How to prepare your body for birth

 

What do the physical therapists want you to do to prepare your body for birth?

Preparing now will give you the best shot at smooth labor and delivery and help you recover postpartum.

With all the changes that can happen during pregnancy, it's easy to feel like you've lost some control of your body. I'm expecting my first baby in a few weeks, so I get it. Luckily, I've had the energy to stay active throughout my pregnancy — keeping up with my strength training workouts and Pilates classes, while making necessary modifications. Still, as my due date crept closer, I wondered if I'd been doing enough to prepare for delivery and postpartum recovery.

So, I started seeing Gabriela Majcher, DPT a New Jersey-based physical therapist specializing in the pelvic floor, at around 30 weeks to tackle everything from low back pain and core strength to hip mobility and push prep. Now I feel more confident in my body's ability, have better knowledge of my anatomy, and my lower back pain is essentially nonexistent. 

1. How to Start preparing as soon as you can.

When I told Majcher that pregnancy has felt like running a marathon, she said this is exactly how moms should think about a typical 40-week pregnancy, not to mention delivery and postpartum. 

"You wouldn't run a marathon without training, so how can you expect your body to respond to all the changes of pregnancy over the nine-plus months without training?" says Majcher. "If I said you had to hold a dumbbell, which keeps getting heavier and heavier, for the next nine months, you'd want to strengthen all your muscles responsible for holding that dumbbell." 

That's why she recommends building the muscles around your baby — pelvic floor, core, hips, glutes — to help your body get used to the added weight and prepare for delivery.

Whether you're six weeks pregnant or six months, "it's never too late to support your body during pregnancy,"  Lettenberger says. Exercise during pregnancy "can lower your risk of gestational diabetes, preeclampsia, preterm labor, and low birth weight," she adds. "It also improves postpartum outcomes, decreasing the risk of prolonged pelvic floor dysfunction."

2. Adjust your routine throughout pregnancy.

It helps to think about what to do based on how far along you are in your pregnancy, says Lettenberger. Your first trimester is a great time to get educated about your changing body and its needs, and to develop a routine — while monitoring fatigue levels, which can run high these first few months, she says. The second trimester is typically when most women feel more energized and can exercise more often. This is also when you'll likely need to start making some modifications to your workouts to accommodate a growing belly and changes in your center of gravity, she adds.

As a general rule of thumb, the first and second trimesters are for strengthening your pelvic floor and core, and the third trimester is all about training to release your pelvic floor and open your hips to prepare for birth, explains Lettenberger.

 

3. Make modifications, as needed.

If you're pregnant, you should get your provider's clearance before starting any physical therapy or exercise routine.) You'll want to verify what's okay, as the advice can vary depending on any complications you may have, but mobility and breath work are generally considered safe, Lettenberger says. 

And if you have a planned cesarean section coming up (or end up having an unplanned one),  strengthening the pelvic floor and core now can help you rebound from this major abdominal surgery, says Majcher. Working with a physical therapist following delivery can help you address scar tissue, rehab your pelvic floor muscles, and strengthen your abdominal wall, adds Lettenberger. 

 

4. Try these strengthening moves.

These moves are great for strengthening your core, which can alleviate pregnancy back pain. By incorporating kegels into your ab workout, you'll also train that mind-muscle connection, which can help postpartum. 

Bird dog

1. Begin on all fours with knees under hips and palms under shoulders. Inhale. 
2. Exhale as you stretch your right arm and left leg out in front and behind you, respectively, while also performing a kegel. Pause. 
3. Inhale as you release the pelvic floor and return to the starting position on all fours. 
4. Repeat on the opposite side, extending the left arm and right leg and performing a kegel at the top of the movement. 
5. Once fully extended, pause before returning to the starting position.

Bear plank

1. Begin on all fours with knees under hips and palms under shoulders. Your spine should be in a neutral position (not arched nor rounded), and your toes should be curled under. 
2. Inhale. 
3. Exhale as you lift your knees to hover slightly off the floor as you engage your core. Hold here for 10 to 20 seconds, being mindful not to hold your breath, before returning to the starting position.  

5. Work on releasing your pelvic floor and increasing the flexibility in your hips. 

As you enter into your third trimester, you'll have a deeper focus on pelvic floor release and hip mobility. These exercises tackle them both.

Supported deep squat

1. Stand in front of a sturdy rack or pole with a heavy resistance band attached to it at the top. Grab the band, and step back far enough to create enough tension to feel stable and supported. (You can also do this by just grabbing onto a pole or a doorframe.)
2. Holding the band, inhale, then exhale as you slowly bend your knees to come into a deep squat. 
3. Pause at the bottom and think about releasing your pelvic floor muscles to drop them closer to the ground. 
4. Inhale as you press through your heels to return to a standing position. 

Hip matrix 

1. Begin in a half-kneeling position with your left knee on the ground and your right foot planted in front of you. 
2. Inhale. Exhale to step your right foot farther out in front of you as you push your hips forward to stretch the left hip flexor. 
3. Inhale, then exhale as you lift your right foot and plant it back down to the floor at the 45-degree position, diagonally to the upper right corner of your space. 
4. Push hips forward to stretch the left hip flexor from this angle. 
5. Inhale, then exhale as you bring your right foot out to the side at a 90-degree angle, performing the same lunge with hip flexor stretch. (Note: Your toes and knees should track along the side angles throughout this movement.)
6. Switch sides to perform the three-angled hip matrix with the left foot moving and the right hip flexor stretching.  

Adductor rock

1. Begin on all fours with knees under hips and palms under shoulders. Extend the right leg straight out to the side with the foot flat on the floor and toes pointed forward. 
2. Hinge at the hips to rock your butt back toward your heels (without sitting back entirely). This should create a stretch in the inner thigh on the right, extended leg.
3. Rock forward to the starting position. 
4. Continue rocking front to back. Then switch sides, extending the left leg directly out to the side. 

6. Practice breathwork, bearing down, and labor positions.

During the third trimester, you'll want to start practicing breathing techniques while bearing down. (This is relaxing your pelvic floor and dropping those muscles, mimicking how you'd push out a stream of pee … or a baby.) You can do this while in various birthing positions, says Majcher. 

By practicing that movement pattern in the third trimester leading up to birth, your brain and body should remember how to do this once it's time for delivery, she says. That's because it takes at least two to three weeks for your brain and body to make new connections (aka neuromuscular re-education).

 

7. Try perineal massage.

In addition to the pelvic floor muscle release practice and hip mobility, at around 34 to 35 weeks pregnant, you can generally start stretching the perineum, the skin between your vaginal opening and anus.

Says Lettenberger, starting a perineal massage routine during the last few weeks of pregnancy has been shown to reduce the risk of tearing. With your OB's approval

, a pelvic floor therapist can show you how to massage and stretch this sensitive area. 

Try this: Insert a finger or perineal wand about an inch into the vaginal canal. Apply pressure to the right side of the perineum, and hold when you feel a stretch for 30 to 60 seconds. Repeat on the left side, then the bottom for the same time. Lastly, trace a U-shape with your finger or wand tracing the sides and bottom of the vaginal opening for 30 seconds.

While you already have a lot on your plate during pregnancy (building a registry, going to all of your prenatal appointments, choosing a name … ), don't forget to add one more thing to your list: taking care of yourself. By doing these exercises, you'll help prepare your body and your mind for pregnancy, delivery, and postpartum. I know I'm glad I did.

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