Prenatal pelvic floor physical therapy is extremely effective in helping to improve maternal well-being, and improve overall childbirth outcomes. (1)

Through birth preparation, prenatal physical therapy can help patients connect with their body, understand the labor and delivery process and confidently go into childbirth with an ability to connect with their pelvis and pelvic floor.

During birth prep with a pelvic floor physical therapist, you will learn and understand techniques including: how to relax your pelvic floor, labor and birthing positions, breathing for productive labor, pushing mechanics, perineal massage, and understanding early postpartum healing

Exercises to relax the pelvic floor

Understanding that you need to relax your pelvic floor for labor and delivery is one of the most fundamental pieces of information that you need to know during pregnancy. 

Many people will say that you need to “get your pelvic for strong for birth” however, a strong pelvic floor is not shown to help reduce adverse birth outcomes.(2) In fact, during labor and delivery your pelvic floor actually needs to relax. 

How do you get the pelvic floor relaxed for labor?

There are 2 positions that help to relax your pelvic floor muscles and widen the pelvis:

1. When your knees are turned in

1. (In sitting) Your hips are flexed so that your knees are higher than your hips.

In addition, your public floor muscles work with your diaphragm and relax when you take a nice inhale. Understanding the diaphragm and pelvic floor connection is huge when it comes to helping to relax your pelvic floor muscles.

Breathing for a productive labor

As mentioned, using your breath is one of the most powerful tools that you will use during labor and delivery. Since the diaphragm is deeply connected to the pelvic floor muscles, the ability to take full deep breaths will help to keep the pelvic floor nice and relaxed during labor. 

In addition, taking nice, deep diaphragmatic breaths helps to relax your nervous system. The diaphragm is controlled by a nerve called the vagus nerve, which is the main parasympathetic/rest and digest nerve in the body. So the more that you can perform diaphragmatic breaths, the more you can keep yourself calm during labor.

Labor and birthing positions to open up the pelvis

Prenatal physical therapy will go over labor and birthing positions that are ideal for you. Ideal labor and birthing positions will vary person to person, depending on their ability to get their pelvic floor muscles relaxed in certain positions. 

In general, most patients will benefit from being upright (i.e. standing/sitting) for as long as possible to let gravity help progress labor and engage the baby in the pelvis.

In addition, we like to discourage patients from spending a significant amount of time on their back. When you are lying on your back, you are actually inhibiting the sacrum or the lowest backbone, to move. During labor this area of your spine must be mobile in order to allow the baby to engage in the pelvis. If you are laying directly on your back, you are restricting that bone from moving, which will not open up the pelvis.

Pushing mechanics

Uterine contraction are actually what pushes the baby out. We always say that you actually can breathe your baby out and should not have to push for hours. Ideally, we want patients to wait until they have a strong urge to start pushing. 

Patients can actually be 10cm dilated, but the baby may be too high in the pelvis. If you were to start pushing before the baby was engaged in the pelvis, you may end up, pushing for an extended period of time which may lead to exhaustion and postpartum pelvic floor dysfunction such as prolapse.

In general, the old-school way of pushing during labor was to hold your breath, bear down and push as if you were to have a bowel movement. Research is now showing that this form of breathing contributes to perineal tearing, excessive pelvic floor pressure and actually causes the pelvic floor muscles to close and contract. 

The “new way” of pushing is called open glottis pushing. In this form, you take a nice deep inhale and then on exhale keep the back of your throat open and mouth open as you push. Often patients will “hum” or “moo” while they are pushing to ensure that the back of the throat is not closed, and they are not holding their breath while pushing. 

When the back of the throat is open during open glottis pushing, the pelvic floor muscles are also open and relaxed. This helps to ensure that you are pushing without exerting too much force to the pelvic floor muscles.

Perineal massage

The perineal body is the space that sits between the vaginal opening and the anus. This space is usually what tears during perennial lacerations that occurs during vaginal births. 

Perineal massage can help to loosen scar tissue from a previous childbirth, and can also get a patient used to the sensation of pressure through the perineal body. 

A pelvic floor physical therapist can teach you the technique that is appropriate for you. 

Postpartum healing expectations 

Typically, postpartum healing is lengthy. “Bounce back” culture in our country encourages women to get into physical activity way before their body is healed and ready. 

In addition, at the six-week postpartum check up, your provider will often “clear you“ for all activities. What patients end up thinking though is that they can just go back to any activity that they were doing even before they were pregnant. However, we cannot forget about the trauma of both 9 months of pregnancy, and childbirth.

Your body sustained an injury and compensations have developed over the 9 months that you were pregnant. There needs to be some sort of rehab and weaning process back into activity. Seeing a pelvic floor physical therapist postpartum is extremely important to help you get back to the activities safely so that you can have a long active journey through life.

Overall, seeing a prenatal physical therapist can help you prepare for birth and teach you exercises to widen your pelvis for birth.

1: https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/aogs.14744

2: https://www.scielo.br/j/rbfis/a/h9qzjBxsmskkdkjRmxMkPqh/?format=html&lang=en