Getting ready for delivery can feel both exciting and scary, and a lot of it is out of your hands. Labor may be fast or slow, and things can change quickly. Still, there are a few small things you can control, and preparing for them can help you feel more ready.
This article covers birth prep with input from Dr. Emma Codman, a physical therapist who works with women during pregnancy. It looks at what to do before and after 34 weeks, how to move and push during labor, and how to care for your pelvic floor whether you plan a vaginal birth or a C-section.
Around 34 weeks, doctors usually clear you for more specific birth prep, such as perineum massage.
Hips need to move well in both external and internal rotation, because the baby moves through different parts of the pelvis during labor.
Pushing on your back is not bad, but other positions may help the pelvis open. Comfort in the moment is what research points to as best.
A C-section still affects the pelvic floor, so pelvic floor physical therapy can be useful before and after.
Leaking during pregnancy is common, but it is not normal, and it can often be addressed.
Talking with your doctor ahead of time helps you advocate for yourself during labor.
Thirty-four weeks is usually when doctors clear you to start more specific birth prep. Before that point, the focus is simpler: stay active in whatever way feels good, take care of your body, and keep your hips strong but also mobile.
After 34 weeks, you can add perineum massage and more intensive hip mobility work. Some people also go back to physical therapy at this point for a more hands-on birth prep session.
The perineum is the bottom of the vaginal opening, and it is often where tears happen during vaginal delivery. Perineum massage aims to stretch and release those muscles. You or your partner insert one finger vaginally, up to about the first knuckle, and stretch down toward the anus and to either side.
Research has shown this can decrease instances of tearing. Nothing is guaranteed, though. You could do it perfectly and still tear or have complications. The point is to feel more prepared and possibly lower the risk.
Perineum massage can also be done during labor. A partner can help release the muscles, or warm compresses can be used to help them loosen and relax.
Early in labor, the baby moves into the pelvic inlet, the base of the pelvis. That is where hip external rotation matters. When the baby comes out through the vaginal opening, it passes through the pelvic outlet, which is where internal rotation matters. Both movements need to be mobile.
Here is how to picture them:
If pelvic floor physical therapy is available to you, an assessment can show whether you are more limited in one direction and whether your perineum is very tense. That can help shape a more personalized plan.
Pushing on your back is not inherently bad. But when you lie flat on your back, gravity is not helping bring the baby out. Some people find it helpful to push on their hands and knees or on their side, even if the baby is ultimately delivered on their back.
Research suggests that wherever you feel most comfortable pushing in the moment is the best position. It is worth asking your doctor beforehand what the hospital offers and whether they are open to different positions.
Biofeedback is one way to explore this. Small sensors are placed on the pelvic floor while you try positions commonly used in labor, such as lying on your side or being on hands and knees. This can show which positions relax your pelvic floor most. It can also show whether you are accidentally tightening your pelvic floor when you try to push.
One cue is to try to push out through the vaginal opening as if you were expelling a tampon. The more common advice to push like you are pooping can put too much pressure toward the anal sphincter side of the pelvic floor. The anal area will still be involved, but the aim is to direct the force out the vaginal opening.
Many hospitals will have you hold your breath while pushing, which is an efficient way to push. If that happens, take a deep inhale and then a small exhale before you hold your breath. That way you are not pushing at the very top of a full breath, which puts a bit less pressure on the pelvic floor while still leaving enough force to deliver the baby.
In general, the more you change positions during labor, the better. Without an epidural, you might walk around or sit on a physio ball and do pelvic tilts, as much as you are able.
If you need an epidural, you need an epidural. It can actually help the pelvic floor relax, because intense pain can make the muscles clench. Many epidurals now come with a pump you control. If you want to keep some sensation or movement in your legs, you can ask about a lighter epidural and try not to press the pump too often. Even with an epidural, a partner or doula can help with positions in bed.
A doula is a certified birth professional who advocates for you and your birth plan. They also help with positioning and know tips for helping labor progress. Usually you bring your own, and a friend does not count unless they are certified.
Planned C-section or not, your pelvic floor still matters. Surgery cuts through the abdominal muscles, and that can lead to dysfunction in the pelvic floor, and sometimes the lower back and hips. That is why pelvic floor physical therapy can help after a C-section, and before it too.
A prep session is mostly an assessment: checking strength, checking for too much tension, and making sure your hips are working well. Building strength beforehand also means you start from a better baseline when you are cleared to exercise again.
These are general educational suggestions, not individualized treatment. Check with your doctor before starting anything new.
If you have pubic bone or sacrum pain, lunges and curb walking may make it worse. In that case, squats and other double-leg activities are the better choice.
Constipation is common in pregnancy. The hormone progesterone slows digestion, and pressure from the baby adds to it. Constipation puts pressure on the pelvic floor and can affect its strength and function. Going less than once a day counts as constipated. It is also okay if you have a bowel movement during labor, and hospitals are prepared for it.
Kegels are not right for everyone. If your pelvic floor is already tight, Kegels may make it more tense. If it is weak, Kegels can help, but always paired with a full release, so you practice both ends of the range. They can also be combined with movements like squats, since the pelvic floor works with the core.
To get a feel for it, sit on a soft surface like a couch. Try a Kegel and see whether you can lift up off the surface, then see whether you can relax and let the muscles loosen down into it. Inhale as you release and exhale as you lift. If you cannot feel either movement, that is a sign to get it checked or keep practicing.
If you have pain anywhere during pregnancy, physical therapy can help figure out why. Options for pain relief are limited during pregnancy, so this can be a useful route. Treatment might include strengthening, stretching, or hands-on manual therapy.
If you are leaking urine, get it looked at. A therapist can assess whether the cause is tightness, weakness, coordination, or a combination.
If you are having symptoms of any kind, get an assessment.
Talk to your doctor about pushing positions and whether they will refer you to pelvic floor physical therapy.
When should I start birth prep in pregnancy?
Before 34 weeks, the focus is staying active and keeping your hips strong and mobile. Around 34 weeks, doctors usually clear you for more specific prep like perineum massage.
Is leaking urine during pregnancy normal?
It is common, but not normal. Pressure from the pregnancy, past symptoms that worsen, or changes in the pelvis can contribute. Physical therapy can look at tightness, weakness, and coordination, and treat the cause.
Do I still need pelvic floor physical therapy if I have a C-section?
Yes, it is still recommended. A C-section can affect the pelvic floor, hips, and lower back, so therapy after surgery is helpful, and an assessment beforehand can be too.
Should I do Kegels while pregnant?
It depends on your pelvic floor. If it is tight, more Kegels may add tension. If it is weak, Kegels may help when paired with relaxation.
How often should I see a pelvic floor physical therapist?
It varies. Without pain, one session with a few exercises may be enough, followed by a return visit around 34 weeks. With pain, weekly visits until it improves are common. After 34 weeks, some people come more often, especially if the perineum is very tight.
Can I exercise during pregnancy?
Generally, if you did an activity before pregnancy, you can keep doing it, with your doctor's okay. Walking is usually a safe choice. Check with your doctor before starting something new.
This article draws on insights from a conversation with NYC based pelvic floor physical therapist, Dr. Emma Codman, about bowel health, hemorrhoids, fissures, and daily habits that support regular digestion. Listen to the full episode below for the complete discussion and additional context.
You cannot control everything about labor, but you can prepare in small ways: keep your hips mobile, learn how you push and breathe, ask your doctor about positions, and get any pain or leaking checked out early. Advocating for yourself starts with knowing your body and having these conversations before delivery.