“I’m due in six weeks and I haven’t even started my kegels yet.”
That’s what my patient said to me last week as she walked in through my office door at our pelvic floor PT clinic, head hung low. She was feeling bad that despite coming to the end of her third trimester, she hadn’t yet started doing this specific exercise that everyone in her life had been reminding her to do.
My response? Relief.
Kegels, or pelvic floor contractions, are not necessarily the right way to train your body for birth. In fact, for many, kegels are contraindicated for the purposes of birth preparation specifically. If you’re confused by this, you’re not alone. Let’s dive into why and discuss 3 ways you can help prepare your pelvic floor and body for birth.
Kegels are a pelvic floor muscle contraction. Kegels to your pelvic floor are the same as bicep curls to your biceps. Kegels, done correctly and when necessary, can help strengthen your pelvic floor just like bicep curls, done correctly and when necessary, can help strengthen your biceps. But if your bicep was tight, your elbow chronically stuck in a bent position, you probably wouldn’t want to focus on bicep contractions. Similarly to if your pelvic floor is tight, which is common amongst young, fit people, you probably don’t need to focus on kegels.
To go one step further, in regards to preparing your pelvic floor for birth specifically, your pelvic floor does not actually need strength. It doesn’t. Your pelvic floor does not push your baby out. The sole job of your pelvic floor during birth is to get the heck out of the way with as little fight as possible. What happens to the pelvic floor during birth, you ask? During a vaginal birth, your pelvic floor stretches 2-4 times its resting length while your uterus and abdominal muscles push your baby out.
So is a strong pelvic floor a problem for vaginal birth? No, not necessarily. But a tight one can be. While strength training for pregnancy and postpartum recovery is recommended to help reduce the likelihood of symptoms like urinary incontinence, pelvic pain and even persistent diastasis recti postpartum, what your pelvic floor and body need for birth specifically is mobility and relaxation.
Now that we’re on the same page, let’s dive into 3 ways to prepare your pelvic floor for birth.
1. Pelvic floor muscle relaxation
Pelvic floor muscle relaxation, the opposite of kegels, is an important part of training your pelvic floor for birth. As discussed above, your pelvic floor stretches 2-4 times its resting length during vaginal birth. Flexibility in these muscles helps to reduce the amount of force required to help them move out of the way. More flexible muscles are less likely to impede the progression of labor and are less likely to experience more severe varieties of tearing during birth.
Pelvic floor muscle tension is not uncommon amongst young, fit people. While tension in your pelvic floor can be associated with symptoms like urinary urgency and frequency (feeling like you have a small bladder), pain with sex, constipation, even hip and back pain, others can have pelvic floor muscle tension and never experience any symptoms. Because your pelvic floor must stretch and relax during birth to allow a baby to pass vaginally, the more control we have over contracting and relaxing our pelvic floor, the better.
For a more detailed breakdown of pelvic floor relaxation exercises, check out this blog post on pelvic floor relaxation for birth. I’ll walk you through some steps to attempt pelvic floor relaxation below, but before I do, I want to highlight that it is normal for this to feel confusing, difficult or frustrating. Just like anything you’re trying for the first time, pelvic floor relaxation takes practice. Here are a few simple steps to begin with:
- When first practicing pelvic floor relaxation, I recommend you get into a comfortable child’s pose or happy baby pose variation.
- Once you’re in position with your knees wide and feet together, start breathing.
- Think about breathing your air down into your belly, into your pelvic bowl.
- Imagine your breath as a wave, filling your belly and pelvis as your breathe in, exhaling the air out.
- As you inhale, you can think about feeling your tailbone uncurl, your vaginal and anal openings relax, or your sit bones spreading. The relaxation happens on the inhale.
- Breathe slowly, in for four and out for four.
- Try various positions – if one doesn’t work, try another.
Check out this pelvic floor relaxation flow on Youtube for more guided practice.
2. Perineal massage
Most folks have heard of perineal massage but aren’t quite sure what it is or how to do it. Let’s clear that right up! Your perineum is the band of tissue that runs between the vaginal and anal opening. It’s the bottom of the vagina, where tearing is most likely to occur during vaginal birth. Perineal tearing occurs in roughly 85% of vaginal births, with most tears impacting only the skin and superficial muscles. Roughly 5% of those who experience perineal tearing will have a grade 3 or 4 tear, meaning a more severe tear.
While performing perineal massage during pregnancy cannot guarantee you won’t tear during labor, it has been associated with reduced severity of tearing during birth. For a detailed description with visuals, check out this free handout on perineal massage and follow along with me below. Perineal massage is the massage of the muscles at the bottom of the vagina from 3 to 9 o’clock, about one inch deep. It is not recommended to begin earlier than 35 weeks and it is always recommended that you receive clearance from your medical provider before beginning. This form of massage is not meant to be painful, but can be pretty uncomfortable. You should never feel such intense discomfort that you cannot breathe and relax through the sensation.
Here are a few simple steps:
- Lay back in a reclined, comfortable and supported position
- Use either your own finger, a pelvic wand, or the help of a partner
- Using lots of lube, insert the finger or wand about one inch into the vagina
- Apply pressure from 3 to 9 o’clock, never causing more than 3/10 discomfort
- If you feel a tender spot, hang out there for a minute or so before moving on
- Perform for about 10 minutes, 1-3 times per week
Though one goal of perineal massage is pelvic floor muscle stretching, another goal is teaching yourself to breathe through the discomfort. Remember to keep your body relaxed and reduce pressure if that feels impossible. Check out this video for more on this topic.
3. See a pelvic floor physical therapist during pregnancy
One last recommendation for preparing your pelvic floor for birth – see a pelvic floor PT during pregnancy rather than waiting until postpartum. As discussed above, it’s so common to have pelvic floor muscle tension and learning to relax your pelvic floor can be incredibly frustrating without support. Not to mention, some folks, particularly those with leakage and prolapse, may actually benefit from pelvic floor strengthening during pregnancy to prepare their body for postpartum recovery.
Bodies are complex and everyone needs something a little different. Working with a pelvic floor physical therapist allows you to gain a better understanding of what your baseline is and what your body needs for optimal support throughout pregnancy and birth. I don’t know who said it, but an ounce of prevention is worth a pound of cure. Working with a pelvic floor PT during pregnancy can help reduce your risk of urinary incontinence, perineal tearing, pelvic pain and diastasis recti postpartum.
If you’re in Austin, we’d love to see you at Lady Bird PT!
Dr. Rebecca Maidansky, PT, DPT
Rebecca Maidansky is a pelvic floor physical therapist and the owner of Lady Bird Physical Therapy, a clinic in Austin, TX that specializes in helping people manage pregnancy pains, prepare for birth and recover postpartum. Rebecca is a passionate pelvic health advocate who is committed to promoting pelvic health education across all platforms, for all people. You can find her writing on Lady Bird PTs blog and find her on Instagram and Youtube. To work with Rebecca, check out her Birth Preparation course or contact her directly to learn more about 1:1 appointments.
Pelvic floor physical therapist
Founder and owner of Lady Bird Physical Therapy
Creator of Birth Preparation and Postpartum Recovery