How to Prepare Your Pelvic Floor for Pregnancy*
August 28, 2023
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This document has been reviewed and approved by a Doctor of Physical Therapy specialized in the Pelvic Floor, Hannah Schoonover, co-founder of EmBody Physical Therapy and Health.
*A Guide for All Bodies Wishing to Experience Pregnancy
**Please note that gender-inclusive language will be used as much as possible, but there will be some usage of gendered anatomical terminology.
Download the PDF here.
If you have the desire to get pregnant, or you are trying to conceive, or will be doing an embryo transfer soon, it is important to know that it helps magnificently if you prepare your body’s pelvic floor muscles to carry that baby, or perhaps babies!
In pregnancy the body’s organs miraculously grow, shift and move to grow a human (or 2 or 3 or 4!) from a group of cells. Take a minute for it to sink in, your body is growing a HUMAN! It only makes sense for your body’s weight to increase as a result from a combination of the uterus growing, the amniotic water in the sac surrounding the baby/babies, the placenta (a new organ that your body grows from scratch too, more than one if you are carrying multiples from different fertilized eggs!) and of course, your tiny human, which according to APA averages about 13 pounds or more if you are carrying multiples, or much more if you are like me and carry big babies larger than 7 pounds. The other weight you gain, is a combination of the extra blood being pumped in your body, extra tissue in the breasts/chest, increased fluid volume and perinatal stores of fat, protein and other nutrients that aid your body in producing milk after birth. That weight depends on each body and its genetics, in addition to the persons food source and availability and their own nature of being and lifestyle.
Imagine jumping on a trampoline, the force of the pressure when you jump is met with a strength that makes you bounce back up. This is what we want our pelvic muscles to do. But if the trampoline is worn out, torn, and doesn’t have elasticity anymore, then when you jump or even walk on it, you won’t be able to feel the push back from it, and you might even dip and possibly fall, that is how tired, tight, and weak pelvic floor muscles act. And if your pelvic floor muscles are tired, your body starts to look for compensation so your body is able to do simple daily tasks like walking. And even though we might not think much about it, and dismiss it as being pregnancy pain and will go after birth, unfortunately that is not always the case. Your body and muscles might still struggle even after you birth your baby/babies and placenta, and it goes back to its pre-pregnancy functions.
Regardless of what your pre-pregnancy weight was, or whether you are known to be a small or a big person, the distribution of pregnancy weight will place pressure on your pelvic floor muscles and tendons. That pressure is there, and your pelvic floor muscles are holding everything up. So, it only makes sense to shift the focus from how much weight you might gain, to what actually matters, how strong your pelvic floor muscles are.
Here are 10 things you can do, to prepare your pelvic floor muscles for pregnancy:
Here are 10 things you can do, to prepare your pelvic floor muscles for pregnancy:
1. Observe your body; and be curious. Look at yourself in the mirror, study your posture while standing, sitting, defecating, what is comfortable for you and what is not, find out why. How do you bend over to pick something off the floor? If you are a person who have been told to be “very flexible” or “double jointed” you could be hypermobile or have hEDS, which means you can benefit from body strengthening before pregnancy. If you are a person who suffers from IBS or has a lot of gut issues pelvic floor strengthening before pregnancy can be also of benefit. Notice the changes in your body physically and mentally and where you are in your menstrual cycle, note down how you bleed, how long you bleed, the color of your blood. Are your periods painful, exhausting, heavy, light, every 25 or 29 or 32 days? Getting to know your body and paying attention to it, will help you in understanding what feels good and not to you. You will understand if something feels off, and lead you to seek answers from a professional. Observing our bodies, is the first step we can take so later we can advocate for ourselves.
2. Body feeling after food; you can keep a food journal with the sole purpose of noting down how your body feels after eating the food, and not for the amount or the calorie intake. Things to observe in your body can be whether you have energy or are you feel sleepy? If you get bloated or have a heartburn? Does the food upset your gut? Does it help your bowel movement or constipate you? Does the food give you a headache? Have you been drinking enough water? Nauseous?
3. Watch your pelvic floor; grab a mirror and say hello to your vulva/genitals! Explore the different areas, externally and internally, press with your fingers and see if any area feels sore. Soreness could mean tightness. With clean hands and trimmed fingernails, insert a finger into your vagina/front hole and perform a kegel, do you feel your muscles? Is it a strong or weak grip? Try pushing your finger out of vagina/front hole, are you able to do that? If there is any weakness or tightness, massage and vibration to the muscles can increase the blood flow.
4. Know your anatomy; and the proper anatomical name! If you speak more than one language, know the proper anatomical names in all of them, and get used to saying them and referring to your body parts without shame associated with it. You can revisit your old biology books and looking up the female and male anatomy, to understand how each organ works and what is its function within our bodies. Even though there is the general anatomical picture of the human body, each body might have some uniqueness to it. Some folks are born with two uteruses, or perhaps two vaginas, some folks have a tilted uterus which can cause very painful periods. Some folks are born intersex (having both female and male genitalia), the list goes on. Don’t be afraid or ashamed to ask questions about what have you noticed about your body.
5. Unclench your jaw; it is connected to your pelvic floor! If you feel like you are clenching your jaw or grinding your teeth, or have suffered from TMJ pain. You probably also have a tight pelvic floor. The first step is to be aware of it, once you notice it, you can’t un do it! The best things to help you relax your jaw is doing horse lips, take a deep breath, and with the exhale, let go of your lips and let them move freely, just like a horse would! Notice what your pelvic floor does when you do that. Cupping the jaw and neck can also help with relaxing the muscles and spreading the fascia. It also worth checking out, why you are clenching your jaw in the first place! Check with your dentist, primary care physician, a speech therapist or even, a pelvic floor physical therapist, they sometimes need to do work in your mouth!
6. Check your breathing; are you breathing correctly? This might sound ridiculous to you, but seriously, if you are not aware of what muscles you are engaging while you breathe, you could be activating the wrong muscles. Take a breath, do you see your chest rising, or is your belly coming out, or do you see your chest and back expanding? What we want to aim for is diaphragmatic breathing. Bring a towel and place it on the bra line on your back and hold the ends with your hands. When you take a breath, breathe into the towel. Did that feel any different than your usual breath? What you need to know is that when you inhale, the diaphragm relaxes and descends down pushing down all your internal organs, and it is up to your pelvic floor muscles to catch them and help them bounce up (remember the trampoline). In order to do so, your pelvic floor muscles drop, but at the same time contract on the inhale to ensure they help your organs bounce back up. On the exhale, the diaphragm contracts and ascends back up, and so your pelvic floor relaxes because it doesn’t need to help the organs bounce back up.
7. Strengthen those glutes; Bridges, squats, donkey kicks. When performing any glute exercise, take a deep inhale, feel your rib cage expanding. Do a slow exhale and engage your abdominal muscles, once you feel them engaged, lift your hips up, or kick your leg back, or rise up from a squat, using your glute muscles. Do not worry about how much you lift your hips up in bridges or kick your leg up in donkey kicks or how low you squat down. What is more important is knowing you are engaging the right muscles. Inhale when you drop your hips down (bridges), drop your leg (donkey kicks), or when you squat down (squat). Avoid doing sets, and stick to doing as much as your body lets you do. Stop when you get tired, you don't want your body to compensate and use other muscles to do the movement. Generally for any exercise, doing the movement slowly with your breath, helps with strengthening the muscle instead of sizing the muscle up which happens if you do fast movement. Fast movements have a higher chance of you not engaging the correct muscles as well.
8. Go for a walk; free walking without carrying anything can strengthen your body, not just your pelvic floor. Make sure you are swinging your arms for more efficient walking. Check out these tips. If you are able to add a 30-minute walk to your daily routine, that would be amazing. If that seems a lot for you, lessen the time, or the frequency of the walk. Start with reachable goals and increase them when you feel you are ready and able. If you are a disabled person with no legs or ability to move your legs, getting fresh air will help you mentally!
9. Sleep with pillows; Get used to sleeping uncomfortably when you are pregnant. Luckily the simple ways of aligning pillows can help align your spine, open your pelvis and provide comfort in your sleep. If you can afford pregnancy pillows, great! If not, no worries, grab any pillows you find around the house. If laying sideways, one pillow should be under your head, one in front of your chest or belly to rest you arm on it, one between your knees, one between your ankles. If laying on your back, place pillows under your knees to help your lower back.
10. Look for a pelvic floor physical therapist; it is very unfortunate that not everyone has access to a pelvic floor physical therapist, especially when the pelvic floor gets a little attention from medical providers. If you are unable to access a pelvic floor physical therapist in person, check out these accounts (that I trust and follow) on Instagram:
Download the PDF here.
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