In today’s vlog, we’re going to be talking about one of my favorite topics. The pelvic floor and pregnancy.

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Hello everyone, and welcome back. I’m Dr. Krystal Lynn Couture, the Pelvic Accu, and I’m here for another blog. Brought to you by the American Acupuncture Council. If you haven’t popped over to the American Acupuncture Council website, you absolutely should because they sponsor amazing vlogs throughout the month.

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In today’s vlog, we’re going to be talking about one of my favorite topics. The pelvic floor and pregnancy.

In order to really understand what’s happening with the body through pregnancy, I want to talk about the energetics of pregnancy and conception, as well as talk about a little bit of the spirit of the Po, evolution, hormones during pregnancy, the Yuan Chi, Teeny bit about pathologies during pregnancy bodily changes and then the restoration and repair process of The body that it goes through during that pregnancy experience so in the simplest terms when we’re talking about conception is going to be the addition of Yin, and yang Right?

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Yin is going to serve us as those prenatal qi energies and the postnatal qi energies. So therefore we’re going to have the connection of essence and blood. Yang is going to serve as the minister fire. As we go deeper into conception, the mum is going to provide different things. Then the father is going to provide, right?

And in order for them to provide these in balance and harmony, they have to be balanced and harmonized within each of the individuals prior to conception. This is going to lead to the healthiest form of. pregnancy and for the fetus, right? So we want the mom to have the spleen, the liver and the heart in good communication with each other, and also in the perfect balance, not in excess.

Not in deficiency, and this is so that making, storing, and the governing of blood will be harmonized for the pregnancy and for the fetus. The chong and the ren also need to be in balance, and they need to be open for pregnancy. to occur. The chang is going to be that mover of the blood and the ren is going to provide us with that yin.

So we want to see harmonization there. We also want to see the kidney jing in a state of vitality, right? We need the mom to be vital when she comes into pregnancy in order for her to remain vital throughout the pregnancy and after the pregnancy because that takes so much. energy. I also need her to be vital because she’s going to be providing that energy to the baby as well.

I want the minister fire again to not be in excess and not be in deficiency. We need the perfect amount of fire. We want the postnatal chi and blood to be in harmony. Which of course is determined by so many life factors and how one is choosing to exist within their life along the path of their Tao.

And then finally the spirit of the Po is going to come in. From the dad, we need the liver to be in harmony. We also need that vitality from the kidney Jing and of course the postnatal Qi and blood. All of these in harmony and balance are going to contribute to a better life. Successful and bountiful, abundant pregnancy that serves the fetus to the highest and best.

So let’s talk a little bit about the spirit of the Po here. So the Po, as we know, is the corporeal soul. It is the tangible. It is the spirit of the lungs and it resides within the lungs. It is a physical soul. So it has a yin nature to it. It is going to be transferred from the mom. To the fetus, the PO, as we know, is the soul that comes in with the body at birth and it dies at death.

So it does not extend its spiritual journey. It’s corporeal. Thus, the constitution of the baby is reflective, not only of the kidney energy of the mom and dad, but also the mother’s lung energy, right? Spiritual access. Chapter eight says the corporeal soul is the entering and exiting. of essence. And I really love that quote.

And I really think working with the Po is so helpful in the journey to working with moms in their fertility phases. So let’s look at the Kinney Jing evolution. Okay. So during menstruation versus pregnancy that we’re going to have a different experience here. So during menstruation, we know that the kidney gin, it links to the Tian Gui, right?

The heavenly waters, the minister fire acts upon that. And then we have menstruation, right? During pregnancy, that kidney gin is going to nourish the fetus and it’s going to replenish and recycle. The Tian Gui is going to replenish and recycle to Restore and serve that kidney jing. So we have two different pathways of what’s happening with the kidney jing here.

Now we’re going to have abundant yin, right? We’re going to have an increase in fluids with that tian gui replenishing and nourishing the fetus. We’re also going to have abundant yang because there’s no release of that minister fire. So there’s a significant abundance within the body, within the pregnant body.

Also, we’re going to have the component of the energy that travels up the chong. To the breasts also with the stomach chi as well. That’s going to transform blood to milk on an energetic level So this kidney gene evolution is two different stories two very different stories of what’s happening in the body And I think that’s important for us to understand as well as to be able to share with our clients What’s happening on an energetic level in their body when their monthly bleed?

is no longer. Let’s talk also about hormones during pregnancy. So we’ll see that at the beginning of the pregnancy, HCG is going to spike and then it will drop the rest of our hormones. So progesterone, estrogen, estradiol cortisol, and of course our placental actogen, they’re all going to gradually increase to the birth.

And then they’re going to quickly drop off. This is why there are so many Different emotions, different feelings, different experiences throughout the pregnancy process and after the birth, there is a drastic change in hormones. We’ll also see just at the birth, we’ll also see oxytocin spike.

And then we’ll see oxytocin and prolactin spiking and cycling. So highs and lows. And that is when the fetus will be, the baby will be suckling, right? So there are those increases if the mom is going to be breastfeeding. So there are continuous changes of what is happening through the hormone cycle.

Now, if the mom is breastfeeding, there is a chance that the progesterone and estradiol, and even the cortisol are going to stay low, which is going to lead to more emotions as well, which are important to consider. So now Yuanqi in the fetus. Yuanqi is derived from prenatal Jing from the parents at conception and stored in the kidneys responsible for growth development and maintenance of life.

Now I really like this quote that I found in the Shilin Temple blog which describes kind of Yuanqi and the cellular nature. So cell division requires a fixed liquid base of Yuanqi which allows the cell which compromises the yin or essence of life to divide. Weakness in the yang qi, or yuan qi, or weakness of the yin causes the cells to lose its true identity, its dao, and to create chromosomal changes which cause the fetus not to develop in a way that is consistent with the laws of nature which desire harmony.

So basically what this is saying is that even at The basic, most simplest cellular level, the body, the fetus is seeking harmony. It is seeking homeostasis, and it is seeking that in alignment with the Tao, with the purpose. And there’s so much power in that, there’s so much understanding in that, and there’s so much energy that is required during that phase.

Very briefly, let’s touch on pathologies of pregnancy. The first that we’re going to talk about is going to be a deficiency which could be of blood and yin as well as kidney deficiency. Now this is going to be particularly seen in those who have a tendency toward overwork and thus may have a pre existing kidney deficiency.

Could be kidney yang or kidney yin depending on other factors, right? It’s really important for us to understand our clients that are over workers. If they are coming in with these types of deficiencies that likely, unless they make major lifestyle changes, they aren’t going to change during the pregnancy.

So we want to address that. We want to be aware of that so that they can have a successful fertility into pregnancy journey. Another thing that we’re going to see. is rebellious chi and rebellious chi is, it makes sense, right? Because of the physiological process that’s happening within the abdomen, that there’s going to be this upward rising energy where there’s meant to be a downward rising energy.

Now, this rebellious chi is going to impact the stomach channel as well as the Chiang Mai. And these are particularly related to emotional stress. So while there is that physiological component, emotional stress is going to compound rebellious chi. There’s also, again, with what’s happening in the middle here, that middle jiao can be obstructed and cause some spleen chi deficiency.

And the buildup of phlegm again, sounds obvious during pregnancy, but important for us to be really aware of. This is also going to be something that can create some disharmony between the Ren and the Chong channel, which we want the Ren and the Chong to be strong for fertility and strong throughout the pregnancy and afterwards.

So why are we bringing up pathology in this workshop? Really the key here is because I want you to be aware of the contributing factors. that can impact pregnancy and also that might impact the pelvic floor. So we start to think about kidney deficiency, right? And if this leads to our liver yang rising, or it liver win rising, that kind of thing, or An ultimate a deficiency in that Yuan qi that’s going to be an impact on the pelvic floor because of its connection with the kidneys, right?

And the reproductive system, that rebellious qi, that confusion, proprioceptive confusion of upward versus downward energy is going to be difficult for the pelvic floor. rises and falls as well, right? With contraction and relaxation. And so if there’s proprioceptive congestion or confusion in the energy channels, there’s going to be physiological proprioceptive confusion.

So want to be really aware of these pathologies and to advise our clients that are coming in for fertility in. The manifestation of overwork in the manifestation of over stress, right? And how they can really focus on this fertility time, focus on this pregnancy time to be with themselves and to be nourishing their own bodies and their babies.

Speaking of, let’s talk about the body. I’m really excited for this section. So in ideal circumstances before pregnancy, what we’re going to see is that the internal organs and the pelvic organs of the abdomen all share space. There’s no major distinction or separation between the organs of the pelvis and the organs of the abdomen.

The organs of the pelvis and the organs of the abdomen, they work in harmony with each other, and there’s enough space. So there’s no crowding within the body kingdom on a physiological level and an energetic level. Now again, this is an ideal situation, right? If we have a client that has endometriosis or has inflammatory bowel disease or something like that, we’re going to see something that looks a little different.

But for our purposes today, this is an ideal situation. At six to seven weeks of pregnancy, things start to grow a little bit. The uterus starts its growth process and the uterus actually within the pelvis starts to put some pressure onto the bladder. This is why we can see the need for increased urination, increased frequency of urination and urgency of urination.

early on in a pregnancy. The placenta is also developing in this six to seven week phase. At 10 weeks, things begin to change. The ligaments of the pelvis actually start to relax just a little bit and the pelvic joints loosen. So this is going to be the sacroiliac joints, the pubic joints, and the hip joints.

And this can actually lead to some of that. early on discomfort within the joints at the very beginning of a pregnancy. So it’s important for us to be aware of. Now, of course, we can also posit that as the ligaments are beginning to change, as they’re relaxing just a little, as the joints have more space, guess what?

The pelvic floor is going to be impacted as well because there’s going to be a little bit of a stretch on the pelvic floor already. So the tension within the pelvic floor is already starting to change at 10 weeks. At 12 weeks of pregnancy, things really begin to move, right? So the uterus is now the size of a grapefruit and it fills the pelvic bowl.

The uterus rises during this 12 week phase. It starts to rise into the abdomen because it’s too big to just stay within the pelvis. the pelvic bowl itself with all the other organs that are there, right? The anterior part of the pelvis sits upon the pubic, I’m sorry, the anterior part of the uterus sits upon the pubic symphysis.

So the bladder here, good news, yay, gets a little bit of relief. But the pubic symphysis is now going to be carrying the load, which progresses over time, right? So we can start to see this shift into pubic symphysis pain at around 12 weeks or a little bit later. Now, between 12 and 36 weeks, the pelvis starts to shift anteriorly.

So it’s neutral position is here and it starts to tilt forward, right? So that starts to begin at 12 weeks of pregnancy. Now there’s an automatic implication to the pelvic floor here, right? Because that pelvic tilt is changing the balance and the position of the ligaments, the tendons, and the muscles within the pelvic floor.

At 20 weeks of pregnancy, things begin to get squished. The rectum, the sigmoid colon, and the small intestine get pushed up and back. The ascending and the descending colon aren’t generally affected during this phase. The uterus continues to move up and push on that lower abdominal And at this point in time, abdominal strength and muscle tautness really impacted the position of the uterus being more anterior posterior.

So someone that has very tight, either fascia or musculature, or has strong abdominal contraction, the. Uterus is going to sit further back, whereas if the abdomen is weak or it’s slack for whatever reason, then the abdomen is going to push forward a bit more. Of course, there is that play with the abdominal muscles and the pelvic floor as well.

They are so deeply connected. I can’t tell you the number of times, not with pregnant clients, but in general with clients postpartum. Or clients unrelated to pregnancy that I work with the abdominal muscles and we can make a shift in the pelvic floor. Such a cool experience. But moving on without getting a ton of tangent at 21, 28 weeks of pregnancy, things really.

get compressed and the weight distribution actually starts to shift at this point. So uterus expands into the mid abdomen. So it keeps expanding upward and it’s pressing now against the stomach. The load is increased upon the pelvic floor and the posture shifts posteriorly. to carry that load.

So the body literally is shifting back into the heels. Now at this point you may actually have clients that are complaining about posterior fascial chain pain. They’re also maybe talking about pelvic floor pain at this point as well because the pelvic floor is really holding a lot of the load here.

At 36 weeks, things really change. The uterus expands to fill the abdomen. It generally meets up to the xiphoid process and there’s pressure upon the diaphragm. That increased load on the aorta, the heart, and the lungs starts to show up at this point. And the abdominal muscles are really supporting the weight.

They’re working really hard to support the weight of the fetus. The vagina. and urethra at this point start to elongate. And then the perineum actually is stretched and enlarged and it begins to protrude outward. So once again, if we’re talking about the perineum, that’s the space between the external anal sphincter and the opening to the vagina in females.

Now, As that starts to expand, we can obviously make the correlation that the pelvic floor muscles are going to be stretched during this time. They’re going to be stretched to uncomfortable limits. At 40 weeks of pregnancy, the body is preparing for birth, and the head of the fetus lowers into that pelvic bowl.

The bladder, again, is compressed, and the colon is compressed. So this leads to all sorts of dysfunction within the excretory phases. If you’ve been pregnant, you know this. If you’ve been married to someone who’s pregnant, you know this. If you work in pregnancy, You know this, right? The round ligament, the utosacral ligament and the broad ligament are stretched.

So now these deep ligaments of the pelvis are beginning to stretch. Ligaments don’t have the same recoil that muscles do or tendons because they don’t have as good of blood flow. So this is important for us to be aware of because this is also going to contribute to what’s happening in the pelvis and the pelvic floor during the recovery process.

Now, postpartum, the body is going to be seeking recovery. The body, generally speaking, is going to be fatigued. It has just worked really hard for ten moons, right? In order to grow. a baby. So it’s going to be fatigued. It is also going to be stretched. The abdomen is going to be stretched. The ligaments are going to be stretched of the pelvis.

The pelvic floor muscles are going to be stretched. The back may actually be tighter from that weight distribution and that anterior pelvic tilt. The uterus, the vagina, the perineum, and the pelvic floor are going to be expanded, stretched, and potentially weakened, right? If we think about it, if a muscle is at its maximum stretch, it’s pretty hard from its maximum stretch to get contraction, right?

Whereas if it’s at a comfortable place in elasticity, getting contraction and relaxation is a lot easier. So there’s going to be some proprioceptive and kinesthetic changes that are occurring as well. Ligaments in the joints are going to be unstable initially. Everything is open and the organs are in a new alignment, which can lead to a lot of body and energy confusion and hormones.

Guess what? They’re all over the place. They are changing frequently and they’re changing differently in different people. So there are a lot of things going on with that body postpartum. In order to restore and repair postpartum, the organs have to return to alignment and function. The uterus size and position all has to return to its, pre pregnancy stage.

The perineum needs to heal. There’s going to be a ligamentous and joint recoil and repositioning that occurs. There’s going to be the fascia, the diaphragms, and the posture are all going to Balance or not balance. If the proper work and attention isn’t done or if the body is in severe depletion beforehand, the muscles of the abdomen, the back and the pelvic floor are all going to change.

The blood and the fluid will level out. And the energy and the meridian flow also hopefully will realign. And then there’s the emotional harmony. All this to say, and we have a whole talk coming up on postpartum, which is really exciting. But all of this to say, the body is going to try to do all of these things on its own.

Why? Because it is always seeking homeostasis. The body wants balance with the body. The Dow, the body wants to be in balance with your purpose here on earth. So it wants to do these things. Now as acupuncturists, we can help clients to intervene in this process and to facilitate the healing in all of these, in all of these phases, right?

There’s more than nine, but I just listed nine out so we can really do an amazing job to support our clients with the. Restoration, the recoil, and the return to their pre pregnancy state. Now, if you’ve been with me and the American Acupuncture Council before, you know that I have previously recorded a pelvic floor intro, a chat on menstruation in the pelvic floor, a chat on fertility in the pelvic floor, and this, of course, is our pregnancy and the pelvic floor chat.

We’ll also be doing a postpartum chat. And a menopause in the pelvic floor chat. So I can’t wait for more time with you. And I really hope you enjoyed our time today. Once again, I want to thank the American acupuncture council for sharing this space and sharing this vlog with acupuncturists around the globe so that we can share these teeny tiny little nuggets of wisdom that hopefully impact you, your practice and your clients.

In a positive way. Here’s some references. Once again, I’m Dr. Krystal Lynn Couture, the Pelvic Accu, and I’ve thoroughly enjoyed my time with you today.

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