Pelvis with a Distance by Georgia O'Keeffe

Pelvic explorations begin with a tour of the basic structure of the pelvis. For me, anatomy pictures aid in my ability to visualize what is going on inside of my body whether in a yoga pose or stuck in my car on a commute.  I hope they prove helpful to you as well.

The pelvis is the bony support of the perineum.  It is made up of four bones which are arranged like a bowl: the two innominate bones, the sacrum, and the coccyx.

The innominate bones are formed by the fusion of three bones – the illium, ischium, and pubis.  The illium is what we often think of as our hip bones and what people often are talking about when they say something like “she has childbearing hips” – a myth we’ll unpack later. The ischial tuberosities are the lower part of the ischium bones and are our “sitting bones”.  The pubis bone is the pubic bone, at the front of the pelvis. The two innominate bones are a mirror image of each other, one on each side of the pelvis. In the illustration below, the labels are all on the left side of the pelvis (your right side facing the image) which is one innominate bone.

The innominate bones both attach to the sacrum, which is a triangular bone at the back of your pelvis.  The coccyx is also known as the tailbone.  Both the sacrum and the coccyx have fused vertebrae – five in the sacrum and four rudimentary vertebrae in the tailbone.

The bones are united by four joints.  The two sacroiliac joints connect the innominate bones to the sacrum.  These joints are easily stressed during pregnancy and cause many women low back pains and aches. The sacrococcygeal joint (not shown in the drawing) is a synovial hinge joint between the fifth sacral and first coccygeal vertebrae which allows both flexion and extension. Extension increases the diameter of the outlet of the pelvis and thus plays an important role in birth. Did you know that if a woman is allowed to be upright during pushing, the sacrum and the coccyx are able to move freely and will open up as the baby’s head comes through the pelvis?  Overextension during delivery may break the small cornua by which the coccyx is attached to the sacrum. It is vitally important that a woman birth in a position that does not impede the movement of the sacrum and coccyx.  More on this in a future post. Lastly, there is the pubic symphysis, a cartilaginous joint which connects the two sides of the pubic bones.

These four joints, influenced by the hormones progesterone and relaxin, are what allow the pelvis to widen during pregnancy and birth. There is also increased flexibility of the sacroilliac joints and the pubic symphysis.  Hyperemia and softening of the ligaments around the joints takes place also.  Excessive mobility of the pubic symphysis can lead to extreme pain and difficulty in walking. Belly binding, either with a product made for use during pregnancy or with a large scarf, can be very helpful for women experiencing pelvic pain. Regular bodywork is helpful, especially in the last trimester  – chiropractic or cranial sacral are both good options, as is massage. It is important to be aware of this extra flexibility during yoga as it is easy to overstretch and end up with low back pain.

True Pelvis | False Pelvis

So back to the “childbearing hips” myth.  You know, the one where if you have wide hips it means you can easily birth a baby? What we think of as our hipbones are the illium part of our innominate bones.  The spacing of these bones has nothing at all to do with birth, and is in fact, the “false pelvis”.  The “true pelvis” is the what the baby descends into and navigates through.

The drawing below shows us the false pelvis on the left, and as you can see, the width of the hips has nothing at all to do with the actual bowl of the pelvis.  The true pelvis lies below the pelvic brim, and is shown in the drawing on the right.  It is composed of three parts – the pelvic brim, also known as the inlet; the pelvic cavity; and the outlet (best view is the third drawing).

What you may notice is that each part of the true pelvis has different diameters and shapes.  The inlet is wider from side to side than it is front to back; the cavity is a curved canal, and the outlet is diamond shaped.  The reason I mention this is there is a relationship between the presenting part of the baby (usually the head) and the pelvis that is important to be aware of.

 As you can see by the drawing above, the baby’s head would fit nicely through the outlet in this position.  However, it would have a hard time descending into the inlet, never mind navigating the curved bowl of the pelvic cavity.  The baby must enter it’s head into the pelvis in a transverse position, navigate the curved cavity, and rotate to the vertical position to birth out of the outlet.  All of this will be expanded upon in a different blog post, but the main point I want to get across is the baby is an active participant in the birthing process. It is important to remember that  the pelvis is not rigid during pregnancy, labor & birth because of the joints and hormonal influence on the joints.

Mapping your own pelvis

Certain parts of your pelvis can be located externally, allowing you to form a mental image of your own pelvis.  Try it now!

On each side, in front, you can feel the illium bones.  The top of these bones, the iliac crest, is where you put your hands on your hips.  It is curved.  Put your hands on the curve and follow it down toward the abdomen. Feel that bony prominence where the iliac crest ends? This is called the anterior-superior iliac spine (ASIS).

In front, beneath the hairline, is the pubic region where the two pubic bones are joined together by the thick fibrous cartilage of the pubic symphysis.

At your low back, you can touch your sacrum, right there in the middle. You can also feel the coccyx at the extreme end, below the sacrum.  If you press through your glutes to either the left or right you can feel the bony ichial tuberosities, aka sitting bones.

Sitting on a firm chair, put both hands on the ilac crests.  Notice the contact made between your ischial tuberosities and the chair. This gives you an idea of the height of your own pelvis.  Form a mental image of its funnel-like shape from top to bottom.

Now, put one hand on your sacrum and the other on the pubis.  You can get a sense for the distance between the front and the back of the pelvis.

These reference points will give you an idea of the exterior dimensions of the pelvis, and will also begin help you visualize the interior dimensions.

(thanks to Blandine Calais-Germain and the fantastic book The Female Pelvis, Anatomy & Exercises for the above exploration exercise!)

Next post – the perineum and soft tissues (muscles & ligaments) of the pelvis!

I’ve been having a lovely romance with yoga lately, rekindling an old flame that was merely an ember for a long time. This relationship led me to a workshop this past weekend at a local yoga studio called “The Pelvis: Foundation of Movement, Fountain of Life”. The co-facilitators, Deane Juhan and Nicole Becker wove a fascinating tapestry with plenty of information, images and body movement/exploration to ground us deeper into our pelvic bowl – both physically and energetically. From a flyer about the workshop:

“The structural support, movement, and energetics of the pelvic bowl constitute our primary foundations.  Its strength, flexibility and conscious organization are central to all of our activities, forming the bridge between our upper and lower body, and the key to the organization of the spine. 

Misalignment of the pelvic bones and sacrum during standing, sitting and moving can result in chronic hip and low back pain, sciatica as well as dysfunction in the digestive, reproductive, and nervous systems.

The two wings of the pelvis and the sacrum “sacred bone” form the container for some of our densest concentrations of the lymph nodes. The pelvic bowl contains the first two chakras–our basic life force, and the divine eros that connects us in fundamental ways to ourselves, to one another, and to the world.  It is the lower engine of our crucial cranio-sacral rhythm, the southern pole of our central nervous system, a major exit for the elimination of toxins.”

As a birthworker, I have a long standing respect & admiration for the amazing pelvis. I love bringing out my model pelvis with clients and demonstrating the movement within the pelvic bones due to the hormones of pregnancy relaxing connective tissue as well as the baby’s spiral journey through the pelvis during labor and birth.

Unfortunately, I was not rooted in my pelvic foundation during my own pregnancy and birth. Looking back, I realize that as a fairly flexible person, I over-stretched during prenatal yoga and did not fully heal a birthing injury to my tailbone during my postpartum. I wasn’t tapped into bodywork (chiropractic, cranial-sacral, etc.) 16 years ago. Plus, I was young! My body didn’t have aches and pains! It wasn’t until the injury re-emerged several years later that I realized I had nagging, chronic achiness in my low back on the left side that had been there for years. I connected with amazing bodyworkers who brought me some relief, but the pain always returned.

As a result of my lack of pelvic awareness, I have been working with lower back & pelvic pain for years now. Sometimes it is not there at all which requires dedication on my end to stay embodied and working toward balance. I call on my bodyworkers when I need them, yet, more and more I am trying to work with yoga as opposed to having someone on the outside manipulate my body into a “balanced” state that I eventually move out of due to ingrained patterns. This awareness I receive from my own body during yoga is very empowering – it’s something I can do for myself! Of course there are other pieces – diet & nutrition being key -  that I integrate into my life to keep me feeling fluid and spacious.  Yet yoga and body awareness are the foundation.  As the pelvis is the foundation of movement…

What arose for me during this workshop is a strong desire to share with women about the pelvis during pregnancy, birth & postpartum. My hope is that having more information and resources will lead to embodied empowerment and juicy wholeness for women during their childbearing years.  That this will be a foundation for them to move into a healthy menopause, as well as an opportunity to teach their own daughters about pelvic health in all its richness.

I will continue this exploration of the pelvis with posts on the pelvis and pelvic floor during pregnancy, birth & postpartum… stay tuned!

Reiki  (pronounced Ray-Key) is he Japanese word for Universal Life Force Energy. It is an ancient, hands-on healing act that balances energy in the body and promotes health on all levels: physical, mental, emotional and spiritual.  “Rei” means Universal, higher power. “Ki” is the life-force energy that flows through and is radiated by every living thing. It is the same as Prana in Sanskrit and Qi (chi) in Traditional Chinese Medicine.

There is an unlimited amount of Ki flowing into and around the earth that anyone can harness for healing.  A person who is attuned as a Reiki healer has had their body’s energy channels opened and cleared of obstructions by the Reiki attunements as well as strengthening their connection to source.  This source can be described in any way the healer or client chooses to name it; Higher Self, Goddess, God, Universe or whatever can be termed primary creation or life energy.  Reiki is not a religion nor affiliated with any religion.  The life force energy is the source of life itself and comes before any religious philosophy.  Reiki is simply a  healing force that follows the Universal Laws of spiritual consciousness and unconditional love.  It is a powerful tool for healing and balance.

Life cannot exist without Ki. As we grow and age we are faced with situations that drain our reserves of energy. An individual with a lot of Ki feels strong and confident.  When Ki is low or weak, sickness of all types comes more easily.  Stress depletes energy at a higher rate than it can be restored.  Stress can be generalized, free floating anxiety, 21st century angst, physical or emotional trauma, lack of sleep, poor nutrition, physical injury, or sickness.  When depleted Ki is not restored, many different problems can arise on all levels: physical, emotional, mental and spiritual.  Since Reiki helps reduce stress and promotes relaxation is can be used as prevention as well as during a time of crisis.  Reiki also assists the client in getting in touch with her or his own inner guidance and wisdom in order to promote self-healing.

I am attuned to Reiki III.  In addition to using Reiki for relaxation during labor, I offer all doula clients a complimentary Reiki session if desired.

Devi Doula is being reborn, aka, this website is under construction.  In the interim, please contact me with any questions you might have about services here.

It has been some time since I have posted here… many changes have transpired in my life and I’m sure in yours as well! One of the wonderful things I’ve found in the last year is an online educational opportunity in Traditional Midwifery – MammaPrimitiva. This is the brainchild of an amazing midwife in Hawaii, Clare Loprinzi. She is sharing valuable knowledge that is hard to come by in many midwifery training programs. She has been a midwife for over 30 years and trusts birth. She is a wise woman, strong & true to her convictions. One of the great things about this program is there are a lot of videos demonstrating the teachings. In addition to Clare there are other teachers sharing their information & skills as well. A strong current of Traditional Chinese Medicine runs through the course as her husband, Joe, is an TCM doctor and acupuncturist. To top it all off, all proceeds from the (sliding scale!) tuition go to Mother Health International clinic in Haiti! She also has a more advanced training called “The Wisdom of the Thirteen Moons” for midwives further along the path as well as a program “Preparing for the Ceremony of Birth” for those who are pregnant… online education at it’s best!

To find out more: MammaPrimitiva