pelvic floor birth preparation
how can a pelvic floor physio help with birth preparation?
Giving birth is an extraordinary experience, filled with emotion, anticipation, and excitement. This is the case for women aiming for a vaginal birth or a planned c-section birth.
For a vaginal birth, the journey through labour can also be physically demanding, especially when it comes to the pushing phase. While many women focus on strengthening their pelvic floor muscles during pregnancy, understanding how to relax these muscles is just as important, if not more so. A pelvic floor physiotherapist plays a crucial role in helping you prepare for labour by teaching you how to push more effectively, reduce strain on your pelvic floor, and minimise the risk of complications such as prolapse and perineal tears. The focus is not just on strengthening the muscles but, more importantly, on learning to relax and coordinate the pelvic floor during labour to ensure a smoother and more controlled delivery.
In the event of a c- section birth, it is equally important to learn how to release and relax the pelvic floor muscles during the later stages of pregnancy to prevent overactivity of these muscles post delivery. Often, the pelvic floor compensates for the loss of abdominal strength whilst recovering from a c- section and if not addressed, can lead to pelvic floor dysfunction and poor core stability.
A pelvic floor physio can provide you with the tools you need to feel confident and empowered in preparation for either birth experience, and also in the event of an unplanned c- section. By having a pelvic floor assessment, practicing pelvic floor relaxation techniques, birth preparation stretches and learning about controlled pushing, labour positions and other strategies such as perineal massage and the epi- no machine in the context of a vaginal birth, you’ll feel more in control during your birth and better equipped to manage your pelvic health postpartum.
why does pelvic floor relaxation matter during labour?
Your pelvic floor is made up of a group of muscles that support essential organs, including your bladder, uterus, and bowel. During labor, these muscles are tasked with allowing your baby to pass through the birth canal. To achieve this, they must be able to stretch and relax appropriately. However, many women don’t realize that during labor, especially during the second stage, their pelvic floor muscles need to relax, not tighten.
If the pelvic floor muscles are too tight or overactive, it can make the pushing phase more challenging. Pushing against the resistance of a tensed pelvic floor can lengthen the time spent in the pushing phase, potentially leading to complications such as perineal tearing or increased risk of interventions like forceps or vacuum-assisted delivery.
Many women unknowingly tense their pelvic floor during contractions, which can make pushing more difficult and painful. A pelvic floor physiotherapist helps teach relaxation techniques aimed at helping you release tension in this critical area. Through a combination of deep breathing exercises, visualization, and stretching techniques, a pelvic floor physiotherapist can help you practice how to relax the pelvic floor, which is essential for an efficient and safe delivery. Learning how to manage your pelvic floor relaxation ahead of time allows you to be more in control and confident when labor begins.
how can I reduce pressure on my pelvic floor during birth?
The way you push during labor plays a major role in how much strain is placed on your pelvic floor muscles. For example, pushing too hard or holding your breath while bearing down can create excessive pressure on your pelvic floor, which may weaken the muscles over time. This can contribute to problems like prolapse (when pelvic organs shift downward) after childbirth.
To reduce the strain on your pelvic floor during labor, a pelvic floor physiotherapist can guide you through controlled pushing techniques and preventing a co- contraction. One example of this is “open-glottis” pushing, where you exhale slowly while bearing down rather than holding your breath. This technique reduces the pressure on the pelvic floor while allowing you to push more effectively. The added benefit is that it helps keep you focused and reduces the likelihood of hyperventilating or becoming overly tense.
Additionally, pelvic floor physiotherapists can suggest labour positions that help reduce strain on your pelvic floor. Positions that encourage the opening of your pelvis, such as side-lying, squatting, or hands-and-knees positions, help your baby descend through the birth canal more easily while protecting the perineum from excessive stretching or tearing. These positions also use gravity to assist in pushing, which helps your baby move down naturally and reduce the effort needed for pushing. We can also individualise these to any aches or pains you might be experiencing in pregnancy. This can make the process smoother and more effective.
On the other hand, lying flat on your back or being semi-reclined during delivery can create more resistance, making pushing harder and potentially increasing your chances of tearing or needing medical intervention. However, some women conceptualise the feeling of downwards pressure better in this position and it may be recommended from your OB and/ or midwives as the safest possible position for you and your baby. Understanding and practicing these positions ahead of time can give you the confidence to communicate with your birth team and choose the best option for your situation.
can a vaginal birth increase my risk of prolapse?
Pelvic organ prolapse is a condition in which the bladder, uterus, or rectum shifts downward due to weakened pelvic floor ligaments and/ or muscles. While pelvic organ prolapse can occur in women at any stage of life (including with chronic constipation, heavy manual handling, ageing and pregnancy itself) it is more common after childbirth, especially following a difficult labour or delivery. Prolapse can cause discomfort, a sensation of heaviness, bulging or dragging in between the legs, or issues with bladder and bowel control.
Poor pushing technique, or a birth that requires intervention, can further increase the risk of prolapse, particularly if you already have overactive or underactive pelvic floor muscles. Interventions such as an episiotomy, forceps or vacuum use, are often necessary and can be lifesaving but they can further increase the risk of prolapse, perineal tearing and pelvic floor muscle dysfunction. If you are concerned about your pelvic floor and the risk of prolapse, or are experiencing symptoms of a prolapse, please reach out to us for an assessment and treatment plan.
how can I help my pelvic floor heal after birth?
It’s not uncommon for women to experience pelvic floor dysfunction after childbirth, which can manifest as symptoms such as urinary incontinence, pelvic pain, or difficulty engaging pelvic muscles. This condition is typically a result of the pelvic floor muscles being overstretched or weakened during labour but can also be due to too much tension in these muscles too. It is important to address these issues early to ensure optimal recovery.
A pelvic floor physiotherapist can support your postpartum recovery by teaching you gentle exercises to restore pelvic floor strength, helping with core reactivation, and guiding you through scar tissue healing. Additionally, they can provide advice on how to prevent long-term issues such as incontinence, pelvic pain, or prolapse. With their expertise, you can begin your postpartum journey with a plan to heal your pelvic floor effectively, restoring its function and strength over time.
If you’re pregnant, consider consulting with a pelvic floor physiotherapist who can help you prepare for labour and offer ongoing support throughout your pregnancy and postpartum recovery. Their guidance can make a significant difference in your labor experience and help you recover quickly and effectively after birth. You can book in for an initial appointment by clicking here.
Authors: Jessica Adams and Divya Koujalgi, 2025