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©2020 by Laura Jawad, LLC.

Childbirth preparation for athletes

Updated: Jan 4



This post is inspired by a topic near and dear to me: the somewhat unique considerations that an athlete might consider when preparing for childbirth. When I was pregnant with my daughter, I pushed my athleticism pretty hard (you can read more about my experience here). And I accomplished a challenging and somewhat traumatic (physically and mentally) vaginal birth. The pelvic floor dysfunction that is a legacy of that pregnancy and childbirth will always leave me wondering how much was due to my athletic choices and physical tendencies, the specific circumstances of my delivery and/or the interplay between the two. What I do know, is that pregnant or not, my athletic activities tend to ratchet up my pelvic floor hypertonicity. And I also know it’s harder to push a baby through a tight pelvic floor than a relaxed one, potentially leading to more injury.


Before I dive in, I want to acknowledge that the research supports the idea that exercise often improves labor and delivery outcomes with respect to shorter labor times, decreased risk of instrument assisted deliveries and unplanned cesareans (1,2). However, the research can’t keep up with the evolving athletic preferences of pregnant athletes. And research studies only explain what happens on average amongst a defined sample group; it’s difficult to extrapolate the results of research studies to individuals. Given the range of individual training history and wide variety of choice in exercise and sports selection, athletes need to be considered on an individual basis.


Given my own experience with muscle tension and a hypertonic pelvic floor, I’m certain that my athleticism exacerbated the difficulties I experienced during labor. So, I’m going to continue this post from the perspective that for particular individuals, they can benefit from down-training their athletic mindset and high muscle tone in preparation for labor.


To begin, I want to clarify my definition of an “athlete”. I believe “athlete” is a self-selected term, and might apply to anyone intentionally pursuing fitness, exercise or movement. Athleticism spans a spectrum of intensity and the way in which your athleticism impacts your pregnancy probably depends on your choice of activity, the intensity at which you pursue it and will vary a lot from person to person.


So why might an athlete need to prepare for childbirth any differently from someone who is sedentary. After all, “fit pregnancy = healthy mom and baby”, right? On average, sure! But this statement also depends on how one defines “healthy mom” and often the definition doesn’t consider things like mental health or pelvic health.


Mindset


Athletes can tend towards a mindset of a desire or desperation for control over their body, driven by athletic performance or aesthetic goals (google Brianna Battles’ discussions of ‘Athlete Brain’). It can lead them to ignore signs and symptoms that their body is on the verge of injury. Add to this that among pregnancy fitness circles, labor is often coined “the ultimate marathon” or “ultimate athletic event” and it may lead some pregnant athletes to treat labor like an athletic goal rather than a physiologic event (Guilty!).


During labor this might show up in a couple of ways: By treating your desired labor outcome like an athletic goal, one might be unprepared for a cascade of outcomes that deviate from their plan or “training”. It can be really traumatizing for someone who is used to being very in control of their bodies to relinquish that control to their biology and accept alternate outcomes. In pursuit of their goal, they might push their body past the realm of (productive) pain into the realm of suffering (check out Penny Simkin’s blog posts under Resources at the end). Or, they might feel like a failure because despite their preparation, they failed to hit whatever goal they set.


Childbirth is a lot less predictable than an athletic competition. And it can take a hell of a lot longer. And you’ll never be able to train for it with the same level of specificity as an athletic event. During childbirth, there are many more degrees of freedom for things to deviate from plan. I strongly suggest you don’t narrow your birth prep in on one outcome so narrowly that you are unprepared in the event that things take at turn you aren’t expecting.


Beyond the brain: Pelvic floor awareness, control and relaxation


There’s the popular idea that athletes are training to be “fit for birth”. But unfit people give birth successfully everyday. And for people who are relatively untrained, there is truth to the idea that improving your fitness benefits you, your baby, improves labor and delivery by numerous metrics and sets you up for a strong recovery. If you were athletic before your pregnancy and you maintain your fitness routine into your pregnancy, you are likely more than “fit enough” for birth. What most athletes need to do is to learn safe strategies and modifications to maintain their fitness through their pregnancy and strategies to relax tension in their bodies to prepare for labor and delivery. I’ll focus on the relaxation piece for the rest of this post.


Athletes tend to carry a lot of tension in their bodies, including in their pelvic floor and pelvic ligaments, and this can create a physical obstacle to overcome during a vaginal delivery. Similarly, certain athletic habits can create obstacles. For example, athletes are really good at tensing their bodies under load or exertion. During sport, this ideally includes the pelvic floor. However, if a birthing parent falls into this automatic pattern while pushing during labor, it can make it a lot more difficult to deliver their baby.


Pelvic floor awareness and relaxation


The pelvic floor needs to be strong and able to support the added weight of the uterus during pregnancy, but it also needs to be able to relax and yield to let baby through. A pelvic floor that does not yield can increase the duration of labor and potentially lead to more pelvic floor injury incurred during delivery or unwanted interventions.


The pelvic floor has three basic positions, relaxed, contracted and bulged. A pregnant person should work on developing awareness of their pelvic floor and develop control over all three positions. Since the contracted position is quite similar to the sensation of holding in urine or gas, it seems to be relatively accessible to a lot of people. Relax and bulge can be a little bit more difficult to access. Relaxing is similar to the sensation of releasing urine and bulging is similar to the sensation of trying to force urine out when you’re in a hurry. If you are having difficulty finding these positions, it is very much worth your time to schedule an appointment with a pelvic floor PT before you have your baby so that you can learn to relax and access these muscles during labor.


Visualization is another excellent tool to assist in pelvic floor relaxation. Two common visualizations associated with relaxing the pelvic floor include picturing your pelvic floor as a flower blooming and opening or as ripples traveling outward from a pebble dropped in water. You can combine pelvic floor relaxation exercises and visualizations in a breathing exercise known as the “Flower Bloom Breath” (link provided in resources below). This is also an excellent breath to practice during the pushing stage of labor and is similar to the birth breathing taught by childbirth education programs including Hypnobirthing.


I encourage you to practice the visualizations, pelvic floor relaxations and birth breathing in positions that encourage relaxation of the pelvic floor and positions that you might want to use during the second stage (pushing) of labor. Two examples of positions that encourage relaxation and that are accessible throughout all trimesters of pregnancy are a reclined cobbler pose and a supported deep squat.


Reclined cobbler pose (left) and supported deep squat (right)

Begin making pelvic floor relaxation a part of your routine no later than 35 weeks into your pregnancy. If you’ve been practicing a connection breath or piston breath, this is the time to start practicing a relaxation breath. A pelvic floor PT will be able to tell you whether or not you should continue practicing piston breathing in the final weeks leading up to your delivery.


Relax during exertion


With the Flower Bloom Breath, you’re practicing a skill that can be really counter-intuitive to athletes: you’re learning to relax your pelvic floor when the rest of your body is under tension. In the gym, we’re trained to exhale on exertion during a lift. And that exhale causes the pelvic floor to reflexively contract during the physical challenge. Take a squat as an example: We inhale on the way down, and as we stand we exhale, contracting the pelvic floor to counterbalance the intra-abdominal pressure created by the exertion.


During labor, we want to be able to exhale during a contraction, which will keep the abdominal muscles active, but keep the pelvic floor soft. If you contract your pelvic floor during a contraction or during pushing, you are working against yourself. We actually want the pressure generated by the exhale to be directed at the pelvic floor to assist in pushing baby out. It can be a bit like patting ones head and rubbing ones tummy at the same time, so it’s an important skill to practice BEFORE going into labor. In the case that you are coached to breath hold and push during labor, it’s the same deal. You need to learn to relax that pelvic floor to help let baby through.


Pelvic ligaments


In addition to pelvic floor considerations, Spinning Babies also recommends that highly athletic mothers pay attention to their sacrotuberous ligament. This ligament connects the tailbone to the sitz bones. When it is tight, it pulls these two bones together, tightening the birth outlet to a degree. Spinning Babies teaches that this ligament can become thick and tight under strenuous physical activity and thus tends towards being tight in highly athletic mothers. A pelvic floor physical therapist can work with you to release the tension in this ligament and create movement in the sacrum.


Speaking of physical therapists, I’m diving into a few of my favorite resources and references below. But first, what has YOUR experience been? I would love to hear how your athletic pregnancy impacted your delivery experience. Please leave feedback below or through my Contact Page!


Resources


So you need to learn to relax the pelvic floor, associated soft tissues or relax under exertion. Who do you go to for help? Pelvic floor physical therapists are an obvious first line. Prenatal massage therapists and chiropractors are excellent additions to your care team and can help balance muscle and soft tissue tension and alignment. Check out my resource page for some links to help you find relevant professionals.


Here are some of my other favorite birth-prep resources that might be particularly helpful for athletes:


Spinning babies website:

Daily Essentials: Suggested stretches and exercises to improve pelvic mobility and increase range of motion in your pregnancy body to prepare for birth.

Side-lying release: This partner-assisted technique , described by Spinning Babies, is thought to release tension in pelvic floor muscles. This is a great addition to the pelvic floor relaxation, visualization and breath work described elsewhere in this post.

Sacrotuberous ligament release


Flower Bloom Breath (YouTube video)


-Pain, Suffering, and Trauma in Labor and Subsequent Post-Traumatic Stress Disorder

-Part 2: Pain, Suffering, and Trauma in Labor and Subsequent Post-Traumatic Stress Disorder: Practical Suggestions to Prevent PTSD After Childbirth

These blog posts are an excellent mindset-check written by pioneering physical therapist and doula Penny Simkin. For individuals who may treat a goal of an un-medicated childbirth as an athletic goal, these blogs offer a wonderful discussion of why you must understand pain versus suffering, when to consider giving yourself some grace, and practical suggestions for dealing with pain during labor.


Hypnobirthing This is the relaxation-based childbirth method I have direct experience with.



References


(1) Clapp III JF, Cram C. 2012. Exercising through your pregnancy: Addicus Books

(2) Bø K, Artal R, Barakat R, Brown W, Dooley M, et al. 2016. Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 2—the effect of exercise on the fetus, labour and birth. Br J Sports Med 50: 1297-305