Pregnancy and Pregnancy: How to avoid a caesarean section?

During the period of pregnancy we must work to be as prepared as possible for the moment of birth. We must recognise that most of the time childbirth is a consequence of what happens during pregnancy. So, at Élite Pilates we work with each patient during pregnancy to prevent the characteristic dysfunctions of childbirth, thus achieving a more pleasant birth.

In this article we will take a chronological overview of the pregnancy to give you an orientation on how to work through the pregnancy and learn how to avoid a possible caesarean section.

How to avoid a caesarean section?

First quarter

The first quarter of the pregnancy as being the most delicate, it was recommended not to exercise. However, the latest updates of clinical practice guidelines advise being active from the first trimester of pregnancy.

Exercise is essential, and scientific evidence shows that women who exercise during pregnancy have a higher risk of heart disease than women who do not:

1. Decreases delivery time
2. Reduced likelihood of caesarean section
3. Less need for instrumental delivery
4. Optimal weight gain
5. Fewer cases of gestational diabetes

It is ideal to be accompanied by a pelvic floor specialist who, after an assessment, we know what we should work on according to each body. It will be individualised training for the body and specific training for the muscles of the perineum.

Second quarter

Between the 16th and 20th week of pregnancy we recommend our re-education programme to become aware of the pelviperineal area, to have control of the pelvic floor and to know for the rest of the pregnancy what is positive and what is not.

In this programme, the first session will be an assessment of the pregnant woman, in which we will identify if there is any perineal risk factor or any pathology. In the following sessions we will aim to:

1. 1.- Becoming aware: it is common not to have a good awareness of the perineal area. We are going to achieve this through visual information and sensory and perceptual work on this perineal area.
2. Protect and control pelvic floor muscles: with the Pilates Method we will strengthen the abdomen without generating pressure, we will make the pelvic joints more flexible to ensure minimum damage to the pelvic floor, and the stretching/normalisation of the muscle groups involved.
3. Give elasticity to the perineal musculature: perineal massage will be performed either with us in the physiotherapy session or at home individually or in pairs. EPI-NO can also help.
4. Prevent injuries during pregnancy: we will learn to correct hyperlordosis by carrying the baby “high”, this helps us not to overload the lumbopelvic area, to have a better abdominal tone and a better fit for the baby.
5. Strengthening the pelvic floor muscles: with Kegel exercises in different postures we will train these muscles. There are two types of fibres, fast and slow, so we will have to do two types of contractions.
   • 5 seconds contraction - 10 seconds rest (10 reps x 5 sets)
   • 1 second contract - 1 second relax (10 repetitions x 6 sets)

Third Quarter

In the last sessions, although we will continue to work on perineal massage and exercises (this work must continue actively at home), we will learn postures that facilitate expulsion and the most appropriate pushing for each moment. In this trimester we want to give the pregnant woman all the possible tools for the moment of delivery.
The positions will vary as the baby moves down the birth canal.

In the Dilatation phase we will make the pelvis more flexible and relax the lumbo-pelvic musculature, reduce the pain of the contractions and relieve the weight of the body (“unloading the trunk does not bother the working uterus”).

In the Expulsion phase As the baby descends through the planes of the pelvis, we are going to position the pelvis freely in one way or another so that the musculature helps the foetus to perform cephalic rotation and is well oriented towards the anterior perineum.

Pushing should be physiological, the woman should push when she feels the urge to push, and should not be done with her mouth closed. The famous phrase “closed mouth, closed perineum”, pushing with the mouth closed would be like pushing the organs outwards, leading to prolapse.

Pushing is accompanied by breathing exercises in labour. All this can be put into practice with the EPI-NO.

With these tips and treatments, there is nothing to worry about if you have a whole pregnancy of work to do so that you are more than ready for the moment of birth.