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Why a Pelvic Floor Therapist Should Be On Your Birth Team 

By: Dr. Gretchen Brooker, DPT, PRPC

There are many recommendations for professionals to have on your team in preparing for birth, which may be an OBGYN, midwife, doula, chiropractor, acupuncturist… but have you considered a pelvic floor therapist?

I would say that most of the time we think of pelvic floor therapists for the recovery part of birth rather than in preparation. However, did you know that the pelvic floor plays a crucial role in pregnancy and birth, not just the recovery?

A common misconception is that the pelvic floor muscles push out your baby and that they need to be strong with lots of kegels to prepare for birth. 

This is not true. 

The uterus is an amazing organ and a powerful muscle, however we do not have voluntary control over our uterus. The contractions of the uterus that begin labor rely on our hormones. The uterus contracts during labor to push baby downward toward the cervix to soften and dilate, then through the cervix and vagina. The role of the pelvic floor is to stretch and accommodate baby as the uterus does the work. So why do we push? We push during delivery to help the uterus, however it is a misconception that we should be “purple pushing” or holding our breath or clenching as we push. As we push, we want to think about breathing baby downwards and not fighting against the uterus. We have to push while maintaining a relaxed and open pelvis and pelvic floor. 

In pelvic floor therapy for birth preparation, our main priority is making sure your pelvic floor can get out of the way and stretch! This requires mobility of the spine, hips and pelvis. If you are experiencing back pain, hip pain or tightness or have any history of pelvic floor dysfunction – we want to address it throughout your pregnancy to improve your labor and delivery experience, and so that you are confident in your birth. We also want you to learn how to push before labor. Practicing breathing, how to breathe downward and descend the pelvic floor is a big part of birth prep!  

Another crucial part of pelvic floor therapy on your birth team is for recovery. The pelvic floor muscles are strained during pregnancy, stretched during delivery and in a crucial stage of healing for the first 5-6 weeks postpartum. Learning how to begin rehabbing the pelvic floor in the first few weeks is crucial to prevent long term pelvic floor dysfunction such as urinary leaking, prolapse and painful sex. The best time to prepare for postpartum and learn how to rehab the pelvic floor starts in pregnancy. Learning to prioritize breathing exercises, gentle abdominal and pelvic floor strengthening, proper lifting and postural holding of baby and simple things like getting out of bed will significantly reduce pain and further strain to the pelvic floor in a sensitive time. 

Don’t forget about pelvic floor therapy as part of your birth and postpartum preparation! Check our next blog on the common pregnancy changes and how it affects your pelvic floor muscle function even years later when rehab from pregnancy does not occur.