Caring for Your Pelvic Floor During Pregnancy: More Than Kegels
Your pelvic floor plays a crucial role in supporting your body during pregnancy and in preparing for birth—but it’s not as simple as just doing kegels. In this post, we’ll explore why balance between strength and relaxation is key, how to spot a tight pelvic floor, and practical tips to keep it healthy for pregnancy and beyond.
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Chances are you’ve been told to do kegels, especially if you’re nearing the end of your pregnancy. But what if I told you that that is an over-simplified answer to a complex need during pregnancy?
The thing is, your pelvic floor is important during pregnancy and birth. But strengthening it can’t be your only focus, for a few specific reasons.
We’ll get into those specifics in a moment. But first, let’s talk about what your pelvic floor is and why kegels aren’t always the answer.
Understanding Your Pelvic Floor
The pelvic floor is a group of muscles at the base of your core. It forms a sort of diamond-shaped hammock that spans from your pubic bone back to your spine.
Your pelvic floor muscles allow you to stop the flow of urine or hold in gas when needed. They also contribute to sexual satisfaction. And of course, they also have parts to play in pregnancy and birth.
To find your pelvic floor, sit upright so your weight is on your sitz bones and not on your tailbone. Pretend like you are trying to stop the flow of urine—clench the muscles around your urethra, vagina, and anus. Those muscles you feel tighten are your pelvic floor muscles.
If you didn’t find your pelvic floor that way, try coughing instead. The slight flick you feel at the base of your pelvis around those openings is your pelvic floor.
If you still can’t feel your pelvic floor muscles, don’t worry. It may just take some practice to become aware of your them. However, it could also mean that rather than being too weak, those muscles are actually too tight…which leads us to the topic of kegels.
To Kegel or Not to Kegel
Many care providers recommend kegels during pregnancy to strengthen the pelvic floor. But what many don’t realize is that lots of women are actually experiencing a tight pelvic floor and need relaxation, not exercise.
Symptoms of a tight pelvic floor can include difficulty starting to pee, frequent constipation, pain during sex, an inability to feel a pelvic floor contraction (like a kegel), low back pain, hip pain, and leaking urine.
A tight pelvic floor can result from habits like always sucking in; poor posture; weak foot, leg, or core muscles; injury; and more.
For women with a tight pelvic floor, doing kegels may not only be unhelpful but can also exacerbate the issue. If you suspect your pelvic floor is tight, consider stopping kegels temporarily and focus on pelvic floor stretches and relaxation techniques instead.
If these help alleviate symptoms or allow you to feel a contraction more easily, continue focusing on stretching rather than strengthening.
The Importance of Strength AND Relaxation
During pregnancy, your pelvic floor helps to support your growing uterus and baby. During labor and birth, the pelvic floor has two more distinct but crucial roles. This is where we see how important both strength and relaxation are.
To understand these two roles, let’s first review how a baby is born.
After a woman’s cervix is fully open, her baby begins to descend from her uterus into her vagina. The pelvic floor muscles surround and support the vagina, so as the baby moves down, her or she presses against these muscles.
To exit the pelvis, the baby must make specific movements. First, they rotate to face their mother’s back after entering the pelvis sideways. Then, they extend their head and neck to navigate under the pubic bone.
A strong, toned pelvic floor helps facilitate these rotations, which is one of the main reasons kegels are recommended.
Beyond assisting with the baby’s movements, a strong pelvic floor can better handle the pressure and stress of labor.
But strength alone isn’t enough.
For the baby to be born, the pelvic floor must relax and lengthen, allowing the vaginal opening to mold around the baby’s head. This transition—from firm support to soft flexibility—requires muscles practiced in relaxation as well as strength.
Your Pelvic Floor and Pushing
When it comes to pushing, your pelvic floor again has two seemingly opposing roles. On one hand, a strong pelvic floor is important for pushing because it can help you control your efforts and make each push more effective.
It also helps you slow the moment of crowning to allow your perineum and pelvic floor time to relax and open.
On the other hand, a too-tight pelvic floor can make pushing more difficult and make tearing more likely.
Like most things, balance is key.
RELATED >> How to Push During Labor: Tips, Techniques, and Trust
Breathing to Support a Balanced Pelvic Floor
Before even considering exercises or stretches for the pelvic floor, let’s talk about breathing. Every time you take a deep 360 degree breath, you essentially do a “gentle kegel.”
Try it—sit upright on your sitz bones, place your hands on your ribs, and focus on breathing deeply until your ribcage can’t expand anymore. Then breathe out slowly and completely.
Do it again and this time notice the subtle rise and fall of your pelvic floor in between your sitz bones—lengthening out with the inhale and rising with the exhale.
If you haven’t done much pelvic floor work, it might be hard to feel, but it is happening!
Focusing on breathing is one of the simplest things you can do to promote a healthy pelvic floor—and it is effective!
Exercises for Lengthening the Pelvic Floor
If you suspect your pelvic floor needs more relaxation than strengthening, here are a few stretches to incorporate into your daily routine to help your pelvic floor learn to relax.
Child’s Pose
Going back to the basics is a great place to start. Child’s Pose is a common stretch that can do wonders for your pelvic floor. When you truly relax into the pose, it lengthens out your pelvic floor muscles to give them a break from the day-to-day tension.
How to Do Child’s Pose
- Kneel with your toes touching and knees apart then sink your hips back toward your heels.
- Extend your arms forward, palms down, and rest your forehead gently on the floor.
- Breathe deeply and slowly, allowing every muscle to relax.
Later in pregnancy, you can support your belly and upper body with a pillow to relieve pressure on your back.
Deep Squats
A traditional yogi squat can be challenging but is a wonderful way to help your pelvic floor relax. The depth of the pose allows plenty of space for your pelvic floor muscles to lengthen out to their fullest extension.
How to Do a Deep Squat
- Stand with your feet hip-width apart or slightly wider with your toes turned out (like 10 and 2 on a clock).
- Slowly lower your body as if sitting in a short chair, keeping your weight even between the balls of your feet and your heels and keeping your back straight.
- Relax your legs, glutes, and feet as you sink into the squat. Extend your arms forward for counterbalance if needed.
If you can’t squat all the way down, you can use a yoga block or rolled up blanket under your backside. You could also enlist a family member for support—have your husband or another person hold your hands while you squat so you can lower your heels to the floor without falling backward.
Alternatively, you can hold on to the knobs of an open door for support.
Adductor Rockbacks
While the name sounds fancy, you’ve probably seen this stretch before—rocking on hands and knees with one leg straight out to the side. Along with promoting mobility in your hips, these rockbacks help to relax and lengthen your pelvic floor.
How to Do Adductor Rockbacks
- Begin on your hands and knees with your wrists under your shoulders and your knees under your hips.
- Move one leg straight out to the side so it is perpendicular to your body, with your foot flat on the ground and your knee bent slightly.
- Gently rock your hips back toward your heels, maintaining a neutral spine. Only go as far as feels comfortable in your body. Keep your core gently engaged to support your back and belly throughout the movement. Let your leg and pelvic floor relax.
- Breathe and rock forward so your shoulders are over your wrists.
- Rock back and forth slowly a few times, pairing your movement with your breath.
- Repeat on the other side.
A Word on Perineal Massage
There’s another topic I’m guessing you’re wondering about…perineal massage. Many care providers and childbirth educators encourage women to perform perineal massage regularly in the weeks leading up to birth.
I don’t. Here’s why.
The research makes two things clear:
- Perineal massage only helps first-time moms. Mothers who have given birth before see no benefit from doing it.
- The benefit to first-time moms was only seen in studies that looked at birth settings with extremely high episiotomy rates (over 20%). In the US (as of 2023), average episiotomy rates in hospitals are about 5%, which makes it hard to generalize those findings.
But how is perineal massage linked to episiotomies?
Most likely, it’s the mom.
The Best Thing You Can Do to Avoid Perineal Tearing
What we can conclude is that the kind of woman who does perineal massage is probably going to make other choices to protect her perineum and pelvic floor, like refusing episiotomies or choosing care providers with low episiotomy rates.
And why is it important to avoid episiotomies? Because they are the leading cause of severe perineal tears.
That’s why your best bet to avoid tearing isn’t perineal massage—or doing kegels or stretches—it’s carefully choosing a provider and birth location with a low episiotomy rate and ensuring you’re on the same page about birth.
When to See a Pelvic Floor Specialist
The pelvic floor and related issues are complex. If you are experiencing pain, leaking, incontinence, or other symptoms that are interfering with normal, happy life, you may need to hire a pelvic floor specialist.
If you feel that a specialist could help you, I recommend choosing someone with a more holistic viewpoint—someone like Dr. Melissa Oleson or Jessica London.
Conclusion: Balance is Key
Your pelvic floor plays so many key roles in your life and, more specifically, during pregnancy and birth. Focusing on both strength and relaxation is key for a healthy pelvic floor and an easier birth and recovery.
Learn to listen to your body and tune into what it needs. If you feel you need to lengthen and relax your pelvic floor, focus on that during pregnancy! If you feel it needs strengthening, do kegels. And if you feel you need more support, don’t be afraid to seek the expert help you need.
While pelvic floor health is important, don’t let it stress you out. Your body and your baby know how to do birth. Your body was designed to birth and it was designed to heal. Trust in that.
Until next time,
Allison
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READ MORE:
5 Exercises to Prepare Your Body for Labor
What is Diastasis Recti? (and What You Can Do To Avoid It)
Perineal Tearing During Birth: What It Is and How to Avoid It
