Pregnant & Feeling Great? Here’s Why Pelvic Floor Therapy Still Matters

There’s a misconception that prenatal pelvic floor therapy is only recommended if you’re experiencing pain, leakage, or other symptoms. Here’s why pelvic floor therapy still matters even if you’re symptom-free.

Pregnancy brings a lot of challenges. Your body is constantly adapting to a growing baby which means more demands on your joints, muscles, and ligaments. For many women, this means increased tension through their pelvic floor muscles because the muscles are working harder to support the weight of your growing baby and working overtime to stabilize your pelvis as it slowly loosens to prepare for birth. Unfortunately, for a vaginal child birth, we need a pelvic floor that can relax and lengthen to get out of our way. That’s where pelvic floor PT for birth prep comes in.

What Does Birth Prep Look Like if I’m not having problems?

During your first birth prep session, your pelvic floor therapist will ask you about your birth plan and preferences (Where are you birthing? Vaginal birth or cesarean? Medicated or unmedicated?) to understand how best to support you. Your pelvic floor specialist will then assess the movement of your hips, spine, pelvis, uterine ligaments, and may suggest a pelvic floor muscle assessment as well (if medically appropriate and only with your consent). Based on these findings, your therapist may perform some hands-on work to help optimize tension and mobility through these areas and may send you home with some “homework” assignments.

1. Perineal Massage

One of the things that I get asked about frequently as a pelvic floor physical therapist is perineal massage. Perineal massage is a technique to stretch the soft tissues of the pelvic floor (muscles, skin, fascia) before birth to reduce your risk of tearing. Perineal massage has some evidence that it reduces the risk of high grade tears (grade 3 and 4) in first time vaginal births. Perineal massage can also teach your nervous system to be used to touch, stretch, and discomfort in this intimate area of your body so that your muscles are less likely to guard/tighten during child birth when you feel these same sensations. 

Some women prefer to have their partner assist them in perineal massage. For women, performing perineal massage themselves can help them become more familiar and comfortable with this part of their body. For these individuals, I recommend a pelvic wand like this one from VWell or this one from Intimate Rose. The wand makes it easier to reach the perineal area without your belly getting in the way. I recommend spending 3-5 minutes on perineal massage 2-4 times per week starting around 32-34 weeks for most of my clients with low-risk pregnancies. 

2. Push Prep

We’ve all seen movies and TV shows portrayal of childbirth where women are on their backs pushing with their legs pulled up towards their arm pits and hold their breath and push as hard as they can – and while this is common, it doesn’t make the most sense if we think about of the anatomy of the pelvis. When you’re laying on your back, your vagina (the birth canal) is actually angled upwards, so you have to push “uphill” to get baby out. This position also limits the movement of the sacrum and tailbone, which means other tissues have to stretch or lengthen more to create space for baby to exit. 

Your pelvic floor therapist can also instruct you on effective pushing strategies and positions and give you real-time feedback on what positions and breathing strategies are helping you the most. There’s no one “right” position, but some positions might help your pelvic floor relax more easily and can use gravity to assist your baby’s movement through the birth canal. Your pelvic floor therapist can help you decide what options work best with your anatomy and your birth plan. 

There’s also no “right” way to push - but some techniques might be more productive than others. Your pelvic floor PT can instruct you on different pushing strategies like how to breathe baby down and use vocalization to relax your pelvic floor and give you feedback on what’s going well and what’s not. They may even instruct you to hold your breath and push. While this isn’t what I recommend to everyone, there are definitely individuals that actually have the most effective pushing and pelvic floor lengthening like this.

3. Mobility Exercises

Based on where your body has tightness or restrictions, your pelvic floor specialist will likely assign you a set of stretches and mobility work to help open up these areas. This might include stretches for the muscles that attach around the pelvis, breath work, and mobility work through your spine. If you’re busy, tired, or just struggling to dedicate the time to birth prep stretches, having a dedicated list of what your body most needs can be a really wonderful starting place rather than trying to do dozens of stretches you found online that may or may not align with where your time is best spent.

4. Education

Pelvic floor physical therapy can help you feel more prepared for birth by providing education about birth-related injuries, the potential use of instruments such as forceps or vacuum, and what recovery may look like after a vaginal birth versus a cesarean birth. Our goal is not to tell you how you should give birth, but to empower you with the knowledge to make informed decisions that are right for you and your baby. Understanding potential risks, benefits, and recovery can help you advocate for yourself, ask the right questions, and feel confident providing informed consent if your medical team recommends an intervention that wasn’t part of your original birth plan.

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Affiliate Disclosure: This post may contain affiliate links. If you purchase a product through one of these links, I may receive a small commission at no additional cost to you. I only recommend products I believe may be helpful to my patients and readers.

Medical Disclaimer: This blog is for educational purposes only and is not intended to diagnose or treat medical conditions. Please consult with a qualified healthcare provider before beginning any new treatment or exercise program.