Preparing Your Pelvic Floor for Birth: A Guide

Preparing your pelvic floor for birth is one of the most important ways to support a smooth labor experience and ensure a quicker, smoother postpartum recovery. With a pelvic floor that is both strong and mobile, you’re giving your body the best tools to meet the physical demands of birth. These muscles will need to relax, lengthen, and withstand pressure as your baby moves through the birth canal. Learning how to stretch and lengthen them during pregnancy can reduce the risk of perineal trauma, including tearing, and lower the likelihood of postpartum pelvic floor issues.

In this, you’ll learn about building a balanced approach to pelvic floor strength and mobility, exercises that can help you prepare, and ways to increase awareness of your pelvic floor muscles for the birth process.

The main things we want to focus on for pelvic floor preparation for birth during pregnancy:

1. Pelvic floor strength and awareness
2. Perineal stretch capacity and tolerance
3. Pelvic floor and adjacent muscle mobility and relaxation
4. Breath work for optimizing pelvic floor expansion

The Importance of Pelvic Floor Strength for Labor

Many people associate pelvic floor health solely with muscle tightness or strength, but effective pelvic floor preparation involves flexibility, endurance, and control. When strong but pliable, pelvic floor muscles better tolerate the stretching and pressure needed for birth. Studies have shown that well-conditioned pelvic floor muscles not only contribute to shorter second stages of labor but also increase the likelihood of an unassisted birth.

A study found that pelvic floor muscle training during pregnancy reduces rates of prolonged second-stage labor, where the baby descends through the birth canal. Building strength can help with the muscle’s ability to  release pressure when needed, reducing obstruction and potentially shortening labor. Strong muscles can better withstand pressure, and when combined with stretching practices, they’ll also be flexible enough to relax and release. So, don’t be afraid to keep up with specific pelvic floor strengthening, as long as you are concurrently working on pelvic floor relaxation and elongation as well.

This combination of strength and mobility prepares your pelvic floor to handle the dynamic pressures during birth while minimizing stress on the muscles. Pelvic floor exercises like kegels focused on 2 second holds followed by full relaxation and then kegels focused on 10 sec holds and full relaxation can build the necessary strength and control for a responsive pelvic floor through pregnancy and even into postpartum. 

Pelvic Floor and Perineal Stretching

Perineal stretching is another powerful technique to reduce the risk of severe tears (grade 3 and 4) during childbirth. Studies show that manual perineal stretching performed during pregnancy can reduce the risk of perineal trauma, decrease the need for episiotomy, and prevent the use of forceps or other assisted delivery methods. Preparing your perineal tissue allows it to become more tolerant to the stretch sensation, which can decrease the discomfort and shock that some people experience during crowning.

Perineal Massage Instructions: How to Get Started

Starting at 34 weeks of pregnancy, you can begin a gentle perineal massage routine to help prepare for birth. Doing this daily is ideal, but even four days a week can make a difference.

You or your partner can perform the massage. Here’s a simple guide to get started:

1. Prepare for the Massage:

• Wash your hands and trim your fingernails for safety.

• Find a comfortable spot where you can reach your perineum easily. Lying on your bed with pillows for support, sitting in a warm bathtub, or any comfortable position will work.

2. Use Lubrication (Optional):

• You can use a water-based lubricant on your thumbs or fingers if you prefer, or you can perform the massage without any lubricant.

3. Begin the Massage:

• Insert both thumbs or two fingers gently into the vaginal opening.

• Take a deep breath in, and as you breathe out, apply slow, steady pressure toward the back of the vagina, in the direction of the rectum.

• Start with light pressure until you get used to the sensation—there’s no need to push too hard.

4. Hold and Stretch:

• As you continue to breathe, hold this gentle stretch for about 60-90 seconds until you feel a slight tingling or numb sensation.

• While maintaining the pressure, slowly glide your thumbs or fingers out to the side in a “U” shape.

5. Repeat:

• Continue this “down and out” U-shape motion for up to 5 minutes, breathing steadily throughout.

6. After the Massage:

• If you feel any soreness, you can place a warm or cold pack on the perineal area or soak in a warm bath to relax.

• Over the coming weeks, you can gradually increase the stretching pressure as it feels comfortable.

 Pelvic Floor and Pelvic Muscle Mobility:

Stretches that focus on pelvic floor lengthening are important in allowing the pelvic floor mobility needed to stretch and elongate and baby is making its way down and out of the body. It’s important to focus on 2 types of stretching: specific pelvic floor lengthening and then adjacent muscles group relaxation and mobility.

There are two types of stretching exercises you can focus on for pelvic floor preparation: Lengthening exercises and stretching the adjacent muscles groups. 

1. Lengthening Exercises: These target the levator ani muscles, which are responsible for supporting the pelvic organs. They also help stretch the superficial and deep transverse perineal muscles, as well as the bulbocavernosus muscles, which surround the vaginal opening. Recommended stretches include:

• Deep Supported Squat: Stand with feet wide apart and lower into a squat position, using support as needed with a yoga block or pillow. This opens the pelvis, stretches the pelvic floor, and allows gravity to assist in the release of tension.

• Child’s Pose with Hips Internally Rotated: This pose increases flexibility in the deep pelvic floor muscles and hips. With hips internally rotated you are getting levator ani widening and even stretching the superficial and deep transverse perineal muscles in the back of your pelvic floor two widen and open. While in child’s pose, rotate the hips inward to target the muscles involved in elongation during labor.

• Happy Baby Pose: Lie on your back and bring your knees toward your chest, holding your feet. This position helps release tension and open the back pelvic floor muscles and open through the bulbocavernosus muscles, which is essential for labor preparation.

2. Stretching Adjacent Muscle Groups: Tension in the glutes, hip rotators, and adductors (inner thigh muscles) can restrict the pelvic floor’s range of motion. When these muscles are tight, they can prevent the pelvic floor from fully elongating, which can contribute to tearing during birth. Here are some recommended stretches to improve flexibility in these surrounding muscles:

• Hip 90/90’s: Sit on the floor with one leg in front at a 90-degree angle and the other leg positioned similarly behind. This stretch helps allow for hip external rotator stretching in the front hip and internal rotator stretching of the back hip.

• Glute Rock Backs: Start on all fours with pelvic in anterior pelvic tilt position and slowly sit back toward your heels, focusing on a gentle stretch in the glutes.

• Adductor Reach-Throughs: From a tabletop position, extend one leg to the side and sit back slightly. Reach your arm on the side of your extended leg under your opposite arm and away from extended leg. This targets the inner thigh, opening the hip and providing greater pelvic mobility.

Research has shown that increased pelvic mobility allows for more effective stretching and can ultimately lower the risk of pelvic floor injuries during labor.

Breathing Techniques for Pelvic Floor Connection

Another critical part of preparing your pelvic floor for birth is learning how to connect your breath with pelvic floor movement. This is an important part of pelvic floor mobility. Your diaphragm and pelvic floor mirror each other as you breathe: they both expand when you inhale and contract and lift when you exhale. Practicing breathing exercises that encourage pelvic floor relaxation and lengthening can help you better control these muscles during labor.

One effective way to practice is to sit on a rolled-up towel and imagine your perineum relaxing and opening with each breath. You can also use a mirror for visual feedback on how your pelvic floor responds to different types of breathing. Here are some breathing techniques to try:

Lying on your side, with a pillow between your legs, have your hand resting on your lower belly. Slowly inhale and imagine your belly expanding down and into your hand. Exhale and let the air passively leave your body. As you inhale in, imagine your pelvic floor opening and expanding away from you.

Use of visual cues: 

1. With your inhalation, imagine a flower blooming down and out of your vagina and anus.
2. With your inhalation, imagine a balloon filling into your lower belly, into your sit bones, and down and into your anus.

With exhalation: Use open vowel, “ahhh”, “ohhhh”, and “uhhh” sounds to allow for pelvic floor opening and elongation as you are exhaling

Work on these breathing strategies in all pelvic floor focused stretches for an increased benefit.

Putting It All Together. Pelvic Floor Mobility for Birth and Beyond.

As you approach your due date, practicing these techniques can help make them feel more intuitive. Your breathing techniques can be done on the toilet while having a bowel movement, where you can feel the natural release of the pelvic floor in a supported position. Practicing in various labor positions, such as squatting, side-lying, or on all fours, is also beneficial, as these mimic the positions you may use during labor.

Using a mirror for feedback can be helpful when working on these breath work techniques and even perineal stretches. Watching your perineum bulge, elongate, and relax can give you a better understanding of how your body is responding, and it can make you more comfortable with the sensations of release and stretch that will be required during birth.

Pelvic floor mobility and strength are essential for birth preparation and postpartum recovery. Building strength, practicing targeted stretching, and learning controlled breathing techniques can collectively prepare your body to meet the demands of labor. Not only do these practices lower the risk of severe tearing, but they also reduce the likelihood of postpartum pelvic floor dysfunction, including bladder leaks, bowel issues, pelvic organ prolapse, and chronic pain.

Taking the time to prepare your pelvic floor can make a meaningful difference during labor and set you up for a healthier recovery postpartum.