While you’re reading all the pregnancy books, painting the nursery and putting away the sweet little onesies- do yourself a favor and devote a little time to prepping your pelvic floor for labor.
The pelvic floor needs to be strong in order 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 during labor and delivery.
A quick anatomy review: Your pelvic floor is a set of muscles and connective tissue that sit inside the base of your pelvis. It forms a diamond that stretches from tailbone to pubic bone, and sitz bone to sitz bone. The female pelvic floor has multiple layers of muscle and three holes (urethra, vagina and anus) and so there are multiple ways to contract it. You contract the urethra when you hold in pee. You contract your anus when you hold in gas. And you “lift” your vagina… when you cue it? Try these suggestions: Imagine trying to lift a blueberry with your vagina. Or, imagine pulling a tissue out of a box with your vagina.
Developing good bodily awareness and control of these muscles is one of the most important things you can do to prepare for labor. After all, the pelvic floor is the exit door. If it opens easily, you’ll have a more efficient birth. Grease the hinges.
Here are a few tips that can help get your pelvic floor in good shape for delivery:
1) Learn how to control your pelvic floor with your breath.
Practice coordinating a gentle pelvic floor contraction (commonly referred to as a kegel) with breathing. On your inhale, take a diaphragmatic breath and relax and release your belly and pelvic floor. On exhale, allow your pelvic floor and belly to recoil or contract reflexively. If you can’t feel your pelvic floor contract on exhale, you can help it along with a gentle pelvic floor contraction. It’s important to place equal emphasis on the contraction AND relaxation. The cycle of contraction and relaxation takes your pelvic floor through a full range of motion and learning to feel that relaxation is an essential part of your pelvic floor prep.
As you get closer to labor, say 35 weeks and later, begin practicing a relaxation breath. To shift the focus on relaxing your pelvic floor, relax your pelvic floor on inhale and then maintain that sense of opening and release during the exhale. Inhale, relax and release. Exhale, hold that release.
I strongly encourage you practice pelvic floor relaxation during your pregnancy; it’s a difficult skill to learn on the fly during labor.
2) Use visualization to facilitate relaxing and opening your pelvic floor.
Try these two common visualizations associated with relaxing the pelvic floor:
1) Picture your pelvic floor as a flower blooming. Allow your pelvic floor (or just think of your vagina) opening on an inhale, allow it to stay open on the exhale.
2) Visualize your vagina opening like ripples traveling outward from a pebble dropped in water. Think about the ripples propagating on the inhale, and continuing to spread outward on the exhale.
You can combine pelvic floor relaxation exercises and visualizations in a breathing exercise known as the “Flower Bloom Breath” (brainchild of @holistichealthphysio) and very easy to find with a quick google). 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.
3) Lengthen and mobilize your pelvic floor while you are pregnant.
Try out the breath work and visualizations in positions that encourage relaxation of the pelvic floor. A couple of positions that encourage relaxation and that are accessible throughout all trimesters of pregnancy are a supported deep squat (pictured above) and a seated or semi-reclined cobbler pose (pictured below).
4) Learn and practice a variety of pushing positions.
Not all pushing positions are created equal when it comes to your pelvic floor. Positions such as hands and knees or side-lying put the pelvic floor in a more relaxed position and are associated with less of a risk of tearing (not a zero risk!). Try practicing relaxing your pelvic floor in these positions, as well as other common positions such as on your back or in a supported squat.
While it’s lots of fun to plan out the perfect positions we’d love to use in labor, sometimes baby has other plans, so it’s best to be comfortable in a variety of poses.
5) Practice perineal massage.
Your perineum is the area between the opening of your vagina and your anus. It’s composed of skin, fascia and muscles.
Perineal massage may reduce your risk of tearing by preparing your tissues and allowing you to become comfortable and tolerant of stretch in your vagina. If you’re game, begin perineal massage around 35 weeks of pregnancy. It will be more effective the earlier you introduce it.
The short video below does an EXCELLENT job of explaining the process.
I can’t understate the value of learning to harness control of your pelvic floor in preparation for labor. If you need additional support gaining awareness of your pelvic floor, or if you want to take your pelvic floor prep to the next level, I recommend a prenatal visit with a pelvic health physical therapist. These professionals can make sure you’re doing what you think you’re doing when you contract and relax (some people have it backwards!), identify parts of your pelvic floor that could benefit from manual therapy and offer advice about birthing positions in which your pelvic floor is maximally relaxed.
If you are looking for 1:1 guidance as you prepare for birth, please reach out. I offer virtual consultations and online personal training tailored to your unique stage of pregnancy and birthing goals.
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My mission is to make sure that having a baby is not a reason why you can’t do all the things.
Contact me if you have questions about exercise or pelvic health pertaining to pregnancy or postpartum. I work with people locally (Seattle’s Eastside: Redmond, Bellevue, Kirkland and surrounding areas) and online to develop personalized pregnancy and postpartum personal training plans. I also offer labor support (birth doula services) within the greater Seattle-Metro Area.