How I Prepped My Body for Birth and Recovery—Insights from a Pelvic Floor PT
As I sit here writing this blog post from The Hive in south Austin, I’m struck by all of the parents with little ones all around me. Pregnancy is so, so hard and yet so many of us pursue it without ever stopping to think about the intense physical demands that pregnancy places on our bodies. As a pelvic floor PT who has worked with pregnant and postpartum people for the last 8 years, I thought long and hard about the physical demands of pregnancy and recovery before planning to have a baby. I spent a year intentionally building strength prior to pregnancy and getting back on my fitness bandwagon and then applied all my clinical knowledge to create the best plan for myself. In this blog post I’m going to walk you through everything I did during pregnancy to work towards my goals, what those goals were and why I did what I did.
My goals for pregnancy were to remain as strong, pain free and comfortable as possible while preparing for a (hopefully) uncomplicated vaginal birth with minimal pelvic floor injury. As an active person, I also wanted to optimize my postpartum recovery so I could return to my workouts as quickly as appropriate and take care of my new little one without avoidable added stress.
I built my personal pregnancy regimen based on evidence and modified it to fit my individual needs. And while this blog post will not be providing medical advice, the general guidelines I followed can be applied to most people in some capacity as they navigate pregnancy.
A couple important notes before we get started :
We cannot control pregnancy or birth outcomes. Theres is a lot we can do to influence our situation, to nudge outcomes one way or another, but at the end of the day so much is out of our hands. While I know that the effort I put in served my body well, it’s also important to remember the importance of genetics, underlying health, access to resources as well as good old fashioned luck.
Everyone’s needs are different. There is no one size fits all prenatal program.
I took the basic, evidence based guidelines and made them my own to fit me. I have a long history as a runner, tennis player, weightlifter and was consistently active prior to pregnancy. Before getting pregnant, I routinely rock climbed, lifted, rowed (indoor only) and did yoga. During pregnancy, I had some difficulty managing my underlying hypertension and was later diagnosed with gestational diabetes so physical activity became even more important to me as it helped manage these medical conditions.
So without further ado, here is how I prepared for birth (and recovery) as a pelvic floor PT who specializes in perinatal health.
Everything I did to prepare my body for birth and postpartum recovery
This is a comprehensive list of what I did to prepare my body for birth and recovery. As pregnancy progressed, my focus and time allotment shifted, but I kept each of these in my routine throughout my entire pregnancy. The 7 things I focused on to prepare my body for birth and recovery included:
Strength training
Core training
Pelvic floor relaxation
Hip openers & full body stretching
Cardio
Continuing to do things I love for as long as they felt good
Pelvic floor PT
Strength Training
Pregnancy places massive new demands on your body. As your pregnancy progresses, a growing fetus places increased stress on your abdominal and pelvic floor muscles. As that happens, your posture begins and continues to shift, the way you walk changes. You may develop food aversions, sleep disruptions, feel things you’ve never felt before. Strength training is always important, but strength training in pregnancy builds resiliency in your body to support you through all of these changes. If you want to hear more about the importance of strength in pregnancy, check out Dr. Christina Prevett’s podcast episode on pain in pregnancy.
Throughout my pregnancy, I weight trained 3-4 times per week. I was weightlifting prior to pregnancy and continued throughout with a brief break in the first trimester when I didn’t want to risk vomiting all over the gym. My nausea unfortunately never went away, but at some point I realized exercise helped it feel a little less intense. I generally focused on big muscle groups, compound movements and single leg work to maintain hip strength and balance. I didn’t do anything new or fancy and would typically lift full body each gym session. For example, one of my works was 4 sets of 6-10 reps of squats, kettle bell swings, bent rows and a thruster with 2-3 core movements.
As far as intensity, I didn’t intend to increase weights while pregnant but I was lifting consistently enough that I was able to go up in weight for a number of movements.
Core Training
This could totally be included under strength training and for me it was, but it deserves its own section since it was an intentional addition to general strength training. People are often scared of core strengthening in pregnancy but as your baby grows, your core has to work harder to support you. Stress on the abdominal muscles and weakness in the core are some common culprits of typical pregnancy pains like back, pelvic and groin pain.
There is nothing dangerous about core strengthening in pregnancy. In fact, strengthening your core during pregnancy has been associated with reduced pelvic girdle pain and general discomfort as well as improved overall quality of life. There’s also data to suggest that core strengthening in pregnancy reduces the severity of diastasis recti and leakage postpartum. Pregnancy is hard, strength makes it slightly less so.
Every gym session that I focused on strength training, I included core work. 3-4 times per week while I was lifting, I’d pick 2-3 isolated core movements to add in to my program. As my pregnancy progressed, some movements needed to be modified. For example, I felt great in a plank from toes until around 35 weeks, at which point I started having more belly button pain. At that point I chose to elevate my plank to a bench and felt much better. Other movements that were part of my rotation included side planks and variations of them, modified Russian twists and lots of exercises on all fours.
Pelvic Floor Relaxation
Your pelvic floor doesn’t push your baby out - your uterus and core do that. What your pelvic floor needs to do during birth is get out of the way. For many of us type-A, butt and jaw clenchers (myself included), pelvic floor tension is our baseline state of being. If this is you, pelvic floor relaxation during pregnancy is key to prepare for birth.
I knew that pelvic floor relaxation was going to be a focus for me during pregnancy because I’ve always struggled with pelvic floor tension. I started intentionally performing pelvic floor relaxation exercises around the beginning of the third trimester and then started using a pelvic wand for perineal massage around week 34 of pregnancy. I also worked with our pelvic floor PTs at Lady Bird PT because manual therapy is so helpful for relaxing chronic pelvic floor tension.
I ended my gym workouts with some deep belly breathing in child’s pose or happy baby and made sure to spend some time breathing into my pelvic floor on days that were focused on stretching. Every day of my third trimester, I spent around 5-10 minutes on targeted pelvic floor relaxation, used my pelvic wand 1-3 times per week and saw my pelvic floor PT monthly to weekly.
Hip openers & full body stretching
Strength is so important in order to remain comfortable during pregnancy and to prepare for postpartum recovery, but you don’t actually need to be strong to push a baby out. What you need is room for baby to find their ideal position, flexibility to move in ways to help them down through the pelvis as you labor and the ability to relax your pelvic floor out of the way while you push. Working on pelvic floor relaxation helps with the push phase, but full body stretching and hip openers during pregnancy help with the other two.
On days that I wasn’t strength training in the gym, I’d focus on these mobility exercises. This was 3 or so times per week throughout the first two trimesters and a daily activity for me throughout the third trimester. I focused on included hip openers, lumbar and thoracic mobility, inner thigh and glute stretching, pec and calf stretches. Some examples include a kneeling hip flexor stretch, a pec doorway stretch, a figure 4 hold and a standing windmill.
Cardio
Because of an old hip injury, biking and running didn’t feel good heading into pregnancy. I really didn’t enjoy rowing while pregnant, so instead I did a lot of walking, aiming for 2-3 miles as many days of the week as I could. I’d also aim for a 20 minute evening walk every day after dinner to help control my blood sugar (thanks gestational diabetes).
Maintaining cardiovascular endurance is hard during pregnancy. Energy and nausea aside, as baby grows they push up on your diaphragm making it hard to breathe at baseline. Stairs felt hard by week 14. If you’re not a cardio athlete pre-pregnancy, walking is an excellent way to maintain cardiovascular health. Any distance is better than no distance and you’ll find that your energy changes day to day. If you do love cardio, the recommendation throughout pregnancy for cardio is aiming for an intensity that makes it hard to sing but allows you to speak while performing the activity.
If returning quickly to running or another form of cardio postpartum is important to you, maintaining your cardiovascular fitness in pregnancy will help.
Continuing to do what I love as long as it felt good
Physical activity is not dangerous during pregnancy. In fact, exercise has been shown to reduce the risk of gestational diabetes, preeclampsia, pelvic and back pain, anxiety and depression, and leakage without any negative impact for parent or baby. Generally, activity you were doing prior to pregnancy is safe to continue if it doesn’t cause symptoms, bleeding or increase your risk of falling on your abdomen.
Prior to pregnancy I enjoyed and regularly rock climbed, hiked, rowed and lifted. I continued doing all of those things as long as they felt good in my body. I stopped rock climbing around 20 weeks because I didn’t like how a pregnancy harness felt. I hiked and weight lifted until the day before my induction. I gave up rowing during the first trimester because of nausea and then didn’t pick it back up because I… just didn’t want to. Which is also ok.
Whatever it is that you enjoy, if it feels good in your body and there’s no risk of injury to your abdomen, it very well may be appropriate for you to continue throughout pregnancy. Remember, movement is good! Talk to your OB, midwife or physical therapist about anything that concerns you.
Pelvic floor physical therapy
Like already discussed, the demands on your body during pregnancy are significant. Pelvic floor physical therapy during pregnancy helped bridge the gap between what I was able to do on my own and where I wanted to be. It helped me stay active and pain free, prepare for birth and get set up for the best possible recovery.
Through pelvic floor PT, I was able to prep my pelvic floor for birth and confirm that my pushing mechanics were on track. This was also instrumental in keeping my small aches and pains small and keeping me moving throughout pregnancy. After an induction at 38 weeks and 27 hour labor, I went into labor without pitocin and pushed for two hours with only minimal tearing - an outcome that felt fantastic to me.
The last picture I took during pregnancy, for your amusement.
Hands on PT work from our team and my knowledge as a pelvic floor PT were a huge part of getting me there.
There’s no magic bullet
When patients come to see me in the clinic with goals like staying strong through pregnancy and preparing for the demands of birth and recovery, they’re often hoping for a magic bullet in the form of an exercise, a prescription, something quick, concrete and easy. But the reality is that pregnancy is a massively demanding experience for your body. While your energy is zapped, while you navigate nausea and discomfort, your body is placed under progressively greater stress. Staying strong, managing these changes and focusing on prehabilitation for recovery is not an easy ask. There’s no one exercise, one program, one recommendation that will get you to where you want to be and there’s certainly no one size fits all method.
But that doesn’t mean that we can’t prioritize.
I am who I am and had the time, the energy, the resources and the desire to do the most. You may not be in that same place. One of the main reasons we do what we do at Lady Bird PT is to help maximize your efforts and time.
If you don’t have time to do it all, that doesn’t mean you can’t make progress towards your goals. But knowing where to devote your efforts can make a huge difference. Contact us to determine what matters most for your body.
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.