How to prepare your Pelvic Floor for Birth

Written by Katie Stan-Bishop - APA Titled Pelvic Health Physiotherapist and the EMP 

When it comes to preparing for birth, we know just how exciting it can be to get lost in preparing your hospital bag, planning your baby's registry or room, or creating the perfect playlist. 

However, whilst it may not be quite as exciting, we would love for you to spend just as much time and energy preparing your pelvic floor for birth. Because the truth is, long after you have changed your last nappy or heated your last bottle, you will still be living with a pelvic floor that supports your active life or in some cases, holds you back from the life you had imagined for yourself.  

In Empowered Birth, the complete physio-led birth preparation program by the Empowered Motherhood Program, you will gain a deep understanding of how your pelvic floor functions, the role it plays in your birth and how you can prepare your pelvic floor for birth to reduce your chances of experiencing common birthing complications such as perineal tearing, prolapse, avulsion and long term pelvic floor complications. 

Understanding the Pelvic Floor and Pregnancy

Think of your pelvic floor as a supportive hammock of muscles that hold up your bladder, bowel, and uterus. Your pelvic floor is also responsible for maintaining continence, increasing pleasure during sex and helping to provide pelvic support and stability. 

You may have noticed a change in your pelvic floor during pregnancy. It may be an increase in light bladder leakage, feelings of heaviness or even increased pelvic or lower back pain. 

During pregnancy, hormonal changes combined with increased blood flow to the pelvic floor muscles cause the pelvic floor to relax and soften as your body prepares for birth. At the same time, your pelvic floor has to take on an increased load as they carry the increasing weight of your baby. 

As your pregnancy progresses, your pelvic floor can start to struggle under this increased load, increasing pelvic floor-related symptoms. 

Why it's so important to do Pelvic Floor Muscle Training in Pregnancy 

During pregnancy, it is important to keep your pelvic floor strong through pelvic floor muscle training and safe pregnancy exercise that includes functional movement patterns. Pelvic floor strength is crucial for reducing the risk of urinary incontinence and pelvic organ prolapse. 

Regular antenatal exercise, including pelvic floor training, has been found to reduce urinary incontinence in late pregnancy and postpartum, as well as lower the risk of anal sphincter injury by approximately 60%. Studies have shown that pelvic floor exercises can decrease the likelihood of third and fourth-degree tears by up to 50%.

Additionally, regular pelvic floor muscle training can help to shorten the second stage (pushing stage) of labour by around 20%. When combined with perineal massage in the antenatal period, there is also a 30% reduction in the need for an episiotomy, with women being 15% more likely to have an intact perineum.

At the same time, it's equally important to learn how to relax and lengthen these muscles for the role of a lifetime - the birth of your baby. One of the maternal risk factors for perineal tearing is a shortened perineal length. We also know that when it comes time to push, your perineum and pelvic floor muscles must lengthen to accommodate the baby out of the vaginal opening. A well-functioning pelvic floor should be able to contract and relax through its full range.  

In Empowered Birth, we help you to maintain strength with safe pelvic floor workouts for Trimester 3 whilst also learning to downtrain, relax and release your pelvic floor with physio-led birth preparation classes.

How to prepare your Pelvic Floor for Birth 

In Empowered Birth, we help you to prepare your pelvic floor for birth in four main ways: 

Strength and Optimal Pelvic Floor Function Many women start Empowered Birth at the start of their third trimester - when they still have three or so months of pregnancy. For this reason, it is essential to maintain strength and control through your pelvic floor. This involves learning to engage fully and, just as importantly, fully relax these muscles through their full range of motion. This helps to build both strength and flexibility. This mindful connection to your body enables you to feel more in tune with the sensations you’ll experience during labour.

Pelvic Floor Downtraining and Relaxation As you draw closer to birth, the focus shifts from 'strengthening' to 'relaxing and opening'. This 'downtraining' process starts with gentle stretching and movement, such as deep squats, child’s pose, or yoga-inspired stretches, which all support the lengthening and mobility of your pelvic floor. These movements also help maintain flexibility in your hips, lower back, and pelvis. 

Perineal Massage A key difference of Empowered Birth is that we teach you the techniques you need to perform perineal massage to help stretch the tissues around the perineum to improve elasticity. Research suggests that regular perineal massage combined with pelvic floor muscle training during pregnancy from 35 weeks onwards can reduce the risk of third and fourth-degree tears by 21% and may reduce the risk of episiotomy by 16%.  This technique can be performed solo, or you may be able to recruit the help of your partner. Perineal massage should allow you to feel gentle pressure and stretch on the tissues.

Using your breath to optimise pushing and pelvic floor opening  Breathing techniques are another key component in preparing for labour. Even though we are breathing all day, every day, we can modify our breathing patterns to assist with relaxation, managing anxiety and fear and deducing the tension in our tissues. Do not be afraid to place your hands on your lower tummy and just below your ribs. This helps to form a connection with your breath. Focus on where the air is circulating. Take this opportunity to tune in for any areas of tension.

It is a good idea to practice different types of breathing patterns, such as those covered in Empowered Birth, regularly in the lead-up to your labour and birth. 

The Role of a Pelvic Health Physiotherapist

The role of a pelvic health physiotherapist involves offering support, knowledge, and practical tools to help you feel more connected to your body as you prepare for birth. I will often help women identify where their pelvic floor muscles are so that they have an improved awareness of how to contract and relax them.

Your pelvic health physio may recommend an internal pelvic floor assessment to identify areas of tightness or discomfort gently. This can be particularly helpful if you have experienced pelvic pain or other concerns. Through targeted techniques, they can assist in releasing tension and improving pelvic floor function. We can also use a real-time ultrasound machine that provides biofeedback and visual assessment of the pelvic floor muscles. This can be a valuable addition to treatment and provide some essential evaluation of your pelvic floor muscles, especially in cases where an internal examination is not performed.

You can contact a pelvic health physiotherapist at any point during your pregnancy. However, many find it particularly helpful to start in the second trimester, around 16-20 weeks. This timing lets you familiarise yourself with the exercises and techniques well before your due date. As part of the assessment process, your pelvic floor physiotherapist may also ask you some questions about your family and medical history that may help to determine if your are at increase risk of pelvic floor dysfunction, from here we can provide you with specific advice and guidance.

Final Thoughts 

Preparing for childbirth is about more than just the big day; it is about caring for your whole self along the way. During your pregnancy, it is important to surround yourself with resources and a care team to support your journey.  

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