Labour Prep and the Role of Pelvic Floor Physiotherapy
Sophie Mason, PT, MPT, BSc (Hons.)
Pelvic Health Physiotherapist
Preparing for labour can bring a mix of excitement, questions, and uncertainty. While much of pregnancy preparation focuses on prenatal appointments, nutrition, exercise, and choosing a birth plan, one area that deserves more attention is pelvic floor health.
Pelvic floor physiotherapy can be helpful during pregnancy regardless of how you plan to give birth. Even if you are planning a caesarean birth, your pelvic floor, hips, spine, and nervous system are all adapting to the physical demands of pregnancy. Physiotherapy can help you better understand your body, manage pregnancy-related symptoms, and prepare for your postpartum recovery.
For those planning a vaginal birth, pelvic floor physiotherapy can also be a valuable part of labour preparation. It can help you understand how your pelvic floor works, how to relax and lengthen these muscles, how your body can move during labour, and what options you may have for managing discomfort.
Ultimately, labour preparation isn't about finding a way to guarantee a particular birth outcome. It is about giving you information, skills, and options so that you can feel confident making informed decisions throughout your labour.
Key Takeaways
Labour requires both strength and relaxation of the pelvic floor muscles. Being able to consciously relax and lengthen these muscles is particularly important during the pushing stage.
Pelvic floor physiotherapy can help you prepare your body and nervous system for labour, including breathing, relaxation, hip mobility, biomechanics, positioning, and strategies for managing discomfort.
Understanding your options can help you feel more confident during labour. Education about positions, equipment, pain management, and pushing strategies allows you to make informed decisions as labour unfolds.
Pelvic floor physiotherapy can be valuable even when planning a caesarean birth, helping manage pregnancy symptoms and preparing for postpartum recovery.
What does the pelvic floor have to do with labour?
The pelvic floor is a group of muscles, connective tissues, and other structures that sit at the bottom of the pelvis. These muscles support the pelvic organs, contribute to bladder and bowel control, and play an important role in sexual function.
During pregnancy and birth, the pelvic floor has an additional job: it needs to accommodate the baby as they move through the pelvis and vaginal canal.
This means that labour preparation isn't simply about strengthening your pelvic floor. In fact, for birth, the ability to relax and lengthen the pelvic floor muscles is just as important as their ability to contract.
During the pushing stage of labour, your pelvic floor needs to soften and allow the tissues around the vaginal opening to stretch. If you habitually hold tension in these muscles, learning how to consciously release them can be an important part of your preparation.
A pelvic floor physiotherapist can assess how well you can contract and relax your pelvic floor, identify areas of increased tension or sensitivity, and teach you strategies to improve your awareness and control.
How can pelvic floor physiotherapy help prepare my body for labour?
A prenatal pelvic floor physiotherapy assessment is individualized to you, your symptoms, and your goals.
One of the most useful skills to practice is pelvic floor relaxation. Your physiotherapist may teach you breathing techniques that coordinate your diaphragm, abdominal muscles, and pelvic floor. For example, you may practice allowing the pelvic floor to gently “drop” or lengthen as you inhale rather than instinctively tightening the muscles.
What role do hip mobility and biomechanics play?
Labour involves a tremendous amount of movement through the pelvis. Your hips, pelvis, spine, and surrounding muscles all work together as you change positions and move through different stages of labour.
This is where hip mobility and biomechanics can become an important part of labour preparation. Your physiotherapist may assess how your hips and pelvis move and teach you different exercises and positions that encourage more comfortable pelvic mobility.
Understanding biomechanics can also help you recognize that there isn't one ideal position for labour. Small changes in hip position, pelvic position, or trunk position can change how different areas of the pelvis are loaded. Having a variety of positions available can therefore be a useful tool for comfort and mobility during labour.
How can understanding the nervous system help during labour?
Labour is not only a physical experience—it is also a nervous system experience.
When we experience pain, the brain and nervous system respond to what is happening in the body, but they are also influenced by factors such as fear, stress, previous experiences, environment, and our sense of safety and control. Understanding this can be incredibly useful when preparing for labour.
Pelvic floor physiotherapy can introduce strategies that support conservative pain management, such as breathing, movement, relaxation, positioning, touch, massage, visualization, and other sensory strategies.
This doesn't mean that pain during labour is “just in your head,” nor does it mean that these techniques will eliminate pain. Instead, the goal is to give you additional tools for managing the experience and helping your nervous system respond to labour in a way that feels more regulated and supported.
Learning these strategies before labour is helpful because they become familiar tools rather than techniques you are trying for the first time when you are already experiencing strong contractions.
Understanding the nervous system can also help take some of the fear out of labour. Knowing how stress and anticipation can influence pain perception allows you to approach labour with more awareness and a greater sense of control.
What equipment and positions can I learn about before labour?
Another benefit of labour preparation is becoming familiar with some of the equipment you may encounter in a hospital or birth setting.
For example, your physiotherapist can explain how a peanut ball can be used in different positions, particularly when you are receiving an epidural and may have less ability to move independently.
You may also practise using a birth ball, pillows, a stool, or other supports. Learning how to use these tools before labour means you don't have to figure them out for the first time when you're tired, uncomfortable, or in the middle of a contraction.
Your physiotherapist can also help you explore different labour positions and discuss how you might adapt them depending on your circumstances.
The goal isn't to create a rigid labour plan. Instead, it's to build a toolbox of options that you can draw from depending on how your labour unfolds.
Should I do perineal massage before birth?
Perineal massage is another commonly discussed component of labour preparation. The perineum is the area of tissue between the vaginal opening and anus, and it needs to stretch significantly during a vaginal birth.
Research suggests that antenatal perineal massage during the final weeks of pregnancy can reduce the likelihood of certain types of perineal trauma, particularly in people having their first vaginal birth. It does not guarantee that you will avoid a tear or episiotomy, but it can be one useful tool for preparing the tissues for stretching.
A pelvic floor physiotherapist can teach you how to perform perineal massage safely and comfortably. This may involve learning where to apply gentle pressure, how much sensation is expected, and how to coordinate the massage with relaxed breathing.
It is important to remember that perineal massage should not be painful. The goal is not to aggressively “stretch” the tissues, but rather to gradually become comfortable with the sensation of pressure and stretching.
When should I see a pelvic floor physiotherapist for labour preparation?
It is never too early to start. Even early in pregnancy, a pelvic floor physiotherapy appointment provides an opportunity to learn about your pelvic floor, connect with your body, and begin building an understanding of what may be helpful during labour.
Labour preparation can start at any point during pregnancy. Starting earlier simply gives you more time to become familiar with the information and practise the skills that may be useful to you.
As pregnancy progresses, your physiotherapy sessions can become more specific to your stage of pregnancy and your goals. This may include pelvic floor relaxation, perineal massage, labour positions, hip mobility, breathing strategies, pain-management techniques, or practising with equipment such as a peanut ball.
And importantly, labour preparation doesn't need to look the same for everyone. Your birth preferences may change as your pregnancy progresses, and your labour may ultimately unfold differently than expected.
At the end of the day, our goal is not to tell you how you should give birth. Our goal is to help you feel informed about your options and confident in your ability to make informed decisions when it comes to your labour.
Birth can be unpredictable, and there is no exercise, technique, or preparation strategy that can guarantee a particular outcome. What we can do is help you understand your body, develop practical skills, and build a toolbox of options that you can use throughout pregnancy, labour, and your postpartum recovery.
At Proactive Pelvic Health Centre, our goal is to help you feel informed, prepared, and confident heading into labour. We can help you understand your pelvic floor, explore different movement and positioning strategies, and build a toolbox of options for managing discomfort. Most importantly, we want you to feel empowered to make informed decisions that are right for you and your birth experience.
References
Beckmann MM, Stock OM. Antenatal perineal massage for reducing perineal trauma. Cochrane Database of Systematic Reviews. 2022;3. Cochrane Library – Antenatal perineal massage for reducing perineal trauma
World Health Organization. WHO recommendations: Intrapartum care for a positive childbirth experience. World Health Organization; 2018. WHO – Intrapartum care for a positive childbirth experience