You wouldn’t run a marathon without training for it. Childbirth should be the same way. Pregnancy, labor, and delivery is just as taxing – or more! – on the body.
You’re busy – working, maybe caring for other children, spending time with friends and family, living life. Where will you find the time to squeeze in extra exercise? Unlike a marathon, you don’t need to spend hours on end training. Practicing a few simple exercises and techniques can help relieve pain and discomfort and prepare your body to bring a child into the world.
Like runners have coaches, you don’t have to train alone. A physical therapist can help you remain more comfortable during pregnancy and labor, as well as prevent potential health issues down the line. Learn about the role physical therapists play in pregnancy and postpartum care, as well as five exercises and techniques you can practice to get your body ready for labor and delivery.
How can physical therapy help during pregnancy?
“I never would have thought about seeing a physical therapist.” Pregnant and postpartum women tell us this all the time.
The American Physical Therapy Association has published a Section on Women’s Health for nearly 40 years. Originally, it focused solely on the care of women before, during, and after pregnancy. While its scope has expanded over the years, helping pregnant and postpartum women remains a cornerstone.
If you think physical therapists only help patients recover from injury or surgery, you’re not alone. While rehabilitation is part of our job, we also focus on injury prevention. As the healthcare industry begins to emphasize wellness more, doctors and patients are becoming more aware of what we can offer during and after pregnancy.
Our team at the University Hospital Physical Medicine & Rehabilitation Clinic focuses on pelvic health. Along with treating male and female bowel problems, bladder dysfunction, and sexual health issues, we also are passionate about working with women during pregnancy and postpartum.
We can help you:
- Learn to push during delivery
- Lengthen pelvic muscles and soften tissue
- Practice getting into labor positions
- Practice relaxation techniques
- Prevent or treat urinary incontinence
- Relieve back pain
- Relieve pain during sexual intercourse
When should I see a physical therapist during pregnancy?
Pain isn’t normal, and this doesn’t change just because you’re pregnant. While your body will change drastically during pregnancy, it doesn’t mean you need to feel uncomfortable or live with pain for 40 weeks or more.
We typically see patients after they have developed pain. Ideally, though, we would like to see you right after the first trimester to start pelvic floor exercises. These keep your pelvis strong and prevent incontinence or prolapse, in which organs such as the uterus fall down or slip out of place. You may have read in a magazine how to do Kegel exercises, but most women don’t do them correctly. We can make sure you are performing them effectively.
Over the course of the pregnancy, we will work with you on proper body mechanics. As your uterus grows, your center of gravity will shift, and your posture and coordination will change. Some muscles will become tight while others will loosen and weaken. We’ll teach you exercises and yoga poses that will strengthen and relax muscles and help you remain comfortable and injury-free.
About five weeks before your due date, we can train you and your partner to do perineal massage. This method relaxes and softens the perineum, the area between the vagina and rectum. It can decrease the likelihood of tearing during delivery.
You may think you know how to push, but you’re likely doing it wrong. We can teach you to push properly so you get the action you’re looking for without holding your breath.
We’ll also work on labor positions so you can get into and out of them comfortably. There is so much going on during labor that you won’t have time to think. By practicing a few things beforehand, they’ll become automatic.
Check with your insurance company about whether you have physical therapy benefits and if they cover wellness visits as well as injury rehabilitation.
Like all health fields, physical therapists specialize in certain areas. When looking for a physical therapist, a few questions to ask include:
- Have you been trained specifically to treat pregnant or postpartum patients?
- Do you do internal work if necessary? This includes intravaginal or intrarectal manual therapy treatment of the pelvic floor muscles, connective tissues, scar tissue, etc.
5 exercises to train for labor and delivery
Exercise can prepare your body for an easier – and perhaps quicker – delivery, and it can help you return to your pre-baby weight sooner. If you weren’t active before pregnancy, there’s no time like the present to get moving.
Whether you’re new to exercise or an old pro, here are five exercises and techniques you can use to prepare your body for labor and delivery.
1. Child’s pose
This yoga pose helps lengthen pelvic floor muscles and ease discomfort.
Kneel down and sit on your heels. Then lean forward slowly and walk your arms out long in front of you. Breathe deeply. You also can rest your elbows on the ground in front of you with your hands supporting your head. As your belly grows, you may need to spread your knees farther apart to create space. If it’s uncomfortable to sit your backside on your heels, you can sit up higher.
Take care to not raise your hips above your heart. Talk to your physical therapist for other guidelines specific to you.
2. Deep squat
Deep squats help relax and lengthen the pelvic floor muscles and stretch the perineum.
Stand with your legs wider than hip width. Slowly squat down as far as you can go with your hands pressed together in front of you.
Your physical therapist can talk with you about how often and how many deep squats you should do.
3. Quadruped cat/cow
This yoga pose helps ease discomfort and decrease lower back pain.
Get on your hands and knees. Exhale and round your back as you tuck your chin toward your chest. Then inhale and gently arch your back downward and look up at the sky.
4. Perineal bulges
This trains you to push during delivery without holding your breath. Holding your breath while pushing is call Valsalva. Valsalva can decrease the rate of blood flow back to the heart, lower maternal blood pressure, decrease maternal blood oxygen and blood flow to the placenta, and increase the risk for injury. It also can increase fetal head compression and fetal distress.
Perineal bulges should only be practiced in the last three weeks of pregnancy. Don’t practice them often because it can place excessive pressure on your pelvic floor structures.
Don’t practice perineal bulges if you have premature rupture of the membranes, vaginal bleeding during pregnancy, or pelvic organ prolapse. Talk with your doctor and physical therapist before starting perineal bulges. They can guide you in best practices and how often to do them.
When you practice perineal bulges, do it in your planned labor and delivery positions. Sit on a small towel running length-wise from front to back. Gently press your perineal body, or the area between the vagina and rectum, into the towel. Think about gently moving the sit bones – the bones you can feel in your glutes – apart and moving the tailbone away from the pubic bone.
You also can use a mirror to make sure the perineum is bulging out and down, not up and in, which is a Kegel and the opposite of what should be performed during delivery.
5. Perineal massage
Perineal massage lengthens and softens the tissues of the perineum. You can start this at 35 weeks of pregnancy. Perform this massage technique for 10 minutes once a day.
Take a warm bath or hold a warm compress on the perineum for 10 minutes to help you relax before the massage.
Sit or lean back in a comfortable position. Put a water soluble lubricant on your thumbs and perineum. Place your thumbs 1 to 1.5 inches inside your vagina. Press downward toward the rectum and to the sides until you feel a slight burning, stinging, or tingling sensation. Hold the pressure for two minutes until the area becomes numb. Breathe deeply and concentrate on relaxing the muscles.
As you continue to press down with your thumbs, slowly and gently massage back and forth over the sides of your vagina in a U movement for three minutes.
Relax and repeat the process once.
After you give birth, you may experience new physical problems that prevent you from fully enjoying life with your new baby. In part two of this two-part series, we talk about how to get your body back after birth.
To talk with a physical therapist about care before, during, or after pregnancy, request an appointment online or call 214-645-8300.