How to Prepare Your Pelvic Floor for Birth
Pelvic floor preparation for labor involves much more than doing Kegels. Your body needs strength, mobility, coordination, pressure management, and the ability to relax and lengthen the pelvic floor. Pelvic floor exercises for birth may include whole-body strengthening, 360-degree breathing, pelvic mobility, labor and pushing positions, and perineal massage. No exercise can guarantee a specific birth experience or prevent tearing, but preparing during pregnancy can give your body more options and help you feel confident going into labor.
There is a big misconception I hear often as a pelvic floor physical therapist: preparing your pelvic floor for birth means doing hundreds of Kegels every day.
“Do Kegels at every stoplight.”
“Do 100 before bed.”
“Keep squeezing and strengthening.”
I even found a handout from a prominent OB/GYN practice in my area encouraging pregnant women to do more than 300 Kegels a day to “prepare their pelvic floor for birth.”
As both a pelvic floor PT and a patient of that practice, I did the obligatory eye roll—and then decided I needed to help change this misconception.
Pelvic floor preparation for labor may include strength, but not just isolated pelvic floor strength. We need strength throughout the core, arms, hips, and legs so you can move into and maintain different labor positions.
Preparing your body for birth also requires:
Flexibility and mobility
Pelvic floor coordination
Pressure management
The ability to relax and lengthen the pelvic floor
Strength and endurance for labor positions
Confidence using different labor and pushing strategies
Before we go any further, let’s set an expectation: no birth preparation exercises can guarantee a specific birth experience or completely prevent tearing.
The goal is to give your body more options and help you feel informed, confident, and prepared.
What Does the Pelvic Floor Do During Labor and Birth?
The pelvic floor is a group of muscles located at the base of your pelvis. It supports your pelvic organs and responds to the increased pressure created by your growing uterus and baby.
Your pelvic floor is also an anticipatory group of muscles. When you cough, sneeze, lift something, or perform that enormous rollover in bed when you are eight or nine months pregnant, your pelvic floor responds—usually without you consciously thinking about it.
It also works with your diaphragm and abdominal muscles to manage pressure throughout your core.
During a vaginal delivery, the pelvic floor has another important job: it needs to lengthen and move out of the way so the baby can pass through the vaginal canal. The muscles experience a significant amount of stretching during birth, which is why learning how to relax the pelvic floor for birth matters just as much as strength.
Pelvic Floor Exercises for Birth Require More Than Kegels
Yes, strength is important—but repeatedly tightening the pelvic floor is not necessarily the best way to prepare it for birth.
A whole-body strengthening approach is often more helpful than isolated Kegels alone. Exercises such as squats, lunges, carries, and functional core movements can strengthen your pelvic floor while preparing your legs, hips, core, and upper body for the physical demands of labor.
Your arms may need to support you on your hands and knees. Your legs may need to hold a squat or kneeling position. Your core needs to manage pressure while your pelvic floor lengthens.
Birth is a full-body job, so pelvic floor exercises for birth should prepare more than one isolated group of muscles.
How to Relax the Pelvic Floor for Birth
Simply telling someone to “relax your pelvic floor” is not always helpful.
When I say this to patients in the clinic, many admit they have no idea what that actually means. They may not know how to tighten, lower, or even identify their pelvic floor muscles.
Relaxation is an active, learned skill—especially when you are experiencing pain or contractions.
Our bodies naturally want to tighten when something hurts. During birth, however, we need the pelvic floor to lengthen as the baby moves through the vaginal canal.
During pelvic floor physical therapy, we can practice this by adding a gentle stretch to the perineum while coaching you through your breathing. This helps you learn how to respond to pressure and discomfort without reflexively gripping your pelvic floor.
Pelvic Floor Preparation for Labor: What Should You Practice?
Effective pelvic floor preparation for labor should help you understand how your body breathes, moves, manages pressure, and relaxes. These are some of the strategies we practice during pelvic floor physical therapy during pregnancy.
Practice 360-Degree Breathing Techniques for Labor
The diaphragm and pelvic floor are designed to work together.
When you inhale, the diaphragm moves downward to make room for the lungs to expand. At the same time, the pelvic floor should gently move downward and lengthen.
When you exhale, the lungs deflate, the diaphragm returns upward, and the pelvic floor naturally recoils.
One of our favorite breathing techniques for labor is 360-degree diaphragmatic breathing:
Find a comfortable seated, side-lying, or supported reclined position.
Inhale gently into your ribs, abdomen, back, and pelvic floor.
Imagine your pelvic floor widening and lowering.
Exhale naturally without gripping your abdomen, glutes, or inner thighs.
This should not feel forced. Take a quiet inhale and passive exhale, then notice what your body allows—and what it does not.
Does one part of your rib cage feel tight? Can you breathe into your back? As your belly grows, the mid-back and rib cage can become stiff. Practicing this breath in a supported child’s pose may help create more mobility through the back and rib cage.
Fun fact: it may also feel really good for that cute little curve in your back that has become more noticeable throughout pregnancy.
Practice Pelvic Floor Lengthening
Your sit bones are the bones you feel underneath you when sitting on a firm surface. When the pelvic floor lengthens, imagine those bones gently widening away from each other.
You can also try these cues:
Picture your pelvic floor softening downward.
Imagine breathing your pelvic floor into the surface beneath you.
Release tension in your jaw, glutes, and inner thighs.
Allow the muscles to lower without pushing or straining.
Visual imagery can be incredibly helpful. Many of our patients use these same cues during labor and delivery.
Not every cue works for every person. Pelvic floor therapy before birth can help you find the language and imagery that make sense to your body.
Try Pelvic Floor Stretches During Pregnancy
Pregnancy hormones increase ligament laxity, but that does not automatically mean your hips and pelvis are moving well.
During pelvic floor physical therapy, we assess how your pelvis moves and whether your hips can comfortably access positions that may help the baby travel through the vaginal canal.
Toward the end of labor, hip internal rotation—think knees in and feet wide—can help create more space through the pelvic outlet. To use that position comfortably, you need adequate hip mobility.
Pelvic floor stretches during pregnancy and other mobility exercises may include:
Supported deep squats
Hip circles on a birth or exercise ball
Pelvic tilts while lying down or sitting
Rocking on hands and knees
Adductor rock-backs or inner-thigh stretches
Supported child’s pose
We may also practice rocking backward with the knees closer together and feet wider, followed by knees wider and feet closer together. These variations help you explore movements that affect the pelvic inlet, mid-pelvis, and pelvic outlet differently.
Stay within a safe and comfortable range. If you have pregnancy-related restrictions or are unsure whether an exercise is appropriate, talk with your medical provider or pelvic floor physical therapist.
Practice Different Labor and Pushing Positions
When you are in active labor and experiencing pain or fatigue, it can be difficult to remember a position you only saw once in a social media post.
That is why we practice labor and pushing positions ahead of time.
Helpful options may include:
Side-lying
Hands and knees
Supported squatting
Kneeling
Semi-reclined positions
Positions using a birth ball or peanut ball
Different positions can change the available space within the pelvis. They also give you options if you become tired, a position feels uncomfortable, or your baby is not tolerating a particular position.
We also encourage patients to bring their birth partner to a session. Your partner can learn how to help you move, provide counterpressure, and suggest different labor and pushing positions when you are focused on managing contractions.
Consider Perineal Massage Around 32-34 Weeks
Perineal massage involves applying a gentle, sustained stretch to the tissues around the vaginal opening.
Many recommendations suggest beginning around 36 weeks. At Envision, we may begin teaching the technique around 32–34 weeks when it is medically appropriate. Babies do not always follow our schedules, and beginning a little earlier gives you time to become comfortable with the technique.
Perineal massage may help you:
Become familiar with the sensation of stretching
Practice breathing while your pelvic floor lengthens
Prepare for the pressure associated with crowning
Tolerate a sustained stretch without gripping
Potentially reduce the risk of perineal tearing or decrease the severity of certain tears
We cannot promise that perineal massage will prevent tearing. Several factors influence whether tearing occurs during birth. The goal is to improve tissue awareness, practice pelvic floor lengthening, and help you feel more prepared for the sensations of delivery.
Always check with your medical provider before beginning, especially if you have been placed on pelvic rest or have pregnancy complications.
Coordinate Your Breathing While Pushing
There is a difference between forcefully holding your breath and coordinating your breathing with pushing.
During pelvic floor therapy before birth, we can help you practice how to:
Breathe into your pelvic floor
Create downward pressure without unnecessary straining
Use your abdominal muscles while allowing the pelvic floor to release
Practice different pushing techniques in several positions
The goal is not to practice forceful pushing throughout pregnancy. It is to understand how to coordinate your muscles so the pelvic floor is not tightening while you are trying to create downward pressure.
Should Pelvic Floor Exercises for Birth Include Kegels?
Pelvic floor strengthening can be helpful during pregnancy, but isolated Kegels are not always the answer.
Many patients come to us with a combination of pelvic floor weakness, muscle tension, and difficulty coordinating the muscles. A pelvic floor can feel tight and still be functionally weak.
Kegels may not be the appropriate starting point if you are experiencing:
Pelvic pain
Difficulty relaxing your pelvic floor
Constipation or straining
Pain with penetration
Pain during pelvic exams
Known pelvic floor muscle tension
This is where an individualized assessment matters. A pelvic floor physical therapist can determine whether you need strengthening, lengthening, coordination training—or a combination of all three.
Signs You May Benefit From Pelvic Floor Physical Therapy During Pregnancy
Consider an individual assessment if you have:
Pelvic, hip, tailbone, or lower-back pain
Urinary leakage or urgency
Pelvic pressure or heaviness
Constipation or difficulty emptying
Pain with penetration or pelvic exams
Difficulty identifying or relaxing your pelvic floor
Concerns about a previous birth injury
Anxiety about pushing or perineal tearing
You do not have to be experiencing symptoms to benefit. Any pregnant person can use pelvic floor physical therapy during pregnancy to better understand their body and prepare for labor.
When Should You Begin Pelvic Floor Therapy Before Birth?
I prefer patients to begin sooner rather than later.
First Trimester: Establish a Baseline
We can establish a baseline and address symptoms such as leaking, pelvic pain, or pressure. Your recommended visit frequency will depend on what you are experiencing and the support you need.
Second Trimester: Build Strength and Mobility
During the second trimester, birth preparation exercises may focus on whole-body strength, endurance, breathing, hip mobility, pelvic mobility, and managing any pesky pregnancy symptoms along the way.
Third Trimester: Prepare Your Body for Birth
Birth preparation becomes more specific during the third trimester. We may work on:
Labor and pushing positions
Whole-body strength and endurance
Hip and pelvic mobility
Perineal massage
Partner-assisted strategies and counterpressure
Breathing techniques for labor
Pelvic floor lengthening
Responding to pressure without tightening
How Pelvic Floor Physical Therapy Can Help You Prepare
A pelvic floor physical therapist may assess:
Breathing and pressure management
Pelvic floor strength, tension, and coordination
Hip, spine, and pelvic mobility
Pregnancy-related pain or symptoms
Comfortable labor positions
Pushing mechanics
Partner-assisted positions and counterpressure
An internal pelvic floor assessment can help us identify which muscles feel tight, which may be weak, and how well you can lengthen your pelvic floor.
However, an internal assessment is never required. It is only performed with your consent and when you are not on pelvic rest or under medical restrictions. There is still plenty we can assess and treat externally.
The Bottom Line on How to Prepare Your Pelvic Floor for Birth
Preparing your pelvic floor for birth is about building options—not achieving perfection.
Strength, mobility, breathing, relaxation, and coordination all matter. Practicing these skills during pregnancy can make them easier to access when you are tired, uncomfortable, and in the middle of labor.
You cannot control every part of your birth experience. But you can learn more about your body, practice different strategies, and enter birth feeling more informed and prepared.
Prepare Your Body for Birth With Envision Pelvic Health & Wellness
Every pregnancy, body, and birth plan is different.
Our pelvic floor physical therapists can help you manage pregnancy-related symptoms, practice labor and pushing positions, learn partner-supported techniques, and create a birth preparation plan that feels right for you.
We proudly serve Chicago's Northwest Side and surrounding communities, including Norwood Park, Edison Park, Park Ridge, Skokie, Morton Grove, Niles, Des Plaines, and Jefferson Park.
You are welcome to:
Book a free discovery call to learn if pelvic floor physical therapy is right for you.
Schedule a pregnancy pelvic floor PT evaluation for personalized, one-on-one care.
Call our clinic with questions about your symptoms, insurance, or payment options.
Learn more about our pregnancy and postpartum services and meet our team.
Book a discovery call or submit a contact form today to learn more.
Or, if you’re ready to book your initial evaluation use the link below.
Frequently Asked Questions
-
It's never too early. Many people benefit from starting during the first or second trimester, while others begin later in pregnancy to focus specifically on birth preparation. Every trimester has different goals, and a pregnancy physical therapist can tailor treatment to your needs. Read our blog When to Start Pelvic Floor Therapy During Pregnancy.
-
Research suggests that regular perineal massage beginning around 32- 34 weeks of pregnancy may reduce the risk of more severe tearing, particularly for first-time vaginal births. It can also help you become more comfortable relaxing your pelvic floor during stretching.
-
Not necessarily. While pelvic floor strength is important during pregnancy, labor requires your pelvic floor muscles to relax and lengthen. A pelvic floor physical therapist can help determine whether you would benefit more from strengthening, relaxation, or a combination of both.
-
Absolutely! Many people come to pregnancy PT simply because they want to prepare for labor and delivery. Pregnancy physical therapy isn't just about treating pain—it's also about education, birth preparation, breathing, pushing strategies, pelvic floor coordination, and postpartum planning.