What if I told you that the aches and pains we think of as inevitable in pregnancy are actually windows into how to have a better birth experience? That those aching SI joints might be telling you something about the position of your cervix…

Our bodies are interwoven with connective tissue, and that connective tissue both supports and guides the position of the uterus and cervix. Depending on how this tissue adapts, and how our movements shift the internal network, it can have an impact not only on pelvic comfort during pregnancy, but on the progress of labor itself!

For those who don’t know about pelvic organ anatomy, let me back up and give some context. Pelvic organs are packed closely together within the confines of our pelvic bowl. The bladder sits in the front, the rectum in the back, and in the middle, for those of us born with one, the queen of the pelvic organs, the uterus!. A round, slightly, asymmetrical shaped, hollow organ, nestled between the other two. The uterus is composed of 3 sets of muscle fibers. An outer set which runs top to bottom, a middle set which interweaves around the blood vessels to the uterus, and an inner layer of concentric circular fibers which ultimately forms the cervix at the base of the uterus in the middle of the pelvic bowl.

But the uterus doesn’t just magically float in the middle of the pelvic bowl. Extending from all sides of the cervix and upper uterine segments is a network of fascial connections and ligaments which create a network of support lines to maintain this central bodily position. One set of ligaments runs from the cervix forward to the pubic bone, another from the cervix and lower uterine segment to the sacrum at the back, and still another set supports the cervix sideways to the inner border of the pelvic bowl. This last set- called the cardinal ligaments- also interweaves with the broad ligament, draping like a shawl over and around the uterus connecting the upper segment to the pelvis. And the round ligaments extend from the upper uterine segment, over the pubic bone and into the outer vulva. The entire pelvic organ structure is supported not just by the muscles of the pelvic floor, but by a web of interconnected ligaments and fascia radiating out to the inner border of the pelvic bowl. And as if this wasn’t impressive enough, the pelvic joints are further supported by ligaments connecting bone to bone (the Sacro-tuberous ligament, and Sacro-spinous ligament as two examples).

Ever seen one of those native american dream catchers? I first encountered these Native American ritual objects when decorating my college dorm room. The circular outer hoop is interwoven with a latticework of crisscrossing threads at the center of which was suspended some ritual object- usually an arrowhead. When I looked more closely at the fascial network within the pelvis, the image of these dreamcatchers sprung to mind. In the center we have the opening of the cervix, but just as the arrowhead rests centrally within the balance of the dream catcher’s woven network, the cervix sits in the interconnected web of internal pelvic ligaments.

If you read my earlier blog post about fear and labor you’ll remember that the muscles of the uterus work in tandem together during labor to draw the cervix up and around the baby’s head as it moves downward (and that anxiety and not feeling safe can impede this process), well it isn’t just the muscles that are guiding the cervix, the ligaments can serve as guidewires for the cervical position in labor also. If the cervix remains centrally located, then the pressure from the baby’s head moving down is evenly distributed into the lower uterine muscle fibers, and the cervix can open smoothly and evenly. But what if the cervix isn’t in the center? What if movement or muscle patterns before and during pregnancy have led to an imbalance in the ligaments? This might result in a twist in the cervix? As I mentioned in the blog post on fear, the cervix opening is akin to pulling a turtle neck over the baby’s head, but what if that turtleneck is twisted, or being pulled more to one side than the other? This would mean that things wouldn’t open symmetrically, or contractions might seem to not be opening the cervix, since it needs to untwist first before it can open.

What would make one ligament stiffer than another? Here we get into the meat of things. There are several possible reasons, but one big one we have control over is OUR MOVEMENTS! Just as muscles respond to what we ask them to do, so too our fascia (which includes ligaments) responds to how we sit, move, and use the body throughout our life. Cross one leg over another more often, and not only do the pelvic floor muscles learn to be shorter on one side, but so do the pelvic ligaments. This isn’t much of an issue when the body isn’t pregnant, but add the weight and expansion of the uterus during pregnancy, and little imbalances start to take on bigger implications.

Go back to the image of the dream catcher, the inner pelvic network is connected to the outer ring of the pelvic bowl. The fascial tension may be affecting not only the cervical position, but the position of the bones as well, and vice versa. Aching SI joints, especially when it’s only one sided indicates that something is pulling too much in one area. And remember the cervical ligaments are connected to the sacrum. This may well affect cervical position. The SI joint is an easier one to see, but fascia is interconnected. Tension from one area may create a subtle twist that like the butterfly weather effect results in a big imbalance much farther away. Something like heartburn could tension around the esophagus, which might lead to tension throughout the abdominal diaphragm, which then impacts the psoas, which then impacts the pelvic floor, which then impacts the labor process…you get the idea. Bottom line? Despite it seeming inevitable that pregnancy brings on aches and pains, don’t ignore them! They are windows into something being out of balance, and if we relieve that tension and pressure, it might impact things we never thought of as being connected. And creating overall balance is one thing which can assist in the body being more ready for labor, birth, and recovery.

So what do we do? Well the solution isn’t as simple as just doing one position over another. There are certain positions such as the Forward Leaning Inversion used in Spinning Babies which directly target the utero-sacral ligaments, but tugging on one area may not unwind tension that originated far away in the body. So the first recommendation I always have for students is to begin becoming aware of the network, and discovering how things feel overall. Then, because the body wants to unwind and restore balance, we might find ways to gently bring space to the tense spots and see how this begins to shift sensations. It may also mean strengthening areas which are not holding sufficient tension, so we can restore the overall balance in the network.

Visualizing the web:

Start by bringing awareness to the network within and around the uterus and pelvis. This exercises can be done standing, sitting or lying down. If standing or sitting, make sure the pelvis is in a balanced upright position like I described in my post “What the Tuck?” If seated be sure the weight is placed on the front of the sitting bones, and if lying down, be on the left side with the top leg supported and the belly leaning against the bed or couch.

From a balanced position, place one hand on the front of the pelvis near the pubic bone, and the other on the sacrum. Mentally imagine the space between your hands and feel the inner circle of the pelvic bowl. Now bring your focus to the center of that circle, deep within the lower belly. Imagine the small circle of the cervix floating there.

Now from that center dot, imagine a silver thread extending forward from the center to the front of the pubic bone. Feel the subtle tension within this thread, toned, but not stiff. Now in turn, imagine additional silver threads fanning out from the central point around the whole bowl of the pelvis, as though connecting to the numbers on a clock face. Each thread gives an equal light tug, supporting and shimmering in its own time. Continue around the circle of the pelvis visualizing each “number” until you return back to the pubic bone at ”12 o’clock”.

Now with the network radiating out, imagine another set of threads beginning form the inner border of the pelvis. Each thread extends from one location, to the one next to it, softly interweaving with the silver network. Like the weave of a soft shawl feel the threads tug and support one another.

Now seeing this web, imagine the breath coming down to touch the threads of the web, and see how this web is not rigid, but breaths and moves with the breath. Inhale softly spreads it open, then the exhale softly lifts it upwards. You may even be able to tell if one side is breathing more fluidly than another.

This exercise in and of itself may not fully unwind tense ligaments. movements like Puppy Dog stretch/Open Knees-Chest, or the more dramatic Forward Leaning Inversion are designed to lightly stretch and balance the posterior cervical ligaments, while movements like gentle bridge pose, or side lunges may impact the anterior and lateral connections. But the key is that we begin to bring awareness not just to the muscles, but the ligaments as well, so that the whole network can engage in its dance of labor. The uterine muscles lift, the ligaments unwind, the cervix opens, and the baby descends and emerges into the world and our arms.

Key Takeaways:

The position of your cervix is influenced by the tension of a network of ligaments inside the pelvis
Aches and pains during pregnancy can indicate an imbalance in either the ligaments or the bones and soft tissues they connect to
Balancing the musculature and connective tissue in the body can help realign the cervix
Specific yoga postures with good alignment can assist in balancing the body’s connective tissue
A well aligned cervix can help create optimal conditions for a smoother labor and birth.