Preparing for Labor – Tips from a Pelvic Health Specialist
Are you pregnant and starting to think about your birth plan? If so, congratulations! Pregnancy is a beautiful time in a woman’s life and should be celebrated. Ever wondered what pelvic floor specialists recommends for labor preparation? Look no further! All of the information online can be so overwhelming, which is why we created this cheat sheet of our favorite tips!
We recommend working with a pelvic health specialist on the following:
Optimize your pelvic positioning and general alignment
The more balanced your pelvis (and the rest of your body) is, the better you will feel, and the more easily your pelvic floor can relax, open and lengthen to allow the baby out. Your PT can help you achieve optimal alignment to set you up for a smooth birth experience and identify other areas of tension or dysfunction that are contributing to an imbalance in your pelvis or otherwise.
Work on your ability to relax and lengthen your pelvic floor
This may be one of the most important things to master! We often hold tension in our pelvic floor “at rest” without even realizing it. If a muscle is tense, and you try to stretch it, you can injure it (think – tearing during birth).
Pelvic floor therapy, self-release techniques, breathing exercises, and stretches are all great ways to start relaxing your pelvic floor. A specialized PT can show you where to start!
Strengthen pelvic floor muscles
Not only do our pelvic floor muscles need to be able to length and relax, they also need to be strong enough to support our baby and organs through pregnancy, as well as assist in pushing when the time comes.
Correctly performing pelvic floor strengthening exercises can help with labor and delivery as well as reduce the chances of incontinence postpartum.
Stay active throughout your pregnancy
Staying active will do wonders for your pregnancy and labor experience. Labor and delivery have been compared to running a marathon, and you do not want to show up to a marathon without any training.
The issue is, women are told to maintain the level of activity that their body is used to once they get pregnant. This is because we do not want to shock your body with a lot of new activity that it is not used to. So if you fall into this category, start with walking and work up gradually. Listen to your body, if you are having an increase in cramping, pelvic pain, back pain, or bleeding, rest and talk to your doctor about the next steps. It is possible to gradually increase your activity and build a program that works for you, even if you’ve never exercised before.
During labor, it is helpful to stay somewhat active in the early stages to help the baby descend into the pelvis. Walking, squatting, bouncing on a ball and stairs are all great ways to facilitate this.
Practice optimal breathing techniques
Breathing techniques are a great, evidence-based tool for pain management during labor. Even if you plan on receiving an epidural, it is important to remember that the epidural may not always be available (for example, due to timing or to a hospital being understaffed) and that the epidural may also not work.
For these reasons, there needs to be a plan B that is practiced for pain management. One of these techniques is using your breath to get through painful contractions. It is recommended to breathe in through your nose, expanding your rib cage and belly, for 2-4 seconds, and exhale like you’re blowing out candles, for 6-8 seconds. Breathing correctly also allows your pelvic floor to relax, allowing you and your baby to progress as efficiently as possible.
Learn evidence-based pushing techniques
It is important to practice proper pushing techniques before you give birth. This will give your muscles the experience of relaxing and moving out of the way so the baby can get through. Too often women are told to strain and push while holding their breath. This is not an ideal strategy as it places so much pressure on your tissues and organs, and can cause more harm than good.
A pelvic floor PT can review proper techniques with you and evaluate if you are doing them correctly.
Learn and practice positioning
There are many positions to work with during labor and delivery. Contrary to popular belief, laboring and pushing on your back isn’t always the most ideal position!
Your PT can review other options such as side-lying, standing, and on hands and knees.
Practice and plan for pain management
It is so important to be prepared with some pain management strategies, even if you plan or receiving an epidural or medication. As discussed above, there are times when the epidural doesn’t work, or when the baby is coming too quickly to receive one.
Some pain management strategies include:
Breathing exercises
Counterpressure applied by a partner or doula
Start perineal massage
Perineal massage in the last few weeks of pregnancy can reduce the chances of an episiotomy, reduce the severity of tearing, potentially shorten labor, and reduce the risk of bladder incontinence in the post-partum period.
The perineum is an area of tissue and muscle attachments between the vagina and the anus. This needs to be able to stretch during birth as the baby comes out. This is the area that commonly tears and requires stitches. To reduce this risk, try massaging and stretching the tissues. This can be done by yourself, or with a partner. Your pelvic PT can show you how to do it correctly!
Plan for the right support person to be there with you every step of the way
This can be a doula, a parent, a partner, or a friend. You want someone there who will support you and help you stick to your birth “plan” as much as possible, and to advocate for you when you are potentially in a lot of pain and/or on pain medications that can impair decision-making. Have several conversations with your support personnel before giving birth with details about your wishes. This is great to also have in writing.
Tips for Labor Itself:
Relax your jaw. The state of your jaw mirrors the state of your pelvic floor. Clenching your jaw tightly during contractions also tenses your pelvic floor. Relax your jaw to relax the pelvic floor muscles and allow the baby to descend.
Low vocal sounds during contractions/pushing. Low vocal sounds work similarly to keep the pelvic floor and jaw as relaxed as possible, as well as to keep the nervous system calm. High-pitched noises further increase the fear-pain cycle by tightening muscles and activating the fight-or-flight system.
Avoid holding your breath if possible. Ideally, push with an open glottis. This will effectively manage pressure on your pelvic floor and decrease the risk of tearing and pelvic organ prolapse. With practice, your transverse abdominus (deep ab muscles) will work to push out the baby as you exhale.
Avoid pushing on your back. Over the years, women pushing out babies on their backs had become normalized, as this is how most OBGYNs were trained to catch babies. However, pushing on your back does not leave any room for your sacrum to move out of the way and allow the baby to exit as effectively as possible. To reduce trauma to your pelvic floor and pelvic pain, try pushing in other positions. Changing positions every 20-30 minutes is helpful for the baby to descend. Even if you have an epidural, with the help of your team, you can still push on your side or on all fours.
Spontaneous pushing. Push when you feel the urge. This will allow you to work with your body’s natural instincts and rhythm instead of tiring yourself out pushing when the doctor tells you to push. You know your body best! And when it comes to labor and delivery, it knows what to do.
When it comes to preparing for labor and delivery, knowledge is power, and having a team of providers to support you along the way is key! We are here to answer any questions for you. Book a Discovery Visit today to learn more about how we can help.