How Doulas, Midwives, and Pelvic Floor Physical Therapists Support a Better Birth
Pregnancy and childbirth involve far more than prenatal appointments and preparing for the arrival of a baby. The way a woman moves, breathes, positions her body, and prepares her pelvic floor can all play an important role in her birth experience.
While we often talk about the role of pelvic floor physical therapists during pregnancy and postpartum, there are other professionals who can provide valuable support throughout the childbearing journey.
Doulas, midwives, and pelvic floor physical therapists each bring a different area of expertise to pregnancy, labor, and postpartum care. Together, they can help women feel more informed, supported, and confident in their choices.
What Is a Midwife?
Midwives are trained healthcare professionals who provide care throughout pregnancy, labor, delivery, and the postpartum period. Depending on their credentials and location, midwives may provide prenatal care, monitor the mother and baby during labor, assist with delivery, and provide postpartum support.
Midwifery care often emphasizes education, informed decision-making, individualized care, and supporting the body's natural processes during pregnancy and birth.
The specific scope of practice for a midwife can vary depending on their training, certification, and state regulations. However, a central focus of midwifery is often helping women understand their options and actively participate in decisions about their care.
What Is a Doula?
Unlike midwives, doulas are not medical providers. Instead, doulas provide continuous emotional, physical, and informational support before, during, and after childbirth.
A doula may help a mother:
Understand her options during pregnancy and labor
Prepare for different stages of childbirth
Use breathing and relaxation techniques
Find comfortable labor positions
Use movement and other comfort measures
Communicate her preferences to her birth team
Feel supported and empowered throughout the birth experience
Doulas can be an important part of a woman's birth team because they provide continuous support while medical professionals focus on clinical care.
Where Does Pelvic Floor Physical Therapy Fit In?
Pelvic floor physical therapists bring another important perspective to pregnancy and childbirth.
The pelvic floor is a group of muscles, connective tissues, and other structures that support the pelvic organs and contribute to bladder, bowel, and sexual function. These muscles also need to coordinate with the diaphragm, abdominal muscles, hips, and the rest of the body.
During pregnancy, a pelvic floor physical therapist can help women better understand how their pelvic floor functions and teach strategies for:
Managing pelvic pain or pressure
Improving pelvic floor coordination
Preparing the body for labor
Learning breathing and relaxation strategies
Addressing urinary or bowel symptoms
Preparing for postpartum recovery
Rather than simply focusing on strengthening the pelvic floor, pelvic floor physical therapy can also focus on learning how to relax, lengthen, and coordinate these muscles when needed.
That becomes particularly relevant during childbirth.
Why Do Birth Positions Matter?
One area where doulas, midwives, and pelvic floor physical therapists may all provide valuable guidance is positioning during labor.
For many years, lying on the back with the legs supported—the traditional lithotomy position—has been a common position for childbirth. However, it is not the only option.
Depending on the circumstances of the birth, women may be able to move through a variety of positions during labor, including:
Squatting
Kneeling
Hands and knees
Side-lying
Standing
Leaning forward
Using a birth ball
Supported lunging
Different positions can change how the pelvis, hips, and surrounding soft tissues move and can provide different levels of comfort throughout labor.
How Movement Can Support Labor
One of the benefits of changing positions during labor is that it allows the mother to respond to what her body is experiencing rather than remaining in one position for an extended period of time.
Upright and forward-leaning positions can allow gravity to assist with fetal descent, while positions such as hands-and-knees or side-lying may provide comfort and allow the mother to rest.
Certain positions may also create more space within different areas of the pelvis.
There is no single "perfect" birth position for every woman. The most appropriate position can depend on the baby's position, the stage of labor, the mother's comfort, medical considerations, and the recommendations of the birth team.
The Goal Isn't One "Right" Position
It's important to remember that the goal isn't necessarily to avoid the lithotomy position at all costs.
There are situations where lying on the back or using a lithotomy position may be medically appropriate or necessary. What matters is that women understand that they may have options when circumstances allow.
Having a birth team that understands movement and positioning can help a mother explore those options safely.
Creating a Collaborative Birth Team
Doulas, midwives, and pelvic floor physical therapists each serve different roles, but their expertise can complement one another.
A midwife provides clinical care and medical support within their scope of practice.
A doula provides continuous emotional, physical, and informational support.
A pelvic floor physical therapist helps women understand and prepare their pelvic floor and the rest of their body for pregnancy, birth, and postpartum recovery.
When these professionals work alongside the woman's medical team, they can help her approach childbirth with more knowledge, preparation, and confidence.
Preparing Your Pelvic Floor for Birth
Your pelvic floor is an important part of the birth process—but preparing for birth isn't simply about doing more Kegels.
Learning how to contract, relax, lengthen, breathe, and coordinate your pelvic floor can be just as important.
If you're pregnant and want to better understand your pelvic floor before childbirth, a pelvic floor physical therapist can help you prepare your body and learn strategies that may be useful during labor and postpartum recovery.
Birth is not a one-size-fits-all experience. The more informed and supported you feel, the better equipped you are to participate in decisions about your care and advocate for the experience you want.
To learn more about the evidence on birthing positions, midwifery practices, pain relief, and protecting the perineum, visit:
https://evidencebasedbirth.com/evidence-birthing-positions/
https://evidencebasedbirth.com/positions-during-labor-and-their-effects-on-pain-relief/
https://evidencebasedbirth.com/evidence-birthing-positions/
https://evidencebasedbirth.com/positions-during-labor-and-their-effects-on-pain-relief/