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Kegel Exercises By: Jan Mallak, 2LAS, AdvCD(DONA) What is a Kegel? Kegel exercises are basically pelvic floor toning or strengthening exercises. The pelvic floor has a figure 8 sling of muscles that surround the vagina and anus in women. These muscles support the bladder, rectum, and uterus. Why are they called Kegels? Dr Arnold Kegel (1894-1972) was an American gynecologist who noticed that childbirth weakened the pelvic floor muscles. So, he invented the perineometer to measure the strength of voluntary contractions of the pelvic floor muscles and he also recommended exercises as a non-surgical treatment of urinary incontinence from perineal muscle weakness or laxity. These exercises focus on the squeezing of the pelvic floor muscles by repeatedly contracting this hammock of muscles going from the front of the pelvis to the coccyx (tail bone). Why are Kegels beneficial? There are 7 reasons why Kegels are beneficial: 1. Improves overall fitness 2. Develops better back/hip support 3. Helps recovery after birth 4. Increases sexual satisfaction 5. Cures bladder leakage 6. Enhances pelvic health during menopause 7. Reduces chance of pelvic organ prolapse - This is when the bladder, rectum or uterus deviate from their initial bodily position. It can lead to leaking of urine or stool, a feeling of vaginal pressure/fullness and/or discomfort with sex. Prolapse is more likely when older and if there is a family history. So, you can see how doing Kegels helps before, during and after birth. It is a lifelong tool to use to maintain/improve health and reduce complications. Many maternity health care providers suggest doing Kegels to:
How are Kegels done? Some determine their pelvic floor muscles by stopping the flow while urinating for just a bit. It is not good to practice it this way, but it does help identify the muscle group and the effort made. The bladder may be incompletely emptied by stopping the pee midstream and that can lead to a Urinary Tract Infection. When can Kegels be done? When initially trying Kegels, sit comfortably in a chair with both feet on the floor and knees apart. Continue breathing normally while you purposely pull in and up on the muscles surrounding the vagina and rectum. As you become familiar and confident with these “contraction” techniques, they can be done anywhere and anytime. Like while standing in the grocery store line, driving, sitting at your work desk and even during sex! My favorites are while washing my hands after a bathroom break or during a red light. At 70, after doing these for decades, I can report that my pelvic floor health is very good (according to my doctor and husband of 50 years)! Which Kegel is best? There are Flicks, Super Kegels, and the Elevator Exercise. Flicks are what most people have probably heard about. Pull in and up on the muscles that you squeeze together when you are a block from home and really have to pee. Most women know what I am talking about! Generally, it involves a 10 second hold a few times done several times a day. Although it is better than nothing, it is like bending your arm at the elbow and touching your shoulder. Not too difficult and it really does not “tax” the biceps very much. The Super Kegel is the same idea but try to hold the muscles upward for a count of 20 seconds. If the muscles begin to fall, pull them back up. That would be like adding a 5 pound can of tomatoes to your hand and then touching it to your shoulder. It is harder work for your biceps, so more gain involved. Doing Super Kegels 6 times a day would be great. These are what I recommend for LIFE! The Elevator Exercise is also very beneficial – especially to prepare a woman for birth and in particular, for pushing. Sit in a chair and imagine that your bottom is the ground floor of an elevator at a department store. Now slowly lift the muscles a bit to the first floor and hold briefly, then a bit more to the second floor and hold briefly, and so on until the 5th floor (BABY DEPARTMENT!). Once you have reached the 5th floor, slowly lower the muscles to each decreasing floor until you reach the Ground Level. Now, BULGE you muscles downward to the BASEMENT floor for a bit - that simulates the act of pushing. You will feel your bottom pressing more against the chair – like when you are pressing the baby out. This can help coordinate your efforts when you may feel confused as to how to direct your downward power to birth the baby. Remember to keep breathing and loosen your jaw while doing any of these Kegels. Open moth = open vagina and relaxed jaw = relaxed pelvic floor muscles which means an easier birth. If you connect Kegels with something you do several times a day (like eating or using the bathroom), you are more likely to do it routinely. Some expectant moms put notes up around the house or at work as a reminder to do this important exercise. Kegels are sometimes called Sexercise because they can improve sensations during lovemaking - for both of you! In fact, dads can check the mom’s changing muscle strength if she squeezes his penis with Kegels during intercourse. What about men doing Kegels? Just like women, men have pelvic floor muscle but theirs encircle the base of the penis and support their bladder and bowels. If men copy stopping the flow of urine while tightening their buttocks, it is a Kegel. The penis will move a bit and the scrotum will lift somewhat. Kegels contribute to a man’s overall health, can enhance sexual performance, can reduce incontinence/dribbling and can help with bladder/erectile dysfunction. They may also alleviate some prostate problem symptoms, particularly after prostate surgery. A solid exercise plan for men is to do 3 sets of 10 short (3 seconds) and 10 long (10 seconds) Kegels twice a day. Thank you, Dr. Kegel! To summarize, Dr. Kegel gave both women and men an easy way to maintain their pelvic floor health and a therapeutic way to prevent or improve possible complications associated with the organs they support. So, thank you Dr. Kegel for your awareness, insight, knowledge, and expertise! Bio for Jan: Before recently retiring, Jan Mallak was a birth professional for over 40 years. During that time, she has functioned as a childbirth educator, birth/postpartum doula, doula trainer/mentor, doula service creator/coordinator, conference speaker, author, and birth consultant. Jan educated thousands of expectant couples, supported over a thousand doula clients, trained hundreds and hundreds of doulas, spoke at many local/national/international conferences, had countless articles/two books published and served in countless birth related volunteer capacities. Jan was one of DONA’s 17 initial Advanced Certified Doulas chosen worldwide and served as a Founding Board Member for the Mid-Atlantic Mothers’ Milk Bank in Pittsburgh. But she feels her greatest accomplishment and proudest moment was being her only grandchild’s doula almost 13 years ago (grandson Zeev).
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What to bring to the hospital/birth center:
Patience: The exact length of labor is unknown. For first time mothers labor is typically longer than women who have birthed before, but that too can vary. My tip would be to assume it will take a long time. Let the medical team focus on the clock and, as much as you can, dive into laborland with your partner. This will relieve you of unnecessary stress and let you be more present. Learning the stages of labor is helpful but know that most people forget this during the heat of the moment - that is okay! You aren’t supposed to be a medical professional- just lean into each moment and help her through each breath and each contraction. That being said, most midwives and doctors follow a standard for you to follow for when to go to the birthplace. Most use the 5:1:1 rule (contractions 5 minutes apart for 1 minute for 1 hour) but follow the instructions of your provider and then let them do the rest of the time keeping when you arrive! “When you allow yourself to be immersed in labor, it is neither boring nor interesting, because the very nature of labor dissolves ordinary boundaries of time and space. You and labor become one. Timing your labor requires remaining conscious-of-self rather than being-in-labor” (England & Horowitz 1998). Presence: Having a doula allows you to step out of the room to make a quick call to update family if desired, use the bathroom, eat a sandwich etc... doing these things in front of your wife/partner during certain times in labor may make her lose concentration and increase pain. Pro tip: Turn off your phone Positive Words: Your wife/partner will feed off your energy. If you are calm, confident, strong, reassuring and patient, she will naturally be more relaxed, and labor will progress more smoothly and less painfully. The more you relax and lean into labor, the more she will be able to let go of control and release tension. It is hard to see the one you love in pain but know that the pain is purposeful. Try different positions, comfort measures, encouraging words, calm and strong back, hand, inner thigh, foot massages, singing to the baby, and match her breathing. If you notice she is making noises don’t discourage but allow her to express her emotions and sensations how they come naturally. Vocalizing in labor: In our culture, it is often frowned upon to be vocal in labor but often these noises are helpful in releasing tension, allowing the baby to move down, and to cope with the pain. Deep, guttural, low moaning/grunting/yelling are the most effective and should be encouraged. If you start to notice her voice rising in pitch or sounding more like screaming, she may be producing these from a place of fear, and this can make her tire out and have less effective contractions. On the next contraction, encourage her to make her voice deeper, you can try matching her sounds as well. Some women are introspective and quiet, some are loud, vocal, yelling, talking, all are natural and there is no ‘right’ way to act/be! Labor Project: Early in labor, it may be helpful to plan a fun activity together; strolling through Target (who doesn’t love Target, let’s be honest), washing & folding baby clothes, baking a birthday cake, gardening, maternity photo shoot, going for a walk through town etc. This can be a good distraction before labor really picks up and will help keep things moving and progressing using gravity. [There is a great chapter on this in the book Birthing from Within.] Join in: If she is walking, rocking, swaying, dancing- join in! Doing so may make her feel less alone and more supported. If she is drinking water, drink some water. Staying hydrated yourself will preserve your energy too. It’s easy to forget about yourself when you are focused on her! Drinking fluids will also remind her to keep hydrated; win-win! Watch & Wonder Her body was created to grow and birth your child. It has been shown that for women who are low risk, labor works best when allowed the freedom to unfold naturally. As the father/support person, your role is to watch, wonder, marvel at the rollercoaster of labor and birth, and support her in comforting ways. Having a doula and a medical provider (midwife or OB) who you trust allows you to relax a little, knowing you are on the same team. Choosing a Care Provider: Medical intervention during birth is very important in certain circumstances and we are lucky to have access to hospitals who can provide treatment when necessary. Unfortunately, many hospitals have policies that are standard practice for everyone, not just women who are at higher risk. Know that you always have a choice for interventions and educating yourself prior to labor will help you to make informed decisions. It is important to find a care provider who listens well and makes you feel comfortable asking questions. It is (almost) never too late to change to a different OB or choose a midwife! Midwives are skilled birth attendants who care for low-risk pregnant women who tend to allow birth to unfold naturally and only intervene when medically necessary, whereas many Obstetricians (OBs) are trained to be obstetric surgeons who perform Cesarean births. They also deliver most babies in the United States and because of their highly skilled training, tend to take a more medical approach to birth. In many other developed countries, midwives are more common than OBs for low-risk pregnant women. Depending on your preference in care, in some hospitals, you can choose to have an OB or Midwife as your provider. In many cities, there is a birthing center where midwives attend low risk births. If you are unsure why an intervention is being introduced, ask your provider for all the information you & your partner need to make an informed decision. Your doula is also there to support you in making an informed choice and help you to advocate for yourself- but does not make decisions for you or speak for you. General tips:
References: England, P., & Horowitz, R. (1998). Birthing from within: An extra-ordinary guide to childbirth preparation. Albuquerque, N. M: Partera Press. |
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