Perineal Preparation for Labor: How a Physical Therapist Can Help

Embarking on the journey of childbirth is akin to preparing for a marathon, requiring physical and mental readiness. Physical therapists specializing in pelvic health are vital in guiding through perineal preparation. Their expertise ensures the correct application of exercises for effectiveness and safety. Regular sessions can aid in pain management, urinary incontinence prevention, and overall pelvic health improvement during pregnancy. 

How can a Physical Therapist help?

The journey of pregnancy, while transformative, should not be synonymous with enduring pain or discomfort. It's a common misconception that pain is a standard aspect of pregnancy; however, this is far from the truth. 

The first trimester

As your body undergoes significant changes, it's essential to address any discomfort early on, ideally starting physical therapy right after the first trimester. Early intervention with a physical therapist can be pivotal in maintaining pelvic health. Initiating pelvic floor exercises soon after the first trimester helps in fortifying pelvic strength, which is crucial in preventing issues such as urinary incontinence or pelvic organ prolapse, where organs like the uterus may shift undesirably. While Kegel exercises are commonly recommended, proper technique is crucial for effectiveness. A physical therapist can ensure these exercises are performed correctly and efficiently. 

Starting the second trimester

As pregnancy progresses, the body's center of gravity shifts due to the growing uterus, affecting posture and coordination. Physical therapy can assist in adapting to these changes. Tailored exercises and specific yoga poses, designed to both strengthen and relax muscles, play a significant role in maintaining comfort and preventing injuries during this dynamic period and may help alleviate stress and help promote a vaginal delivery. Some prenatal yoga poses include:

1. Child’s Pose (Balasana) - This gentle yoga pose stretches the pelvic floor muscles and eases discomfort, especially beneficial as the pregnancy progresses.

2. Deep Squats - Effective in relaxing and elongating the pelvic floor muscles, deep squats also aid in perineal stretching. Proper technique involves a stance wider than hip-width and deep squatting.

3. Quadruped Cat/Cow (Marjaryasana/Bitilasana) - This yoga flow, alternating between back arches and rounds, is excellent for alleviating lower back pain, common in pregnancy. 

The third trimester

Approaching the due date, around five weeks prior, physical therapists can also guide in the practice of perineal massage. This technique is instrumental in softening and relaxing the perineum, the area between the vagina and rectum, thus reducing the likelihood of stitches and tears (including an episiotomy) during delivery. Perineal massage can be done on your own or with a perineal massage tool. Involving a partner in perineal preparation can be beneficial. They can assist in perineal massage, provide support during exercises, and contribute to a supportive environment. This involvement can also enhance the partner's understanding and empathy towards the birthing process

In addition, during the third trimester, a physical therapist can teach the most efficient methods for pushing, ensuring you avoid techniques like breath-holding, which can be counterproductive. Finally, they can also focus on labor positions, ensuring that you are comfortable transitioning into and out of these positions during labor. Familiarity with various labor positions and relaxation techniques can lower anxiety and enhance the birthing experience. These birth preparation techniques ease transitioning between positions during labor.

The Integral Role of Physical Therapy in Perineal Preparation

Perineal preparation is an essential component of childbirth readiness. Incorporating a range of perineal exercises, mind-body techniques, and nutrition, along with professional guidance by a physical therapist (and doula and midwife), expectant mothers can significantly improve their labor experience.

Early and consistent preparation of your body for childbirth can empower you, leading to a more positive and manageable childbirth experience with even less postpartum pain.

 Perimom is delighted to be a partner of APTA Pelvic Health