Pelvic Floor Relaxation for Birth: Why It Matters + Where to Start
If you’ve never thought about your pelvic floor prior to pregnancy, you’re not alone. Many of us move through our lives never thinking about these incredibly impactful muscles that control our bladder, bowels, sexual function and contribute greatly to our core strength. But as birth starts to get closer and you begin to get inundated with pregnancy related content, pelvic floor relaxation for birth preparation is probably something you’ve stumbled upon.
You’ve probably heard about different exercises, like kegels, to keep your pelvic floor strong. Learn more about why kegels aren’t enough to keep your pelvic floor happy here. But when it comes to birth, strength isn’t the topic of highest concern.
Birth doesn't actually require a strong pelvic floor - recovery may, but that’s a topic for a different day. Birth requires a pelvic floor that can fully let go, on command, at exactly the moment you're pushing a baby through it. If your pelvic floor doesn't know how to do that, regardless of how strong it is, the coordination of pushing a baby out may feel more challenging.
So let's talk about what your pelvic floor is actually doing during birth, why relaxation matters, how to tell if you're carrying tension in these muscles, and review some practical tips so you can get started at home.
What the Pelvic Floor Actually Does During Birth
Your pelvic floor is a group of muscles that span from your pubic bone to your tailbone and from sit bone to sit bone. Your urethra, vagina and rectum pierce through this muscle group.
In daily life, pregnancy or otherwise, these muscles need to be strong and flexible to allow you to pee when you want to, to hold in pee when you don’t want to and to do the same with poop and farts. They need to be able to relax to allow for pain free penetration, rhythmically contract to create an orgasm and they need to be strong enough to support your pelvic organs.
During birth, however, strength becomes momentarily irrelevant. As baby descends through the pelvis, your pelvic floor has to relax, lengthen and open to allow the baby to exit. Think of these muscles as the gate keepers of your pelvis. During birth, we want them getting out of the way.
Why Relaxation Matters
During vaginal childbirth, your pelvic floor stretches up to 3 times its resting length. Tight, guarded muscles that don’t know how to release under pressure can have a harder time moving out of the way and can contribute to longer push phases during labor, difficulty effectively coordinating a push and potentially increasing tear risk.
For some, learning to relax your pelvic floor muscles takes no time at all. For others, particularly those with hypertonic muscles, this can take a little extra effort. Keep reading - that’s what we’re getting into today!
Signs Your Pelvic Floor Might Be Tight
Muscles are happiest when they're strong, flexible, and coordinated. When they're lacking in any of these areas, they can start acting out and in the case of your pelvic floor, that often shows up as tightness, or hypertonicity. Tightness and strength are often mistaken for the same thing, but they're actually very different.
Think of your jaw. Healthy jaw muscles need both flexibility (to fully open your mouth) and strength (to bite down firmly). Both of these are necessary for a healthy, happy jaw. But someone who grinds their teeth and clenches their jaw is using plenty of strength without any flexibility. Over time, that movement pattern can lead to TMJ pain, difficulty opening their mouth fully, and headaches from the tightness around the joint.
The same thing can happen in your pelvic floor. Here are some signs your pelvic floor muscles might be tight:
Pain with sex or tampon insertion
Constipation or straining with bowel movements
Difficulty starting urine stream or experiencing a stop-start flow
Feeling like you have a small bladder
Lower back, hip, or tailbone pain
But don’t fret if these sound familiar - there’s so much you can do to prepare your pelvic floor for birth!
Where To Start: Relaxing Your Pelvic Floor For Birth
Diaphragmatic breathing
This is the foundation of pelvic floor relaxation and a little anatomy lesson helps explain why that is. When most people think core, they think of their abs. But your core is actually a closed pressure system made up of four different parts, kind of like a soda can. You have your diaphragm on top, its primary role is controlling your breath. You have your pelvic floor muscles along the bottom, the abdominals in the front and your spine and paraspinal muscles along your back. Pressure can’t get in or out of this system, just like a soda can when the lid is closed. As a result, when one part of the system moves, it affects the rest of it.
So when your diaphragm descends while you take a breath in, your pelvic floor is meant to mimic the movement and drop/relax while your belly rises. This graphic by Burrell Education is a great visual of what I mean. As you exhale, you should feel your belly fall and your pelvic floor gently rise.
Practice this breath pattern while lying on your back or sitting upright to start. Relaxation will peak at the top of your inhale and should feel like your tailbone is uncurling, your anal opening is relaxing or like your sit bones are spreading.
Watch the video for a visual.
Positional practice: deep squat, child's pose, happy baby
If you're unable to feel the movement in your pelvic floor with the exercise above, try child's pose, happy baby pose, or a deep squat. In all three positions, your spine stays neutral while your hips are externally rotated and flexed, placing your pelvic floor in its most relaxed position, often making the sensation of relaxatoin easier to notice.
That said, these positions only help if you can actually relax into them, so modify as needed. Watch the videos below for prenatal modifications that may make each pose more comfortable. And if it's not obvious right away, that's okay. Give yourself a few minutes in each position daily until the sensation starts to click.
Here are some prenatal modifications for:
Practice pelvic floor relaxation during bowel movements
If you’re still struggling to feel your pelvic floor relax, practice your diaphragmatic breathing during bowel movements. As you inhale, you may feel like it’s a bit easier for stool to descend. While you exhale, you should feel your muscles return to baseline. What’s nice about practicing during a bowel movement is that it’s typically apparent when your muscles contract instead of relax because stool either comes down or goes back up.
Perineal massage in third trimester
Perineal massage is a great way to work on tight pelvic floor muscles and can help relax tight muscles. This technique can be done using a finger, with the help of a partner or using a tool like a pelvic wand. You insert the wand or finger about one inch into the vagina and apply pressure from 10 o’clock to 2 o’clock, avoiding pressing up into the urethra.
You can typically begin around 34-36 weeks of pregnancy after consulting with your OB or midwife. You can download our free perineal massage guide for visuals and detailed instruction or learn more about perineal massage and perineal tearing in this blog post.
When to see a pelvic floor PT for hands-on assessment
All of the above are great places to start on your own, but some people are holding tension that's hard to identify or release without help. If you're going through these exercises and still can't tell whether you're contracting or relaxing, if any of the "signs your pelvic floor might be tight" sound familiar, or if you're already dealing with pain, those are signs it may be worth getting assessed.
A pelvic floor PT can do an internal exam to actually feel what your muscles are doing, tell you whether you're contracting or releasing, and use manual therapy to release tension that’s getting in your way.
The Bottom Line
Preparing your pelvic floor for birth isn't just about strength, it's about coordination. Your pelvic floor needs to know how to contract and how to fully let go, and for most of us, the letting go part takes a little practice.
You don't need to get this perfect. You just need to start building awareness so your brain can let go and your body do what it already knows how to do when the time comes.
If you want individualized guidance heading into birth, we'd love to help. Book a prenatal pelvic floor PT session at Lady Bird PT.
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.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.