Here’s how a pelvic floor PT preps for labor & childbirth

If you’re pregnant and thinking about preparing for labor or childbirth, chances are you’ve already been scouring the internet and/or tapping into your inner circle, seeking all the advice for how to best prepare your mind and body for what’s to come. And because our phones are always listening, you’re probably also being flooded with birthing class advertisements and emails full of tips and tricks.

But with all this information flung at you at once, it’s understandable to feel overwhelmed. It can be hard to parse through the mountains of advice and know which options are best for you. And is any of it even worth your time?

As a pelvic floor PT with specialized training in pregnancy, childbirth and postpartum care—and someone who has had two babies myself—I want to make this easier for everyone. That’s why I’m bringing you my top 5 recommendations for what to focus on to physically prepare your body for birth.

First, is birth-prep really that important?

Overwhelmingly yes.

Birth preparation is crucial for a positive birth experience and optimal postpartum recovery. Physically preparing yourself for birth can help lessen pain and discomfort during labor, minimize injury and prevent postpartum issues related to birth trauma. Plus, taking the time to prepare for birth can help reduce any anxieties or stress you may have by providing the confidence and skills you need the most.

1 . Get familiar with your pelvic floor muscles

As a pelvic floor PT, I have made friends with my pelvic floor and continually nurture that relationship. Unfortunately, most women and people born with vaginal anatomy have a huge gap in knowledge when it comes to their pelvic floor muscles and just how important they are.

The pelvic floor is a multilayered group of muscles at the bottom of your pelvis. It forms a sling of support for your pelvic joints and your pelvic organs, including your bladder, rectum, and growing uterus. These muscles are crucial for several important body functions, including:

• Bladder and bowel control
• Sexual function
• Providing physicall support during pregnancy and childbirth

While you may have heard that you should be doing kegel exercises during pregnancy to prevent leakage, there is so much more to learn about when it comes to pelvic floor muscle training. And unfortunately, the important “how, what, when, where and why” details are often overlooked. 

And these are important details, especially considering that pelvic floor muscle training in pregnancy is linked to several benefits including:

• Shorter first and second stages of labor—this is a huge benefit!
• Improving or preventing pelvic floor dysfunction late in pregnancy and in the postpartum period
• Reducing the incidence and intensity of postpartum low back pain

To prepare for birth, it’s important to learn all you can about your pelvic floor muscles, including:

• Their location
• How to contract and relax them at the right time
• Their important role in bowel, bladder and sexual health
• Symptoms of pelvic floor dysfunction during pregnancy and postpartum
• Optimizing pelvic floor muscle strength during pregnancy (including kegels as well as flexibility and coordination training
• Available treatment options for any pelvic floor symptoms that pop up

While pelvic floor symptoms such as bladder leakage, pelvic heaviness and pain during sex are very common—especially after birth, with as many as 87% of people reporting pelvic floor symptoms such as bladder leakage, even 5 years after birth—these symptoms are rarely ever something you just have to deal with. There are highly effective treatment options, including pelvic floor physical therapy, that can offer hope for pelvic floor healing.

If you’re unsure where to start, talk with your obstetric healthcare provider or a pelvic floor physical therapist for guidance on understanding and caring for your pelvic floor muscles during pregnancy and beyond.

2. Practice the top labor and birthing positions

In early labor, it’s helpful to rest and conserve your energy—even sleep if you can. But as you approach active labor and contractions intensify, you’ll want to get up and move around. Moving in and out of different labor and birth positions will reduce your discomfort and prevent slow progress during labor. Switching positions at least once every 30 minutes or so is recommended. 

Of course, when you’re in the throes of active labor and intense contractions, thinking about which laboring positions are best for you can be challenging. This is why intentionally learning about and practicing different birthing positions beforehand is a really important part of birth preparation.

Even as a pelvic floor PT who has gone over these positions with patients countless times, I chose to practice them often myself to keep them top-of-mind.

Positions for early labor

As your contractions become more regular and intense, and your cervix thins and dilates, you’ll find it easier to rest. Try these positions to support and rest your body: 

• Backward sitting on a chair
• Rock in a rocking chair
• Kneeling with upper body on a birthing ball
• Hands and knees with pelvic tilts

Positions for active labor

As your contractions are more regular and intense, and your cervix fully dilates, different positions can help to manage discomfort and help the baby move further down the birth canal.

If you don’t yet have an epidural, useful positions include:

• Walk or slow dance with your birthing partner
• Squatting
• Child’s pose with your hips in the air
• Standing with one foot up on a chair

If you have an epidural, try moving between side-lying (don’t forget both sides), and seated with the back of your bed elevated.

Positions for transition (pushing phase)

When it is time to help move the baby out, your main goal is to find a position where you feel powerful and in control of your body. If you don’t have an epidural, consider:

• Side-lying with your top leg supported
• Seated on a birthing chair
• Kneeling with your upper body supported 

These positions are just the tip of the iceberg. There are so many ways to modify them for your individual needs and goals during labor. If you have any pelvic or low back pain, reaching out to a pelvic physical therapist is extremely important. They can educate you on effective birthing positions and help you modify any position to help keep your body safe, and minimize the risk of further injuring yourself during birth.

3. Learn how to push effectively

While your uterus does the majority of the work during labor, it’s important to know how to push effectively to support its contractions. By effectively pushing, you are helping your body move your baby safely and efficiently through the birth canal. This can impact birth outcomes, and it can be important for the health of both you and your baby after birth.

There are two types of commonly used pushing methods: 

1. Closed-glottis pushing (Valsalva, coached, or “purple” pushing)

• This is when you hold your breath and push.
• Typically, you are coached to hold your second breath for 10 seconds and push with each contraction, repeating two or three times. 
• You are coordinating your pelvic floor muscles to relax while using intra abdominal pressure to help you push.

2. Open-glottis pushing (“exhale” pushing or “breathing your baby out”)

• This is when you inhale and then exhale while pushing.
• The focus is on lengthening your pelvic floor while pushing with your abdominals.
• You take as many exhale pushes as you need throughout the contraction.

Which pushing method is best? Research doesn’t necessarily support one type of pushing over the other. A recent prospective cohort study compared birth outcomes between open-glottis and closed-glottis pushing techniques among over 3,000 birthing individuals. There were no significant differences in satisfaction with the birthing experience, psychological status at 2 months postpartum, or morbidity for the birthing person or their newborn. This study also found no difference in the use of forceps or vacuum first-time birthing people. A randomized control trial found similar results, with no differences in pushing effectiveness, perineal injury, postpartum hemorrhage, or newborn outcomes when comparing pushing methods for those using an epidural during birth.

As part of your birth preparation, it is really helpful to learn about both pushing methods and practice them in the birthing positions you plan to use. And since research supports both pushing techniques, you can choose whichever feels most comfortable for you and your body during labor.

Making time to think through and practice pushing is very, very hard to do alone. That’s why even I worked with a pelvic floor PT on this—and I recommend you do, too.

4. Make time for perineal massage

If you’re planning for a vaginal delivery, perineal massage is a “must include” when it comes to preparing your body—and more specifically, your pelvic floor—for birth. The perineum is the space between your vaginal opening and anal openings. It is packed with important pelvic floor muscles and nerves, and at least 85% of birthing people will encounter some amount of perineal trauma during a vaginal delivery (including cuts from an episiotomy, or a tear). 

More severe perineal trauma, including 3rd and 4th degree perineal tears (also known as OASIS or obstetric anal sphincter injuries), is linked to more significant pelvic floor issues like anal incontinence and sexual pain. Additionally, there is a higher likelihood of experiencing a repeat 3rd or 4th degree tear in subsequent deliveries.

Antenatal perineal massage, or massage done during your pregnancy, has been shown to lower the risk of more severe perineal trauma and complications after birth. It can also be an incredibly empowering way to become more familiar with—and in control of—the intense stretching sensations of the skin and muscles of your perineum.

While perineal massage is encouraged for most pregnant folks, it isn’t safe for everyone. It’s best to check in with your obstetric care provider before starting. In general, avoid perineal massage and check in with care provider if:

• You have preterm labor
• You have an incompetent or insufficient cervix
• You have had premature rupture of membranes
• You’re having vaginal bleeding during pregnancy
• You are put on “pelvic rest”
• You have a vaginal infection or herpes lesions

By incorporating perineal massage into your birth preparation, you can help reduce the risk of severe perineal trauma and enhance your control and familiarity with your pelvic floor during delivery.

5. Prepare for postpartum 

I saved the best (and most important) for last. Because the work doesn’t stop once your baby is born, one of the most important things you can do to prepare for birth is prepare for postpartum.

It’s probably not surprising (especially if you’ve already been through it before) but the early postpartum period is packed full of navigating multiple new challenges all at once. You’re getting to know a brand new baby, you’re endlessly tired, hungry and thirsty, and you’re managing postpartum mood changes while dealing with any chronic health issues or new aches and pains (just to name a few).

Like the saying goes: “The best defense is a good offense.” For your postpartum, it’s important to learn:

• How to advocate for yourself at the hospital, and after discharge
• How to manage pain and swelling in the early days
• How to care for any wounds (whether they are perineal injury or abdominal incisions because of a C-section)
• Which self-care supplies you will need even just minutes after delivery
• The signs and symptoms in the postpartum that you need to be aware of so that you know when, and who to call for further emotional or physical support in your recovery.

How to get support as you prep for birth

By focusing on these five key areas during your birth prep, you can feel more confident and empowered as you approach your birthing day. While every birth is unique, taking the time to properly prepare your mind and body can set you up for a more confident, informed, and successful birthing success. When you should start preparing for birth, depends a lot on your goals for your pregnancy and birth. The majority of research recommends focusing on certain things starting around 34 weeks through the end of your pregnancy.

And consider scheduling a consultation with a pelvic PT in your area to help guide you more specifically through the birth preparation process.

Unsure who to call? The pelvic physical therapists at Origin Physical Therapy are experts in pelvic and obstetric health. They have the knowledge and experience you need to support you as you prepare for birth, and in the postpartum period while you heal. You can see them online no matter where you live in the United States, or in-person if you are near one of their clinics.