The pelvic floor is a complex group of muscles and connective tissues situated at the base of the pelvis, acting like a hammock that stretches from the pubic bone to the tailbone. This muscular sling provides crucial support for the bladder, uterus, and rectum, and it plays a direct role in maintaining urinary and fecal continence. Preparing these muscles and surrounding tissues is a proactive step that can significantly influence the experience of childbirth and promote a smoother physical recovery afterward.
Foundational Exercises for Strength and Relaxation
Preparing the pelvic floor for birth involves developing both the ability to contract the muscles and the equally important ability to fully relax them. The traditional pelvic floor contraction, often called a Kegel, involves a gentle “squeeze and lift” sensation, as if stopping the flow of urine and holding back gas simultaneously. It is important to isolate these muscles without tensing the buttocks, thighs, or abdominal muscles, which can be done by practicing a hold for three to five seconds, followed by an equal period of complete release. Regular practice, such as performing 8 to 12 repetitions three times daily, helps to build the endurance necessary to support the increasing weight of the growing fetus.
The relaxation aspect becomes particularly relevant as the due date approaches. This exercise focuses on consciously releasing and lengthening the muscles, moving the pelvic floor in a downward and outward direction. Learning to fully relax this area helps the muscles to stretch and open. Practicing this relaxation technique helps prepare the body for the involuntary opening required during delivery.
Enhancing Tissue Elasticity Through Massage
Perineal massage has been shown to reduce the risk of severe perineal tearing and the need for an episiotomy, particularly in first-time mothers. The massage should typically begin around the 34th or 35th week of pregnancy and can be performed daily or at least three to four times a week for about five minutes per session.
To perform the massage, a water-soluble lubricant or a natural oil, like sweet almond oil, should be applied to the perineum. The individual or a partner inserts one or two clean fingers approximately three to five centimeters inside the vagina. Gentle, sustained pressure is then applied downward toward the rectum and to the sides in a U-shape until a stretching or tingling sensation is felt. Holding this stretch for one to two minutes allows the tissues to adapt and become more pliable for the final stages of labor.
Utilizing the Pelvic Floor During Labor and Delivery
The conscious practice of pelvic floor relaxation is directly applied during the pushing stage of labor. Healthcare providers often recommend “open-glottis pushing,” which involves exhaling or making a gentle sound while pushing, rather than holding the breath and bearing down forcefully. This technique prevents excessive pressure buildup and allows for a more controlled descent of the baby.
Controlled pushing minimizes the abrupt force on the perineal tissues, which allows them to stretch gradually instead of tearing suddenly. As the baby’s head begins to crown and the perineum reaches its maximum stretch, consciously relaxing the pelvic floor muscles is important. This final moment of relaxation, often coached by the birth team, helps to ease the head out and reduces the risk of significant lacerations.
Knowing When to Consult a Specialist
While self-directed preparation is beneficial, a Pelvic Floor Physical Therapist (PT) can provide individualized guidance. A specialist consultation is warranted if a person is unable to correctly identify or isolate the pelvic floor muscles during exercises, which is a common difficulty. They can use techniques like internal examination or biofeedback to ensure the exercises are being performed effectively.
Consultation is also highly recommended if pain is present, such as pelvic girdle pain, low back pain, or pain during intercourse, as these symptoms can indicate muscle tension or underlying dysfunction. Persistent symptoms like urinary incontinence or feeling pressure in the pelvis suggest that self-management may be insufficient. A PT can create a personalized program that addresses specific weaknesses or tightness, optimizing the body’s readiness for birth.