Pelvic Floor Tips for Expecting Moms: A Physiotherapist’s Guide

As an expecting mom, you’re likely focusing on baby preparations, prenatal vitamins, and birth plans, but have you thought about how your pelvic floor is handling all the changes? These muscles play a crucial role in supporting your growing belly, maintaining bladder control, and preparing for birth and recovery.

Let’s dive into my top five pelvic floor tips to keep you feeling strong, comfortable, and confident throughout pregnancy and beyond.

1. Understanding the Inner Core Unit & Pelvic Floor (It’s More Than Just Kegels!)

Many moms-to-be are told to “just do Kegels,” but that’s only part of the story. Your inner core unit consists of four key muscles that work together to provide stability, support, and function:

• Diaphragm: Your main breathing muscle, which coordinates with the pelvic floor for optimal pressure management.

• Pelvic Floor Muscles: A group of muscles that support the bladder, uterus, and rectum.

• Transverse Abdominis: The deepest abdominal muscle, acting like a corset to support the spine and growing belly.

• Multifidus: Small but powerful back muscles that help stabilize the spine.

A well-functioning pelvic floor isn’t just about strength—it’s about balance. Some women have weak pelvic floors, while others hold too much tension, which can lead to discomfort and pain during pregnancy and labor (Bø et al., 2015). The key is not just strengthening but also relaxing these muscles when needed.

Learn the Core Breath Technique

Instead of focusing on isolated Kegel contractions, the Core Breath Technique ensures that all four deep inner core muscles work together. This technique helps create better pelvic floor control and prepares your body for pregnancy, birth, and postpartum recovery.

How to Do the Core Breath:

• Sit comfortably or lie propped up on your back.

• Inhale deeply through your nose, allowing your ribcage and belly to expand while your pelvic floor gently lengthens.

• Exhale slowly through your mouth, engaging your deep core by feeling a gentle lift of the pelvic floor while drawing your lower belly inward (as if hugging baby closer to your spine and picking up a blueberry with your vagina).

• Repeat 10 reps, 1-3 sets, focusing on slow, controlled movements. Always focus on quality over quantity

Individualized Pelvic Floor Training Is Key

Many women unknowingly perform Kegels incorrectly, sometimes bearing down instead of lifting, which can worsen symptoms (Bø & Herbert, 2013). This is why working with a pelvic floor physiotherapist is highly recommended—to ensure you are doing the right exercises for your specific needs.

In some cases, strengthening the pelvic floor may not be the right answer—especially if there is excessive tension or pain. A professional assessment can help determine whether you need strengthening, relaxation, or a combination of both.

2. Practice the Flower Blossom Breathing Technique

Instead of focusing only on contracting your pelvic floor, it’s equally important to learn how to relax and lengthen it—especially as you prepare for birth. The Flower Blossom Breathing Technique is a simple yet powerful way to coordinate your breath with your pelvic floor, encouraging it to open and release rather than grip and tighten.

How to Do It:

• Find a comfortable seated or lying position.

• Place one hand on your belly and another on your perineum (between the vagina and anus) to bring awareness to the area.

• Inhale deeply through your nose, imagining your pelvic floor softening and expanding, like a flower gently blooming.

• Exhale slowly through your mouth, allowing your body to stay soft without clenching or gripping.

• Perform 10 repetitions, for 1-3 sets

This technique helps train your pelvic floor to release and lengthen, making it easier to relax during labor (Simpson et al., 2019). Recommend starting this breath technique in your third trimester as you are getting closer to birth.

3. Manage Pressure on Your Core

As your belly grows, increased pressure is placed on your abdominal and pelvic floor muscles. To protect these muscles, keep these tips in mind:

• Avoid breath-holding during activities like lifting or getting out of bed. Instead, exhale as you exert effort (Vleeming et al., 2008), as I like to say “blow as you go.”

• Roll to your side first when getting out of bed rather than sitting straight up (this helps prevent diastasis recti) (Benjamin et al., 2014).

• Be mindful of constipation—straining on the toilet increases pelvic floor pressure. Stay hydrated, include fiber-rich foods in your diet (Woodley et al., 2017) and consider using a Squatty Potty or a footstool to elevate your knees above your hips, which promotes a more natural and relaxed position for bowel movements.

4. Practice Pelvic Floor Relaxation for Birth

A tense and guarded pelvic floor can make labor and delivery more difficult. In addition to Flower Blossom Breathing, try:

• Perineal massage (starting around 34 weeks) to help desensitize the perineal tissue and create a sense of safety when feeling the stretching sensation of birth. This technique allows you to gradually get used to the discomfort of perineal stretching in a controlled, relaxed way, making it easier to stay calm and release tension during labor (Beckmann & Stock, 2013). Focus on slow, deep breathing (great time to practice your flower blossom breath) as you or your partner massage to reinforce the brain-body connection that stretching does not equal danger.

• Deep squats to encourage pelvic opening (Simpson et al., 2019).

• Using a birth ball to gently open the pelvis and help baby get into an optimal position for birth. Sitting on a birth ball while making slow, circular hip movements or gentle rocking can relieve pelvic tension and encourage baby to descend into the right alignment for delivery. This also helps reduce discomfort in late pregnancy by improving mobility and circulation in the pelvis (Guittier et al., 2016).

• Visualization exercises, imagining your pelvic floor “melting” like butter with each breath.

5. Know When to Seek Help

Pelvic floor issues like leaking urine, pelvic pain, or pressure are not just “normal” parts of pregnancy. If you experience any of these symptoms, a pelvic floor physiotherapist can provide personalized exercises and techniques to help you feel your best (Mørkved & Bø, 2014).

Pregnancy is an incredible journey, and taking care of your pelvic floor now will set you up for a smoother birth and faster postpartum recovery. If you have any questions or concerns, don’t hesitate to reach out—I’d love to help!

Ready to Support Your Pregnancy Journey?

Your pelvic health is just as important as preparing for your baby’s arrival. By taking small steps now, you can set yourself up for a smoother birth and recovery. Explore more expert-backed tips and resources on our website, watch my latest YouTube exercise videos, listen to my Spotify pelvic floor breathing guides, and follow me on Instagram @leadphysio for daily pelvic health insights!

Written by:

Lea Damata, PT, MScPT, BSc

Physiotherapist, Pelvic Health

References

• Beckmann, M. M., & Stock, O. M. (2013). Antenatal perineal massage for reducing perineal trauma. Cochrane Database of Systematic Reviews, (4).

• Benjamin, D. R., van de Water, A. T., & Peiris, C. L. (2014). Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy, 100(1), 1-8.

• Bø, K., Hilde, G., Stær-Jensen, J., & Siafarikas, F. (2015). Can pelvic floor muscle training prevent and treat pelvic organ prolapse? Acta Obstetricia et Gynecologica Scandinavica, 94(4), 377-383.

• Mørkved, S., & Bø, K. (2014). Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: a systematic review. British Journal of Sports Medicine, 48(4), 299-310.

• Simpson, M., Warke, K., & Phillips, C. (2019). The effectiveness of squatting exercise on pelvic floor dysfunction: a review. International Urogynecology Journal, 30(6), 889-898.

• Vleeming, A., Schuenke, M. D., Danneels, L., & Willard, F. H. (2008). The functional coupling of the deep abdominal and paraspinal muscles: the effects of motor control training on muscle activation in chronic low back pain patients. Spine Journal, 8(6), 708-716.

• Woodley, S. J., Boyle, R., Cody, J. D., Mørkved, S., & Hay-Smith, E. J. (2017). Pelvic floor muscle training for preventing and treating urinary and fecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews, (12).

• Guittier, M., Gouy, S., & Roger, V. (2016). Use of a birth ball in pregnancy: a review of the effects on pelvic positioning, fetal descent, and labor. Journal of Obstetric, Gynecologic & Neonatal Nursing, 45(1), 78-87.