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Prenatal Baseline Recommendations

Prenatal Baseline Recommendations

By Leona Ham

Pelvic PT

If you are considering getting pregnant, you are pregnant or you just had a baby, you need to strongly consider involving a pelvic floor physiotherapist in your health care team.  Here is why!

Pregnancy

What is a Baseline?

A baseline involves using tools and assessment techniques that can be easily used by another person to assess certain levels of function, strength, and health status.  The information and data gathered in a baseline test can be used to compare to an individual’s state after injury or change in health status.  Blood pressure measurements gathered by a cuff are a common assessment that can be used to track changes over time, by tracking blood pressure, changes in cardiovascular health can be identified and perhaps treated before a more serious health condition develops.

Pelvic Floor Physiotherapy Baselines should include:

1. Pelvic Floor muscles: Can be assessed using a strength, endurance, and coordination assessment tool

2. Diastasis Rectus Abdominus (DRA)

I would recommend you see the same Healthcare Practitioner for your baseline and postpartum follow-up assessment.  If you must see a different practitioner then you will need to know the following information from your baselines:

1. Pelvic Floor muscles: The data or numbers that were recorded for your strength,  endurance, and coordination

2. Diastasis Rectus Abdominus (DRA): The data or numbers that were recorded and how many measurements were taken, the anatomical landmark that was used relative to the multiple measurements and what position your body was in, and what movements were used to create the changes in the Rectus Abdominus muscle tone

Why is a Baseline Beneficial?

1. Pelvic Floor Muscles: This is frequently overlooked and often goes unnoticed until someone starts to have symptoms. In my practice, I have seen all women at varying stages of their life cycle.  Some of these individuals have very strong pelvic floors and leak urine and others have weak pelvic floor muscles and leak. This tells me that having a strong pelvic floor does not mean that you will be symptom-free.  There are limited studies that have been completed on what number in measurement defines a strong pelvic floor.  What the research does consistently identify is that pregnancy and delivery will reduce the pelvic floor muscle strength and that when you compare women who have never been pregnant to women who have, the strength is less in the women who have been pregnant. What is not clear is what the magic number of measurement is that defines when someone has regained full strength.  Therefore, the best strength comparison is your own individual strength comparison.  If prior to getting pregnant you are symptom-free and post-pregnancy you develop symptoms, your baseline number can help guide treatment by determining if your symptoms are due to pelvic floor weakness.

2. Diastasis Rectus Abdominus (DRA): Research varies around the condition of DRA.  Most of the research indicates that to be diagnosed with DRA you need to have around 2 centimetres of separation between the two medial sides of the Rectus Abdominus Muscle.  Research has also discovered that some women prior to pregnancy have a baseline that is greater than 2 cm and that measurement can be dependent on where along the abdomen the distance is assessed. In my practice, I have had women very worried and concerned because they have been told that they have a 4 cm or 4 finger separation and they need to get back to less than 1 finger separation or less.  This worry is completely unnecessary and research has indicated that not everyone falls within the 2 cm normals.  Your normal could be 1.5 cm above your belly button and 2.5 cm below.   The best comparison is your own individual comparison.

Resources

  1. Antonio Corvino  , Dario De Rosa, Carolina Sbordone, Antonio Nunziata, Fabio Corvino, Carlo Varelli,  Orlando Catalano. Diastasis of Rectus Abdominis Muscles: Patterns of Anatomical Variation as Demonstrated by Ultrasound. Polish Journal of Radiology 2019; Dec 15; 84:e542-e548. doi: 10.5114/pjr.2019.91303.
  2. Yun Zhao , Mei Xiao, Fei Tang, Wan Tang, Heng Yin, Guo-Qiang Sun, Yin Lin, Yong Zhou, Yan Luo, Lu-Man Li, Zhi-Hua Tan. The Effect of Water Immersion Delivery on the Strength of Pelvic Floor Muscle and Pelvic Floor Disorders During Postpartum Period: An Experimental Study. Medicine (Baltimore). 2017 Oct;96(41):e8124. doi: 10.1097/MD.0000000000008124.
  3. Yun Zhao 1, Li Zou 2, Mei Xiao 3, Wan Tang 1, Hai-Yi Niu 4, Fu-Yuan Qiao 4 Effect of Different Delivery Modes on the Short-Term Strength of the Pelvic Floor Muscle in Chinese Primipara. BMC Pregnancy Childbirth 2018 Jul 3;18(1):275. doi: 10.1186/s12884-018-1918-7.
  4. Thorgerdur Sigurdardottir 1, Thora Steingrimsdottir, Arni Arnason, Kari Bø. Pelvic Floor Muscle Function Before and After First Childbirth. Int Urogynecol J.  2011 Dec;22(12):1497-503. doi: 10.1007/s00192-011-1518-9.
  5. Poorandokht Afshari 1, Fariba Dabagh 1, Mina Iravani 1, Parvin Abedi 2Comparison of Pelvic Floor Muscle Strength in Nulliparous Women and Those With Normal Vaginal Delivery and Cesarean Section.  Int Urogynecol J. 2017 Aug; 28(8):1171-1175. doi: 10.1007/s00192-016-3239-6.
  6. Gertrude M Beer 1, Antonius Schuster, Burkhardt Seifert, Mirjana Manestar, Daniela Mihic-Probst, Sina A Weber The Normal Width of the Linea Alba in Nulliparous Women. Clin Ana. 2009 Sep;22(6):706-11. doi: 10.1002/ca.20836.
  7. Boissonnault J.S., Blaschak M.J. Incidence of diastasis recti abdominis during the childbearing year. Physical Therapy. 1988; Jul;68(7):1082-6. doi: 10.1093/ptj/68.7.1082.
  8. Rath A.M., Attali P., Dumas J.L., et al. The abdominal linea alba: an anatomo-radiologic and biomechanical study. Surg Radiol Anat. 1996;18doi: 10.1007/BF01627606.