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Introduction
Pelvic health is a critical yet was a historically overlooked aspect of maternity care. For too long, issues related to the pelvic floor—such as incontinence, prolapse, and discomfort—have been minimised, normalised, or ignored altogether. For midwives and student midwives, understanding the role of the pelvic floor in pregnancy, labour, and postpartum recovery is essential to providing holistic and preventative care. With this in mind, RealBirth v4 introduces a new, dedicated module on pelvic health—designed to educate, empower, and promote evidence-based support for pregnant women and people.
What is Pelvic Health?
Pelvic health refers to the optimal functioning of the pelvic organs (bladder, uterus, and bowel) and the muscles, ligaments, and connective tissues that support them. At the heart of this is the pelvic floor, a hammock-like group of muscles that stretches from the pubic bone to the tailbone, playing a vital role in bladder and bowel control, sexual function, and supporting the growing uterus during pregnancy.
When pelvic health is compromised, women and people may experience symptoms ranging from urinary incontinence and constipation to pelvic organ prolapse and chronic pain. Yet despite its importance, pelvic health is frequently under-discussed in clinical settings and underestimated by many experiencing symptoms.
Pelvic Floor Changes During Pregnancy and Birth
Pregnancy and childbirth place significant strain on the pelvic floor. Hormonal changes (notably increased relaxation and progesterone) soften ligaments and tissues, preparing the body for labour but also weakening pelvic support structures. The physical weight of the growing uterus, changes in posture, and the process of vaginal birth—especially prolonged or instrument-assisted births—can stretch or damage these muscles.
This can lead to postpartum complications including urinary incontinence, painful intercourse, or even pelvic organ prolapse. However, many of these outcomes are preventable or manageable with early education, screening, and treatment.
Recognising the Symptoms
Pelvic floor dysfunction can manifest in numerous ways. Common symptoms include:
- Stress urinary incontinence (leakage during laughing, coughing, or physical activity)
- Urge incontinence (sudden, intense need to urinate)
- Constipation or straining during bowel movements
- A heavy or dragging sensation in the pelvis
- Bulging in the vaginal area (possible sign of prolapse)
- Discomfort during intercourse
Despite the prevalence of these symptoms, many women do not seek help—believing it’s simply part of motherhood or ageing.
The Hidden Problem: Silence and Stigma
Pelvic health concerns are surrounded by stigma, embarrassment, and misinformation. Many women suffer in silence, unaware that effective treatment is available. This silence is compounded by societal taboos around female anatomy and function, as well as a healthcare system that often fails to prioritise pelvic wellbeing.
The result is a cycle of underreporting, delayed diagnosis, and diminished quality of life. Midwives, positioned at the frontline of maternity care, have the opportunity—and responsibility—to break this cycle through open conversations, screening, and early intervention.
Women’s Experiences: Voices That Matter
The RealBirth team spoke with women who shared deeply personal accounts of pelvic floor dysfunction. For some, symptoms emerged during pregnancy; for others, they became evident weeks or even months postpartum. What unified their stories was a lack of prior information and a sense of isolation. “I thought leaking was just part of having a baby,” one woman shared. Another expressed anger: “Why did no one tell me this could happen?”
These testimonials underscore the urgent need for comprehensive pelvic health education in antenatal and postnatal care. Women deserve to be informed, prepared, and supported.
Introducing the RealBirth V4 Pelvic Health Module
To address this need, RealBirth v4 now includes a dedicated module on pelvic health. Developed with input from pelvic health physiotherapists, midwives, and service users, the module is designed to be both educational and empathetic. It explores:
- Anatomy and function of the pelvic floor
- Changes during pregnancy and birth
- Preventative exercises and physical activity
- Early signs of dysfunction
- When and how to refer to specialist care
The module is fully integrated into the RealBirth digital learning environment, allowing everyone with interactive content, reflective exercises, and real-world scenarios. It emphasises trauma-informed care, inclusive language, and the importance of listening to service users' concerns without judgment.
Why This Matters
By embedding pelvic health into routine learning and clinical practice, we shift the narrative from reaction to prevention. Midwives play a vital role in early detection, education, and advocacy. The RealBirth v4 module empowers them to start conversations, normalise help-seeking, and offer appropriate support or referrals.
In doing so, we move closer to a model of maternity care that truly respects and protects long-term health—not just during pregnancy and birth, but throughout the lifespan.
Conclusion
Pelvic health is not a luxury or an optional topic—it is a fundamental component of comprehensive maternity care. Through awareness, training, and innovations like RealBirth v4, we can ensure that no birthing person feels unprepared, unsupported.
References
- Royal College of Obstetricians and Gynaecologists (RCOG) (2021). Pelvic floor health. https://www.rcog.org.uk
➤ Offers professional guidance on pelvic floor assessment and referral. - NHS England (2023). Pelvic health clinics: improving care for women before and after birth.
https://www.england.nhs.uk
➤ Outlines the national strategy to improve access to pelvic health services. - Dumoulin, C., Cacciari, L. P., & Hay-Smith, E. J. C. (2018). Pelvic floor muscle training versus no treatment for urinary incontinence in women: A Cochrane Review. Neurourology and Urodynamics, 37(2), 741–745.
➤ A landmark review supporting pelvic floor training as an effective intervention. - Bø, K., & Frawley, H. C. (2019). Exercise and the pelvic floor–what do women want to know? British Journal of Sports Medicine, 53(10), 569–570.
➤ Highlights the need for proactive pelvic health education in antenatal care. - National Institute for Health and Care Excellence (NICE) (2021). Urinary incontinence and pelvic organ prolapse in women: management. NICE guideline [NG123].
https://www.nice.org.uk/guidance/ng123
➤ Comprehensive clinical guidance relevant for midwives and referral pathways. - Woodley, S. J., Boyle, R., Cody, J. D., Mørkved, S., Hay-Smith, E. J. C. (2017). Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews, (12).
➤ Reviews evidence for prevention and treatment strategies in maternity care.
