What does pelvic floor physiotherapy entail and how does this change during pregnancy?
Because every pregnancy is unique, it is best to have at least one pelvic floor exam to establish a baseline, ensure safety, and tailor a treatment plan before beginning pelvic floor exercises. Doctors trained in pelvic floor health can:
- Ask questions about your health history that may affect pelvic floor muscle function
- Perform an internal and external examination to address problem areas or, if using virtual care, guide a pelvic floor muscle self-examination
- Teach you how to prepare your body for childbirth and give you personalized exercises to facilitate childbirth
As your pregnancy progresses, your doctor may gradually adjust pelvic floor physical therapy exercises to meet your individual goals. Your program can start with positions that make it easier to connect with the pelvic floor muscles and then progress to positions that offer more challenge. For example, if your pelvic floor is tight, your doctor may first teach you how to relax your pelvic floor muscles by practicing a Happy Baby Pose with breathing techniques. If drug-free birth is your desired outcome, you can continue learning effective hands-and-knees pushing techniques.
Are pelvic floor exercises and therapy relevant for people planning both vaginal and cesarean section deliveries?
Yes. Regardless of how you give birth, pelvic floor health is important during pregnancy and postpartum. It is estimated that approximately half of all pregnant people experience symptoms of weakened pelvic floor muscles. This can eventually cause problems with bladder and bowel control and sexual discomfort.
During pregnancy, the tension on these muscles increases as they support the weight of the baby, the placenta, the uterus and the increased blood volume. Hormones, such as relaxin, are also secreted in preparation for birth, which loosen the ligaments and contribute to the flexibility and instability of the pelvic joint.
What specific stretches, strengthening movements and mobility exercises are most helpful?
Until you can see a pelvic floor physical therapist, learning about how your pelvic floor muscles work during labor and pelvic floor exercises you can practice during pregnancy can help you identify specific muscles and increase flexibility. Be aware that some well-intentioned pregnant people do pelvic floor exercises but are actually doing them incorrectly. Proper muscle identification and exercise technique are essential for supporting your changing body and growing baby.
How can I physically prepare your body for labor during each trimester?
First trimester
Regular exercise overall, it’s a healthy habit to adopt or maintain during pregnancy.
Staying active with cardio and strengthening exercises can improve your body’s ability to:
- Adapt to the ever-changing shape
- Carry the extra weight of pregnancy by strengthening muscles and joints
- Prepare for and increase the stamina needed for labor
A good exercise routine includes an adequate warm-up before and cool-down after exercises. Aim to spend 30 minutes each day doing activities that you enjoy and feel comfortable with. These can include walking, running, dancing, yoga, swimming and aerobics classes.
Moreover, for pelvic floor exercises during pregnancy, it is never too early to start. You can start with basic exercises in the first trimester!
Second trimester
As your baby continues to grow in the second trimester, the uterus rises above the pelvis. You may experience an increase in urinary incontinence. Depending on the type of incontinence you experience, pelvic floor exercises can help strengthen or relax the muscles to provide relief. A pelvic floor physical therapist can help you determine which exercises are most effective and instruct you on how to perform them effectively.
Third trimester
If you plan to give birth vaginally, the focus of pelvic floor physiotherapy shifts to learning to prepare for childbirth in the third trimester. This is accomplished by learning how to relax and lengthen your pelvic floor muscles. Focusing on deep abdominal and breathing exercises can also help you prepare for the pushing phase of labor.
Additionally, the perineal muscles and tissues between your vagina and anus can be stretched significantly during the pushing phase of labor. Perineal massage is a great way to get your body ready for labor, starting around age 35e week. Your pelvic floor physical therapy doctor can teach you effective massage techniques that you can perform yourself.
Why is lengthening/relaxing the pelvic floor so important during late pregnancy and childbirth?
To facilitate vaginal birth, the pelvic floor muscles need to stretch and thin. Physical therapy to prepare for childbirth may include squatting exercises that can increase the flexibility of the hip muscles and pelvic floor, and diaphragmatic breathing to help relax and lengthen these muscles.
How can pelvic floor physiotherapy be helpful for planned cesarean section deliveries?
Exercises during the third trimester that continue to progressively condition the pelvic floor and abdominal muscles can Reduce muscle weakness and nerve tension muscles as your due date approaches, especially if constipation has been a problem. After delivery, your pelvic floor physiotherapist can provide you with individual guidance and support during recovery after a caesarean section after surgery.
How can you prepare mentally and emotionally for childbirth?
Spend some time visualizing your birth and thinking about the fact that things can happen during labor not in your control and it’s no one’s fault. Pay attention to emotions that arise and give yourself permission to feel them. You can use your feelings to provide useful information that will help you create a plan that includes your preferences; offers plenty of room for flexibility, as every birth is unique; and focuses on the end goal: a safe birth for you and your baby.
What are some practical mindset strategies as your due date approaches?
- You can get questions answered and be informed about current best practices and birth options by attending in-person or virtual childbirth classes. Research suggests that participation in prenatal classes can help improve a mother’s emotional well-being before and after childbirth. These classes cover a variety of topics, including the physiology of labor, pain management techniques, and general tips on how to mentally prepare for labor.
- Prenatal yoga classes can teach breathing, stretching and relaxation positions that are specifically beneficial during pregnancy and childbirth. They can help in the fight stress and anxiety symptoms during pregnancy.
- Setting up mental health care with a professional trained to work with pregnant people can be a proactive step toward reducing anxiety and learning effective coping strategies. Working with a mental health professional will even help prevent symptoms of postpartum depression, but if they do arise, you already have a known resource ready to provide help and support. Seven Starlings And Mavida Health are great resources for people looking to connect with a mental health provider.
Whether this is your first pregnancy or you have given birth before, practicing pelvic floor physical therapy and mental preparation exercises can help you feel empowered during your pregnancy journey and delivery. At Origin, our pelvic health specialists understand the unique challenges of pregnancy. Book a visit today to help you prepare for the smoothest birth and postpartum recovery possible. You got this!
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