Let’s face it, pregnancy does a number not only on your emotions but also your body.

Your center of gravity has shifted, your balance is off, swelling is ever-present, there’s excessive hormones everywhere you turn, not to mention (from a PT point of view) there’s an extra load on your pelvic floor, your abdominals are over stretched, diaphragm squished (along with every other organ), back muscles are shortened and hip muscles are stressed…. Yea, it’s a lot and I just want to take this second to say, you’re an athlete. An athlete that can also grow another human! So, as the badass human growing athlete that you are, you need to prepare your body for birth. This is your Olympics, your world series, your championship game…. Catch my drift?

As a pelvic floor PT, I spend almost every day preparing folks for their best birth. I empower them to walk into one of the biggest events of their life without fear but with confidence that their body and mind are ready. I want to go through a few things I like to focus on when educating and empowering women to rock their births. 

1. Support

Choose your birth team wisely. Make sure you have asked your delivery team any and all questions that are important to you, and DO NOT feel bad for having tons of questions. Also don’t feel bad for not knowing which questions to ask, here are a few I think are important to add to your list: 

• What labor signs should I look out for?

• What are my chances of a vaginal delivery vs. C-section?

• Are there any complications you are concerned about for me? 

• What is my likelihood of tearing? (perineal massage can help lower your risk)

• What are my pain relief options and the pros and cons to each?

• What positions do you suggest?

Some important providers for a pregnancy/postnatal care team include: A birth provider (OBGYN, midwives, etc.), a doula, a pelvic floor PT, a prenatal massage therapist, chiropractor and a trusted mental health provider in case you need them after birth (postpartum blues/depression is very common and needs to be normalized/talked about and addressed more often).

2. Strengthen

Get your body strong prior to conceiving and during those first and second trimesters. This will help tremendously during labor and the early postpartum period. In general, you want to make sure your back and hips are strong as your center of gravity continues to shift forward. Starting out strong before delivery will help you be able to do all the things you want to do after labor more easily. It is best to see a pelvic floor PT or personal trainer who specializes in pregnancy and postpartum related exercises. This way, your exercise plan is tailored to you, your body, your strengths and weaknesses and what your body specifically will need during labor.

3. Shift

At 35 weeks shift your focus to stretching, relaxing and softening the pelvic floor to prepare for delivery. During labor, you need to know how to relax your pelvic floor, the correct way to breathe and good positions for labor/pushing. It is helpful if your pelvis has already been regularly moving into positions that will be needed during birth. It is also helpful to gain the mobility and length in the pelvic floor muscles that are needed as you are pushing.

Some of my favorite activities for softening and relaxing the pelvic floor are:

• Gentle bouncing while sitting on a vestibular ball.

• Performing pelvic clocks (circles with your hips) while sitting on a vestibular ball.

• Deep belly breathing in positions that lengthen the pelvic floor (think child’s pose, deep squat, happy baby).

Birth prep appointments are perfect for going through these exercises, learning how to protect your pelvic floor and gaining more important birth information so that you feel fully prepared for your best birth! We perform birth prep appointments around 34-35 weeks in person and also virtually.

4. Stretch

Perineal massage is SO IMPORTANT. Studies show that perineal massage can decrease tearing significantly. Start perineal massage around 35 weeks. You can perform this on yourself but it is often easier for a partner to perform perineal massage for you. Perineal massage between pushes as well as a warm compress provided by your birth provider can also help!

For perineal stretching, start with performing 5-10 minutes a day:

• Begin by washing your hands. Lubricate your thumbs with a natural oil such as olive oil or a water based lubricant. 

• Lay in a semi-reclined position on your bed in a butterfly position with your feet together and knees apart. 

• Insert your thumb in your vagina to the first knuckle, slowly and gently press slightly down and hold gentle pressure for 5-10 seconds Focus on the area of 3-9 o’clock. Then perform "U shaped" massage from 3-9 o'clock. 

• You should feel pressure, burning, stretching, and slightly uncomfortable, but no pain. Try to stay relaxed to allow the pelvic floor muscles to be relaxed and work on your deep belly breathing throughout the stretches.

**Contact your birth provider to get clearance to begin.

5. Self-Led Pushing/Pushing Position

This means that you push when you feel like you need to versus when you are told to. Our bodies are pretty awesome and they usually know what to do.

NOTE HERE: patients pushing with an epidural cannot fully feel the urge to push and will need help from their birth team for timing of pushes.

One of my favorite push positions is side lying and you can push in side lying with a peanut ball under your top knee even with an epidural. Pushing in side lying helps to prevent tearing as well as allows the tailbone to drop back like it should during pushing. When on your back, the tailbone is limited by the surface you are sitting/lying on. Try to talk with your birth care team ahead of time about what positions you would like to try to push in.

In conclusion, just remember your body was made to do this. Take a deep breath, ask for help when you need it and go rock that birth, mama.

Jessica Bowman, PT, DPT
Owner and lead Physical Therapist at Fort Worth Pelvic Health