Preparing for Birth with your Pelvic PT

Congratulations on your pregnancy and your growing baby! Whether you are in your first trimester or nearing the end, a pelvic floor physical therapist can be instrumental in your pregnancy, labor & delivery, and postpartum recovery. For this blog post we will be discussing how a pelvic floor physical therapist can help you physically prepare for your birth.

Pelvic floor Relaxation
Think of your pelvic floor as a gate between inside the womb and the outside world for baby. Below you can see the pelvic floor highlighted in a black line showing the “gate” that lives between your baby and the outside world. This gate needs to properly open and relax for baby to come through and out of the birth canal. We want to prepare during your pregnancy and begin teaching your pelvic floor how to relax and open. There are a few ways we can do so! First by focusing on your breathing and being in tune with what your pelvic floor is doing. Take a few minutes a day to perform deep relaxing breaths. Visualize pelvic floor relaxing and opening up with each inhale. The second way to relax pelvic floor is by stretching it. My 3 favorite stretches for the pelvic floor are butterfly, child’s pose, and deep squat. Hold these stretches for 60 seconds 3 times per day. Again, in these poses think about relaxing your pelvic floor versus clenching and squeezing.

Optimal pushing positions
Getting yourself in various positions during labor and the pushing phase can help facilitate baby down into the birth canal with more ease. These positions will look different whether you have an epidural or not. With an epidural your provider will likely want you in the bed, BUT this does not mean you are stuck on your back. There are many positions for you to utilize such as side lying, hands and knees, squatting on bed, use of the squat bar, and utilizing “tug of war” with a sheet or towel. With your pelvic PT, you will review your options for position in both the laboring and pushing phase. We will put you in these positions and see what is comfortable for you. This way when the big day comes it is not your first time doing them.

Tearing prevention
Tearing prevention is a huge piece of what we do in pelvic PT. We teach you how to properly perform massage to your perineum (space between vagina and rectum) to increase the stretch of the tissue and get it ready for baby. Perineal massage prepares the tissue for birth, reduces the risk of 3rd and 4th degree tears, decreases the need for stitching, and improves healing times. If you are seeing a PT we start performing this early on, but teach you how to complete it at home around 34-35 weeks pregnant. We can also teach partners how to perform it on you as sometimes it can be hard to reach with your belly in the way. Below you can see an image of the vulva with the perineum highlighted.

How to properly push
Yes! There is a right and a wrong way to push. The pelvic floor needs to be relaxed during your pushes to allow baby to come out of the birth canal. Again, if we think of the pelvic floor like a gate, we don’t want to be closing gate while baby is descending. We want pelvic floor to be open and relaxed. This means NO KEGELS when pushing. When we push, we want to keep our glottis (throat) open and avoid bearing down and holding our breath. We want to think about breathing baby out and down almost like we are pooping! Lots of women are coached in delivery to hold breath while pushing but that should be something of the past. If you plan to or have an epidural I recommend using a mirror to watch yourself push. This can help to show you what an efficient push looks like if you can’t feel it. Pushing properly promotes efficiency, prevents tearing, and reduces risk of prolapse. When working with pregnant moms, I like to start coaching you through practice pushes around 35/36 weeks. This gives you a few weeks to gain confidence, knowledge, and power before the big day.

Postpartum prep
Most first-time moms have no idea what to expect postpartum. Doctors and midwives often don’t have the time to discuss this with you while you are pregnant, but it is so important! Your physical therapist will talk you through everything you need in your postpartum kit to set yourself up for success including perineal bottle, perineal spray/foam, squatty potty, pads, and ice packs. We also spend time discussing how to safely return to exercise. This is very individualized based on someone’s prior activity level and the progress of recovery. Most of us aren’t ready to jump back into our exercise routine (or have sex) after 6 weeks. Just because your OB/midwife clears you at 6 weeks doesn’t necessarily mean you are mentally, emotionally, or physically ready. Below is an image of the proper “potty posture” with use of a squatty potty. This is so helpful in those first few weeks postpartum.

Education and knowledge
What your pelvic PT educates you on will be tailored specifically to you and your pregnancy. What are your birth preferences? Are you planning a hospital, home, or birth center birth? Do you plan on having a vaginal or cesarean delivery? Are you interested in pain medications? Do you plan to breastfeed?

….Not sure what your preferences are? That’s ok too! We will educate you on all your options so you can make an informed decision.

Whether this is your 1st pregnancy, 2nd, 3rd, or 4th having a pelvic physical therapist on your team can tremendously help you prepare for birth in these 6 ways and more! At Blossom Physical Therapy we treat all pelvic floor conditions, but helping women through pregnancy and prepare for birth is a huge passion of ours. We believe seeing a pelvic PT during pregnancy should be a standard practice of care.

One of the best parts about seeing a pelvic PT during your pregnancy is having someone who can address the changes that are happening in your body as they come up. This can be low back pain, sciatica, neck pain, pain with sex, round ligament pain etc. Having pain during pregnancy is NOT normal, and please don’t let anyone tell you otherwise. There are many treatments we utilize such as soft tissue massage, dry needling, cupping, and exercise prescription to keep you pain free during this special time.

Please reach out with any questions you have! We are here to help.

Dr. Melissa offers free phone consults prior to scheduling your appointment.