tension at the outermost layer, which Dr. Gretchen explained could contribute to the risk of perineal tearing during delivery.
Treatment began with manual techniques to improve pelvic stability and mobility, including uterine ligament massage and soft tissue work to the muscles surrounding the pelvis. Also, Dr. Gretchen included glute engagement exercises and level 1 deep core stabilization in various positions to decrease the stress on her pelvic bones. As sessions progressed, they worked on trunk and pelvic rotation with adductor strengthening to improve the support and movement around the pubic bone. Prep for labor and delivery activities were also included throughout the sessions focusing on perineal massage, identifying and addressing fears, and pain management techniques specifically tailored to Ashley’s needs. The program incorporated our 3 step perineal massage technique to decrease chances of perineal tearing.
Pain decreased overall during the pregnancy and she was able to walk with less pain. A follow up was performed postpartum and she reported a fast, natural birth without an epidural or medications. The pain management techniques, perineal massage, and pushing coordination were helpful for her and she had no deep tearing. She just had very minor brush burns- no stitching needed. This helped her feel much better and much more like herself as compared to her first labor and postpartum. Dr. Gretchen is now working with Ashley on a workout program tailored to her needs to ensure she gets back into the exercises she wants to do postpartum to prevent prolapse, urinary incontinence, back pain, hip pain, and pelvic floor weakness.
