Preparing Your Body for Labour and Delivery: How Pelvic Physiotherapy Can Help
With our incredible pelvic physiotherapist, Agnes Budyn
Preparing for birth involves much more than packing your hospital bag and choosing a birth plan. Your body is preparing for one of the biggest physical events it will ever experience — and pelvic health physiotherapy can be an important part of that preparation.
Whether you are planning a vaginal birth, a C-section, or simply want to feel more confident and prepared for whatever your birth experience brings, a prenatal pelvic physiotherapy session can help you understand your body, prepare your pelvic floor, and learn strategies that may make labour and your postpartum recovery more comfortable.
Why prepare your pelvic floor for birth?
When we talk about the pelvic floor, we often focus on strengthening. During pregnancy and birth, however, the ability of the pelvic floor to relax, lengthen and coordinate is just as important. During a vaginal birth, the pelvic floor and surrounding tissues need to accommodate the baby as they move through the birth canal. Being able to relax these muscles and coordinate them with your breathing and pushing can be an important part of birth preparation. Pelvic physiotherapy can also help you better understand common sensations during labour, different positions that may be helpful, and how your pelvic floor can respond to contractions and pushing.
The goal isn't to "guarantee" a particular birth outcome — birth is unpredictable — but rather to help you feel more informed, confident, and prepared.
What happens during a labour preparation session?
A prenatal pelvic physiotherapy appointment is individualized to you and your pregnancy. Depending on your needs, a session may include:
1. A discussion about your pregnancy and birth plans
We'll talk about your pregnancy, previous births if applicable, symptoms you're experiencing, your birth preferences and any concerns you may have.
This is also an opportunity to discuss questions such as:
What should I expect my pelvic floor to feel like during labour?
How do I relax my pelvic floor?
What positions may be helpful during labour?
How should I breathe during contractions?
What happens during pushing?
How can my partner support me?
What can I do to prepare for a vaginal birth?
What should I expect from my pelvic floor after delivery?
2. Pelvic floor assessment
Your physiotherapist may perform an external and/or internal pelvic floor assessment. This can help determine whether your pelvic floor is primarily tight, weak, well-coordinated, or having difficulty relaxing.
Although it can provide a lot of insight and help you connect to the pelvic floor area, an internal examination is not mandatory. Your physiotherapist can still provide a great deal of education and preparation without one.
3. Learning pelvic floor relaxation
One of the most important skills we can work on is learning how to let the pelvic floor relax and lengthen.
This may involve:
Breathing and relaxation strategies
Coordinating the diaphragm and pelvic floor
Practising pelvic floor "drop" or lengthening
Learning how to release unnecessary tension
Finding comfortable positions for pelvic floor relaxation
This is particularly useful for people who tend to hold tension in their pelvic floor or have pelvic pain.
4. Birth positioning and movement
Your physiotherapist can teach you different positions that may be comfortable during labour and discuss how movement can help you respond to contractions.
Depending on your circumstances, this may include practising:
Side-lying positions
Hands and knees
Supported squatting
Forward-leaning positions
Pelvic mobility exercises
Hip and pelvic movement
The goal is not to prescribe one "perfect" position, but to give you options you can use during labour.
5. Perineal massage education
For people planning a vaginal birth, we may also discuss perineal massage and teach you how to perform it safely at home. Research suggests antenatal perineal preparation may help improve tissue awareness and elasticity, particularly in first-time mothers, although it cannot eliminate the possibility of tearing or other birth-related injuries. Your physiotherapist can show you the technique, discuss when to start, and help you determine whether it is appropriate for you.
6. Pushing and breathing strategies
There is often a lot of confusion around "how to push." Rather than simply telling someone to push harder, pelvic physiotherapy can help you understand how to coordinate:
Breathing + abdominal pressure + pelvic floor relaxation + positioning
We can practise different breathing and pushing strategies so that you have more tools available to you when the time comes and give you feedback via an internal assessment if applicable.
When is the best time to book a pelvic physio appointment?
Ideally, the recommendation to book a labour preparation appointment is around 30–34 weeks of pregnancy.
This gives you enough time to:
Learn and practise pelvic floor relaxation
Address any pelvic pain or other symptoms
Learn birth positions and movement strategies
Discuss perineal massage
Practise breathing and pushing strategies
Ask questions before you get too close to your due date
For someone experiencing pelvic pain, urinary leakage, pelvic pressure, painful intercourse or significant pelvic floor tension, it can be beneficial to see a pelvic physiotherapist much earlier in pregnancy rather than waiting until the third trimester.
And if you're already 36, 37 or even 38 weeks — it's not too late! Even one appointment can provide valuable education and practical strategies.
What if I'm having a planned C-section?
You may be wondering:
"If I'm having a C-section, why would I need pelvic physiotherapy?"
It's a great question — and the answer is that pregnancy itself places significant physical demands on the pelvic floor, abdominal wall and musculoskeletal system, regardless of how your baby is delivered.
A C-section does not mean your pelvic floor has had a "free pass."
During pregnancy, the pelvic floor continues to support the increasing weight of the uterus and changing abdominal pressure. You may still experience urinary leakage, pelvic pressure, pelvic pain, constipation, hip or back pain, or pelvic floor tension.
A prenatal pelvic physio session before a C-section can help you:
Prepare your pelvic floor. You can learn how to properly contract and relax your pelvic floor and understand how to manage pressure during pregnancy and after birth.
Prepare your abdominal wall. Your physiotherapist can teach you appropriate strategies for movement, breathing and core activation that can be useful during pregnancy and postpartum.
Learn how to move after surgery. Getting in and out of bed, standing up, coughing, sneezing and caring for a newborn can be challenging after abdominal surgery. Learning strategies ahead of time can make those early days more manageable.
Understand postpartum recovery. A C-section is major abdominal surgery. Your physiotherapist can discuss activity progression, lifting, walking, abdominal recovery and when it may be appropriate to gradually return to exercise.
Address pregnancy-related symptoms. You can still experience pelvic pain, back pain, pelvic pressure or bladder and bowel symptoms during pregnancy, regardless of your planned mode of delivery.
And what if my birth plan changes?
One of the most important things I tell my patients is:
Prepare for your birth — but don't feel that you have to control your birth.
You may plan a vaginal birth and end up having a C-section. You may plan a C-section and go into labour beforehand. You may have an epidural, require an assisted delivery, or have a birth experience that looks completely different from what you imagined.
Pelvic physiotherapy isn't about preparing your body for one "perfect" birth.
It's about giving you knowledge, options, and confidence that you can take with you into whatever birth experience you have.
Your birth preparation checklist
By the time you reach the final weeks of pregnancy, you ideally want to have:
✓ A good understanding of your pelvic floor
✓ The ability to relax and lengthen your pelvic floor
✓ Breathing strategies for labour
✓ Several comfortable labour positions
✓ An understanding of pushing and pelvic floor coordination
✓ Information about perineal massage if appropriate
✓ Strategies for managing pelvic pain or pressure
✓ A basic understanding of early postpartum recovery
✓ Strategies for getting in and out of bed and moving comfortably after a C-section
✓ A plan for when to seek postpartum pelvic physiotherapy
Don't wait until something is wrong
Pelvic physiotherapy isn't only for people who are experiencing pelvic floor problems. Pregnancy and birth are major physical events, and learning how to prepare your body beforehand can help you feel more confident going into labour and the early postpartum period.
Whether you're planning a vaginal birth, a C-section, or simply want to be prepared for the unexpected, a prenatal pelvic health assessment can be a valuable part of your birth preparation.
If you're currently pregnant and would like to learn more about preparing your pelvic floor for labour and delivery, consider booking an appointment with a pelvic health physiotherapist around 30–34 weeks, or earlier if you are experiencing symptoms or have specific concerns.
Your birth doesn't have to go exactly according to plan for your preparation to be worthwhile. The goal is to give you the tools to feel informed, supported, and confident throughout the process.
Agnes Budyn, P.T.
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