Birth Prep

Overview:

    • Pelvic Floor Muscles during birth/prep to minimize tearing

    • Pelvic Anatomy 

    • Breathing Techniques

    • Positioning to progress labor

    • Pushing Techniques and Positions

    • Epidural Considerations 

Pelvic Floor Muscles

  • What do they do:

    • PFM contract, relax, bulge (lengthen)

      • To contract: squeeze openings, then lift

      • To Relax: letting everything go

        • Flower blooming, feel from pubic bone to tailbone opening as well as SITs bones (sit on ball)

      • To bulge/lengthen: gentle pushing downward (like pushing out a tampon)

        • Do this during pushing phase 

    • Prep with Perineal Massage/stretching

      • Massage perineum (between vaginal and anal openings) 

      • 3-9 o’clock

      • Can start at 34/35 weeks (check with OB, Midwife prior to starting)

      • Self, partner

      • Lubrication or bath/shower

      • Sitting in bath tub or standing with one foot on stool

      • Can use a pelvic wand (Intimate Rose)

      • 5-8 min, few times week

      • Evidence: reduce grade 3/4 tears, Brain connection with PFM, Improve postpartum healing

Pelvis Anatomy

  • Inlet (top part of the pelvis)

    • Helps the baby engage into the top of the pelvis

    • Exercises where knees out, toes in

      • Child’s pose

      • Fig 4 stretch, FR, massage

      • Deep Squat 

  • Mid pelvis 

    • During active labor helps baby move down the birth canal

    • Asymmetric positions

      • Lunging with birth ball, at bed, at counter

      • Side to side movements 

  • Outlet (bottom of the pelvis)

    • Helps the baby’s head have the most room to exit

    • Exercises/positions knees in, toes out

      • Hands/knees 

      • Sidelying using peanut ball, partner holding leg in this position 

Breathing Techniques

  •  During contractions

    • Inhale: feel ribs expand 360 degrees and relax PF

    • Exhale: continue to relax PF and let go

  • During pushing 

    • Inhale: ribs expand

    • Exhale: blow like blowing up a balloon and bear down (pushing out tampon) 

    • Remember

      • Uterus pushes the baby out, Pelvic Floor Muscles need to relax and lengthen

    • Practice pushing (37 weeks)

      • Exhale through open mouth (like blowing up a balloon)

      • Pelvic floor stays relaxed and bulges/lengthens 

      • 5 times, 2-3x/week - get used to the sensation

Hip Stretching: Maximize Hip Internal Rotation, External Rotation 

  • Hip External Rotation

    • Deep squat

      • Can hold onto something or sit on stack of books/FR

    • Foam roll/massage glutes - trigger points

    • Piriformis stretch (figure 4) - sitting in chair or on floor

  • Hip Internal Rotation

    • Sitting with a ball/FR/pillow between knees, rotate toes out

  • Hip ER/IR

    • 90-90 position in sitting

    • Windshield Wipers 

  • Child’s pose rocking: knees out/toes in AND knees in/toes out 

  • Hip circles on hands and knees

  • Figure 8s and pelvic tilts on gym ball 

BONUS: Jaw release

  • Jaw and Pelvic Floor Connection - tension in one can lead to tension in another

  • Remember open mouth and low moaning noises can help PFM relax during labor

  • Massaging in circular motion at TMJ

  • Stretching the muscle as you open your jaw

  • Place tip of tongue behind teeth to help release jaw tension during the day

Positions to progress labor

  • Continue changing positions and use gravity

    • Stand: lean at wall, bar, edge of bed

    • Sitting

    • Child’s pose (less pressure on PFM, can help with back pain)

    • Sidelying 

    • Squatting

    • Lunging

    • Birth Ball: rocking, swaying, sitting or leaning

    • Use peanut ball

    • Birth stool or sitting backward on toilet

  • Partner Assisted/Doula

  • Towel assisted belly support - helps with back labor

  • Hip squeeze on all fours - opens pelvic outlet

  • Sacral pressure on all fours - helps with back labor

  • Pushing Positions

    • Knees in/toes out to open the bottom of the pelvis

    • Use gravity

    • Whatever you want

      • Hands/knees

      • Squat

      • Sidelying 

Epidural

  • Sidelying with leg supported (foot up) or with peanut ball

  • If laying on your back: place towel rolls on either side to allow sacrum and tailbone to move

Planned C-section

  • Advocate/talk to your provider:

    • Your incision/scar appearance - staples, stitches, glue

    • Ask from them to tell what is going on

    • Immediate skin to skin

    • Clear surgical drape

    • Support team - anesthesiologist - nauseous or sleepy - let them know

  • Unpack your things - no unnecessary moving and bending after

Exercise Routine for Birth Prep

  • Breathing

    • Breathing with Pelvic Floor Relaxation/Lengthening x10 

      • Do this in different positions - seated, on ball, standing, hands/knees etc

      • Find what feels best

    • Practice Pushing Breath x5 (after 37 weeks)

  • Hip Mobility x10 each

    • Child’s pose

    • Child’s pose rocking: knees out/toes in AND knees in/toes out

    • Hands/knees hip circles 

    • Adductor Stretch (hands/knees with one leg straight, rocking)

    • Fig 4 stretch, FR, massage

    • Deep Squat 

    • Sitting with a ball/FR/pillow between knees, rotate toes out

    • 90-90 position in sitting

    • Windshield Wipers 

    • Birth ball: Figure 8s and pelvic tilts 

  • End with hands/knees core contraction breathing for stability 

  • Perineal Massage