Here’s the gist of today’s post: A company called Materna Medical is conducting research on a device that will pre-stretch a woman’s pelvic floor during the first stage of labor.
NO I AM NOT JOKING.
YES I AM AGOG.
There is so much going on in this article, I don’t even know where to start.
I want to believe that the creators of this device have nothing but good intentions. I want to believe that someone is paying attention to the (in hospital) birthing stats about women and their pelvic floors. There is, indeed, a major problem with unyielding pelvic floors, stalled labors, perineum tears as well as avulsions and it is time that this issue be thoroughly addressed. Unfortunately, it is my opinion that the designers of this device have entirely misread the problem.
STAND BY FOR SEMANTICS
In the case of an unyielding pelvic floor, the problem is not “the hole is not getting bigger,” the problem is “the muscles are not releasing.” So instead of forcing a woman open, literally against her will (even if her will is subconscious -- see tension lesson below) can we please spend $1.2 million dollars looking at WHY the pelvic floor is so tense it doesn’t release? And before we spend that $1.2 million dollars on NEW research, can we review all the OLD research on pelvic floor tension and its relationship to chronic stress, heavy exercise, too little movement, diastasis recti, trauma, anxiety, and myofascial disfunction? Or are we happier continuously circumventing the problem? (P.S. If anyone has $1.2 million dollars, or even 1/10th of that, I am happy to design and source this project.)
Since I’m not a Women’s Studies scholar, a psychologist, a medical doctor, or therapist I won’t comment on the grander implications of a device that overrides firm, physical boundaries set by a woman at what is, perhaps, the most vulnerable time of her life. I am, however, a biomechanist so let’s talk mechanics.
(But before we do, check out the weirdest picture on my blog, ever. I was going for "jaws-of-life-meets-pelvic-floor" visual but ended up with a creepy picture of my one-year old's shirt on the head of my suspenders-wearing husband. I'm leaving it in for effect. A creepy effect.)
Today’s lesson on tension: Although we use the same word (tension) in many cases, not all tensions are the same. Tension can be created actively through a conscious “tense this” signal. The same kind of active tension can also be created through a subconscious reaction to a stressful situation. Tension can also be created passively through long-term skeletal malpositioning. In these cases, the orientations of the proteins that make up the muscle are different.
Some examples to “picture” what I’m talking about:
- I tell you to flex your right elbow to 90° and you do it (conscious active tension).
- Something startles or scares you and you tense your traps, drawing your shoulders up toward your ears without you realizing it (unconscious active tension).
- Your arm in a cast that flexes your elbow to 90° for a summer, resulting in an arm that doesn’t straighten all the way when you cut the cast off (passive tension).
Tension is, literally, the resistance to deform, but having tension says nothing about why or how the tension was created. In some women the pelvic floor is being tensed actively and in some it is passive. And to make things more complicated in some woman there are both active and passive tensions occurring. In many cases the pelvic floor being brought to the delivery room is in an unnaturally high state of tension -- both active and passive. To stretch it passively and aggressively is the equivalent to your Physical Therapist busting open your frozen shoulder that took a year to create.
I understand the device developers believe TWO WHOLE HOURS is a ton of time, but I would ask them all to lie down to see if the experience of me getting FULL RANGE of motion of their hamstrings over TWO WHOLE HOURS is without pain or discomfort. Oh, wait, it appears that the device would have to be used with pain medication: "In order to reduce or eliminate any discomfort, the device could be used under epidural analgesia or local anesthesia on the vagina. "
Wait, there's more: "Based on preliminary work, it is anticipated that this device will need approximately 1-3 hours of dilation time to successfully reduce the internal stresses in the tissue in preparation for the 2nd phase of labor."
It appears that the developers of this device see the pelvic floor damage problem as a rate issue. If they can figure out a way to stretch out the pelvic floor over two hours instead of the few minutes then ALL THE PELVIC FLOORS CAN BE SAVED. I actually get what they are going for here, but again, the developers are attempting to solve the wrong problem. It is entirely natural for the pelvic floor stretch-load to occur over a very short period of time (minutes). As long as women have been having babies, the rate of loads widening the urogenital hiatus have been quick. It is, however, entirely unnatural for the pelvic floor muscle to stretch to 3.5 times its resting length over a two-hour period. The problem is not the rate -- the problem is the resistance. Applying general sports-medicine stretching theory to the pelvic floor -- a tissue that's been doing this for eons -- is a large scientific misstep.
The tension in a woman’s (or man’s for that matter) pelvic floor is the long-term accumulation of habit, whether that habit be repetitive positioning, loads through exercise, chronic stress, or plain old practice. In the case of a vaginal delivery, the pelvic floor can have both inactive and active tension going on (toss in a little apprehension, especially if you’re a first-timer and you up the resistance).
With a little preventive work, women can learn about relaxing those active tension patterns. And one can work on the inactive tensions leading up to delivery. I do like the designer's idea of preventive muscle “conditioning” very much, but ask any physical therapist how long it can take to soften up the pelvic floor. Does it take two hours? Two months? Two years? The time to prepare the pelvic floor is not at the final hour, but throughout a lifetime, or at least throughout the pregnancy. Note there is a big difference between softening a pelvic floor to yield in the exact way nature requires and opening it to 10cm. The second stage of delivery does not begin with a pelvic floor wide open and no one knows why or if a natural level of initial resistance is needed. From my favorite integrative gynocologist, Eden Fromberg, DO (in response to the linked article):
"The pressure of the presenting part of the fetus on the pelvic floor is part of the dance. I just can't see isolating the pelvic floor the way this device intends to, as if it won't affect other parameters. My thought is to educate women about how to best achieve their physiologic potential and to try that before resorting to drugs and devices."
So. Is it possible that a device like this can improve the rate of vaginal delivery? Absolutely. But does it matter only that the rates be improved? Can we raise the bar and consider the entire birthing experience for mother and child -- before, during and (long, long) after?
For more on pelvic floor hypertonicity, please read: