Hold It Mama: The Pelvic Floor and Core Handbook. M. O'Dwyer. Buderim, Australia: RedSok Publishing; 2011. Soft cover, 203 pages, $24.99.
M O'Dwyer. Buderim, Australia: RedSok Publishing; 2011. Soft cover, 203 pages, $24.99. Mary O'Dwyer is a women's health physiotherapist with more than 30 years' experience. Her first book, Hold It Sister, was published in 2010 and targets women of all ages. The current book, Hold It Mama: The Pelvic Floor and Core Handbook, is a bit more focused on the childbearing women.
The book has 14 chapters covering the span of the childbearing year. There is a list of references for each section, which includes up-to-date journal articles. Unfortunately, for the health care professional, references are not included in the text. This does make it easier for the general public to read. Resources are also provided with many patient support Web sites (mostly Australian).
"The Pelvic Floor" (section 1) includes signs of pelvic floor weakness, anatomy, and exercises. There are many practical descriptions and practice activities. Pictures of pelvic floor muscle (PFM) exercise positions in first section would be helpful.
The second section, which focuses on pregnancy, provides a good review of body mechanics and self- help for pelvic girdle and low back pain. Guidelines are given for several common complaints of pregnancy including diastais recti, anal fissures, constipation, and vulvar vericosities. The American College of Obstetrics and Gynecologists guidelines are used as a guide for exercise during pregnancy.
The "Preparing for Labor," "Labor," and "Birth" sections all cover a wide range of topics including relaxation activities, perineal massage, squatting, and birth plans. Monitoring, epidural, episiotomy, and instrument birth are discussed with their influence on the PFMs. Conservative management of birth including massage, transcutaneous nerve stimulation, and positions during labor as well as a brief description of the stages of labor and self-help ideas are reviewed in section 5. Types of cesarean births are also discussed.
Early postpartum recovery includes information on diastasis recti management (much of which is antidotal expert opinion) and postpartum pelvic organ prolapse (POP) (with pictures), and pessarys are described. Postpartum pelvic girdle and low back pain symptoms are described with a fairly comprehensive list of self-help treatments like posture, abdominal support, massage, early core exercises, and more. Postpartum depression is also addressed.
Section 7 does an excellent job of describing post- partum care of episiotomy, coccyx injury, and other perineal trauma after vaginal delivery. Immediate post-cesarean section recovery is covered in section 8 with a discussion of body mechanics and wound care.
Section 9 does a very good job of describing a self- PFM assessment starting with the introitus scar and progressing to PFM damage/weakness and POP. Women are encouraged to discuss findings with their physicians. An extensive description of scar massage and management for both abdominal and perineal scars is given in section 10. Section 11 reviews return to intimacy and loss of libido. This section also reviews "vaginal exercisers" including biofeedback, electrical stimulation, vaginal weights, "pelvic toners," and vaginal dilators and encourages readers to seek assistance from a pelvic physical therapist.
Postpartum exercise guidelines are given encouraging a slow return to previous activities. "Shrink the belly routine" includes PFM exercises in various positions with pictures. Progression of exercises is focused more on larger core muscles like abdominals and gluts.
A section on international birthing practices provides a summary of birth and postpartum practices in a variety of countries. The fistula epidemic is also discussed. The final section reviews issues to maintain long-term pelvic floor health including avoidance of constipation and excessive increased intra-abdominal pressure, good posture, and the knack.
This book is written with encouraging and empowering language and covers a wide variety of topics concisely. However, the text is very comprehensive and sometimes complex. Instructions and information might be best used in conjunction with therapy treatments for further explanation and individualization. The author often recommends consultation with a pelvic physical therapist. It is clear that the author is well versed in current evidence and common approaches to PFM treatment. I would recommend this book for anyone looking for a good review of PFM issues related to childbearing.
Beth Shelly, PT, DPT, WCS, BCB-PMD
Moline, Illinois